MC TV The Evolving Biosimilars’ Landscape Explore the complexities of the biosimilars’ landscape, such as naming, interchangeability and substitution, differences in the manufacturing processes, as well as the approval pathways & FDA guidelines for biologics, including draft guidance on biosimilars. USA-BIO-106112 MC TV The Evolving Biosimilars’ Landscape Explore the complexities of the biosimilars’ landscape, such … Read more

Expect more denials as more specialty drugs are introduced and prescribed Thomas Reinke Lurking behind the challenge of effectively managing high-cost specialty medications is the equally difficult challenge of managing an effective prior-authorization process. “The FDA labels for specialty medications are becoming increasingly detailed. We try to manage these medications in line with their approvals, … Read more

The Nuka Way One of the four 2011 Malcolm Baldridge National Quality Award winners in health care is Southcentral Foundation, a nonprofit organization established in 1982 to serve Alaska Natives who live in and around Anchorage. The Southcentral Foundation (SCF) describes itself as a Nuka system of care — Nuka being an Alaska native name … Read more

The Objective of the Data Protection Statement Will Be to notify you All of This The personal data collected might include your own address, town, postal Code, state, telephone number, current email address, ip, in addition to some private information which you decide to provide (“Personal Data”). This info is likely to likely be utilized … Read more

Oncologists hope to start a national discussion about which drugs are reasonable to prescribe and pay for In June, more than 30,000 specialists and researchers mobbed the scientific meeting of the American Society of Clinical Oncology in Chicago (ASCO), an annual rite of passage for virtually every major new cancer drug to be introduced to … Read more

Health plans have many options to improve how they handle these costly therapies Thomas Reinke 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 … Read more

United HealthCare and Humana, two of the nation’s largest for-profit managed care companies, have agreed to a $5.5 billion merger. The resulting company will operate as United HealthCare in 48 states and Puerto Rico. The move is one of the largest instances yet of the consolidation taking place in the managed care industry. When con- … Read more

Convenient care clinics, as they like to be called, are spreading quickly because members and plans like them In the past 12 months retail clinics have spread like a rash over the health care landscape — the kind of rash they can easily treat in 15 minutes or less, for around half the cost of … Read more

December was like a bad dream for Aetna U.S. Healthcare. The AMA raised a public stink against the nation’s largest for-profit HMO over its physician contracts in Florida. The same week, Rhode Island cracked down over a physician shortage. And, if this were not enough, a physician revolt in Texas against AUSHC widened. Actually, the … Read more

Using a rise of almost 3 percent each calendar yr, rectal cancer is just one among the most rapid growing factors behind cancer mortality and incidence. But additional wide spread screening and individual Papilloma virus vaccination might reverse this tendency. “It’s roughly that more than 75 percent of U.S. grownups have no idea that HPV … Read more

We have certified centers that do a great job for some patients, reducing downstream costs, but are of little benefit to others Under the radar screen for a very long time, stroke care and rehabilitation are changing dramatically, and that has major implications for managed care. After a stroke, 50 percent to 70 percent of … Read more

Libby Black, PharmD GlaxoSmithKline, Research Triangle Park, NC Thomas Hulsey, ScD Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC Kwan Lee, PhD GlaxoSmithKline, Brentford, London, United Kingdom Daniel C. Parks, PhD U.S. Payer Evidence Group, GlaxoSmithKline, Research Triangle Park, NC Myla D. Ebeling, RA Division of Neonatology, Department of Pediatrics, … Read more

The idea of evidence-based medicine lies at the heart of managed care. But looking only at today’s fairly crude quality indices would be like measuring a diamond with a tape measure. Does pressure for ever-improving quality ‘scores’ endanger the real quality of health care? By Maria Kassberg, Contributing Editor and Paul Wynn, Senior Editor These … Read more

They’re customized to local caseloads and conditions, they coordinate with primary care practices, and they focus on building trust with patients A busy primary care physician and a major insurance company in a health care system in the Northeast were becoming frustrated trying to manage the seemingly out-of-control HbA1c and dangerously high blood pressure of … Read more

Careful attention to a comprehensive treatment plan could forestall or prevent the need to add drugs and costs to a patient’s regimen Rachel M. Renshaw Diabetes treatment largely has been a matter of waiting for failure: Eat healthily and exercise, and if blood glucose isn’t controlled, try drug therapy. If that doesn’t work, add a … Read more

