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Kenneth Gordon, Professor of Dermatology at Northwestern University, talks about the oral medication apremilast, recently approved for psoriatic arthritis. Apremilast offers a major benefit to patients — especially those who don’t want an injectable medication. Its response rates are high and it is very well tolerated. More like this Psoriasis Patients’ Options Include Effective Oral … Read more

Will HEDIS ’98 Mean More Reliable Data? NCQA has tightened plans’ sampling and reporting procedures. And more plans will submit audited data. The agency hopes this will give purchasers better apples-to-apples comparisons of plans. COVER STORY Reinsurance: Are You on a Firm Footing? Reinsurance, once a sleepy part of managed care, is changing. Provider stop-loss … Read more

The roots of modern managed care go back to prepaid health plans of the 19th century, but many of the concepts we use today were embraced in ancient times. The Babylonians had a system with many parallels to the present one. AT THE DAWN OF CIVILIZATION, about 4,000 years ago, nomadic Semite tribes developed a … Read more

Kaiser Permanente’s experience proves that plans play a valuable role in ensuring that all Americans have access to care MANAGED CARE April 2009. ©MediMedia USA Kaiser Permanente’s experience proves that plans play a valuable role in ensuring that all Americans have access to care As an integrated delivery system, Kaiser Permanente serves as an especially good environment … Read more

EMPLOYER UPDATE In Bleeding Edge: The Business of Health Care in the New Century (Aspen Publishers, 1998), the medical economist J.D. Kleinke predicted that traditional MCOs eventually would give way to new and more rational models of health care. One step in this evolution would be providers’ realization that they can make more money by forming entities … Read more

Program helps uninsured patients Parkland Hospital, an 800-bed safety-net facility serving Dallas County, Texas, is teaching uninsured patients how to self-administer intravenous (IV) antibiotics for outpatient parenteral antimicrobial therapy (OPAT), and the innovative approach appears to be paying off. The program lowered 30-day readmission rates by 47% over a four-year period, according to a study … Read more

Health-insurance Leads independently and Favorably to the Health of adults also into the reception of proper preventative care and services for chronic and severe ailments. These decisions take into consideration the continuing limits of this largely observational research which affirms themas discussed below. This Last chapter considers the wider consequences of That the Committee’s findings, … Read more

Whether you define managed care as a treatment philosophy or a payment mechanism, it’s here to stay. Regardless of the mutations managed care has undergone in the last decade-plus, it is an entrenched part of the health care system — as confirmed by a recent study of physician practice revenue by the Center for Studying … Read more

Amgen is making a huge bet on biosimilars and helping to define the market. The company announced that it is targeting 6 biotech blockbusters and will start selling them as  biosimilars in 2017. The initial targets: Avastin, Herceptin, Rituxan, Erbitux, Humira and Remicade. That’s over $40 billion in product. Even a small savings, like 15% … Read more

Inpatient care is the largest portion of health care spending in the United States. A new survey from the Healthcare Cost and Utilization Project, under the auspices of the Agency for Healthcare Research and Quality, estimates that inflation-adjusted hospital costs grew by 24.6 percent to $343 billion from 2001 to 2007. The report identifies which … Read more

The days of employers scrambling to provide a choice of health benefits packages to lure and keep employees may be ending. The New York Times reports that large companies across the country are sharply reducing the number of HMOs they offer. It’s an effort to survive in an environment that features rising health care costs … Read more

Health plans concerned about the cost of pharmacy benefits might want to look at potential effects of prescription drug reimportation — formulary issues and legal questions, to name two — even if full implementation is a while off. It’s fair to say that the 106th Congress will never be known for its decisiveness in the … Read more

We often use such words as “quality,” “transparency,” “accountability,” “evidence-based,” and “effectiveness,” but not always in the same ways. Quality, like beauty, is in the eye of the beholder. The word is ubiquitous in health care, but what does it mean to health plan leaders, providers, patients, and payers? Is quality a process, a tactic, … Read more

In North Carolina, a pilot program that has moved most Medicaid recipients in Mecklenburg County, which includes Charlotte, into managed care is saving about $16.5 million a year, while offering improved access to physicians. Those are the findings of a preliminary study conducted by researchers at the University of North Carolina at Charlotte. The state’s … Read more

Novel Coronavirus disorder 20-19 is a continuing pandemic which has influenced the whole planet. The Indian government has reacted ardently and quite habituated into the catastrophe, by way of a nationally lock down. Even the healthcare systems inside the united states are trying hard to keep up fair care across disease spectra, while reacting the … Read more

Defining discretionary health care is no easy task, but it may be imperative for ‘consumer’ health plans seeking to get patients more involved Defining discretionary health care is no easy task, but it may be imperative for ‘consumer’ health plans seeking to get patients more involved If a woman is experiencing chronic back pain, her … Read more

J.D. Kleinke HEALTH PLAN 2009 J.D. Kleinke is a medical economist and consultant based in Portland, Ore. His books include Bleeding Edge: The Business of Health Care in the New Century and Oxymorons: The Myth of a U.S. Health Care System. Health care delivery in the U.S. in 2009, prompted by the Medicare prescription bill’s … Read more

FEATURE Managing the High Cost of Obesity Alone, medications and behavior modification aren’t solutions. Obesity”s complexity makes it difficult for payers to develop a strategy for reducing weight-related costs. Every day sees a headline about obesity: “Counting Calories Has Become a National Pastime,” “Obesity Rates Reach Historic Highs in More U.S. States,” “New Way to … Read more

John Marcille The Northwest Hospital & Medical Center in Seattle, Wash., is doing some interesting things with clinical decision support (CDS), an area that we expect to have an increasingly positive influence on the Bobbsey Twins of health care: quality and cost. Greg Schroedl, MD, the hospital’s chief medical officer, points to order sets that … Read more

The accountable care organization hung like an ornament on a Christmas tree, helping to ensure passage of Obamacare, says David J. Brailer, MD. Four years later, however, the money needed to make ACOs work is not there. Here’s a frightening contrarian view: The Centers for Medicare & Medicaid Services is poised to fail. That’s the … Read more

New Engineered Skin Substitute for Pediatric Burns Permaderm consists of both epidermal and dermal components   August 9, 2016 Linkedin Share Button Tweet Widget(link is external) Positive results have been reported from a clinical study of Permaderm (Amarantus BioScience Holdings/Cutanogen Corporation), an engineered skin substitute (ESS), in children with life-threatening severe burns. ESS has received … Read more

First Once-Daily, Nebulized Bronchodilator Available at End of 2018 The FDA has approved revefenacin (Yupelri, Theravance Biopharma, Dublin, Ireland and Mylan, Canonsburg, Pennsylvania) for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD). A long-acting muscarinic antagonist (LAMA), Yupelri is the first and only once-daily, nebulized bronchodilator approved for COPD in the U.S. … Read more

Post-Acute Care Vendors Allow Plans To Focus on Hospital, Medical Costs Interview by Peter Wehrwein Tweet Widget(link is external) Shortening lengths of stay in nursing homes and hospitals, cutting back on readmissions, delivering safe, effective care at home—his company can make these things happen, says John Driscoll, 56, who has been the CEO of CareCentrix … Read more

Impressive savings and compliance rates seen for those enrolled in Choice Fund, the insurer’s consumer-directed plan Frank Diamond Managing Editor A new presidential administration and calls for universal health coverage may finally stem the wave of benefit restructuring that has engulfed the managed care industry in recent years. After all, consumer-directed health plans need enrollees … Read more

DELIVERY MODELS Lessons have been learned from early PHOs, which lacked direction and had misaligned interests between hospitals and physicians. At St. Joseph’s Health System in Atlanta, physicians and hospital administrators are working together to contract with managed care companies, design protocols for medical care, and get ready to accept capitation. As they do, they’re … Read more

Despite the extensive attention paid to consumer-directed health plans, a survey conducted by the Kaiser Family Foundation shows that these types of plan arrangements have made only small inroads in the employer market. Such plans cover about 5 percent of all covered workers, which is not statistically different from the 4 percent share recorded in … Read more

Massachusetts Insurance Commissioner Linda Ruthhardt last month issued a report that criticized elements of a plan by Blue Cross and Blue Shield of Massachusetts to split itself into three companies. The report could spell trouble for Blue Cross, because Ruthhardt must rule on the breakup –which the company says is crucial to its future success. … Read more

From the constantly Altering healthcare Arena, one in which Policy makers are funneling hospitals, health care groups, and integrated health systems to some world in that they need to simply take more risk for his or her individual inhabitants, the pressure is mounting on providers to deliver superior outcomes. Really, within the last several months, … Read more

Sutter Health, an integrated health system of 26 hospitals and 5,000 physicians in California, is using capitation to encourage greater cost-effective care. But it’s not Sutter’s primary care physicians who are being capitated. When Sutter finishes work with its medical groups on a new payment scheme, primary care physicians will be paid on a fee-for-service … Read more

Also called observational research, these studies dig down to the provider and patient level rather than analyzing only population-level data Thomas Reinke Random controlled trials may be the gold standard in formal clinical research, especially for approval of medications and the development of clinical guidelines, but real- world studies are stealing the limelight as the … Read more

There’s a line between encouragement and coercion that doctors say some health plans ignore. Given physician defensiveness, can any approach to DM work? Does capitation make effective buy-in nearly impossible? By Frank Diamond Senior Editor The fate of any disease management program ultimately rests with physician buy-in. It’s a corner of health care where HMOs … Read more

High cost-to-benefit ratio will limit acceptance A new report from business intelligence provider GBI Research states that six pancreatic cancer drugs are expected to gain approval by 2021, all of which have demonstrated significant improvement in progression-free survival and/or overall survival in clinical trials. Market growth is anticipated in the eight major countries of the … Read more

The American Medical Association’s January attack on so-called physician “gag rules” has been embraced by a number of HMOs since U.S. Healthcare came out in favor of minimal restrictions. Most recently,32 California HMOs have advocated open and unrestricted communication between physicians and patients about medical conditions and insurance issues such as reimbursement. “Doctors have the … Read more

The less common form of hemophilia — acquired hemophilia — can now be treated with recombinant activated factor VII Hemophilia is typically thought of as an inherited bleeding disorder. Both common types of hemophilia — A (factor VIII deficiency) and B (factor IX deficiency) — are passed to males via a defective X chromosome from … Read more

At a glance Greater Detroit Area Health Council Constituents: 110 employers, unions, government agencies, consumer groups and health care providers Defining characteristic: Brings together a cross- section of the seven-county Detroit metro area, which has a population of 4.5 million, rather than just purchasers of health care. Success point: Demonstrates that health care coalitions can attack the issue … Read more

Name Last modified Size Description Parent Directory 30-Dec-2000 15:10 – ../../../archiveMC/9711/9711.addyears_large.gif 02-Jan-2001 00:08 17k ../../../archiveMC/9711/9711.addyears_small.gif 02-Jan-2001 00:08 11k 9711.amap.shtml 02-Jan-2001 00:08 9k 9711.capitation_part..> 02-Jan-2001 00:08 19k 9711.capitation_part..> 02-Jan-2001 00:08 18k 9711.capitation_part..> 02-Jan-2001 00:08 9k 9711.compass.map.gif 02-Jan-2001 00:09 15k 9711.compass.nationa..> 02-Jan-2001 00:09 15k ../../../archiveMC/9711/9711.compass.pdf 02-Jan-2001 00:09 155k 9711.compass.regions..> 02-Jan-2001 00:09 28k 9711.compass.reportc..> 02-Jan-2001 00:10 30k 9711.compass.shtml … Read more

It is with fantastic sadness we declare towards the LDI community which A convention event commemorating Dr. Cooper’s life and donations is being proposed for family, coworkers and friends in the prospective date. Instead of flowers, donations could be made for the Cooper Family Research Fund, maintenance of this University of Pennsylvania Abramson Cancer Center … Read more

Sumatriptan transdermal system can cause burns and scarring Teva Pharmaceuticals has decided to temporarily suspend sales, marketing, and distribution of its Zecuity sumatriptan iontophoretic transdermal system, or migraine patch, to investigate the cause of burns and scars associated with the product. The FDA has advised health care professionals to discontinue prescribing Zecuity. Patients should stop … Read more

When the approach in one town is major surgery and in another, it’s watchful waiting, you know there’s a problem. Unwarranted variation in medical practice is costly — and deadly. Analysis of Medicare data reveals that per-capita spending per enrollee in Miami is almost 2.5× as great as in Minneapolis, even after adjusting data for … Read more

Controversy about cost stalked the presentation of trial results of CheckMate 025 at the 2015 European Cancer Congress. In this randomized, head-to-head trial of 821 patients with advanced renal cell carcinoma (RCC) who had lost response to antiangiogenic therapies, those given nivolumab (Opdivo) had a 5.4-month overall survival (OS) advantage and fewer grade 3 or … Read more

The FDA Recently researched 5 10 (k) clearance into applications developed by Max-Q AI which takes advantage of AI to find brain bleeds on CT images, in accordance with a study released Nov. 8 from AI at Healthcare. “The Accipio Ix Intracranial Hemorrhage platform uses AI technology to automatically analyze non-contrast mind CT pictures, and … Read more

For much of the last decade, providers and payers have been trying to figure out how to make ACOs work and deliver on the promises of value-based care. The results? Let’s call them mixed to middling. Now, with a new decade starting, it may be direct contracting’s turn to be the great hope. Just before … Read more

MARKET TRENDS Managed Medicare’s trouble may have something to do with underfunding or rich benefits, but for health plans, market share has a lot to do with it, too. David Ricks Joe Suminski Why did several major HMOs drop out of Medicare+Choice (M+C) last year? The health plans say it was because of “inadequate government … Read more

Overall, the Plan would likely takeaway health care out of a few million Americans and raise charges for more, notably low carb people today and the mid century. However, it’d instantly end the demand that most Americans own insurance, that has been tremendously unpopular, notably with all Republicans, reduce national jurisdiction over the medical system … Read more

Think you know everything physicians should consider when they take on a capitated contract? You may be surprised by what you learn from this practice-management consultant’s succinct advice. Whether you’re ready or not, capitation is coming to your neighborhood — if it hasn’t already moved in. Under capitation, of course, an HMO or other managed … Read more

Oregon’s governor signed a bill creating a reference formulary for Medicaid. The new law bases reimbursement for all medications in a class on the cost of a chosen “reference” drug in that class…. Pharmaceutical Research and Manufacturers of America is suing the Centers for Medicare and Medicaid Services (formerly HCFA) for approving Maine’s new drug-discount … Read more

The turbocharged rush to offer choice to consumers leaves a question in its wake: Choice of what? It turns out that consumers value having a choice in providers more than having a choice of health plans, according to a study by the Commonwealth Fund, which warns that “policymakers should be cautious about embracing the individual … Read more

Deal with people’s isolation and disconnection to head off physical health problems—and possibly health care costs. First, a story—because Robin Caruso, the chief togetherness officer at CareMore, loves telling stories. There once was a man who heard voices. He heard voices because of the bipolar disorder that had plagued him for years. As part of … Read more

Medication was restricted by the dependence on data which reflect an”average” patient’s answer to preventative or curative interventions. This technological evidence continues to be significantly less than optimal for discovering the curative options best suited for human patients, requiring educated guesswork and trial and error throughout the clinical decisionmaking procedure. The clinical treatment of patients … Read more

Sooner or later on your own life, you’ve felt that the energy of a hug during a challenging moment. There is something really comforting about setting some one’s arms wrapped around you, permitting you to understand that things will probably be fine. That’s exactly just what one volunteer application in Firelands is trying to complete … Read more

New software capabilities provide the power to integrate medical and pharmacy data One by one, health plans and PBMs have successfully overcome important hurdles in pharmacy management. Waste has been reduced through smarter dispensing, the proportion of days covered has generally increased, and in many classes adherence has improved. Pharmacy directors have also played a … Read more

(CSA), meaning it has no currently accepted medical use and also a high possibility of misuse. Oahu is the exact classification as alcoholism. And when the United States Food and Drug Administration Requires a marijuana-based medication, then your DEA is going to be made to re evaluate the plant classification. The DEA’s Announcement came in … Read more

In his first remarks on value this past spring, HHS Secretary Alex Azar made a bold statement about the urgency facing those of us who work in health care. “This is no time to be timid,” Azar told the Federation of America’s Hospitals. “Today’s health care system is simply not delivering outcomes commensurate with its … Read more

Abstract Purpose: Electronic health records (EHRs), now used by hundreds of thousands of providers and encouraged by federal policy, have the potential to improve quality and decrease costs in health care. But interoperability, although techncially feasible among different EHR systems, is the weak link in their chain of logic. Interoperability is inhibited by poor understanding, … Read more

Hindsight is 20/20, but was this predictable? After a year and a half of hard work, a blue-ribbon commission that set out to keep Medicare from running into a ditch itself slid off the road, thanks to deep ideological divisions regarding government’s role in health care. The commmission disbanded without a recommendation — consigning the … Read more

ACO UPDATE The Tortoise and the Hare Hospital-led ACOS may have some advantages in the beginning, but the physician group ACOs may win out in the long run Hospital systems certainly have the organization part of the accountable care organization (ACO) going for them: access to capital, all different kinds of infrastructure, advanced IT, and … Read more

A G. is a principal at Gosfield & Associates in Philadelphia. She’s a nationally known health care lawyer and a former chairwoman of the National Committee for Quality Assurance. As health care expenses go up, dissatisfaction with the style of care with controlled costs will lead to more stratification in the industry in the form … Read more

Costs are rising as physicians order more of all kinds of tests, from low-cost routine tests to high-cost genetic assays When a friend’s child had a rare neurological disorder recently, Michael J. Misialek, MD, a pathologist at Newton-Wellesley Hospital in Massachusetts, was asked about the diagnostic value of a lab test. The cost of this … Read more

Here at Managed Care, we offer in-depth discussions on the complex issues of the day by respected experts inside and outside the industry. Sometimes, however, we address issues informally. When an interesting story breaks, for example, it sometimes makes sense to discuss it in this space, rather than wait a month for a full-blown article that, … Read more

Alice found a Wonderland. What we found last week, when the Center for Medicare & Medicaid Services (CMS) released cost information for the 100 most common diagnoses and procedures in over 3,000  hospitals, is beyond Alice’s imagination. Some of the cost differences for the identical billing diagnoses qualify for “you cannot make this stuff up.” … Read more

“The high cost of prescription drugs is a crisis,” says Maine Senate Majority Leader Chellie Pingree. “Working people tell us they make a difficult choice between filling their prescription or buying food or heating oil — or, in many cases, going broke.” Pingree is the primary sponsor of Maine’s Act to Establish Fairer Prescription Drug … Read more

