The 37-year-old has a title: executive vice president of Optum. But she wears many hats, including running a division that sells affordable hearing aids that cost from free to $599 for UnitedHealthcare members. Non-plan members can get similar hearing aids for up to 70% less than they’d pay in other outlets.
Opioid overdoses have killed more than 300,000 since 2000—and the death rate is rising. Buprenorphine could save thousands more lives than it does—if it weren’t for legal barriers, a fear of disruptive patients, and insurance red tape. And it can be prescribed in the primary care physician’s office.
The medical home model for delivering health care is getting tested for people with mental health problems. Missouri has been a pacesetter. By using a cost-based prospective payment system for health home patients, Missouri Medicaid shifted providers’ emphasis from periodic acute care-to-care management with a focus on preventing high-cost exacerbations.
IN THIS ISSUE
Demand for mental health services outstrips the supply of psychiatrists. Aggravating the situation: Many psychiatrists don’t take insurance. Nurse practitioners and physician assistants are beginning to fill the gap.
Q&A
Insurers are playing ‘small ball’ and not showing leadership, says the former congressman. And some ‘spin-dry’ inpatient providers are doing more harm than good in combating the opioid epidemic. Meanwhile, Kennedy, who chronicled his own harrowing mental health and addiction struggles in a 2015 memoir, says he has been sober for more than six years.
Palliative care would fill a need and could save health care dollars in the process. But providers often need to patch together CPT codes to get paid for it.
LEGISLATION & REGULATION
Nonquantitative treatment limitations may be why care for mental health and substance abuse disorders isn’t keeping up with coverage gains.
MEDICATION MANAGEMENT
Some say gene editing platforms like CRISPR are a truer version of gene therapy because they are designed to home in on a particular genomic location.
VIEWPOINT
Because physicians and health plan members both value choice, the current weak market for Inflectra and Renflexis could be a passing phase.
TOMORROW’S MEDICINE
Ingrezza and Austedo were approved last year. ICER calculations raise questions about their price.
NEWS & COMMENTARY
Paul 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.