New Mexico has just granted medication-prescribing authority to psychologists — a development with broad potential implications for the field of mental health. I say “potential” because New Mexico is, after all, far from the centers of influence, and it’s possible no one will notice. But it’s a bold precedent. The intent is to allow better … Read more

The ACO Gamble It has been tried again and again. But government and private payers are wagering on ACOs as a way to hit the health care jackpot: managed costs and high quality. Robert Calandra Pioneer ACOs get props for financial, quality results Speaking Plainly: How One Health Plan Ungobbled the Gook Are confusing, repetitive, … Read more

Unlike cardiovascular disorder, including difficulties with the whole circulatory system, cardiovascular illness affects only one’s center disease. Based Approximately inch at 4 deathsTrusted Source from the U.S. occur as a result of cardiovascular problems, which affects most of sexes in addition to all racial and cultural groups. Within the following guide, find out more about … Read more

A Conversation with Suzanne F. Delbanco The executive director of the Leapfrog Group says that the organization pleads guilty to trying to create ‘aspirational’ standards for health care. Suzanne F. Delbanco is the first executive director of the Leapfrog Group. Founded by the Business Roundtable in the fall of 2000, the group seeks to mobilize … Read more

It wasn’t that long ago that the buzz in health care circles was about Express Scripts flexing its muscle to negotiate deep discounts for the new hepatitis C drugs. CVS Caremark and UnitedHealthcare’s OptumRx followed suit. Unfamiliar to the public, PBMs seemed to be emerging as the new heavy hitters of American health care, doing … Read more

Three health plans outline steps they are taking to deal with the effects of growing consolidation of providers Joseph Burns 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 … Read more

Sometimes patients are angry. Sometimes it is a symptom of their illness. Either way, nurses are on the front lines of health care and bear the brunt of the physical and verbal abuse from patients; gender may be a factor. In California, hospitals and other health care providers are now required to keep a log … Read more

Now that large companies are adding health information to their benefit portals on the Web, insurers will have to work more closely with them. Offering provider directories online to employees is now a ubiquitous practice, but years ago, General Electric beat most insurance companies to the punch. Today, GE has put hospital and physician rating … Read more

Some of the biggest insurers in the country will do whatever it takes to promote their offerings under Medicare’s new prescription drug benefit Every three months, Roger Gates checks the pulse of the new Medicare Part D drug benefit. His latest diagnosis: It’s weak, and not showing much life. Back in June, Gates’s market research … Read more

Beware of the spillover effect regarding the endorsement of 12 measures for coordination of care last month by the National Quality Forum. The measures focus on areas such as medication reconciliation, proper use of the ED, and timely initiation of care. “The NQF has a special line to/relationship with Medicare, so anything recommended by NQF … Read more

John Marcille You can’t blame them, really. You can’t fault state legislators for looking for fiscal relief from the foundations created when not-for-profit health plans become for-profit entities. The organizations are expected to dispense around $450 million a year to widely diverse causes that fall under a broad — very broad — description of a … Read more

President and Ceo of Palatin Technologies. “Contrary to corticosteroids, immunosuppressive agents, and biological treatments targeting specific cytokines or glands, melanocortin receptor inch peptides work to solve chronic inflammations and restore normal immune function. We anticipate initiating clinical trials together with PL-8177 to get non infectious uveitis, a top medical requirement disorder with limited treatment choices.” … Read more

A new device can partially restore central field vision to thousands who suffer from a common cause of blindness The Hubble, an enormous telescope orbiting the globe, is a wonder of 20th century science that allows us to see far into the cosmos. On a totally different scale, medical scientists have developed the smallest telescope … Read more

Use telehealth to avoid expensive inpatient care and deliver excellent care to even the most remote places. Who says a hospital needs to have beds? Certainly not the executives at Mercy Virtual Care Center, the world’s first virtual hospital. Housed in a slick new building outside of St. Louis, the doctors and nurses gather in … Read more

John Marcille It’s a fact that the nature of managed care as it has evolved, with the HMO or some other insurance (or sometimes just administrative) company in the position of paying for everything but often not having the last word on what’s being done in the clinics, has frustration built into it. Why do … Read more