Overall Success Results in the CHECKMATE-214 study had Not been Likely to learn until the next half 2019. Therefore Thursday’s statement that an independent data monitoring committee recommended stopping the trial early as a result of efficiency proved to be a welcome rise in bristolmyers. CHECKMATE-214 was made to enlarge that tag to comprise formerly … Read more

TOMORROW’S MEDICINE Treating severe vesicoureteral reflux involved complicated, expensive surgery. Now an injectable agent that forms a valve can lead to normal urination. Thomas Morrow, MD Vesicoureteral reflux (VUR) is probably not at the top of the list of concerns for most managed care executives, but it is of great importance to the parents of … Read more

Adjusted for inflation, physicians’ net income from the practice of medicine declined 7 percent between 1995 and 2003, according to a national study reported by the Center for Studying Health System Change. Primary care physicians and general surgeons fared the worst in keeping pace with inflation; specialty occupations did much better. The study cites flat … Read more

System maps colon, creates 3-D images Check-Cap Ltd., a medical diagnostics company based in Israel, has entered into an agreement with GE Healthcare to develop high-volume manufacturing of an x-ray source for Check-Cap’s ingestible capsule for colorectal cancer screening. The investigational system uses ultra–low-dose x-ray and wireless communication technologies to scan the inside of the … Read more

Clinical Brief: Abatacept for Rheumatoid Arthritis This Brief summarizes “Abatacept for Rheumatoid Arthritis Refractory to Tumor Necrosis Factor-Alpha Inhibition” (Genovese et al, New Engl J Med 2005), and includes a managed care analysis by Jaan Sidorov, MD. Depression in the Workplace Download supplement Even though depression is common and treatable, it remains a significant problem … Read more

MANAGED CARE October 2010. ©MediMedia USA The proportion of Americans reporting treatment for diabetes who took oral medications to treat their condition rose from 60 percent in 1997 to 77 percent in 2007 — a 28 percent increase. During that period, the proportion taking insulin to control their diabetes fell from 38 percent to 24 percent, according … Read more

Don’t be fooled, warns the noted health care economist: High-quality care costs more, not less. The Internet will increase demand for the best care. J.D. Kleinke is the founder and president of Denver-based Health Strategies Network. The company provides Internet strategy, design, and development services for pharmaceutical and biotechnology companies, and operates Pharmapath.com, an information … Read more

Color charts Also available as PDF More than 1 in 8 people changed their personal physician or other primary provider of health care last year. Personal preference was the most common reason. One in every five changed for reasons related to health coverage, but that’s down from 1 in 4 just four years ago — … Read more

Trogarzo, an anti-HIV monoclonal antibody, is an advance. But FDA approval was based on a study of only 40 people—and it had no control group. It is safe to say that few people read a June 5, 1981, report in the CDC’s Morbidity and Mortality Weekly Report that described five cases of a rare lung infection, Pneumocystis carinii pneumonia … Read more

To get But this evaluation may take around two to finish, sequential testing might have to rule out the chance of false negative outcomes and there’s now a lack of RT–PCR test kits, and underscoring the urgent demand for alternate methods for quick and precise identification of patients using COVID-19. But CT alone might have … Read more

Whilst the COVID-19 pandemic captured hold ancient this Year, a tiny drug company outside Philadelphia was unable to promote a chemical which might help patients fighting to their own lives. Paratek Pharmaceuticals had spent over two decades developing and analyzing a antibiotic called omadacyclinethat went for sale at america at 20-19 for use against bacterial … Read more

Obesity is the Likely Culprit, Study Says Death rates from heart disease, diabetes, stroke, and related disorders have been decreasing for decades, but recently, those rates have slowed or stalled. “At best, progress has slowed to a halt, and, at worst, our rates of cardiovascular disease are going up,” said Steven Nissen, chief academic officer … Read more

For the past 20 years, the VA has labored at one of the most advanced electronic medical records in the country – and is giving the technology away. Private vendors object that it relies on outdated software. It’s “snow bird” season in Phoenix. They’re easy to spot, driving in cars displaying plates from cold Midwestern … Read more

It’s Managed Care 2, Lawyers 0, in the question of whether ERISA requires health plans to disclose physicians’ financial incentives. The U.S. Fifth Circuit Court of Appeals upheld a lower court ruling that dismissed a case against several HMOs. Health plans still face a number of class-action suits, however, over various types of incentives; one … Read more

“Psoriasis is a profoundly apparent infection, and it is fundamental that these more youthful patients and their parental figures have choices that can viably decrease the hard to-disguise and frequently misconstrued plaques,” said Michael Siegel, Ph.D., Senior VP of Exploration and Clinical Undertakings for the Public Psoriasis Establishment. “It is urging to have new treatment … Read more

By reducing restenosis, these devices will save managed care money. Technophiles would be hard pressed to come up with better names than Cypher, Cypher Stallion, Achieve, Taxus, Express and Maverick. But it is unlikely that most managed care executives would guess that these names represent an industry that, up until now, has been neglected by … Read more

Will ‘Essential Benefits’ Break the Bank? The size of the essential benefits package may determine whether insurers can operate in the highly regulated exchange market. Expect strong lobbying from health care interest groups. Michael D. Dalzell PSA Fails the Test, but Does It Matter? Clinical executives at health plans want to see how providers react … Read more

DM Grows, Though Under Fire Some question disease management’s cost-effectiveness, but major insurers have seen enough to induce them to expand programs Frank Diamond Many States Preparing Laws Rejecting Individual Mandate The most attractive element of the congressional reform plan — at least in the eyes of insurers — is drawing fire in at least … Read more

It might seem to be straight out of science fiction, but there’s solid science and engineering behind it Thomas Morrow, MD The hand is an engineering marvel. It can extend a finger to use an ATM, securely hold a toddler’s hand to cross a busy street, hold and turn a key, pick up a foam … Read more

Recent survey results show that HMO enrollment is continuing its rapid advance. As of July 1, 1996, it accounted for 24.0 percent of the nation’s population. While just two years earlier only three states had HMO enrollment totals of more than 30 percent of their populations (Massachusetts, 36.2 percent; California, 35.3 percent, and Oregon, 33.6 … Read more

Some hospitals are considering installing copper surfaces to cut down on the spread of pathogens Thomas Morrow, MD Most people associate stainless steel with food preparation, hospital surfaces, and other places where sterility is desired. I challenge any reader to find an operating room devoid of stainless steel. And for good reason: Stainless steel is … Read more

Your wellbeing and the strength of the networks we serve is our main concern. As we as a whole change our lives in these quickly evolving times, kindly realize our group is here to assist you with getting the chaotic speed and help you discover the consideration you need. We need you to deal with … Read more

CDHPs and catastrophic insurance plans can save consumers money, but do high deductibles add to overall costs down the line? The rising cost of health insurance premiums for employers — up 131 percent in the last decade, to an average $13,375 per year for family coverage, according to the Kaiser Family Foundation — has led to … Read more

NCQA’s Quality Compass Points to Plan Differences The first comparative report of health plan performance produces surprising revelations — and a starting point for assessing a plan’s quality. But some people caution not to read too much into the numbers alone. Michael D. Dalzell The March of Capitation: Reversed or Just Delayed? Contrary to many … Read more

A CMS demonstration program will determine whether Medicare Advantage health plans improve their quality scores by responding to bonuses that correspond with a five-point rating scale Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD Scott Guerin, PhD Medication nonadherence costs billions. It costs almost $300 billion in avoidable medical spending — billions that payers can … Read more

Treatment is not significantly different from placebo Disappointing results have been reported from a phase 3 study of Keyzilen (Auris Medical Holding AG) in patients with acute inner-ear tinnitus. The study did not meet its two coprimary efficacy endpoints of statistically significant changes in tinnitus loudness and tinnitus burden compared with placebo. Keyzilen is a … Read more

For a lot of Americans, the price of taking and filling their medications is overly muchbetter. So much therefore, 44 percent of respondents at a brand new online survey say that over the previous calendar year, they failed to purchase atleast one clinically necessary prescription for free. That is based on a internet flash survey … Read more

Ex-Prisoners In Need of Care Frank Diamond There’s a gap in the proverbial health care safety net that’s big enough for a whale to swim through. People who are incarcerated, on probation, or on parole — what a recent study calls the “justice-involved population” — make up 22% of the 13 million newly eligible people. … Read more

In an effort to make the best use of specialty drugs, everybody gets into the act at Independence Blue Cross While specialty pharmacy may be the most costly element in case management programs for complex conditions like multiple sclerosis, it may not be the most important. Managing comorbidities and the effect of functional limitations on … Read more

A study by the Rand Corp. suggests that high managed care penetration in urban areas is forcing a slow but tangible physician migration to the country — away from HMOs. Rand followed 75,000 doctors who finished graduate medical education between 1989 and 1994. Early in the period, primary care physicians tended to settle in metropolitan … Read more

Experts, including many health plan medical directors, agree: We have a long way to go. It’s essential rhetoric for both political parties that America has the best health care in the world. Bill Clinton said so when he was president and George W. Bush says so today. Republican Senate Majority Leader Bill Frist says we … Read more

Cologuard is no substitute for colonoscopy for high-risk patients, but if this new tool means more people get screened, it could save lives It’s no fun hitting “the big 5-0” in our youth-oriented culture, and adding more angst to that milestone is the recommendation that people also start to be screened for colorectal cancer (CRC). … Read more

Amgen is making a huge bet on biosimilars and helping to define the market. The company announced that it is targeting 6 biotech blockbusters and will start selling them as  biosimilars in 2017. The initial targets: Avastin, Herceptin, Rituxan, Erbitux, Humira and Remicade. That’s over $40 billion in product. Even a small savings, like 15% … Read more

By assisting doctors, insurers can get all the payment that they are due, but that too often is lost Marcia Naveh, MD Chief Medical Officer Matrix Medical Network Health insurers participating in managed Medicare have never experienced as wide a gap between actual and potential payment as currently exists. Simply stated, Medicare managed care payments … Read more

Enrollment growth in consumer-directed or high-deductible health plans stalled last year, according to a survey by the Employee Benefit Research Institute and the Commonwealth Fund. “Enrollment in CDHPs and HDHPs is virtually unchanged from 2005,” says the survey. “Only 1 percent of the privately insured population ages 21-64 are currently enrolled in CDHPs, representing 1.3 … Read more

In an effort to protect the pharmacy benefit for employees, companies are using a variety of techniques to manage expenditures. A survey by Hewitt Associates shows that nearly 50 percent of employers that offer pharmacy benefits have added, or are in the process of adding, a third-tier copayment, with the top tiers generally including “brand-name … Read more

There’s this family of nonsmokers: a man, 37; woman, 35; boy, 11; and girl, 9. This could be the beginning of a script for a politically correct movie. What it is, actually, is the assumption made by a study by a research company, Ehealthinsurance, that suggests that someone living in Spokane, Wash., might want to … Read more

While there has been movement in many states, health plans would first want to make sure that they wouldn’t be breaking any law If you were looking for a poster child for medical marijuana, Bill Britt might be your man. The 53-year-old Long Beach, Calif., resident was a cute, burbling 10-month-old baby when he came … Read more

Neil Caesar, J.D. It is important for a medical group’s internal structure and inter-physician documents to be updated to reflect the realities of managed care. Let’s examine, for example, the departure of one of the group’s physicians. Say that physician is not retiring, but is withdrawing from the group because of disagreement over the practice’s … Read more

I’ d love to tell you that we planned it this way, but it just happened. Many of the articles this issue deal with managing pharmaceuticals, with several focusing on specialty pharmacy. I pull a comparison from the shelf, one about publishing a newspaper before a presidential election: One topic overrides all others. There’s this … Read more

A summary of ECRI Institute’s Emerging Technology Evidence Report Managed care leaders are striving to make evidence-based decisions about new and emerging health technology. Managed Care and ECRI Institute have collaborated to disseminate bimonthly summaries of the Institute’s Emerging Technology Evidence Reports. ECRI Institute is an independent not-for-profit organization that researches the best approaches to … Read more

It’s all about choice these days. Different routes, same destination. In this case, it’s reading Managed Care when and where you like, and if you own an iPhone or an iPad, you can do that with our new app available at the Apple Store. Search for “Managed Care,” “P&T,” “Biotechnology Healthcare,” or “MediMedia,” or just … Read more

When financial incentives were withheld from 35 outpatient facilities owned and operated by Kaiser Permanente, physicians were less likely to screen for four quality indicators. In particular, the screening rate for cervical cancer dropped even lower than before the incentives were instituted, according to a study in the British Medical Journal. The indicators were screenings … Read more

MANAGED CARE June 2000. ©2000 MediMedia USA What with lawsuits and poor financial performance, 1999 could hardly be termed a good year for HMOs. Despite those setbacks, the some HMO executives seemed to do OK for themselves. Of course, what’s not shown here is how executives in other industries fare while in the trough. (Remember … Read more

Three health plans outline steps they are taking to deal with the effects of growing consolidation of providers For Georganne Chapin, a report that hospitals and physicians were wielding increased market power in several cities was not news. The president and CEO of the not-for-profit Hudson Health Plan in Tarrytown, N.Y., was well aware of … Read more

The consulting company PricewaterhouseCoopers, which prefers to call itself PwC now, placed caring for people with dual eligibility among its list of the top 10 health care industry issues in 2013. The people who qualify for both Medicaid and Medicare are considered to be the country’s sickest and poorest people, falling “through the cracks of … Read more

Metastasis is understood to be the dissemination of altered cells in their site of origin to remote websites, where by all these cells that are transformed may finally contribute to progress of tumor habitats. A significant curative attempt in jelqing was dedicated to stopping cancer development. But a lot more than 90 percent of departure … Read more

Having transformed the market, pharmacy benefit management companies are now in for some shaking up themselves. More tightly controlled formularies are one possibility. In just a few years, pharmacy benefit managers have become major players in health care, profoundly influencing physician prescribing habits, performing needed functions for health plans, attempting to control market share for … Read more

Can HMOs be sued for the practice of offering bonuses to physicians who help them keep the cost of care down? That’s a question the U.S. Supreme Court has agreed to decide this term, in the first major case involving HMO liability to reach the high court.involving HMO liability to reach the high court. An … Read more

Together with medical maintenance’s slumping price, sub-optimal caliber, and also excess waste significant developments from our inhabitants’ wellbeing, it’s recognized the U.S. medical care process should improve. Lots of new maintenance delivery units are now used and tested. Payment designs may also be radically varying in the feeforservice (FFS) version to value-based settlement versions. These … Read more

ADYNOVATE and the diluent is likely to probably be pre-assembled from the BAXJECT III reconstitution strategy. “In Shire our attention is to the individual, so we’re happy to Provide our hemophilia A patients having a brand new option which may permit them to organize their own treatment with fewer steps,” explained Perry Sternberg, mind of … Read more

A judge in Fort Worth last month ordered Harris Methodist Health Plan to stop fining physicians who exceed pharmacy budgets. District Judge Bonnie Sudderth ruled that Harris Methodist Health Plan’s risk-sharing mechanism violates a state law that bars HMOs from paying physicians or other providers in ways that even indirectly create incentives to limit medically … Read more

Bills that each speech piece-meal problems within the more expensive Affordable Care Act, for example how to take care of those who’ve pre existing health states, just how far more to bill seniors when compared with young folks, and also the way exactly to spur individuals to stay continuous coverage all through their lifetimes. Most … Read more

Virus may be evolving, experts say   Zika investigators now believe that microcephaly in newborns and Guillain–Barré syndrome in adults may be just the most obvious disorders caused by the mosquito-borne virus, according to a report from Reuters. Fueling that suspicion are recent discoveries of serious brain and spinal cord infections, including encephalitis, meningitis, and … Read more

Mental health parity has resurfaced as a legislative initiative. The U.S. House Education and the Workforce Committee’s Subcommittee on Employer-Employee Relations held a hearing on March 13 on the legislation. The bill would require that insurers’ level of mental health coverage be on a par with physical health coverage. Access and costs, including deductibles, would … Read more

Despite their attraction, these cost-control programs don’t always deliver The pressure on employers to manage the rising costs of health care is increasingly focused on the pharmacy benefit plan. Within the pharmacy benefit, there is a significant expenditure differential between specialty and traditional drugs. In 2012, traditional drug expenditure actually decreased by 1.5%, while specialty … Read more

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – 0002.washington.html 20-Jun-2003 16:09 8k 0002.uk.html 20-Jun-2003 16:09 17k 0002.qna_bodenheimer..> 20-Jun-2003 16:09 24k 0002.outlook.html 20-Jun-2003 16:09 2k 0002.news_warning.html 20-Jun-2003 16:09 2k 0002.news_tenncare.html 20-Jun-2003 16:09 2k 0002.news_headlines…> 20-Jun-2003 16:09 2k 0002.news_comeback.html 20-Jun-2003 16:09 2k 0002.legal.html 20-Jun-2003 16:09 7k 0002.hospitals.html 20-Jun-2003 16:09 18k 0002.harvard.html 20-Jun-2003 16:09 16k 0002.editorsmemo.html … Read more

Name Last modified Size Description Parent Directory 28-Aug-2000 11:10 – ../../../../archiveMC/9711/9711.addyears_large.gif 17-May-2000 12:17 17k ../../../../archiveMC/9711/9711.addyears_small.gif 17-May-2000 12:17 11k 9711.amap.shtml 17-May-2000 12:17 8k 9711.capitation_part..> 17-May-2000 12:17 19k 9711.capitation_part..> 17-May-2000 12:18 17k 9711.capitation_part..> 17-May-2000 12:18 8k 9711.compass.map.gif 17-May-2000 12:18 15k 9711.compass.nationa..> 17-May-2000 12:18 15k ../../../../archiveMC/9711/9711.compass.pdf 17-May-2000 12:19 155k 9711.compass.regions..> 17-May-2000 12:19 28k 9711.compass.reportc..> 17-May-2000 12:19 30k 9711.compass.shtml … Read more

Plans seem curiously unconcerned about technology that helps workers compare premiums, other features Even as health plans demand transparency from providers to encourage smart shopping by their members, several major employers in California are making it easy for their workers to shop for health plans. The Health Plan Chooser, developed by the Pacific Business Group … Read more

Heart attack sufferers experience better outcomes when their attending physician is a cardiologist than when he or she is a family physician or an internist, says a study published in the Journal of the American College of Cardiology. Other have found cardiologists to be more aware of and willing to rely on cutting-edge therapies, but … Read more

