ISSUE APRIL 2018 - Managedcaremag.com

ISSUE APRIL 2018

Opioid Deaths Among Women Not Getting the Attention They Warrant

FRANK DIAMOND

Deaths of women from opioid addiction spiked 400%, according to CDC data. Alison Colbert of Duquesne University argues for a gender-specific approach.

Social Determinants of Health: Stretching Health Care’s Job Description

LOLA BUTCHER

Providers and payers are being asked to tackle the ‘upstream’ causes of poor health. Medicaid managed care organizations are being asked to screen enrollees for social needs. Some targeted efforts have translated into cost savings and make sense in value-based arrangements. But are we asking the health sector to take on too much?

3 Social Determinants Strategies

A look at three different approaches that seek to address social needs in a strategic and somewhat comprehensive way. At this point, all of them are experiments, and no one knows which will prove to be sustainable, replicable, or even beneficial to the patients and communities they seek to serve.

Ending Medicaid as We’ve Known It

The Trump administration and CMS Administrator Seema Verma are on their way to giving the 53-year-old Medicaid program a major makeover, changing it from being an entitlement program based on income to something that may more closely resemble a temporary assistance program with work, premiums, and other…

Karl Brown’s Hardscrabble Roots Prepared Him for His Medicaid Mission

FRANK DIAMOND

Karl Brown, MD, the chief medical officer of Molina Healthcare of Utah, emphasizes that growing up he didn’t have it as bad as most of the Medicaid beneficiaries he’s responsible for. But he did learn how to tough out an illness. “If you were sick, you just hoped you got through it OK,” says…

How RWE Is Becoming the Real Deal

THOMAS REINKE

Second of two parts The FDA is laying groundwork that will play a major role in determining the future of real-world evidence. In just a few years the use of RWE has expanded dramatically, but it has yet to establish a clear role for itself. As evidence, it continues to take a back seat to randomized…

Medical Tourism: Once Ready for Takeoff, Now Stuck at the Gate

RICHARD MARK KIRKNER

Denver businessman Thomas Hiland was typical of the medical travel tourist. In 2005, he needed a mitral valve replacement. This was before the ACA’s guaranteed issue mandate, and he could not get health coverage. A nearby hospital quoted him $150,000 for the procedure; other U.S. hospitals priced…

Career Opportunities

Health Alliance Plan (HAP): SVP Business Development & Chief Marketing Officer

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising. Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to [email protected](link sends e-mail) or online at http://p.rfer.us/HENRYFORDlXqAJA(link is external)

IN THIS ISSUE

EDITOR’S MEMO

Taking On Too Much

PETER WEHRWEIN

LEGISLATION & REGULATION

Why Medicaid Managed Care Is Looking Outside the Traditional Coverage Box

RICHARD MARK KIRKNER

Social determinants of health come into focus to keep beneficiaries out of the hospital.

MEDICATION MANAGEMENT

Take a Bow, Pharma, for the Hepatitis C Drugs

The direct-acting virals revolutionized the treatment of hepatitis C. They also ushered turbocharged pricing. At least patients—and society—got a major health benefit in return.

THE PAYERS’ PLAYBOOK

Aetna’s California Case Puts New Focus on Prior Authorization

JOSEPH BURNS

The CNN story once again puts controversy about prior authorization into the spotlight. But is it necessary to review the entire medical record?

VIEWPOINT

Finding Our Way To Serving the Underserved

ZACHARY HAFNER

BOOK REVIEW

Take the Slow Boat To Healing

PETER BOLAND

VIEWPOINT

Questions Health Plans Must Ask Before Considering a Laboratory Benefit Management or Prior Authorization Program

TOMORROW’S MEDICINE

New Test for Diagnosing Insulin Resistance Could Turn the Tide Against Diabetes

THOMAS MORROW, MD

Diabetes is the scourge of our times, but we have been chasing the wrong culprits. A simple, $40 test of insulin resistance could put us on the right track.

NEWS & COMMENTARY

Deep Brain Stimulation Presents Radical Fix to Dire Opioid Crisis

NEWS & COMMENTARY

Earlier Diabetes Increases Mortality

NEWS & COMMENTARY

CVS To Dominate Pharmacy Networks

NEWS & COMMENTARY

Opioid Overdoses In Children Soar

NEWS & COMMENTARY

Managed care rules in Medicaid

NEWS & COMMENTARY

Briefly Noted April 2018

Paul Lendner

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.

Career Opportunities

TRENDING

IN THIS ISSUE