Nausea and vomiting are the most frequent side effects in patients undergoing chemotherapy, which badly impact the standard of life of compliance and patients together with chemotherapy. The antagonists of all 5-hydroxytryptamine-3 receptors would be most reliable in curing chemotheapy-induced nausea and throwing up. Trans-dermal granisetron has been approved at 2008 by FDA for treating … Read more

By a 392 to 26 vote, the House of Representatives passed the 21st Century Cures Act, which would speed FDA approval for drugs and medical devices and allow the agency to include real world evidence in the approval process. Drug companies will be able to submit drug data summaries, instead of the clinical trials that are … Read more

In favor of advocating the approval of GP2015, Sandoz’s planned biosimilar into Amgen’s Enbrel. Biosimilar to address rheumatoid arthritis, polyarticular juvenile rheumatoid arthritis in patients aged two decades or older, rheumatoid arthritis, ankylosing spondylitis and plaque psoriasis. When approved, Sandoz noted GP2015 may help expand treatment alternatives readily available to patients, healthcare providers and payers. … Read more

Before the ACA, Then the Amount of uninsured Americans Climbed Overtime, From 2013, the season ahead of the significant policy terms and conditions of the ACA went to effect, over 44 million people lacked policy. Inch Underneath the ACA, huge numbers of people have attained medical care, and also the prosecution rate dropped to a … Read more

The Medicare Payment Advisory Commission is asking Congress to promote primary care and to hold providers accountable As health insurers search for ways to address unsustainable cost increases, an influential government commission is urging Medicare to step into the lead. The Medicare Payment Advisory Commission, which advises Congress regarding the Medicare program, recommends reorganizing the … Read more

Genetic testing has taken off and may usher in a new era of genetically tailored health care. Insurers are figuring out how to cope with the avalanche of information. Could genetic counselors as standalone practitioners be part of the answer? Americans have fallen in love with the genetic test. They’re convinced their own personal genomes … Read more

At a glance Gateway Purchasing Association St. Louis, Mo. Founded: 1995 Members: 26 large employers Covered lives: 250,000 First-year accomplishments: HMO enrollment up from 27 percent to 36 percent Aggregate HMO premium expenses 19 percent lower in 1996 than they would have been by 1995 rates Planned for Fall 1996: Consumer report cards with member-satisfaction and HEDIS data Managed … Read more

“Advanced access means that if somebody wants an appointment, you offer the appointment for today.” It’s not that difficult to implement. Bob Carlson Contributing Editor The longer the wait for an appointment, the better the doctor, right? Not any more. Not when happy patients start telling friends and neighbors about the excellent doctors who can … Read more

CMS’s vision of a new kind of managed care organization fails to demand anything of patients while placing added pressures on providers Richard G. Stefanacci, DO, MGH While much has been written about accountable care organizations (ACOs), especially the myriad items for which these organizations are held accountable, little has been discussed about the roles … Read more

By E. Loren Buhle Jr., Ph.D. Organizations establishing “dot.com” operations on the Internet are Wall Street’s darlings, offering the lure of large profits when the organization goes public. This presumes that online operations will supercharge their markets — and investors’ pocketbooks. While online organizations are truly changing the commercial landscape, online drugstores have many issues … Read more

Health plan consolidation is giving the industry the mass it needs to do this year what was predicted last year, but didn’t happen: boost premiums substantially to prop up the bottom line.Hewitt Associates, the consulting firm, predicts nationwide premium hikes of 7 to 10 percent, up from last year’s average 3.7-percent increase. Glimpses of what’s … Read more

Assessing the length of the industry exclusivity and reacting precisely to the modern agglomeration of patent expiries are critical to the results of all pharmaceutical businesses. This methodical review investigates various tactical and strategic management strategies by obeying the appropriate literature and practical cases on patent sampling approaches. It discusses the way the mixture of … Read more

Primary care physicians experienced a 2.8 percent median increase in compensation last year, and specialists in general reported a 4.3 percent median increase, although some notable medical specialties experienced decreases in compensation. Results are compiled in the Medical Group Management Association’s Physician Compensation and Production Survey: 2003 Report Based on 2002 Data. Invasive and noninvasive … Read more