FDA Approves Single-Tablet Regimen Odefsey for Treatment of HIV-1 Infection Combo pill demonstrates antiviral efficacy at one-tenth the dose of Viread   The FDA has given the nod to Odefsey (emtricitabine 200 mg/rilpivirine 25 mg/tenofovir alafenamide 25 mg) for the treatment of human immunodeficiency virus-1 (HIV-1) infection in certain patients. Emtricitabine and tenofovir alafenamide [TAF] … Read more

The programs are well received, for the most part, even though it is still hard to measure their value By Lola Butcher As employers and health plans spend increasing sums on employee health management services, from health risk assessments to end-of-life case management, the question keeps coming up: Are we getting our money’s worth? Although … Read more

Congressional Republicans, eager to please in an election year, seem willing to support a pharmacy benefit in Medicare. That, combined with the drug industry’s new willingness to negotiate on the issue, has heightened speculation that a benefit plan will pass this year…. Foundation Health has consolidated its commercial plans into two divisions — East and … Read more

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – 0003.washington.html 09-Apr-2003 23:29 8k 0003.states.html 09-Apr-2003 23:29 8k 0003.qna_jessee.html 09-Jun-2003 11:44 19k ../../../archives/0003/0003.percut.table1b.gif 01-Mar-2000 12:00 42k ../../../archives/0003/0003.percut.table1a.gif 01-Mar-2000 12:00 68k ../../../archives/0003/0003.percut.pdf 01-Mar-2000 12:00 118k 0003.percut.html 09-Apr-2003 23:29 25k 0003.pbmeval.html 09-Jun-2003 11:44 11k ../../../archives/0003/0003.pbeval_chart2.gif 01-Mar-2000 12:00 28k ../../../archives/0003/0003.pbeval_chart1.gif 01-Mar-2000 12:00 8k ../../../archives/0003/0003.outlook.pdf 01-Mar-2000 12:00 43k 0003.outlook.html … Read more

When Kaiser Permanente Northern California rolled out a new electronic health record (EHR) system for outpatients a few years back, a team of researchers considered it a golden opportunity to evaluate how such systems affect care and outcomes. The staggered implementation of the EHR system at 17 KP-owned medical centers from 2004 to 2009 allowed … Read more

MANAGED CARE September 1999. ©1999 MediMedia USA Washington Watch Reports of the death of the Agency for Health Care Policy and Research, to borrow from Mark Twain, appear to be exaggerated. After flirting with extinction, AHCPR may well be making a full recovery, thanks to newfound bipartisan support in Congress. Under pending legislation, AHCPR, once the target … Read more

Transparency in contracting is a great thing, but it takes vigilance to keep it from clouding over “What’s in a name? That which we call a rose by any other name would smell as sweet.” Juliet was speaking of Romeo, and expressing a universal truth. Unfortunately, pharmacy benefit management companies (PBMs) would like the world … Read more

The Food and Drug Administration approved Truxima whilst the very first biosimilar into Rituxan for patients using CD20-positive, bcell non-Hodgkin’s lymphoma to be applied as a sole agent or in conjunction with chemotherapy. Healthcare professionals should assess the prescribing information from the tagging for detailed info in regards to the approved applications. View full prescribing … Read more

As the federal debate on the Price of prescription In a investigation of insured patients,” Prime Therapeutics quotes it might cost up to $4.5 billion yearly for the world’s medical care system to cover a combo medicine which features Kalydeco – an existent and treatment sold by Vertex Pharmaceuticals — combined side the other Vertex … Read more

Don’t expect Rep. Tom Campbell’s bill granting collective-bargaining rights to health care professionals to get far, despite its 26-2 romp out of committee. House GOP leaders aren’t enthusiastic about the bill, but sources told the Associated Press that Speaker Dennis Hastert promised Campbell a floor vote in exchange for his support of a GOP tax-cut … Read more

Patients who endure coronary episodes, or flare-ups of congestive cardiovascular breakdown, can be really focused on in an assortment of medical clinic areas. However, another investigation recommends that they’ll charge more regrettable in clinics that depend vigorously on their escalated care units to really focus on patients like them. Truth be told, contingent upon where … Read more

Before deciding last month to create a physician union, the AMA’s policy-making House of Delegates no doubt got a motivating shove from events in Texas just days earlier. There, physicians may have gained some bargaining clout that federal antitrust laws deny them when Gov. George W. Bush signed Senate Bill 1468, which had passed both … Read more

When an employer group shifts from one health plan to another, why not allow them to take their claims data to the next health plan? That way, the new plan would gain immediate knowledge of the specific disease burden faced by its new members and be able to act accordingly vis-à-vis care management programs and … Read more

Martin Shkreli takes a slap in the face A group of Australian high school students has recreated the key ingredients of Daraprim––the toxoplasmosis drug that the infamous Martin Shkreli acquired in 2015 and then jacked up the price of a single pill by 5,000%––for a mere $2, according to a news report from the British … Read more

An observational analysis of pharmacy claims collected from 2001 to 2003 by researchers at Brigham & Women’s Hospital finds that where a person lives and the socioeconomic implications of that location have a lot do with his use of generic drugs. Of the 5,399 new prescriptions filled during the study period, 1,262 (23.4 percent) were … Read more

PlanLink from Allianz Life Insurance Company of North America Name of regional HMO network: PlanLink Middleman for HMOs in network: UltraLink Number of HMOs on board: 30 Number desired for effective coverage: 150+ Time needed to build network: 2 years Size of target purchasers: 50 – 700 employees HMOs that may participate: Open Hypothetical Widge … Read more

Formulary design, contracting, and other strategies will be key to maximizing the opportunities of brand patent expirations Lipitor’s anticipated patent expiration in November will be a blockbuster event in further tempering the escalation of pharmacy costs, but there may be other benefits. Lipitor (atorvastatin) is the world’s biggest drug ever says George Van Antwerp, general … Read more

To comprehend the amount of comprehension, usage, and also comprehension of biosimilars one of caregivers, doctors, as well as the overall populace in america and europe; perceptions of biosimilars when compared with originator biologics; perceived benefits and pitfalls of clinical trials; and also if advocacy groups impact patients’ readiness to try out a biosimilar. Techniques: … Read more

A House-Senate conference committee expects to craft a compromise managed care reform bill by the end of this month. The sometimes contentious committee meetings have been punctuated by disagreement on liability. In the end, the committee is expected to endorse a limited right to sue health plans — despite Chairman Don Nickles’s ardent opposition to … Read more

Payments reduced for 758 institutions Nearly half of the nation’s academic medical centers are being punished through one of the federal government’s sternest attempts to promote patient safety, according to a report from Kaiser Health News (KHN). Medicare is reducing a year’s worth of payments to 758 hospitals, including some of the most prestigious teaching hospitals … Read more

Insurers feel pressure to incorporate new agents into their drug benefit, but evidence of effectiveness is questionable Thomas Reinke The diabetes results are pouring in. Study after study shows that pharmacist-led medication therapy management and other interventions increase adherence and lower HbA1C levels. While these goals are important, they may miss the boat in terms … Read more

Study adds to growing body of research that depict disparities in care A large study from Kaiser Permanente, involving more than seven million adults, found significant differences in the diagnosis and treatment of mental health conditions based on the race and ethnicity of the patients. The new study, published in the journal Psychiatric Services, also found … Read more

Mrs. Clocker had lung cancer five and a half years ago. Last month, she ran a full marathon. This month, she is dying. She does not understand how this could happen. She had the surgery, of course. She endured all of the chemotherapy without a word. She ate only organic vegetables and grains and free-range … Read more

Reaching for the Stars: Medical Directors Feel Pressure To Score Medicare Advantage Points This key clinician executive has a lot of responsibility as CMS gets set to distribute 2015’s bonus payments Nan Myers A Conversation With Mary D. Naylor, PhD, RN: Managing the Transition From the Hospital A pioneering advocate for transitional care for older … Read more

Health plans weigh whether giving up control of the conversation with patients is worth all the possible benefits Do you tweet? Are you linked in? Have you been tagged, or viewed? These days, social media sites such as Twitter, LinkedIn, and Facebook are all the rage, with insurers like WellPoint and Humana slowly getting into … Read more

Despite the focus on the international situation, Americans are still keenly interested in just how they’ll get the medical care they need. It’s another election year, and health care is once again a big card to play in the high-stakes world of presidential politics, where each chip in the policy game represents billions of dollars … Read more

Advocates say it will transform health care; detractors warn against overestimating its potential Neil Versel Google is getting into health care with a personal health record being introduced in cooperation with the Cleveland Clinic, and may have other products in mind. Microsoft, already a strong player in the sector, got a jump on Google a … Read more

Here are some of the challenges that health insurers face this year In the for-profit sector in particular, pressure to grow is intense, and many of the leading national payers reported less than forecasted enrollment. Pressures on growth exist in the not-for-profit sector as well, but the focus may be different. In some cases — … Read more

Like a resident at Johns Hopkins at pediatrics, Dr. Narang was not Always pleased with what he witnessed –a lot of process errors and patient security openings, and an excessive amount of waste. Healthcare tools weren’t being spent in the ideal way, ” he detected. “I had been struck by [the truth ] we spent … Read more

Health plans have apparently accepted, with new zeal, what many of them have stated for years: Healthier patients will cost less in the long run, even if preventive care costs more up front. The Wall Street Journal reports on some of the programs that health plans have launched in an effort to “coax, cajole and … Read more

Insurers Find Ways to Fill Holes of a Broken Behavioral Health System   With approximately $5 billion worth of state cuts in mental services from 2009 to 2012, the elimination of nearly 4,500 public psychiatric beds during the same time period, and a shortage of behavioral health providers, it is no surprise that many Americans … Read more

BY MICHAEL S. VICTOROFF, M.D. There’s a lot I don’t understand about the venture tort industry. In the most lucrative example of “tortuosity” to date, some lawyers have struck a rich deal with the tobacco industry. How and why are matters for legal historians. It’s unclear to me just what form of justice this case … Read more

Strolling the linguistic battleground upon which we toil each day, one nearly trips over the clichés “if it ain’t broke, don’t fix it” and “leave well enough alone.” “They’ll do,” you think, as you pick them up, brush them off, and march them once again into the breach. But cliches are like stereotypes — sometimes … Read more

Neil Caesar, J.D. Dark-suited gentlemen stride purposefully into your reception area and ask to see the person in charge. The visitors announce that they are with the federal government — the U.S. Attorney’s Office, or the FBI, or the Office of Inspector General — and that they have a warrant to seize documents and other … Read more

There was a time when provider-sponsored organizations were the government’s great hope for the spread of managed Medicare. But less than three years later, the nation’s only Medicare PSO is cashing it in. And no PSO applications are pending with the Health Care Financing Administration. Albuquerque, N.M.-based St. Joseph Healthcare sponsored the only PSO to … Read more

The UnitedHealth executive brings experience in public health and physician leadership to bear on issues facing health plans The health insurance industry is uniquely positioned today to make a profound difference in how our health care system evolves, and working in that environment is a privilege, says Reed Tuckson, MD, FACP, executive vice president and … Read more

A growing controversy in MedPAC and in physician organizations could spill over into how all health plans compensate doctors Few topics roil doctors more than the pay, and arguments over Medicare rates are always among the most heated. To ward off scheduled cuts in federal rates, physicians each year mount an emotional coast-to-coast political blitzkrieg … Read more

Having transformed the market, pharmacy benefit management companies are now in for some shaking up themselves. More tightly controlled formularies are one possibility. In just a few years, pharmacy benefit managers have become major players in health care, profoundly influencing physician prescribing habits, performing needed functions for health plans, attempting to control market share for … Read more

During one week last October, thousands of pharmacies around the country placed frantic calls to PCS Health Systems, the pharmacy benefit manager. They were looking for $200 million in reimbursement checks that should have gone out the previous Friday. What callers heard was a brief statement to the effect that PCS had changed its annual … Read more

If the White House indeed takes on tort reform this year, it will be interesting to see if any meaningful legislation results and what effect it might have on health care. Doctors in this litigious age tend to practice defensive medicine, and that means more use of expensive imaging technology — as our cover story … Read more

EMPLOYER INITIATIVES A new urgency means that tiered formularies and higher copayments will become even more widespread, a recent survey indicates. Frank Diamond Senior Editor The nation’s employers want to continue to force workers to take a more active role in the battle against soaring prescription drug costs, according to a recent online survey of … Read more

It will take some time to fully digest the 592 pages of new rules for the Medicare Shared Savings Program (MSSP) ACOs. You can get started and read them for yourself here. But few items pop out even in an Evelyn Wood reading of the first 30 or so pages. CMS is going to allow the Track … Read more

The biotech field is booming and managed care is scrambling to level the playing field by creating competition. The recent “Pharmaceutical Evaluation Survey, 2002” by Health Strategies Group reports that 57 percent of medical directors see biotech drugs as a concern both now and in the future. There is good reason to be concerned. There … Read more

Another day, another projection about the coming primary care shortage. This time, it’s projected that the United States will need 52,000 more PCPs by 2025 because of population growth, aging, and expansion of the number of people with insurance coverage under the Affordable Care Act, according to a study in the November/December issue of the … Read more

Finally, some encouraging news about physician supply. Enrollment at medical schools increased by 3.1 percent this year and if that continues, total enrollment could go up by 30 percent by 2016, according to a study by the Association of American Medical Colleges. Eleven medical schools included in the survey admitted their inaugural classes between 2007 … Read more

For individuals, which suggests finding ways to induce expansion of These For providers not contracting with Medicare Advantage, it is the right time for you to bite the bullet and figure out a fruitful enterprise model or think of starting their very own plan. For investors, that can be a macro fashion also therefore, a … Read more

Type Title Author Story How Doctors Are Paid Now, And Why It Has to Change webadmin Story Are We on the Way to a Real ‘Learning Health Care System’? webadmin Story Herzlinger Predicts ACOs, PCMHs Will Fail webadmin Story What the Primary Care Physician Shortage Means for Health Plans webadmin Story Disruptive Innovations That Will … Read more

“The high cost of prescription drugs is a crisis,” says Maine Senate Majority Leader Chellie Pingree. “Working people tell us they make a difficult choice between filling their prescription or buying food or heating oil — or, in many cases, going broke.” Pingree is the primary sponsor of Maine’s Act to Establish Fairer Prescription Drug … Read more

Michael Levin-Epstein Washington Watch HMOs may delay compliance with HIPAA electronic transactions and code reporting requirements for one year under legislation passed by Congress late last year. However, the new law doesn’t affect information privacy requirements slated to take effect in 2003. If health plans want to forge ahead with compliance, federal regulators aren’t going … Read more

Cancer rates have been declining over the last ten years, but the number of cancer survivors is expected to soar by about 30% over the next decade, according to a study by the American Cancer Society (http://tinyurl.com/cancer-2024). There were 14.5 million cancer survivors as of Jan. 1, 2014; there will be 18.9 million by 2024. … Read more

House calls for the frail and chronically ill are making a comeback. But CMS and private payers are still figuring out how to make the economics work.   Eyes on the prize. Bill Hanigan, a wheelchair-bound retired school teacher, talks about his health problems with geriatrician Deborah Kylander, MD. “Geriatrics is not glamorous,” says Kylander. … Read more

With access only to claims data, health plans strive to promote the importance of screening to their providers Tony Berberabe Associate Editor Depression affects 13 million to 14 million adults in the United States and often occurs with other mental health problems such as bipolar disorder, anxiety, and post-traumatic stress, as well as physical illnesses. … Read more

With a third oral therapy for multiple sclerosis, clinicians now have more choices to manage the devastating symptoms of the disease In the past 10 years, no single disease has received as much attention in “Tomorrow’s Medicine” as multiple sclerosis. This group of patients, whose disease causes severe lifestyle disruption and eventual death, had no … Read more

Johnson & Johnson has suspended international trials of a medication in precisely the exact same class being an experimental medication made by Japanese pharmaceutical company Bial, whose evaluations in France left anyone braindead and others hospitalized. A He explained J&J will reevaluate its conclusion once it’s extra details. Officials At France have said 90 individuals … Read more

The FDA has declared Synjardy XR pills for the treatment of type two diabetes in older people. In conjunction with exercise and diet, Synjardy XR may increase blood glucose. Synjardy XR comprises equally equally empagliflozin along with metformin. Empagliflozin can be really actually just a sodium-glucose cotransporter two inhibitor that eliminates surplus sugar as a … Read more

Educating members about Medicare Part D saves patients a lot of anguish and payers a lot of money Londoners are very familiar with the expression “mind the gap,” a warning to subway passengers of the sometimes large gap between the train door and the station platform. On this side of the Atlantic, it could aptly … Read more

In the first half of 2010, five of the largest for-profit managed care companies — WellPoint, UnitedHealth, Aetna, Humana, and Cigna — reported high profits, according to a KPMG report. The net income of these companies collectively increased 20.2 percent in the first half of 2010 to $6.05 billion, compared with the same period in … Read more

SNAPSHOT With the rising costs of prescriptions and other issues relating to implementation of the new Medicare drug benefit, it is no wonder that policymakers are considering new approaches to addressing drug costs. And while prescription drug spending is a relatively small fraction of national health care spending, it is one of the fastest growing … Read more

What Can Be Done to Counteract Growing Power of Providers? Three health plans outline steps they are taking to deal with the effects of growing consolidation of providers A Conversation With Regina E. Herzlinger, PhD: A New Individual Market on the Horizon Health care reform sets the stage for employers to bow out of health … Read more

President and CEO of PRS Healthcare Consulting, Larkspur, Calif. Medical director, Vascular Medicine Center, Holston Medical Group, Kingsport, Tenn. Associate professor of medicine, University of Pennsylvania Health System, Philadelphia, Pa. President and founder, Med-ERA, New York, N.Y. Full text in PDF Introduction Although the prevalence of diabetes has steadily increased in this country for years, … Read more

New regulations for managed Medicaid promise to shake up an industry that, apparently, needs very much to be shaken up. The implications of last week’s Kaiser Family Foundation (KFF) report (http://files.kff.org/attachment/issue-brief-reading-the-stars-nursing-home-quality-star-ratings-nationally-and-by-state) on the state of nursing homes (hint: not so good) builds even more anticipation about CMS’ plan to unveil the regulations any day now. … Read more

Wellmark Blue Cross & Blue Shield finds that technology can enhance doctor buy-in with dramatic results Frank Diamond Insurers discovered long ago that tying physician performance to extra income is pretty effective for improving outcomes and controlling costs. One health plan in the Midwest finds that giving clinicians power can also go a long way … Read more

Extended-release formulation improves glycemic control The FDA has given the green light to Jentadueto XR (linagliptin and metformin hydrochloride extended-release tablets, Boehringer Ingelheim/Lilly) for the treatment of type-2 diabetes (T2D) in adults. The product combines 2.5 mg or 5.0 mg of linagliptin with 1,000 mg of metformin. Linagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, works by … Read more

With their high milk production and short generational time, these bovids are ideal bioreactors able to dramatically increase the protein yield Sanofi-Aventis CEO Chris Viehbacher told the Financial Times that his company had “missed the boat” when it comes to diversifying into biologics. He expressed his realization that biologic drugs have revolutionized the pharmaceutical industry. … Read more

A summary of ECRI Institute’s Emerging Technology Evidence Report Editor’s Note: Managed care leaders are striving to make evidence-based decisions about new and emerging health technology. Managed Care and ECRI Institute have collaborated to publish bimonthly summaries of the Institute’s Emerging Technology Evidence Reports. ECRI Institute is an independent not-for-profit organization that researches the best approaches … Read more

Recent discovery has made expect for a worldwide vaccine which may fight All breeds of flu. Currently, different vaccines for various breeds are counseled that will need to be upgraded yearly and this also proves to be nuisance for many people. The areas of the herpes virus which are shared around all of influenza strains … Read more

“Physicians don’t like prior authorization,” says Steven E. Wegner, JD, MD, chairman of the North Carolina Community Care Network, made up of 15 networks with more than 3,500 physicians and 1 million Medicaid and SCHIP enrollees. “They have to call the insurers, it’s time-consuming, and it’s frustrating trying to understand the criteria that a health … Read more

The push for health savings accounts (HSAs) continued as managed care plans and employers were given more guidance by the Treasury Department on just what those products may cover. New guidelines, issued March 30, say that the HSAs may be used to cover some preventive services and prescription drugs. Managed care organizations had been awaiting … Read more

ASHP urges changes to improve patient care and decrease costs The American Society of Health-System Pharmacists (ASHP) is calling on Congress to ban all direct-to-consumer (DTC) advertising of prescription drugs and medication-containing devices. The ASHP House of Delegates, convened at ASHP’s 2016 Summer Meetings and Exhibition this week in Baltimore, Maryland, approved a policy that … Read more

COVER STORY How Doctors Are Paid Now, And Why It Has to Chang Everyone knows about the perverse incentive of fee-for-service medicine, but that hasn’t had much effect on its use Every year, physician groups take doctors’ temperature on the issue of pay, and every year, they are feverish. Professional associations such as the Medical … Read more

A Conversation With F. Randy Vogenberg, PhD, RPh: Changing Market for Pharmacy Benefits Tight budgets and an increasing influx of expensive biologic drugs make it imperative to rethink risk management John Marcille At a time when health care reform is uncertain and hard-to-categorize biological drugs are becoming a greater share of overall costs, health plan … Read more

ZW25 binds simultaneously to two different targets   August 19, 2016 The FDA has accepted an investigational new drug application for ZW25 (Zymeworks Inc.), a bi-specific antibody, for the treatment of certain human epidermal growth factor receptor 2 (HER2)-expressing cancers. The phase 1 clinical trial is anticipated to begin later this month. ZW25 is an … Read more

It is an idea whose time has finally come: Today’s clinical pharmacists are involved in virtually all aspects of medical care In the late 1980s and early 1990s it was called pharmaceutical care services or cognitive pharmaceutical care, and it was practiced by only a handful of pharmacists. The first organized effort was in Asheville, … Read more

A recent study in Health Affairs compared individual plans to employer-sponsored plans in terms of scope of benefits, cost-sharing provisions, premiums, expected out-of-pocket costs, and actuarial value. But while premiums in an individual plan may be attractive for those who are young and healthy, with some plans offering guaranteed renewal without risk-rating, most Americans find … Read more

Blue Health Intelligence ran an investigation of a business medical policy asserts database and adverse events which was made to paint a fuller, more realworld picture of adverse events. The database comprised patients, ages 18-64, confessed to a healthcare facility at 2016 and 2017. Throughout September 2006 on June 2012, adults using ≥1 HIV International … Read more

Device treats arthritis of the big toe joint Cartiva, Inc., has received premarket approval from the FDA for its Cartiva Synthetic Cartilage Implant (SCI) for arthritis of the big toe joint. The approval allows the company to begin U.S. marketing of the first synthetic cartilage device cleared by the FDA. Cartiva SCI is intended for … Read more

Travis Singleton: Basically, it’s reverse osmosis in 60 days. And that I really don’t believe that is an understatement to state. And 45 percent of these were becoming over 100 solicitations every year. To me, it was just like that they were the main draft select weekly before the draft. This really has been the … Read more

Knocking down walls: Cigna ends preauthorization for opioid addiction treatment You’ve all seen the headlines and statistics: “Drug overdose deaths have now surpassed fatal car accidents, with more than 47,00 lethal overdoses in 2014.” “In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of … Read more

color charts The West Coast may be the cradle of managed care, but today managed care is catching on fastest in New England and across the amber waves of grain. Managed care market penetration was up 54 and 52 percent respectively in the upper Northeast and North Central states from 1996 to 1997, according to … Read more

Pharmacy benefit managers will charge employers a straight administrative fee, rather than make much of their income through deals with the drug industry Martin Sipkoff It may have been a shotgun wedding, but the Big Three pharmacy benefit management companies have tied the knot with an unlikely partner, the HR Policy Association’s Pharmaceutical Purchasing Coalition. … Read more

Along with traditional systemic therapies, the American Academy of Dermatology recommends four biologic agents as first-line treatment for psoriasis patients who are candidates for systemic therapy. Thomas Morrow, MD Vice President and Medical Director, Matria Healthcare, Atlanta Full text of this article is available in PDF. Psoriasis is one of the most common skin disorders, … Read more

Harried Doctors Try to Ease Big Delays and Rushed Visits The transformation of the Anchorage clinic is part of a new movement in the practice of medicine that is trying to improve the age-old and often disheartening experience of a visit to the doctor’s office. It is aimed at placating patients who are fed up … Read more

The trickle-down approach to coverage—worry about employers and consumer satisfaction takes care of itself—doesn’t work in the new health care environment. CXOs gain traction. Poor customer service is out. We’ve known that for many years. Now in health care, even mediocre customer service is out. CMS said so last year when it eliminated financial bonuses … Read more

Solutions were to 1999 as new paradigms were to 1995. That year, new paradigms, it seems, were growing on trees, they were that common. Now, solutions are even more in evidence. You can’t walk down the sidewalk without stepping in one. For instance, the following are all from news releases and other marketing and public … Read more

Florida will soon test a program that could provide competition for HMOs serving the Medicaid population. Other states are watching. Chart: Florida, physicians, and hospitals could do well under the PSN model Florida is to become a proving ground for direct contracting come Oct. 1, when Medicaid recipients in Dade and Broward counties will be … Read more

NCQA President Margaret O’Kane and a panel of clinically oriented administrators call for emphasis on making the best care financially attractive to physicians, plans, and employers. People die and health care costs soar because too many plans and providers fail to meet and report compliance with established standards of care. But many health plans and … Read more

Chronic nonmalignant pain demands treatment and evaluation different from severe pain. The pathophysiology differs, and there’s often a level of ed disorder. Since they’re self-reinforcing, opioids might be hunted and also be reported to boost chronic pain, even if they can make the condition worse during the time. There are lots of effective alternatives to … Read more

For cosmetic reasons, this type of hearing system is desirable, but how much does it cost and who are the best candidates? Thomas Morrow, MD According to the National Institutes of Health, about 15 percent of all adults in the United States suffer from some level of hearing loss. The prevalence increases dramatically with age, … Read more

President Clinton’s impeachment trial has diverted attention from health care reform, which has been quietly thrust into high gear. Regarding Medicare, the administration proposed two ideas: cutting paymentsto hospitals and channeling 15 percent of budget surpluses to the Medicare trust fund. Some of the newfound money would cover prescription drugs. The Health Insurance Association of … Read more

You might call the Austin Regional Clinic in Austin, Texas, an anomaly, an exception to the conventional wisdom about managed care. The clinic, most of whose patients are covered by managed care plans, has seen its medical malpractice insurance rates decline conspicuously in the last few years. Many health care experts have a contrary expectation: … Read more

Features COVER STORY Onerous Regulations Put ACOs on Ropes Health insurers can be doing more to come up with creative ways to pay providers and organize care DIGITAL | HTML Payers Step in With ‘Real-World’ Comparative Effectiveness Research With access to large patient populations, health plans are in a position to mine a fresh set of data, … Read more

During 2000, favorable incentive policies helped employees of integrated health plans to enjoy larger percentage increases in base pay and total cash compensation than employees of integrated health care providers, such as physician-management companies and fully integrated care-delivery systems. A nationwide survey of 850 health care networks (IHNs) conducted by William M. Mercer Inc. also … Read more

Open vs. Minimally Invasive Hysterectomy: Commercially Insured Costs and Readmissions   Abstract Purpose: To analyze commercial payer differences in the average costs and readmission rates between inpatient open hysterectomies and three types of outpatient hysterectomies: laparoscopic, laparoscopic assisted, and vaginal. Design/Methodology: A retrospective claims data analysis was conducted using the 2012 and 2013 Truven Health Analytics MarketScan … Read more

More than six dozen HMOs have characteristics that put them in danger of going out of business, according to projections by InterStudy publications. InterStudy looked at specific operational aspects of HMOs that shut down in 1999 and determined that 75 now operating fit the same mold. These characteristics of plans that ceased operations are significantly … Read more

It’s hard to open any health-related publication these days and not find stories about accountable care organizations (ACOs). Commentary ranges from extolling ACOs as our last, best hope for achieving high-value care in the U.S., to others criticizing ACOs as a thinly disguised return to the 1990s model of managed care and HMOs. While it’s … Read more

A CONVERSATION WITH WILLIAM F. JESSEE, M.D. The president of the Medical Group Management Association encourages changes that would bring physician practice and medical record-keeping in step with the times, and decries the lack of medical standards across plans. William F. Jessee, M.D., brings a wide range of experience to his job as president of … Read more

Health plans are expanding MTM — once considered a Part D mainstay — to their commercial businesses. Thomas Reinke MANAGED CARE October 2011. ©MediMedia USA Health plans are expanding MTM — once considered a Part D mainstay — to their commercial businesses. Thomas Reinke Results from an ongoing North Carolina medication therapy management program show just how … Read more

After more than four months of wrangling with the issue in a working group, the House GOP leadership released an outline of its package of insurance reforms and consumer protections. And it wasn’t long before the proposal, developed under the guidance of Illinois Rep. Dennis Hastert, was attacked from many sides. Democrats and consumer groups … Read more

Some state officials have real doubts that health plans offer any viable solution to the problem of providing care while budget deficits grow. John Carroll Contributing Editor Late last year, 35,000 Oklahomans on Medicaid were told that they had to get by with a slightly reduced level of health care. Six percent less, to be … Read more

CPOE systems, according to data from the Leapfrog Group, do an inconsistent job of shielding patients from serious errors Thomas Reinke Medication safety and computerized physician order entry for hospital medications are the top priorities in the meaningful-use incentive payments that begin in 2011. These two items are listed as the first and second objectives … Read more

Newer cancer drugs which enlist your body’s immunity system are improving the probability of survival, however rivalry between them just isn’t reining at prices which could currently top $250,000 annually. A’s pipeline of cancer medication enlarged by 63 per cent between 2005 and 2015, as stated by the QuintilesIMS Institute, and also a fantastic portion … Read more

Two to one, Washington State voters rejected Initiative 673, the so-called patient-choice measure that would have allowed people to keep their doctors after joining an HMO, changing jobs or switching health plans. The measure also would have forced insurance companies to disclose how much of each premium dollar is spent on actual health care delivery. … Read more

All-products provisions in health plan provider contracts are slowly being negotiated, legislated, and regulated out of existence. They are now illegal in at least four states; legislation is pending in several others. Non-negotiable all-products requirements leave physicians with an all-or-nothing choice: Either agree to be on the provider panels for all current and future products … Read more

The static approach overseen by United States Pharmacopoeia shortchanges beneficiaries and benefit plans Claudia Schlosberg, JD Richard Stefanacci, DO As patients and their physicians go about the annual process of evaluating Medicare prescription drug plans, and as Medicare plan sponsors begin to develop formularies for plan year 2012, (and the Centers for Medicare & Medicaid … Read more

Fueled by slowdowns in both private- and public-sector spending, health care expenditures in the U.S. rose 4.8 percent in 1997 — the lowest rate of increase since the government began keeping statistics in 1960. (See charts) But the Health Care Financing Administration, which released the tallies last month, warned that higher medical inflation was likely … Read more

California seems to be the place where health plans have decided to crack down on hospital costs by spurring better outcomes. Blue Cross of California, for example, says it is relying on evidence-based reports on volume and quality of outcomes for coronary artery bypass grafts (CABG) in launching its Centers of Expertise program. The idea … Read more

The medication is approved for use with a company diagnostic, the real-time IDH2 Assay, that will be utilized to detect certain mutations from the IDH2 gene in patients with AML. “Idhifa is a targeted treatment that satisfies an unmet requirement for patients With relapsed or refractory AML who’ve an IDH2 mutation,” said Richard Pazdur, M.D., … Read more

The UC-Berkeley health care economist says the cost-control and performance-improvement methods we’ve been developing for years can work, but implementing them on a wide scale may come as a last resort James C. Robinson, PhD, MPH, teaches classes and does a wide range of research in health economics, health care technology policy, and public health. … Read more

With more than 360 biotech products in the pipeline, high-cost injectable drugs are about to flood the market. How will we control the expenditure? The pharmacogenomic explosion is about to go off, and the health care industry is bracing for the skyrocketing costs associated with these specialty drugs — 99 percent of which are administered … Read more

The technology’s been around, but early participants often were burned. New Internet-based products threaten to turn nonbelievers into yesterday’s news. BY JOHN CARROLL CONTRIBUTING EDITOR When Dan Griffin, M.D., finished his medical training two years ago, he began a new course in another type of science: computer technology. For more than two months, working 40 … Read more

Costs are rising as physicians order more of all kinds of tests, from low-cost routine tests to high-cost genetic assays When a friend’s child had a rare neurological disorder recently, Michael J. Misialek, MD, a pathologist at Newton-Wellesley Hospital in Massachusetts, was asked about the diagnostic value of a lab test. The cost of this … Read more

When fluids flow through plumbing, energy declines necessarily happen. On the 1 hand, that is a result of friction which develops between the pipe and the fluid. On the flip side, side effects also occur over the fluid on account of this viscosity of their fluid. The faster the more fluid escapes, the more the … Read more

An estimated 12 million Americans are infected each year by a sexually transmitted disease that, if left undiagnosed and untreated, can lead to infertility, mental and physical debilitation and death. Curing the most common of these diseases has become clinically easier, a message officials at the Centers for Disease Control and Prevention want to deliver … Read more

When financial incentives were withheld from 35 outpatient facilities owned and operated by Kaiser Permanente, physicians were less likely to screen for four quality indicators. In particular, the screening rate for cervical cancer dropped even lower than before the incentives were instituted, according to a study in the British Medical Journal. The indicators were screenings … Read more

UM for outpatient discretionary echocardiography appeared to reduce testing rates significantly ABSTRACT Purpose: This study evaluated the impact of an outpatient echocardiography utilization management (UM) program relative to a matched control (non-UM) group by measuring changes in utilization rates overall and within specific cardiac-risk subgroups. Methodology: Administrative claims data for enrollees from five states were queried from … Read more

COVER STORY Tax Reform Could Remake Insurance Senate Majority Leader William Frist hears the rumblings. Conservatives and liberals alike think that it might be time to end the tax exclusion for job-sponsored health benefits. CDHC Will Change Your Job As consumer-directed health plans become more popular, physician executives will need to hone marketing and other … Read more

Throw-out opium, that the Creator himself seems to scribe, for we frequently find the vivid red poppy growing at the corn fields, as though it were predicted that anything there’s to be fed up there should be pain to become soothed; dispose off a couple particulars our physician’s art failed to detect; throw-out wine, and … Read more

MANAGED CARE February 2008. ©MediMedia USA Insurers have maintained strong earnings in recent years — much to the delight of stockholders — because of relatively stable expenses, improved case management, and new technology. However, a report by A.M. Best Company, a global credit rating organization, suggests that insurers will need to navigate a challenging financial landscape in … Read more

The bone system, but frequently moves in to the bloodstream. CML makes up about 10-15percent of incident leukemia cases. From the U.S., approximately 48,000 people you live with CML. Approximately 9,000 brand new CML cases were diagnosed from the U.S. at 20 17. Recognition of this crucial role of this BCR ABL protein in CML … Read more

Comparing the 19 states with the lowest HMO penetration with the 19 states carried last month by Republican Presidential nominee Bob Dole reveals a startling similarity. With only four exceptions, they’re the same states. The resemblance would be even greater if HMO enrollment in pro-Clinton Louisiana (11.0 percent penetration) were to nose ahead of that … Read more

By John La Puma, M.D. The language of medicine is an art. Careful and elusive, Aristotelian and poetic, it takes years to learn, lasts forever, and is known only to the privileged. It is hard to mimic without giving away one’s pretension, and it is hard to shed without giving away the farm. Ordinary words … Read more

As per a research from Dr. MacLean and also the American College of Physicians, 3-5 per cent of their excellent measures were more tolerable. “We think the resources needed to display substantial Inhabitants for maltreatment also to track followup are directed in care procedures whose connection into improved health is encouraged with stronger evidence,” Dr. … Read more

President Trump is expected to issue an executive order today that will make sweeping changes to the country’s system of health insurance coverage and begin the unwinding of the ACA. The action is a result of the inability of GOP members of Congress to begin dismantling Obamacare. Trump has been vocal about his displeasure at … Read more

Department of Healthcare Management, Carlson School of Management, University of Minnesota Also available in PDF Structure of this Article Do Insurance Constraints Benefit Consumers? This section provides the conceptual background for the historical shift of employer-based health insurance to managed care. It is vital for understanding the present transition to defined contribution benefits and individual health … Read more

Blue Shield of California members are changing utilization patterns as a result of hospital tiering, say company officials. The company is making further changes in its Network Choice program. David Joyner, Blue Shield’s senior vice president for network management, tells the Contra Costa Times that “there’s some evidence that people are starting to think about … Read more