MD Anderson has some experience with this sort of ambitious effort, and its president has some can-do suggestions to make it work. Peter Wehrwein PDF version: MC_1602_Cancer_Moonshot.pdf Tweet Widget(link is external) President Obama’s announcement of a “cancer moonshot” to cure cancer in his State of the Union address is a reminder that cancer is now … Read more

P&T Digest: Pain Management Randall P. Brewer, MD, Chief Medical Editor Chronic pain is a significant public health issue in the United States and an important concern for MCOs. Untreated or undertreated pain can evolve from a symptom to a chronic condition in its own right, one that has serious comorbid, economic, and quality-of-life consequences. … Read more

Case management, prior authorization, and drug utilization control are required Tom Reinke In the world of pharmacy benefits, health plans and PBMs have generally done a good job of meeting customers’ needs — the needs of employers. Costs have been brought under control, financial transparency has improved, benefit designs are flexible, and adherence programs are … Read more

The Final ACA Wellness Provisions and the Reticence of the EEOC Though the Department of Health and Human Services and Department of Labor issued final regulations concerning “Incentives for Nondiscriminatory Wellness Programs in Group Health Plans,”1 employers and health plans must still navigate unresolved inconsistencies between the Affordable Care Act (ACA) and the Americans with … Read more

Study shows how mindfulness meditation reduces pain   A new study demonstrates that mindfulness meditation works on a different pain pathway in the brain than opioid pain relievers. The researchers noted that because opioid and nonopioid mechanisms of pain relief interact synergistically, the results of this study suggest that combining mindfulness-based and pharmacological/nonpharmacological pain-relieving approaches … Read more

HMOs Continue Losing Ground On Liability Issues at State Level The recent U.S. Supreme Court decision offers a nice breather, but executives should not let down their guard, as an Illinois ruling shows. Electronic Medical Records: If Not Now, When? The technology’s been around, but early participants often were burned. New Internet-based products threaten to … Read more

Artiss, a fibrin product, is a breakthrough, allowing burn patients to avoid anesthesia, staples, and a subsequent operation to remove the staples Most people dread a severe burn. Each year there are about 2.4 million burn injuries in the United States; half a million people require medical attention, and approximately 4,500 die. Skin grafts are … Read more

Washington Watch Medicare reform — and especially prescription drug benefits within Medicare — no longer appears to be the burning issue it once was on Capitol Hill. The culprits: priorities and money. “It’s looking like the price may be too high, and I think there’s no sense of urgency about it right now,” one Capitol … Read more

If everyone can see what everyone is doing, we’ll have better care at lower costs. First task: Create common standards. Martin Sipkoff Contributing Editor Our health care system is as huge and cumbersome as an elephant, and all the players — like the blind men in the story — see the elephant differently. Doctors holding … Read more

Submitted by Paul Terry on Thu, 2012-01-12 11:05 Having just finished reading Walter Isaacson’s brilliant rendition of Steve Jobs’s life and career, I’ve considered whether there are health care marketplace lessons to be garnered from his central casting in the extraordinary tech wars for primacy over the past 25 years. I’d commend this biography to anyone who … Read more

Sen. Ron Wyden’s bill promises to provide universal coverage without draining the federal treasury. Too good to be true? A universal coverage plan that has been gradually gaining the support of senators cleared a major obstacle recently, winning an opinion from the Congressional Budget Office that it could actually generate budget surpluses after it becomes … Read more

The Segal Co., a New York-based consultant to employers, estimates an 18-percent increase in the cost of providing a pharmacy benefit this year. Prescription-drug claim expenses are expected to consume 15 percent of all costs of providing health benefits to active employees and retirees under age 65, and 40 percent of the cost for retirees … Read more

Two California HMOs are hanging their physician group ratings out on the Internet for the world, literally, to see. Health Net’s report cards Health Net’s second annual member satisfaction report card separates groups by region. Performance is relative to other physician groups in that region. Group ratings of “excellent,” “very good,” and “good” are derived … Read more

The pendulum has swung back and forth on hormone replacement therapy. Bespoke and supposed more ‘natural’ hormone combinations put together by compounding pharmacists have become popular. Mainstream endocrinologists see compounding as risky, partly because the practitioners who prescribe it may not see the dangers. JoAnn Pinkerton, MD, a gynecologist whose medical practice focuses on women’s … Read more