A new report from business intelligence provider GBI Research states that the Alzheimer’s disease market will more than double from just under $5 billion in 2014 to an estimated $10.4 billion in 2021, at a compound annual growth rate of 11%. This impressive market growth will occur across the eight major markets (U.S., Canada, the … Read more

“Look before you leap” might be the saddest phrase one can hear in free-fall, but it seems to be the advice given by the Agency for Healthcare Research and Quality regarding the patient-centered medical home. “Primary care clinicians, health care systems, insurers, state governments, families, and communities” see PCMHs as a solution to many of … Read more

Although plans are not restructuring fee schedules in consumer-directed health plans, providers think their agreements need fine-tuning. When Blue Cross and Blue Shield of Florida introduced a consumer-directed health plan last summer by expanding its PPO product to include a health reimbursement account and higher deductibles, the insurer, like most health plans instituting CDHPs today, … Read more

Episode-based,”bundled” obligations attended to the forefront of this national conversation on fighting climbing healthcare expenses. From the dominant, feeforservice version for hospitals, reimbursement, physicians, along with post-acute care providers document different states and so are paid separately for provided services when they have been linked to one bout of maintenance. By comparison, bundled obligations want … Read more

Many who claim to be constructing such entities are really creating ‘clinically integrated organizations’ Organizations that are not aligned with the definition of an ACO can be more accurately described as clinically integrated organizations (CIOs). The major difference between the two is that true ACOs, by definition, are Medicare fee-for-service (FFS) entities only. HMOs compared … Read more

Whatsoever the 109th Congress soweth, so shall the 110th Congress reap. Just before adjourning last month, the outgoing Congress passed legislation that would set up a pay-for-performance program in Medicare. The reviews, by critics who can wield votes as well as opinions, have been mixed, and there is already doubt about the law surviving in … Read more

Employers continue to be true believers in wellness programs, according to a Kaiser Family Foundation study (http://tinyurl.com/wellness-stuff), despite skepticism heard in some quarters. The most vociferous critic these days is Al Lewis, the founder of the Disease Management Purchasing Consortium. As Managed Care reported earlier (http://tinyurl.com/Lewis-take), Lewis doubts that wellness programs do much good and … Read more

A ‘health insurance czar’ might not make the final bill, if there is one, but the proposal evokes centuries-old tension Frank Diamond Managing Editor We’re gambling. The “health choices commissioner,” a k a the health insurance czar, might not be an issue when you read this. The legislative process that promises to bring us health … Read more

David M. Lawrence, MD, MPH, guided the country’s largest not-for-profit health plan through the tumultuous managed care decade. Frank Diamond Senior Editor When David M. Lawrence, MD, MPH, departing CEO of Kaiser Permanente, says that his immediate plan upon retirement is to write a book, one wonders whether he is following the example of Winston … Read more

In a familiar cartoon, a professor writes long, learned equations on a blackboard. To connect the profundities on either end, he writes in the middle, “Then a miracle occurs.” IPAs, done well, are the miracles that connect the ends of health care. Karen L. Trespacz, J.D. Contributing Editor When you look at a brick wall, … Read more

A quality incentive program in California is yielding results that could be replicated in Medicare and other pay-for-performance (P4P) programs nationwide, according to “Advancing Quality Through Collaboration: The California Pay-for-Performance Program.” The report was issued by the program’s sponsor, the Integrated Healthcare Association (IHA), a collaboration of California health plans, physician groups, and hospital systems. … Read more

There’s still no “magic pill,” but new medications abound. With the disease uncontrolled in millions, it’s time to get utilization management just right. A report from the Pharmaceutical Research and Manufacturers Association (PhRMA) says there are 180 new medications in the pipeline for type 1 and type 2 diabetes. That number reflects the boundless therapeutic … Read more

Under the Health Care Financing Administration’s Medicare+ Choice Regulations (called “Megaregs” by some wags inside the Beltway), seven different types of managed care arrangements are eligible for risk contracting, including preferred-provider organizations, medical savings accounts and provider-sponsored organizations. Thus, physicians and other providers, such as hospitals and home-health care agencies, can form PSO networks and … Read more

QUALITY ASSURANCE A clearinghouse was created that stores details about malpractice suits and disciplinary actions. So how come HMOs don’t use it? John Carroll Contributing Editor It all seemed simple 15 years ago. A young congressman from Oregon, Ron Wyden, came up with a plan to track bad doctors. Wyden was troubled by reports that … Read more

Until GE found a better way to produce and deliver I123, most nuclear medicine labs had to make do with an isotype that produced an inferior image This edition of Tomorrow’s Medicine highlights neuroblastomas and pheochromocytomas — two different tumors that affect widely differing age groups but share several characteristics. Neuroblastoma Most people do not … Read more

At a glance Healtheon Corp., BeneSphere Administrators, Benefits & Risk Management Services Goal: To reduce benefit administration costs by reducing paper work Strategy: To market Internet-based benefits administration systems to managed care plans, insurers and employers; replace paper forms with electronic transactions For more information: www.healtheon.com www.benesphere.com www.best-online.com Thanks to the range of health benefit options they … Read more

The Anthem-WellPoint merger is a done deal, thanks to buyer Anthem’s generous offerings to two states whose approvals were needed to create the largest health insurer in the country. The merged entity, to be called WellPoint and have headquarters in Indiana, will have 28 million members in 13 states. Anthem chairman Larry Glasscock will serve … Read more

When an employer group shifts from one health plan to another, why not allow them to take their claims data to the next health plan? That way, the new plan would gain immediate knowledge of the specific disease burden faced by its new members and be able to act accordingly vis-à-vis care management programs and … Read more

Medco’s ‘gaps in care’ approach saves $900 million by targeting 15 chronic conditions Carol Milano Its costs exceed $177 billion annually. It results in 125,000 deaths, nationwide. Nonadherence to medication is so prevalent that about half of the 3.2 billion prescriptions issued in the United States are not taken as directed. To encourage compliance, Medco … Read more

Spending on statins increased 156 percent between 2000 and 2005, according to “Trends in Statins Utilization and Expenditures for the U.S. Civilian Noninstitutionalized Population, 2000 and 2005,” issued by the Agency for Healthcare Research and Quality. In 2000, outpatient prescription expenditures for statins amounted to $7.7 billion. That rose to $19.7 billion in 2005. Statins … Read more

Although almost all businesses were touched by the slowdown, some weathered the recession better than others. In particular, large health insurers flush with cash had been buying up regional provider-owned plans — but that buying spree is slowing down, says A.M. Best, the credit rating company. The company says that in the wake of health … Read more

Though there are challenges to serving the elderly, movers and shakers say that they should be able to cut costs in pilot populations by 5 percent. John Carroll Medicare has been working hard to become disease management’s new champion. And its newly rolled-out DM pilot program for fee-for-service beneficiaries offers much to win — and … Read more

John S. “Jack” Linehan of Epstein Becker Green on Copay Accumulators   4 Ways Hospitals Can Use Their Pharmacies To Cut Costs, Improve Care   State legislatures spring ahead with restrictions on drug copay accumulators   PBMs Need To Be Disrupted, Not Disintermediated What ICER Pricing Would Mean for U.S. Drug Spend Health Advocates Can Learn … Read more

Pembrolizumab has been accepted to be used in combination with platinum and gold Fluorouracil for many patients and as one agent for patients whose tumors state PD‑L1 according to an FDA‑approved evaluation. The FDA also expanded the planned usage for the PDL1 IHC 22C3 pharmDx kit to utilize usage for a companion diagnostic apparatus to … Read more

The Bush administration needs to “immediately” start using states as laboratories to come up with solutions to save a health system in crises, according to a report by the National Academy of Sciences. The report, issued by a panel of experts appointed by the academy’s Institute of Medicine, urges that such solutions as universal health … Read more

With payers no longer the lone voice for real-world outcomes, who interprets value and how it is interpreted changes Value is in the eye of the beholder, they say. One man’s definition of value is just one man’s definition. Whatever you bring to the table will be judged by someone else’s idea of its worth. … Read more

New Hepatitis C Regimen Stimulates Changes in Therapy Management Costly protease inhibitors work well in many patients, but call for careful monitoring Thomas Reinke NEWS & COMMENTARY Out-of-Pocket Costs Hamper Utilization A Conversation With Lee N. Newcomer, MD, MHA: Payments With Purpose UnitedHealthcare’s VP for oncology says it will take time to come to grips … Read more

Dire Forecasts by Republicans and Insurers Who the 2010 health law Would cause personal Medicare health plans to improve prices and lower benefits on beneficiaries are proven to be false alert — for today. The Obama government on Thursday said that the almost 12 million Additionally, they said, premiums dropped by a mean of seven … Read more

The job market looks rosy for pharmacists: The U.S. Department of Labor expects employment of pharmacists to increase much faster than the national average of all occupations through 2016. Specifically, employment of pharmacists is expected to grow by 22 percent between 2006 and 2016. The increasing number of middle-aged and elderly people, who use more … Read more

Pharmacy benefit managers will charge employers a straight administrative fee, rather than make much of their income through deals with the drug industry Martin Sipkoff It may have been a shotgun wedding, but the Big Three pharmacy benefit management companies have tied the knot with an unlikely partner, the HR Policy Association’s Pharmaceutical Purchasing Coalition. … Read more

Policies that create environments that support healthier eating, lower sodium consumption, and increased physical activity offer greater promise of reducing hypertension than does merely educating people about the dangers of high blood pressure, according to the Institute of Medicine’s “A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension.” And who could argue, … Read more

This spring, readers of the policy journal Health Affairs [March-April 1997, 16:2:121 – 124] heard from a top for-profit HMO executive about the challenge of trying to deliver quality health care and be a good corporate citizen while also satisfying shareholders. The executive described the “grow or go” imperative that faces publicly traded, for-profit companies … Read more

Health insurance plans’ net income plummeted 36 percent in 2008, according to a recent report by Mark Farrah Associates, a consulting company. The company cites — what else? — the recession and market turmoil. While overall revenues increased 6.2 percent, from $270 billion in 2007 to $287 billion in 2008, profit margins fell from 6.2 … Read more

The AMA is evaluating how and whether to proceed with its physician accreditation program, which has been unable to gain attention from health plans and hospitals. Credentials verification and site reviews will be completed for physicians who have applied for AMAP certification, but no new applications are being accepted for now. The goal was for … Read more

Washington Initiatives In late January, President Clinton proposed Medicare spending reductions over the next six years totaling $138 billion, a figure he characterized as “a halfway point” between his own final target last year of $116 billion and the $158 billion the GOP put on the table last year after at first insisting on $270 … Read more

Oncologists may no longer mark up the cost of specialty drugs. If the plan works, you can bet that other insurers will adopt something similar. By the end of this year, UnitedHealthcare will be reviewing data from five oncology groups to determine whether a pilot payment program for cancer care should be expanded. Lee Newcomer, … Read more

They’ve been burned here in the past, but physicians – and the HMOs that they contract with – may have learned some lessons. By JOHN CARROLL Contributing Editor When David Calabrese took over two years ago as director of managed care pharmacy for Provider Service Network, a Boston management services organization, he was stepping into … Read more

The Oncology Care Model can be really a charge version by the Centers for Medicare and Medicaid Services built to reduce costs and enhance quality in healthcare. Key elements of caliber for the OCM arise from the 13-component cancer maintenance program. We analyzed the literature to comprehend the worth of prediction at OCM-directed preparation non-small-cell … Read more

Step-therapy, the requirement Which more cost effective/inexpensive Medication and remedies have to be prescribed for someone before an even expensive/less costeffective medication or therapy is going to be reimbursed, and has come to be a frequent condition by insurers during the past couple of decades. Today, patients and other stakeholders have been wondering why whether … Read more

Candida auris worries CDC A potentially lethal fungus known as Candida auris has been identified in at least 61 people in the United States––mostly in New York (39 cases), New Jersey (15 cases), and Illinois (four cases)––as of April 13, 2017, according to statistics from the Centers for Disease Control and Prevention (CDC). In an interview with STAT, Dr. … Read more

Integral portion of a 21stcentury doctor’s job description. The Hospitalist queried over the usual couple of coding and charging pros about the information they’d distribute to clinicians navigating the settlement maze. Meanwhile, hospitalists Need to be cautious they are not excessive In their charging methods. “The name of this video game isn’t simply to charge … Read more

Doctors have a saying: ‘Half of what we know is wrong.’ In which half is the conventional wisdom that competition is society’s best hope for improving quality and controlling costs? Doctors have a saying: ‘Half of what we know is wrong.’ In which half is the conventional wisdom that competition is society’s best hope for … Read more

California Gov. Pete Wilson and legislative leaders of both political parties have defined what they want in managed care reform legislation. All agree on the need to expand enrollees’ rights to appeal coverage denials. Rather than endorse specific pending bills or proposals of a managed care reform task force that completed its work earlier this … Read more

Insurers want to obey laws, but those laws are hard to understand and it is tempting to simply define coverage equality downward New rules governing treatment of patients with mental health and substance abuse disorders raise more questions than they answer. In November, three federal departments, including Health and Human Services, issued rules under the … Read more

Type Title Author Story Wish List: 10 Things You Want From Your PBM webadmin Story From Theory to Practice: Identifying Authentic Opinion Leaders to Improve Care webadmin Story Can Value-Based Design in Pharmacy Save Money and Cut Heart Attacks? webadmin Story Can Arthroplasty’s Costs Be Contained? webadmin Story Retail Clinics Expand In Numbers, Services webadmin … Read more

Senators John Even the legislators had spent writing a detailed bill which promised to alter the country’s method of energy and climate change, and these certainly were likely for a press conference at seven days to unveil their own job. Kerry, Of Massachusetts,” Graham, of South Carolina, along with Lieberman, of Connecticut, had been known … Read more

Senseonics was awarded FDA approval for its Eversense Continuous This could be actually the very first FDA-approved CGM strategy to incorporate an entirely conductive sensor to find sugar, which is exploited for approximately 90 days. “The FDA is dedicated to progressing publication products “These technologies make it possible for patients to obtain much better control … Read more

Mergers and acquisitions have allowed hospitals to call the shots in negotiations with health plans the last several years. Now, there’s indication that the party may soon be over, thanks to the intervention of employers. The California Public Employees’ Retirement System has managed to keep HMO premium increases in line with what’s going on nationally … Read more

MANAGED CARE September 2011. ©MediMedia USA The Brain Attack Coalition (BAC), a group of medical and scientific organizations, both not-for-profit and governmental, that are leaders in the field of stroke, has recommended using magnetic resonance imaging (MRI) of the brain in lieu of computer tomography (CT) if it can be performed within 25 minutes of being ordered, … Read more

Despite a rise in the use of quality incentives to determine physician compensation, productivity remains the predominant determinant. “Despite the recent interest in pay for performance, quality-based physician compensation has been around for a long time,” says James Reschovsky, PhD, coauthor of “Physician Financial Incentives: Use of Quality Incentives Inches Up,” a report issued by … Read more

Program helps uninsured patients Parkland Hospital, an 800-bed safety-net facility serving Dallas County, Texas, is teaching uninsured patients how to self-administer intravenous (IV) antibiotics for outpatient parenteral antimicrobial therapy (OPAT), and the innovative approach appears to be paying off. The program lowered 30-day readmission rates by 47% over a four-year period, according to a study … Read more

The PBM industry stands at the intersection of two recent blockbuster announcements. Mergers, acquisitions, and other activities have resulted in a growing number of health plans owning a PBM capability similar to Anthem’s in-house PBM IngenioRx. And the Trump administration proposed a rule to eliminate rebates from pharmaceutical companies to PBMs. While every stakeholder in … Read more

Humor depends on truth, and a funny sequence in a currently running situation comedy involves a television executive making a cameo appearance on one of his shows. Suddenly, reflexive actions become an amateur actor’s overdone gestures. When he “walks” into the scene, he resembles the just oiled Tin Man in The Wizard of Oz. Incentives, … Read more

Good morning, cyberdocs: If you’re in Illinois and you contract with First Health Group PPO, you might want to spend a little more time answering patients’ E-mails. There’s gold in that keyboard.First Health Group says it will soon begin to pay physicians $25 for each clinical E-mail conversation with a patient, when it’s done over … Read more

Descend in to Toronto for its Alzheimer’s Association International Conference this season, will be coming with a continuing series of expectation –regardless of the ton of latestage failures to its disorder on the last ten years. In Reality, the failure rate on this interval was a shocking 99 percent At a disorder which affects around … Read more

Progression-free success is how long that the folks dwelt without The cancer growing. Entire survival is the way long that the people dwelt whether the cancer climbed. IMpassion130 analysis was no more than a calendar year. The FDA endorsement of Tecentriq for breastcancer can be a accelerated approval based on progression-free success effects. Continued endorsement … Read more

Isomeric Pharmacy Solutions failed repeated FDA inspections The FDA has obtained a court order shutting down a Utah drug-compounding facility that it accused of making and distributing adulterated, unapproved, or misbranded products. U.S. District Judge Robert J. Shelby has entered a consent decree of permanent injunction between the United States and Isomeric Pharmacy Solutions of … Read more

Year:  2011  |  2010  |  2009  |  2008  |  2007  |  2006  |  2005  |  2004  |  2003  |  2002  | 2006 January Cover Story What Doctors Don’t Know About the New Plan Designs Can We Design a Fair Benefit For Bariatric Surgery? Case Management Meets Home Care Old Techniques Never Die, Nor Even Fade Away Q&A A Conversation with James Robinson, PhD Full contents … Read more

Survey respondents were requested to supply their reimbursement for patient attention. For utilized doctors, which includes wages, bonus, and profitsharing gifts. For spouses, it features earnings after taxation and allowable business expenses before taxes. Simply fulltime wages have already been already reported. Family physicians are one of the smallest earners of most physician specialties. Still, … Read more

Intermountain Healthcare’s checklist for providers cut mortality rates for this fast-moving, and sometimes lethal, condition Intermountain Healthcare’s checklist for providers cut mortality rates for this fast-moving, and sometimes lethal, condition In November 2001, when the New England Journal of Medicine published a study about how to better treat severe sepsis, clinician executives at Intermountain Healthcare … Read more

Features COVER STORY What Can Be Done to Counteract Growing Power of Providers? Three health plans outline steps they are taking to deal with the effects of growing consolidation of providers DIGITAL | HTML Q&A A Conversation With Regina E. Herzlinger, PhD: A New Individual Market on the Horizon Health care reform sets the stage for employers … Read more

Three new surveys suggest that employers are bracing for hefty hikes in the cost of health care in 1999, as the era of low- or no-rate increases grinds to a halt. Managed care plans can expect the push for greater choice to continue, even as buyers increasingly complain about rising premiums. The three surveys — … Read more

Washington Watch Whatever diversion prescription drug proposals have provided, Medicare+Choice is back on Congress’s radar screen. But while sentiment is again running strong among legislators to address the wounded program, Congress is now racing a clock that is ticking ever closer to the elections. A recent GAO investigation found that in 1998, Medicare spent about … Read more

Approximately 310,000 supposed measles cases have already been reported as the beginning of 20-19, the WHO says. The Congolese government and the WHO established an emergency vaccination programme September. Over 18 million children under five were vaccinated throughout the country at 20-19 , ” the WHO says. However, Bad infrastructure, strikes on health centers and … Read more

Can commercial health plans learn from Medicare Advantage Prescription Drug Plans that have four or more formulary levels? A three-tier formulary has become a standard in commercial drug plans in recent years. But the new Medicare Part D market has resulted in a vast — critics say bewildering — array of benefit and tiering options. … Read more

The new regulation may even upgrade doctor payment at the Medicare program as a portion of the executive order President Trump issued in October. 1 brand new payment code, called Principle Care Management, is a portion of the new rules and can make incentives for physicians to concentrate on improving care of chronic ailments. It … Read more

With Anxieties of Having an avian Flu pandemic Managing Uncontrolled, It’s Honest to ponder how such a conference could impact the fiscal well being of insurance from the States. Effectively, go up on of time and ponder, however, do not expect purposeful replies only yet. That is due to the enormous doubt around the essence … Read more

Employers and health insurers are asking consumers to put ‘more skin in the game’ with high-deductible health plans but don’t provide incentives for them to choose high-value care. Since 2005, when only a million Americans were enrolled in high-deductible health plans (HDHPs) with a health savings account (HSA), the number of Americans enrolling in these … Read more

Well-Being and the Next Industrial Revolution There was a moment at the recent “Health Matters Summit” hosted by The Clinton Foundation that in years past would have struck me as totally implausible. President Clinton was chairing a panel of experts for a session titled, “The Quest for Longevity and Our Rising Death Rates.” Reginald Eadie, … Read more

Package designs Offering more-thorough self-administration Directions can help pharmaceutical businesses address patient adherence difficulties. 25-27; even Las Vegas Convention Center), Alan Davies, world wide design director, Essentra (Booth Number N-540), can talk how engaging, how smart packaging may permit better communication to patients that are controlling their doses in your home. Davies replies Afew Questions … Read more

MANAGED CARE September 1999. ©1999 MediMedia USA Electoral politics, the Internet, and much more sophisticated patients have all helped to redistribute power among managed care players. Frank Diamond Senior Editor Freud was wrong. The great question isn’t “What does a woman want?” The great question, as we tumble toward the final presidential election of the millennium, is … Read more

Aetna’s Decision to partially withdraw from the significant supply of President barackobama’s medical care law will be leaving several Americans with just 1 or even no medical health insurance alternatives, threatening regulations’s promise to keep to decrease the amount of those who’ve been too sick or too feeble to access policy. Aetna, retaliating in a … Read more

Primary care physicians and internists who have tried “temping” have found something to their liking: fewer hassles, decent money, and enough perks to make it economically feasible. In fact, 7 of 10 physicians surveyed by a major health care recruiting company say they are more satisfied in their locum tenens assignments than they were in their previous … Read more

Biosimilars will probably not take the United States pharmaceutical market by storm but they may find faster acceptance here than they did in Europe, one expert tells the Wall Street Journal. Kate Keeping of the research company Decision Research Group says that U.S. physicians are much more familiar with biosimilars than European physicians had been before biosimilars … Read more

COST CONTAINMENT The pharmacy director of Blue Cross of Oklahoma shares his company’s success with using three tiers and coinsurance to promote member responsibility. Thomas Kaye, RPh, MBA Pharmacy Director, Blue Cross and Blue Shield of Oklahoma Also available in PDF Drug-benefit design poses a strong challenge to health plans: how to provide stewardship of … Read more

Alzheimer’s disease has proven to be a daunting foe. A cure remains elusive as treatments have come up short, perhaps because most have been based on a faulty hypothesis. The medicines on hand might temporarily ease symptoms—if the patient is lucky. But that’s about it. File under frustrating. In fact, you could hear the frustration in … Read more

Government scrutiny of health care organizations is at an all-time high. This scrutiny — whether by FBI agents and federal prosecutors, agents from the Office of the Inspector General, or state agents investigating Medicaid or general insurance fraud — is increasingly directed at medical groups. It now goes far beyond a search for purposeful deception … Read more

Scott Weingarten, M.D., M.P.H., is director of health services research at Cedars-Sinai Medical Center in Los Angeles, an associate professor of medicine at the University of California÷Los Angeles School of Medicine, consulting medical director for PrimeHealth, a managed care network of physicians and health care organizations, and a widely published authority on evidence-based medicine. Recently, … Read more

State governments don’t always use the legislative route to bring about change. Two states recently took administrative steps to strengthen the hand of patients in managed care plans.In New Jersey, the Department of Health released HMO draft regulations that cover a host of issues including recertification, quality and access, the appeals process and financial standards. … Read more

At a glance   ‘Corporate Strategies For Women’s Health’ Washington Business Group On Health A few statistics: Projected female employees joining U.S. work force by 2000   63% Companies putting limitations (copayments, deductibles, caps) on behavioral health care that they don’t put on other health services   87% Companies with a sexual harassment policy   93% Companies with a workplace violence … Read more

Three conditions — hepatitis C, diabetes, and cancer — show how budgets can be busted (and patients harmed) if providers and payers don’t astutely manage the use of costly new drugs Linda Cahn Every profession has its maxim for survival. For academics, it’s “Publish or perish.” For lawyers, it’s “Bill or move on.” What should … Read more

A large Southern California medical group is telling its doctors to accept less money or find another source of patients. St. Joseph Medical Corp. of Orange, Calif., is demanding that its 590 doctors agree to changes in their contracts that would, in essence, lop about 10 percent off their pay. The group says it will … Read more

Latest Issue Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen. www.managedcaremag.com

Cigna has become the second of eight health plans to reach a settlement with about 600,000 physicians over allegations that the insurers delayed or rejected physicians’ insurance claims for medically necessary treatments. In agreeing to pay $540 million to settle the class-action lawsuit, Cigna follows the lead of Aetna, which came to a settlement with … Read more

Health plans appear to be having some trouble fulfilling a federal mandate that 80 percent of questions from Medicare beneficiaries about pharmacy coverage be answered within 30 seconds. The fast-approaching deadline for enrolling in a Medicare drug plan may be partly to blame. “The large amount of interest in our prescription drug plans, as the … Read more

The FDA approved the Gene-therapy Zolgensma for pediatric patients Over two decades with spinal muscle atrophy, for example individuals that are presymptomatic in identification. The main genetic killer of babies under two decades old, is an advanced, youth, neuromuscular illness brought on by a mutation in one gene. Kiddies with SMA1 don’t meet motor landmarks … Read more

The Academy of Managed Care Pharmacy thinks there’s a better way for health plans and pharmacy benefit managers to make formulary decisions than by simply looking at line-item budget figures. AMCP will test a set of guidelines for pharmacy and therapeutics committees to follow when adding or removing products from formularies. Intending its guidelines to … Read more

Scientists at the Wellcome Trust Sanger Institute in Cambridge, United Kingdom, and their international collaborators have shown that acute myeloid leukemia (AML) is not a single disorder, but at least 11 different diseases, and that genetic changes explain differences in survival among young AML patients. Published in the New England Journal of Medicine, the groundbreaking study … Read more

In a study involving three large HMOs, researchers reviewed encounter and claim data for specialty services associated with different rates of performance of invasive procedures. Barry G. Saver, MD, MPH, and colleagues hypothesized that procedure rates would be higher for physicians paid using fee-for-service methods, intermediate for salaried specialists, and lowest for physicians paid under … Read more

Name Last modified Size Description Parent Directory 04-Jan-98 21:46 – ../../archiveMC/9710/9710.compmon.g1.jpg 03-Nov-97 23:48 21k ../../archiveMC/9710/9710.compmon.g2.jpg 03-Nov-97 23:48 22k ../../archiveMC/9710/9710.compmon.g3.jpg 03-Nov-97 23:48 16k ../../archiveMC/9710/9710.compmon.pdf 03-Nov-97 23:48 72k 9710.compmon.shtml 03-Nov-97 23:47 2k 9710.contents.shtml 09-Dec-97 00:51 3k 9710.dental.shtml 03-Nov-97 23:47 10k ../../archiveMC/9710/9710.dental_chart.gif 03-Nov-97 23:47 9k 9710.employer.shtml 03-Nov-97 23:47 8k 9710.empltest.shtml 03-Nov-97 23:47 10k 9710.ethics.shtml 03-Nov-97 23:47 8k 9710.fraud.shtml … Read more

A report detailing clinic-level cost and quality of cancer care in Washington State is a first—adding its own stamp on efforts to measure value in oncology. Senior Contributing Editor Former New York Mayor Ed Koch famously asked residents, “How’m I doin’?” Driven by a desire to improve service through transparency, Koch told NPR in 1981, … Read more

Getting less-than-hale elderly enrolled can finally be a sound business strategy for HMOs that comprehend the new rules and have sufficient IT capability. John Carroll For years, Marilyn Kramer viewed recruitment ads for Medicare+Choice plans with a somewhat jaundiced eye. There was, she says, always plenty of singing and dancing featured. But what about white-haired … Read more

An early managed care idea that the marketplace once rejected is now being embraced by employers and offered by health plans   In the 2011 movie Moneyball, the general manager of the Oakland A’s is portrayed as one of the smartest executives in baseball. A former player and first-round draft choice, GM Billy Beane pores … Read more

According to a recent study of AMA data, it now seems clear that managed care is having a depressing effect on the earnings of most physicians, including some in primary care. As of 1994, the latest year for which figures are available, only general and family physicians were bucking the downward trend, continuing to post … Read more

Many who claim to be constructing such entities are really creating ‘clinically integrated organizations’ Organizations that are not aligned with the definition of an ACO can be more accurately described as clinically integrated organizations (CIOs). The major difference between the two is that true ACOs, by definition, are Medicare fee-for-service (FFS) entities only. HMOs compared … Read more

GlaxoSmithKline plc today announced it’s received The FDA also approved upgrades into this Warnings and Precautions portion of labelling for its ICS/LABA class. These labelling upgrades were approved December 20th 2017, following an overview of safety data from 4 randomized controlled security trials filed by three organizations, including GSK. At 2010, for manufacturers of LABA-containing … Read more

Positive results have been reported from two pivotal phase 3 trials of DRM04 (Dermira, Inc.), a topical anticholinergic product candidate in development for the treatment of patients with primary axillary hyperhidrosis (excessive underarm sweating). Both studies compared DRM04 with vehicle. The ATMOS-1 and ATMOS-2 trials were designed as identical, randomized, double-blind, vehicle-controlled studies to assess … Read more

As Part D enrollees approach their coverage limits, their decisions are significantly affected through the doughnut hole period Also available in PDF ABSTRACT PURPOSE: The unsupplemented Medicare Part D prescription drug benefit does not provide coverage for stand-alone prescription drug plan (PDP) beneficiaries within the coverage gap (often called a doughnut hole) in Medicare Part … Read more

The godfather of disease management talks about how the industry went wrong, and is now going right, in describing its own value To the degree that one person can be credited or blamed for the very existence of a $1.1-billion segment of American health care, Al Lewis is that person when it comes to disease … Read more

Reflecting the continuing foundering economy, membership rolls at nine major managed care companies continue to decline. In particular, WellPoint reported membership declines in its commercial risk business, according to the “2010 Managed Care Industry Report” from the KPMG Healthcare & Pharmaceutical Institute. The other eight companies are Aetna, Amerigroup, Coventry, Health Net, Health Spring, Humana, … Read more

The curiosity about cannabis-based services and products to treating refractory epilepsy has sky rocketed in the past couple of decades. Pot and other cannabis products using high material at – tetrahydrocannabinol, used mainly for recreational purposes, are normally unsuitable for this particular sign, chiefly since THC is correlated with numerous unwanted side effects. In comparison … Read more

New hepatitis C medications fuel rising costs The Kaiser Family Foundation has examined trends in Medicare spending on prescription drugs, how Medicare coverage affects beneficiary access and costs, and what the public thinks about different options for keeping drug costs down. The foundation found that total and per capita Part D spending has increased rapidly … Read more

MANAGED CARE June 2009. ©MediMedia USA More employers and plan managers are looking at offshore options, but few are taking the plunge Richard Mark Kirkner Four years ago Thomas Hiland, a suburban Denver businessman, needed mitral heart valve replacement surgery. He could have gone to the University of Colorado Hospital, or the Mayo Clinic, or the Cleveland … Read more

Mergers and acquisitions continue to be one of the hottest topics in managed care, as health plans increasingly find themselves in a position where they need to grow or else, according to A.M. Best, the rating company. “A.M. Best expects growth of stockholders’ equity in 2004 to be augmented by significant increases in goodwill because … Read more

DM is God’s gift to managed care. Or is it? Here is a discussion of areas that make evaluating a DM program a complex, if not ineffable, proposition. Also available in PDF Disease management, embraced by both Wall Street and the medical world, is the most rapidly growing sector of the medical management industry. There … Read more

Blue Cross Blue Shield of Massachusetts believes its newly inked provider pact with Caritas Christi Health Care — a community-based hospital network in New England with a network of 1,100 physicians that cares for about 60,000 members — will help bury the industry’s fee-for-service payment model. In a nutshell, the payment plan — dubbed an … Read more

Medical school enrollment, it is hoped, will rise to meet the ever-growing demand for physicians, according to a survey by the Association of American Medical Colleges (AAMC). “First-year medical school enrollment in 2017–2018 is projected to reach 21,434 — a 30% increase from 2002–2003,” says the survey, which does not estimate what specialties students will … Read more

Renal cancer drugs are equivalent to placebo in adjuvant setting Two widely used targeted-therapy drugs approved by the FDA for the treatment of metastatic kidney cancer—sorafenib (Nexavar, Bayer/Onyx Pharmaceuticals) and sunitinib (Sutent, Pfizer)—are no more effective than a placebo in preventing return of the disease, according to a new study from the Abramson Cancer Center … Read more

TOMORROW’S MEDICINE Enhanced management continues due to a greater understanding of the intricate glucose balance and the shortfalls of existing medications. Thomas Morrow, MD The United States is facing an unprecedented challenge from type 2 diabetes, a disease characterized by a combination of insulin resistance and progressive pancreatic beta cell dysfunction. The glucose balance is … Read more

There was a time when commentators confidently predicted that Bill Clinton’s presidency would stand or fall according to the fate of his administration’s ambitious program for reforming health care to guarantee all Americans coverage. That’s coverage, remember, and not mere access, as I recall Hillary Clinton stressing in a November 1993 speech that drew sharp … Read more

Cover Story In Early Diagnosis, Too, We Find That Less Is More The United States Preventive Services Task Force has recommended against several screenings, yet health plans are finding that it’s not so easy to just drop coverage Michael D. Dalzell Medical Marijuana Coverage Still Lost in the Legal Weeds While there has been movement … Read more

Asthma Pill Shows Promise in Small Clinical Trial The first new asthma pill in decades has produced promising results in a small clinical study, potentially paving the way for another treatment option for patients by the end of the decade, according to a Reuters report. Read more FDA Advisors Schedule Meeting to Review Hepatitis B … Read more

Data interchange systems will improve medical management at the provider and payer levels Accountable care organizations (ACOs) sit as the foundation for the future of health care in two recently passed milestone federal laws. But on what will that foundation be placed? Health information exchanges (HIEs) have been put forward as one answer — and … Read more

NEW OPTIMISM FROM THE ‘FATHER OF THE HMO’ Paul Ellwood Jr., M.D., comes closer than anyone else to being the father of modern managed care. He coined the term HMO, and he — along with Stanford University economist Alain Enthoven — has played a key role in shaping the nation’s understanding of managed care and … Read more

Drug Cost-Sharing Amounts Stable 2010 to 2011 From Managed Care The vast majority of Part D plans follow a tiered cost-sharing structure with incentives for members to use less expensive generic and preferred brand-name drugs. Cost-sharing has increased since 2006, but the Kaiser Family Foundation reports in “Analysis of Medicare Prescription Drug Plans in 2011 and … Read more

About 99 percent of workers in plans sponsored by employers have a prescription benefit. And while the majority don’t have to pay a separate prescription deductible or have an annual out-of-pocket limit that applies only to prescription drugs, about 13 percent do, according to the 2012 Kaiser/Health Research & Educational Trust (HRET) Employer Health Benefits … Read more

Download PDF Introduction Identifying the reasons for poor financial performance of health plans is important for startups and health plans expanding their markets and for state and federal regulators who aim to promote competitive markets, for health insurance. This is especially important during a time when 112 members of the House of Representatives have cosponsored … Read more

The health reform law signed by the president in August authorizes a pilot program of tax-free medical savings accounts. MSAs have been touted as an antidote to HMOs, but some say the two are compatible. Female patient, 52, calls her HMO for a well-woman appointment. “Nothing available for three weeks.” “I’d like to come sooner,” … Read more

In this column we follow new developments in systems and technology for health care. Despite the downturn in technology stocks, the stream of new technology and dot-com products for health care has not diminished. As each new product is announced, users are told how it will save them time, save money, save staff, enhance quality, … Read more

An international working group of 23 scientists convened by the International Agency for Research on Cancer (IARC), the cancer agency of the World Health Organization, has evaluated the carcinogenicity of drinking coffee, maté, and very hot beverages. The working group found no conclusive evidence for a carcinogenic effect of drinking coffee. However, the experts did … Read more

Its 2007 HEDIS physician performance manual puts greater emphasis on cost of care Tom Reinke NCQA’s latest specifications for measuring physician performance shift the focus on tracking efforts from “How?” to “How well?” Generally, past efforts to evaluate physicians on quality and cost have been focused on the processes, activities, and items to be measured. … Read more

Cobas Zika test is made by Roche Molecular Systems The FDA has approved the first Zika virus detection test for use in screening the nation’s blood supply. The cobas Zika test (Roche Molecular Systems, Inc.) is a qualitative nucleic acid test for the detection of Zika virus RNA in individual plasma specimens obtained from volunteer … Read more

5 Threats To Value-Based Insurance Design VBID is a promising approach to improving health and cost outcomes, but its use has been limited. Expanding it to complicated interventions will require a lot of effort. A Conversation With Helen Darling: Large Employers’ Reform Agenda The National Business Group on Health’s CEO looks for employers and insurers … Read more

Picture a drug that has been compounded for decades and sold at a low price. The FDA approves a new formulation, and the price goes through the roof. Earlier this year, a controversy erupted after the FDA approved an injectable form of progesterone for preventing premature births. For decades, the medication had been sold by … Read more

Access to Celebrex and Vioxx under HMO drug formularies has increased about 50 percent over the past two years, according to data from MediMedia Information Technologies’ Formulary Compass. Access (defined here as having a status of first tier, second tier, prior authorization or on formulary, but not third tier) to Celebrex increased from approximately 45 … Read more

Ideally, Real World Signs Are Always looped Back to the Drug development procedure. There’s a deep reservoir of advice regarding negative effects, adherence, and gaps in efficiency among sub populations embedded inside the numerous sources of realworld signs. Extracting it’s going to need work. As the health care sector continues to become concurrently more Patient-centered … Read more

Parents Need to Tap Down Fear Parents learn early that it’s sometimes best to downplay things. Children facing surgery whose parents worried excessively about the procedures were more likely to feel greater postoperative pain, than other pediatric surgery patients. Children who didn’t sleep well in the days leading up to surgery also had a harder … Read more

BY JOHN A. MARCILLE What goes around comes around.” Those of us not of vindictive temperament hope the adage applies to good things as well as bad. Perhaps that’s the reason physicians seem to warm to the idea of a health care system in which patients can purchase their own insurance with the help of … Read more

The managed care backlash has claimed another casualty: Financial incentives in physician contracts as a means of controlling utilization. Is capitation far behind? Has risk become another one of those “four-letter words”? Utilization-management incentives and global capitation seem to be in retreat. Public distaste for perceived managed care abuses, more government oversight, class-action lawsuits against … Read more

Only 15 states admit to preparing to deploy these vehicles for essential services, but others are said to be working behind the scenes John Carroll Howard “Rocky” King has less than three months to complete a blueprint for the state of Oregon’s planned health exchange. Even now the state director is submitting pieces of the … Read more

Medicare beneficiaries could gain a lot from managed care, and so could health plans. But it’s not all that easy. Peter Wehrwein The Balanced Budget Act of 1997 tied the fate of the $200 billion Medicare program to managed care. In theory, Medicare and managed care were made for each other. But how will it … Read more

Many physicians question the fairness of a deal between the American Medical Association and the government that give doctors a bonus when they follow certain rules At first take, the American Medical Association’s recent deal to advance a compromise on Medicare payments by cooperating on a timetable to introduce a new set of pay-for-performance quality … Read more

If something isn’t done and done fast to combat the rising rates of resistance to antibiotics, then the world could face economic damage comparable to that of the 2008–2009 global financial crisis, according to a United Nations report. That report, by the U.N.’s Interagency Coordination Group on Anti­microbial Resistance, doesn’t mince words, starting with the … Read more

They’re young, they’re hungry, and they claim to be approaching business problems from a different angle. Will these entrepreneurs succeed? December 1, 1999 STEVE HEIMOFF Odyssey Healthcare Inc. Medcath Inc. Trizetto Group Inc. The go-go years of the 1990s have been a great time for health care entrepreneurs. What with the Internet, the booming economy, … Read more

The recent Associated Press report that hundreds of physicians nationwide grow 7 million pounds of tobacco in 23 states made me wonder: How much should our private lives reflect our public ones? One of the first times I noticed that there was a difference was about 15 years ago while training with a prominent medical ethicist … Read more

A Conversation with Jayson Slotnik, MPH, JD This biologics industry spokesman knows that health plans can only be won over by the financial argument. In 2003 for the first time, biologics accounted for a majority of FDA approvals. Biotech’s focus is expanding from products that treat relatively rare diseases to treatments for conditions that affect … Read more

LOG IN REQUEST NEW PASSWORD Username or e-mail address: * You may login with either your assigned username or your e-mail address. Password: * The password field is case sensitive. Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen … Read more

Resources Disease Management Forum Call for Manuscripts Subscribe Rate Card Production Details for Ads and Inserts Classifieds Recent blog posts Disruptive Innovation Could Up-End an Innovative Industry Is There an Advocate in the House? Health Reform and the Use of Financial Incentives in Wellness Programs An Easy and Profitable Way to Turbocharge Disease Management? Welcome … Read more

A chance encounter with an unhappy reader (a physician) spurs a flood cliches about why doctors are “justified” in their refusal to move out of the dark ages Homeland Security, take note: The other day, I was attacked in an airport. The attacker, in this case, was a friend of mine who serves on the … Read more

Get your scorecard. There’s another entry in the managed care legislative sweepstakes–the Health Care Quality, Education, Security and Trust Act or, inside the Beltway, QUEST. Introduced by Republican Sen. JimJeffords of Vermont, QUEST is scheduled for markup this month. The key element is QUEST’s creation of a Health Quality Council that would issue comparative quality-of-care … Read more

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Plagued by higher costs and the need to provide at least bare bones coverage, more companies, and smaller ones, are self-insuring. Plagued by higher costs and the need to provide at least bare bones coverage, more companies, and smaller ones, are self-insuring. Three years ago, Tammy Carr could offer her employees at Arco Concrete an … Read more

An on the Web Portal identifies this page that supplies Users an entry way to many different advice, links, tools, and much more. Originally, these portals were known to as links ; nevertheless, these portals function various diverse purposes. On average, on the web portals are all intended to provide users a number of their … Read more

The good times rolled on for the nation’s HMOs in 2003, according to Weiss Ratings. The industry nearly doubled its profits, earning $10.2 billion, an 86 percent increase from the $5.5 billion it earned in 2002. Kaiser Foundation Health Plan was the big winner, reporting a $1.1 billion increase in earnings. That is about one-fifth … Read more

COVER STORY Should Consumers Be Present On an HMO’s Board of Directors? More consumers on HMO and integrated-system boards might not bring the benefits that advocates expect, yet some plans do find them helpful. MargaretAnn Cross Formulary Submission Process Catches On … Slowly If drug purchasers are so bullish on what the AMCP format can … Read more

Monoclonal antibodies remain popular FiercePharma has compiled a list of the top 15 cancer medications that are expected to dominate the oncology market in 2022. According to the report, oncology drugs remain the fastest-growing category in pharma, with anticipated sales of approximately $90 billion over the next five years. Among the top six drugs on the … Read more

The AMA has come out with its strongest condemnation of online prescribing, recommending that action be taken against physicians who prescribe based solely on a patient’s answers to an online questionnaire.The AMA contends that this practice “falls below a minimum standard of medical care.” State and federal agencies are paying more attention to online prescribing, … Read more

Consultants say an emerging type of plan that one-ups the point-of-service option could be the wave of the future. The idea rolls a preferred-provider organization, HMO and POS plan into one. Members choose how to use benefits in exchange for differing out-of-pocket expenses. In Texas, Aetna U.S. Healthcare and Harris Methodist Health Plan are reportedly … Read more

An investigation into a clinical test in France that left one person dead and put five others in a hospital has found evidence of brain damage in people who took high doses of the experimental pain medicine, according to a report from NPR News. The early-stage clinical study was shut down in January when the adverse … Read more

The diary is one of the most esteemed and powerful legal books in the nation. Edited by students board, approximately onethird of each subject’s contents is composed of student notes handling current legal developments, with all the residual articles being committed to articles and opinions from academics and professionals. Broadly speaking 1 issue every year … Read more

How do you devise a capitation plan that works? With understanding, hard work and gumption, says the chief financial officer of Sharp Rees-Stealy Medical Group in San Diego. Developing a successful compensation system for physicians in a medical group means creating a method that can evolve with the group practice. Of the different schemes around … Read more

Plans looking for a low-risk way to experiment with new benefit designs might start with the pharmacy benefit. If “consumer-directed health care” is the hottest catchphrase on everyone’s lips, surely the next phrase to follow is “pharmacy benefit.” And while a consumer-directed pharmacy benefit is offered by only a few plans today, that may change … Read more

To appraise a computer-based prior consent system which has been created to add and examine 2 new theories for doctor review: that the tool could minimize denials by providing realtime decision aid with other options when the initial petition was non compliant, and also the tool will amass adequate details to build a registry. A … Read more

This pioneering medical legal authority says health plans and physicians should stop fighting over scraps the government throws them. Steven B. Epstein, J.D., the founding member of Epstein Becker & Green, is a pioneer in health care law. Epstein, the senior health partner in the practice’s Washington, D.C., office, has a broad perspective on managed … Read more

While Aetna U.S. Healthcare prepares its appeal of a California jury’s $120 million liability verdict, it’s simultaneously preparing for the worst — suing its own insurers to make sure they cough up their share if need be. The Hartford Courant reports Aetna’s reinsurers could be on the hook for $76 million if the courts reject … Read more

We heard a lot about primary care in the early days of managed care. Gatekeepers were supposed to steer patients to specialists only when necessary, and even limit unnecessary treatment. They still do that, but to a much lesser extent. Remember, we also heard a lot about the Patients’ Bill of Rights. The public revolted … Read more

Medicare fee-for-service providers are being encouraged to participate in the fifth annual health care provider satisfaction survey of Medicare fee-for-service contractors. The Medicare Contractor Provider Satisfaction Survey (MCPSS) is an opportunity for providers to offer feedback to CMS on their satisfaction, attitudes, perceptions, and opinions about the services rendered by their respective contractor. Survey questions … Read more

Insurers are busy merging with retailers and providers in vertical integration deals after attempts at horizontal combinations hit antitrust roadblocks. While 2019 might not see the mega-mergers of 2018, “I don’t think it will be a slow year,” predicts Stephen Burrill, vice chairman and health care leader at Deloitte LLP. Much of the action is … Read more

John Carroll Contributing Editor With access to large patient populations, health plans are in a position to mine a fresh set of data, but concerns about bias remain MANAGED CARE June 2011. ©MediMedia USA With access to large patient populations, health plans are in a position to mine a fresh set of data, but concerns about bias … Read more

Chronic Fatigue syndrome is a intricate disease characterized by clinically and psychiatrically unexplained relieving fatigue that’s not alleviated by rest and can be combined with symptoms of protracted post-exertion malaise, unrefreshing sleep, diminished concentration or temporary memory, joint or muscle pain, pain, sore throat and tender lymph nodes. CFS affects atleast four million adults in … Read more

Residents and fellows want to work in the suburbs or city, where they have professional and personal ties, according to a survey by Cejka Search. The company gave questionnaires to about 16,000 residents and fellows. Of the 750 respondents, 95 percent said that they would prefer to work in the suburbs. Eighty-four percent selected a … Read more

Because specialty drug expenditures will grow, P&T committees may become more involved with drugs provided under the medical benefit Specialty pharmaceuticals have contributed substantially to the rise in the nation’s drug bill over the last several years. Given their presence in the FDA pipeline, they are expected to continue to do so. Without a near-term … Read more

Doing Well by Doing Good Minnesota’s HealthPartners helps to introduce Uganda dairy farmers to prepaid health care. Care and delivery improve. Cover Story Physician Incentives: Fading Away Health plans use financial incentives less and less to control utilization and physician behavior. Public outcry over perceived wrongdoings, plus government and legal oversight, are why. The Doctor … Read more

The retail prices of the 50 pharmaceutical products most prescribed to the elderly increased almost three times the rate of inflation last year, says a Families USA study. Prices for the medications jumped 7.8 percent, compared to the 2.8 percent rise (energy costs excluded) in the Consumer Price Index…. The New York State Department of … Read more

Missouri’s insurance department has spelled out exactly what HMOs in the state have to do to comply with employee choice provisions of regulations passed last year. Insurance Director Jay Angoff sent a bulletin to the more than 30 state-licensed HMOs specifying the choices they must offer to members of plans covering 50 or more workers. … Read more

MANAGED CARE June 2010. ©MediMedia USA In response to concern that there will be a shortage of physicians, the Association of American Medical Colleges (AAMC) recommends a 30 percent increase in U.S. medical school enrollment by 2015. A new report from the AAMC’s Center for Workforce Studies suggests that enrollment is on track to reach that goal, … Read more

Annualized relapse rate reduced compared with interferon beta-1a The phase 3 SUNBEAM trial, which evaluated the efficacy and safety of ozanimod (Celgene), an investigational oral, selective sphingosine phosphate receptor 1 (S1P1) and S1P5 modulator, in patients with relapsing multiple sclerosis (RMS), met its primary endpoint in reducing the annualized relapse rate (ARR) compared with weekly interferon … Read more

A Minnesota medical group that contracted with HealthPartners, a not-for-profit HMO, was able to improve cost of care, physician compensation, and patient access without harming patient satisfaction when the group converted from a salary payment system for physicians to one solely dependent on physician productivity. Before 1998, physicians were paid a salary, with all their … Read more

Step treatment implies attempting more affordable alternatives before “venturing up” to drugs that cost more. Here’s an illustration of step treatment. Suppose you’re having sensitivity issues. You should initially have a go at utilizing an over-the-counter prescription. On the off chance that that doesn’t help you, attempt a Level 1 medication. On the off chance … Read more

Bruce Bode, MD Atlanta Diabetes Associates Michael Silver, MD Medical Director, United Health Care, New York Richard Weiss, MS Managed Solutions, Mount Freedom, New Jersey Kathryn Martin PharmD, Managed Solutions, Mount Freedom, New Jersey Also available in PDF Introduction The cost burden of diabetes is significant. In 2007, the total costs associated with the disease … Read more

Dispersing throughout the Americas, also to change between three thousand and four thousand people, a disorder expert said on Thursday. The WHO’s Directorgeneral stated the spread of this mosquito-borne Disorder had gone out of a moderate hazard to a of alarming proportions. Regional office, said”We could get three or four million cases of Zika virus … Read more

But It’s clear This inconsistencies in approach, an absence of orientation in conclusion and also a narrow focus on controlling cost and also shifting risk from the funding period — now’s average approach — are going to address this. We are in need of an alternative strategy. The one which aims significance and whole-life functionality. … Read more

Health Plans Deploy New Systems To Control Use of Lab Tests Costs are rising as physicians order more of all kinds of tests, from low-cost routine tests to high-cost genetic assays Joseph Burns Accolade’s Expanding Clientele Likes Its Emphasis on Members The company bets that forging stronger ties with patients will result in more appropriate … Read more

The epidemic of lethal bacterial ailments connected to polluted clinical scopes has been worse than previously reported due to varied oversights and coverage failures by extent manufacturers, hospitals and regulators, in accordance with a brand new U.S. Senate report. The analysis demonstrated the out break was wider-spread than previously reported. They also ascertained that supervision … Read more

MANAGED CARE September 1999. ©1999 MediMedia USA The National Committee for Quality Assurance says it will begin an accreditation program for medical groups two years from now. Still in development, the program would provide third-party judgment of physicians across plans. Many plans now issue their own report cards on physician group performance. Given that HMOs’ and NCQA’s … Read more

Caregivers Fill Crucial Role But Don’t Get Much Help Their care of loved ones defrays costs that would otherwise have to be borne by the health care system, but they too often go it alone.   Susan Ladika Anna Boyle is struggling to figure out how to care for her mother. After a string of … Read more

It wasn’t long ago that Medicare held a special lure for HMOs, which saw the government’s foray into managed care as a lucrative opportunity. But if a PacifiCare decision last month is any indication, Medicare is no longer the golden egg. The company’s five-year strategic plan calls for aggressive expansion in the commercial market — … Read more

Despite a widening gap between the expense of HMO and PPO plans, more employers than ever offer PPOs — and their employees are taking them up on it. Nationwide, the share of people who have employer-sponsored insurance and who are enrolled in PPOs rose 3 percentage points from 1998 to 1999, while the share enrolled … Read more

In California, Aetna U.S. Healthcare has addressed a major complaint of the state’s leading physician organization — that relatively low capitation rates force pediatricians to eat the cost of recommended vaccines. Aetna’s California plan will begin to pay physicians for any immunizations newly recommended by the American Academy of Pediatrics and the Centers for Disease … Read more

Technical, financial, existential—health information exchanges (HIEs) have been plagued by all sorts of problems. But payers want in because of value-based payment. In 2014, California’s two big Blues health plans, neither known for being particularly Pollyannaish, sunk $80 million into building a database of information about the state’s patients. It was an unusual move, given … Read more

As they evaluate the performance of their health care vendors, employers are focusing less on cost and more on performance: What are the outcomes for the money they’re spending? More like this Costly biologics have plan sponsors looking at benefit designs Where do new diabetes treatments fit in? Will mobile devices and apps have a … Read more

BY JOHN LA PUMA, M.D. The business of medicine is in serious trouble. Disenchantment with day-to-day practice is on every middle-aged face I know in medicine. Just a cursory review of the managed care terrain turns up distressing news such as an alleged “paper” hospice in Chicago accused of fabricating records and bilking the government … Read more

Health plans can offer several kinds of assistance to physicians who are having trouble caring for these patients It is not for every illness that the FDA recommends massage and emotional support. But fibromyalgia is not like most other illnesses. First, it should be said that there is no longer any question about whether fibromyalgia … Read more

Acute kidney injuries (AKIs) increased greatly from 2000 to 2009 in terms of both incidence and mortality rates, according to a study in the Journal of the American Society of Nephrology. The authors describe acute kidney injuries as those requiring dialysis. “The total number of deaths associated with dialysis-requiring AKI rose from 18,000 in 2000 … Read more

Final text of TPP has no biosimilar surprises The final full text of the Trans-Pacific Partnership (TPP) is out, and it will stir up some debate again over the massive trade deal. But for those watching how the trade pact might affect the international market for biosimilars, the unveiling of the full text doesn’t seem … Read more

Gocovri Was approved by Both the U.S. Food and Drug Administration (FDA) Within a Add-in Treatment for off episodes in Individuals Who Have Parkinson’s disease. Adamas Pharmaceuticals, that acquired the therapy, declared its endorsement within the U.S. to get Parkinson’s patients taking levodopa or carbidopa. Off episodes are intervals Where levodopa-based treatments cease To work, … Read more

To Help restrain the coronavirus disorder 20-19 pandemic, optional procedures are cancelled in many US hospitals with government dictate. The objective of this analysis is to gauge federal hospital settlement and online gain reductions because of optional medical process restored throughout the coronavirus disorder 20-19 pandemic. The National Inpatient Sample and the nation wide Ambulatory … Read more

For some specialists, it might appear as though they are being compelled to accomplish more with less assets just to keep up their training income in an inexorably perplexing medical services climate. This inclination isn’t a result of your creative mind. While a huge number of new orders and troublesome authoritative prerequisites have been layered … Read more

Life is change. We here at Managed Care are breathing new life into our website by changing its look, but not only the look. Sure, it is more streamlined and easier on the eyes, but the change that excites us is in the content, which is richer and more interactive. Our home page is now … Read more

A computer alert system and a process that steers patients toward high-performing doctors are part of Aetna’s program The relationship between health plan and physician is delicate. Doctors resent insurer oversight, viewing it as an intrusion into the sacred physician-patient relationship. Some health plans now want to convince doctors that the plans’ efforts are aimed … Read more

Policy Makers And insurance companies have been compelling people dependent on opioids to abstinence-based detoxification apps, but a new study concludes that both methadone and similar drug-maintenance treatments save money and lives. When the almost 47,000 Californians who began treatment for opioid-use disease in 2014 had received immediate usage of methadone or a different opioid-agonist … Read more

Washington Watch Get any mail about the Financial Services Modernization Act? You’re not alone. Insurers and financial institutions are flooding customers’ mailboxes about their rights to protect medical and financial information under what’s better known as the Gramm-Leach-Bliley Act. But just how GLB will affect health plans isn’t totally clear. GLB requires affected institutions to … Read more

The aerospace giant has direct contracts with health care systems in four markets. Should insurers worry that other large employers will cut them out and start dealing directly with integrated delivery systems? Is there a better way to deliver health care when thousands of employees are scattered across 50 states? Does one large employer have … Read more

What the For-Profit Trend In Health Care Really Means For-profit HMOs are setting the growth pace these days, and some not-for-profit plans are switching to for-profit status to keep up with the competition. But are the two types of plans really so different? The Corporate Practice of Health Care At a Harvard School of Public … Read more

Prospective Value-Based Assessment Of New Health Care Technologies and Practices From Theory to Practice: Identifying Authentic Opinion Leaders to Improve Care Computerized Decision Support and the Quality of Care An Evidence-Based Evaluation of Percutaneous Vertebroplasty Patient and Physician Satisfaction With a Pharmacist-Managed Anticoagulation Clinic: Implications for Managed Care Organizations Identification of Resource Use And Associated … Read more

Some HMOs may be more willing than you think to help financially troubled medical groups survive. A willingness to cooperate is key. San Jose Medical Group is an old hand in managed care. In 1972, it became the first physician group in California other than Kaiser Permanente to accept prepayment. By the early ’90s, SJMG … Read more

The nation is in an uproar over rising medical costs, and much of the problem is excess or inappropriate utilization Last year an article appeared in the Journal of the American Medical Association whose title says it all: “The Perfect Storm of Overutilization.” The lead author was Ezekiel Emanuel, MD, PhD, of the department of … Read more

The medium-term forecast for Medicare spending has brightened considerably, according to the boards of trustees of the Social Security and Medicare trust funds. The boards’ most recent projections are that per-capita increases in Medicare spending will be lower than previous projections and that Medicare spending as a whole will grow more slowly than spending in … Read more

The Congressional Budget Office, a non partisan set of experts who test U.S. legislation,” said the bill could reduce federal deficits by $119 billion between 20 17 and 20 26. The Report could provide added ammunition to Democrats who have accused President donald-trump and congressional Republicans of putting fortunate and lowincome people at an increased … Read more

Increased health plan insolvencies have state regulators scrambling to re-engineer oversight tools. Many states are now using risk-based capital models to monitor health plan finances, but as more physician groups assume risk, it is becoming more complicated to prevent health plan insolvencies. The trend has shifted from the indemnity-plan failures of the early ’90s to … Read more

Going on the Offensive Against Defensive Medicine The $60 billion to $108 billion that could be saved through tort reform would help 2.4 million to 4.3 million uninsured get coverage, the government claims. John Carroll Current Billing System Fosters Error, Dishonesty If clinical mistakes were as common as clerical ones, nobody would leave a hospital … Read more

The findings underline the need for greater instruction, policies and research healing effective, safe inpatient medication prescribing. Data gathered from 2006 to 2015 from the Centers for Disease Control and Prevention’s National Ambulatory Medical Care Surveysthat provide advice on physician office visits over the U.S.. The researchers examined the frequency, trends and explanations why physicians … Read more

B-cells and their markers, once overlooked in the pathophysiology of rheumatoid arthritis, may hold the key for a new treatment regimen Recently an elderly woman looked with excitement at her first great-grandchild. As with all mothers, young and old, she is filled with the irresistible urge to cuddle the miracle of life facing her. As … Read more

Roche’s Patent dispute using London-listed Shire within the Korean drug maker’s brand new haemophilia medication Hemlibra has escalatedwith Shire filing a new motion within an U.S. court which Roche says intends to avoid a few patients from accessing its medication. The Patent dispute in the U.S. district court at Delaware underscores Hemlibra’s possibility to carry … Read more

The Food & Drug Administration’s approach to this stage of a drug’s life cycle is inadequate When health plans and PBMs evaluate new medications for efficacy, safety, and cost, safety is the thing they know the least about. Safety data are limited by the vagaries of the new-drug approval process and by several factors internal … Read more

An exchange of letters in the Journal of the American Medical Association last year titled “Physician Marketing of Nutritional Supplements” revealed that some physicians have qualms about selling supplements in, from, and out of the office. Managed care should have a special interest in sales of supplements in the office, and especially in their multilevel … Read more

Tiger in the Fiscal Room: Beware the Increasing Cost And Number of Orphan Drugs While Congress worries about physicians’ salaries and employers bemoan the cost of imaging, it’s orphan drugs that might deserve most attention Ed Silverman Calling Something an ACO Does Not Really Make It So Many who claim to be constructing such entities … Read more

Full text in PDF Objectives: The objective of this study is to examine the acceptance of disease management programs (DMPs) for type 2 diabetes among patients as well as physicians in Germany. Background: DMPs began in the United States in the 1990s. The German government developed interest in DMPs for specific conditions and implemented them nationwide in … Read more

Article also available in PDF format Innovative programs created by health plans around the country are credited with boosting immunization rates to unprecedented levels, especially among infants and older children. But what makes these programs, which go by such names as “Getting Bigger,” “Great Expectations for a Healthy Baby” and “Health Ride,” so successful? There … Read more

Now that five states have medical marijuana laws in place, more physicians are being forced to take a hard look at pot as medicine. But whether health plans will follow suit is a hazy issue, depending largely on whether federal authorities soften their stance against palliative uses of marijuana. Washington, Oregon and Alaska voters passed … Read more

One important way that we can improve care for people with chronic diseases is to have medical records that are online and accessible when needed. Jack Ebeler Nearly a decade after Americans’ initial encounters with the Internet, and not long after President Bush called for every American to have an electronic medical record by 2012, … Read more

The commission and employers are fighting over whether incentives make the programs involuntary When the federal court in Minneapolis denied the Equal Employment Opportunity Commission’s request to block Honeywell’s employee wellness program for 2015, employer groups and their lawyers exhaled, then went right back to holding their breaths, wondering what the next move by the … Read more

Group purchasers of health care—employers, unions, and federal and state governments—know the odds are stacked against them. If they want care that’s fast, good, and cheap, they’re lucky to get one out of three. Hitting any two of these goals is like winning the lottery. They also know low-quality care can cause them to pay … Read more

Speaking of profitability problems, HMOs can at least be happy they’re not physician practice management companies. The PPM industry is trying to find its sea legs after MedPartners announced it would dump its 238 physician practices and concentrate on its pharmacy benefit management and other lines of business. The MedPartners decision effectively ices talk of … Read more

It seems that every year we publish at least one “what’s old is new” story. But really, why shouldn’t that be the case? When an old, discarded idea comes around again, maybe it means that it should not have been discarded in the first place. The return of capitation was one such article; another was … Read more

With Zytiga joining the ranks, managed care may have a way to develop an oncology strategy for a common type of cancer Thomas Morrow, MD It was in Venice in 1536 that the anatomist Nicolo Massafist first described the prostate. It was not until over 300 years later that cancer of this gland was first … Read more

Primary care physicians enjoyed a 4 percent increase in compensation in 2006, less than the aggregate of medical and surgical specialties, which had a 6 percent increase, according to the American Medical Group Association. But if you look at the graph below, you’ll see that over the three years ending in 2006, primary care specialties … Read more

Backers hope that provider-sponsored organizations will offer some pretty strong competition to conventional Medicare and Medicaid HMOs. Opponents claim PSOs have been given an inappropriate advantage. The federal government’s recent blessing of a new variety of managed care delivery vehicle, the provider-sponsored organization, offers an attractive opportunity to physicians, hospitals and other providers. If they … Read more

After years of short shrift from payers and insurers, substance abuse services get renewed interest. Health Plans in particular are re-evaluating their approach. Substance abuse costs our society more than $260 billion a year for comorbidities, law enforcement, and treatment, but less than 2 percent — about $5.5 billion — goes for treatment, according to … Read more

Bowing to public condemnation, Kaiser Permanente will no longer require psychiatrists to write prescriptions for some patients they have not seen. The not-for-profit organization says its psychiatrists now will examine all patients before a prescription is written. A San Diego psychiatrist filed suit against Kaiser, claiming it fired him after he refused to prescribe medication … Read more

Clonally expanded T cells can be reservoirs of infectious HIV Researchers have discovered that clonally expanded human immunodeficiency virus (HIV)-infected cells can persist and produce new virus over many years in patients receiving combination antiretroviral therapy (cART). Thus, any cure for HIV infection will have to attack these cells to permanently clear the virus, according … Read more

Health care issues generated political brinkmanship as the 106th Congress skidded toward Election Day — capped by President Clinton’s declaration of a limited series of patient rights regulations following Congress’s failure to pass a patient rights bill. The Clinton administration ordered the Labor Department to prepare standards covering Americans who receive health benefits through their … Read more

With a foreword from Dr. Lucian Leape, a creator of today’s patient safety movement, and cooperation by a number of those most distinguished pros directing the field nowadays, the Curriculum can be currently a 10-module, online class which offers a brief history of this individual safety field, clarifies the science and areas of safety, gift … Read more

By John David Irvin, M.D. Second of a Two-part Series Searching for a new job is something I do not relish. Nonetheless, it’s something many of us have to do. Before I packed my bags, while I was still working for a 30-member specialist group on the East Coast, I investigated new positions back in … Read more

Financial, regulatory, and access problems continue. Still, this remains a growth industry and some have found a way to profit. Martin Sipkoff Contributing Editor Fifty-nine percent of the nation’s nearly 43 million Medicaid enrollees are part of a managed care plan — a big segment of a demographic group that is younger, fatter, often sicker, … Read more

Some vendors are moving from offering just a few programs to embracing systems that try to deal with all the complicated overlaps. In the early days of disease management, tackling even one of the top chronic ailments was a stiff challenge. Today, inside CorSolutions, the push is on to handle 30. CorSolutions kicked off the … Read more

Sisyphus had to roll that boulder up the hill as punishment for deceit. Telling the truth has its own rewards, thankfully, because sometimes that too can seem a Sisyphean enterprise. Yet another warning that antibiotics are being overprescribed, this time in a letter in the April 11 issue of the New England Journal of Medicine (http://tinyurl.com/antibiotic-prescribing). The … Read more

Year:  2011  |  2010  |  2009  |  2008  |  2007  |  2006  |  2005  |  2004  |  2003  |  2002  | 2002 January Cover Story Making the Case for a Health Care Fed: Should Uncle Sam Decide What Works? Health Care Should Be More Transparent Harness Information To Make Health Care Work Something ‘NICE’ Can Come Out Of This When Physicians Skills Fail Collaboration Beats … Read more

Nearly 80 per cent of children hospitalized in the USA are awarded medication which were approved just for mature patients, a new study found. Even though the research did not start looking at safety problems, the clinic is potentially problematic, experts said. “the situation in which you are using a medication off-label is, often times, … Read more

Transparency in contracting is a great thing, but it takes vigilance to keep it from clouding over Linda Cahn “What’s in a name? That which we call a rose by any other name would smell as sweet.” Juliet was speaking of Romeo, and expressing a universal truth. Unfortunately, pharmacy benefit management companies (PBMs) would like … Read more

Presidentelect Donald Trump has plumped for Rep. Tom Price, a fierce critic of this Affordable Care Act and also a proponent of all of the country’s entitlement programs, to lead the Department of Health and Human Services. In A news launch Tuesday, Trump announced his variety of Cost, a third-generation physician who chairs the House … Read more

Conducted the trial, state the twice-a-year treatment might be safely supplied without or with statins, based upon individual patient requirements. Finally, inclisiran can help reduce the probability of heart attacks and stroke associated with high cholesterol. “We seem to have discovered a flexible, easy-to-take, protected, remedy These discounts are past what could be be achieved … Read more

BY NEIL CAESAR, J.D. The Stark II regulations allow many forms of physician compensation, as long as they are “commercially reasonable.” But the ambiguity of the law may spur some concern among physicians, who must try to determine how that phrase will be defined. This requirement shows up under Stark II’s approvals of employment relationships, … Read more

Health plans have many options to improve how they handle these costly therapies The effectiveness of biologic medications, like all other medications, is dependent on patients’ adherence, a challenging proposition. But data about measuring adherence are inconsistent and often difficult to interpret. The medications and the catastrophic conditions they treat are difficult to manage, and … Read more

s the breast cancer drug Avastin the opening salvo that brings efficacy, toxicity, and costs together? Who will blink first — health plans, providers, regulators, or patients? John Carroll Contributing Editor About three years ago, Medicare made a key change in how it covers cancer drugs for off-label uses. It expanded the number of compendia … Read more

Full text in PDF ABSTRACT Objective: To evaluate the effect of 17 alpha-hydroxyprogesterone caproate (17P) on reducing the rate of neonatal intensive care unit (NICU) admissions and premature births in a managed Medicaid population that has a history of preterm delivery. Specifically, to measure the effect of initiating 17P treatment during the recommended time frame of … Read more

Incorporating pharmacogenomic (PGx) information into an institutional formulary can be a daunting task because few standardized methods exist, making the analysis of clinical PGx data at the formulary level particularly difficult. Researchers at the University of North Carolina conducted a Medline search for articles that used terms such as “formularies, hospital,” and “pharmacogenetics.” This yielded … Read more

Even if the the goal is unattainable in this country, working toward it might produce interesting experiments in cost efficiency Frank Diamond Managing Editor What might be overlooked in recent reports about the viability of pay-for-performance pharmacy programs is this: It can’t happen. Or, at least, it can’t happen here in the United States at … Read more

Congressional Republicans, eager to please in an election year, seem willing to support a pharmacy benefit in Medicare. That, combined with the drug industry’s new willingness to negotiate on the issue, has heightened speculation that a benefit plan will pass this year…. Foundation Health has consolidated its commercial plans into two divisions — East and … Read more

Medical directors “define who they are based on how much they have achieved,” points out Thomas J. DeLong, PhD, of Harvard Business School, one of the experts quoted in our cover story about medical director burnout. How is achievement measured? Sometimes, medical directors are hopelessly caught up in the business of managed care, a long way … Read more

At a glance ‘Corporate Strategies For Women’s Health’ Washington Business Group On Health A few statistics: Projected female employees joining U.S. work force by 2000   63% Companies putting limitations (copayments, deductibles, caps) on behavioral health care that they don’t put on other health services   87% Companies with a sexual harassment policy   93% Companies with a workplace violence policy   57% … Read more

Because of this, FDA is working closely with the manufacturers to make sure a well-organized withdrawal out there from the USA, and also to make sure health care professionals have the information that they will need to closely sign their patients using Zinbryta to the following therapy. No new patients may begin accepting Zinbryta or … Read more

Providing free handheld or even desktop computers is a small step toward minimizing medication errors. Will docs finally abandon pen and pad? Tony Berberabe Associate Editor Physicians react to change in a many ways. Some are “early adopters,” some are “late adopters,” and some are “non adopters,” clinging stubbornly to the way they have always … Read more

The Department of Health and Human Services has created a task force to develop an Internet-based medical-error clearinghouse. The project will eventually link 10 federal data bases, including the Data Bank. On the heels of this came a pronouncement from the provider community that U.S. health care “isn’t very good.” As part of its “Pursuing … Read more

224,000,000 dollars spent by Medicare to hospitalize beneficiaries who quit 1 of 6 HMOs within three months of their admissions 20,000,000 dollars Medicare would have paid to those six HMOs (now under federal investigation) if the same patients had remained members 710 physicians — out of 710 — told Western Journal of Medicine researchers they … Read more

As Congress wrestles with Medicare prescription-drug coverage, HMOs are considering how such a mandate would affect Medicare HMOs’ ability to compete for fee-for-service enrollees. A Barents Group study of HCFA data, current as of May, notes that 83 percent of Medicare HMOs’ basic plans offer a prescription benefit — perhaps Medicare HMOs’ most powerful lure … Read more

Standard & Poor’s expects the health insurance industry sector to continue to improve its credit rating in the second half of the year, according to its report “Rosy Midyear Outlook for U.S. Health Insurance in 2005.” This healthy glow can be attributed to a variety of factors, according to Shellie Stoddard, a credit analyst at … Read more

Type Title Author Story Dealing With Providers Always Takes Balance webadmin Story Prescription Drug Reimportation: Panacea or Problem? webadmin Story When Should Insurers Cover Off-Label Drug Usage? webadmin Story How MCOs Can Get Optimal Value from Their Pharmacy Benefit Managers webadmin Story What’s Good for the VHA Is Not So Good for Medicare webadmin Story … Read more

State lawmakers want hospitals to reveal what they’ve negotiated with health plans for lists of services that grow ever longer A few weeks ago the North Carolina legislature significantly upped the ante on what qualifies as price transparency in the health care industry. Lawmakers easily passed a bill that requires hospitals in the state to … Read more

Outcomes-based Pricing Program Puts Money in Beneficiaries’ Pockets Harvard Pilgrim’s program gives rebates to beneficiaries if Repatha doesn’t help them avoid a heart attack or stroke. Tom Price, the ACA’s Ardent Foe, Pushes For Repeal and Replace–With a Smile HOWARD WOLINSKY Affable and engaging, the new HHS secretary is a staunch conservative who says ACA … Read more

The issue is how extensive the list of covered medications should be for the new Medicare pharmaceutical benefit. The stakes are enormous. The United States Pharmacopeia isn’t what you’d consider a controversial organization. But when Congress selected USP to develop a model drug formulary that could be adopted by pharmacy benefit managers and health plans … Read more