For 25 Years … The Leading Voice in Managed Care In-depth reports, original research, news, Q&As; with nationally respected health care leaders, and expert commentary on the latest developments in medicine, pharmacy, and biotechnology in relation to managed care. Managed Care delivers high-interest full-length articles and shorter features on clinical and business aspects of the … Read more

Injectable drugs should be covered by Medicare if beneficiaries administer them less than 50 percent of the time, according to a clarification on this issue by the Centers for Medicare and Medicaid services that’s set to take effect Aug. 1. The clarification aims to resolve CMS’s ambiguity on injectable drugs. It came in a memo … Read more

Though the medications are used by only a small percentage of the population — about 1 to 5 percent — spending on specialty drugs has grown between 15 and 20 percent for several years. That is expected to continue to outpace nonspecialty spending for several reasons: a high percentage of newly approved drugs will be … Read more

In 2002, Jeffrey Brenner, MD, founded the Camden Coalition of Healthcare Providers, one of the earliest efforts to identify and care for the neediest—and most expensive—patients. These patients are the 5% of the U.S. population who account for 50% of all health care spending, as the federal Agency for Healthcare Research and Quality (AHRQ) has … Read more

PEER-REVIEWED Retrospective Cohort Study of Medication Adherence and Risk for 30-day Hospital Readmission in a Medicare Cost Plan ABSTRACT Purpose: Reducing hospital readmissions requires deploying appropriate interventions to groups at highest risk for readmission. Long-term medication adherence may indicate one’s ability to manage recovery and chronic illness after discharge. If so, medication adherence also may be … Read more

Name Last modified Size Description Parent Directory 04-Jan-98 21:46 – 9702.badrap.shtml 21-Mar-97 15:43 17k ../../archiveMC/9702/9702.compmon.gif 21-Mar-97 15:43 20k 9702.compmon.shtml 21-Mar-97 15:43 3k 9702.compmon2.gif 21-Mar-97 15:43 20k 9702.contents.shtml 21-Mar-97 15:43 3k 9702.editorsmemo.shtml 21-Mar-97 15:43 2k 9702.electronic.shtml 21-Mar-97 15:43 22k 9702.employer.shtml 21-Mar-97 15:43 8k 9702.ethics.shtml 21-Mar-97 15:44 7k 9702.frogreply.shtml 21-Mar-97 15:44 10k 9702.legal.shtml 21-Mar-97 15:44 7k ../../archiveMC/9702/9702.news.gif … Read more

The estimated annual cost of treating patients with sepsis is approximately $20 billion in the United States, making sepsis the costliest medical condition in this country. Each year, an estimated 750,000 people die from sepsis in the U.S. But according to an article in the Journal of the American Medical Informatics Association, a hospital in Huntsville, … Read more

Joseph Burns Contributing Editor For-profit insurers will evolve by developing lines of business beyond health insurance, predicts Wendell Potter, an author and former insurance company communications executive. “I don’t see insurers going out of business,” says Potter, the author of Deadly Spin, An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care … 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

We have identified 11 technologies and financial arrangements that may affect American health care.  Please indicate which category you believe most accurately describes their future over the next 2–5 years. • Follow this link to take the survey.

Assessing the quality of medical care delivery is just one among the most critical challenges confronting US medical care. Performance measurement is utilized to track the caliber of maintenance which health plans and healthcare groups deliver, however efficient performance dimension demands timely use of accurate and detailed data. Tracking clinical operation will require not merely … Read more

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – ../../../archives/0001/0001.compmon.gif 01-Jan-2000 12:00 39k 0001.compmon.html 07-Jun-2003 12:33 2k ../../../archives/0001/0001.compmon.pdf 01-Jan-2000 12:00 42k 0001.contents.html 09-Apr-2003 23:25 3k ../../../archives/0001/0001.cover.jpg 01-Jan-2000 12:00 10k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 12k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 15k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 15k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 16k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 8k 0001.dmpac.chartpac…> 01-Jan-2000 12:00 7k 0001.dmpac.chartpac…> … Read more

The FDA has approved the supplemental new drug application for carfilzomib (Kyprolis, Amgen) for injection in combination with dexamethasone or with lenalidomide (Revlimid, Celgene) plus dexamethasone for the treatment of patients with relapsed or refractory multiple myeloma who have received one to three lines of therapy. The FDA also approved carfilzomib as a single agent … Read more

MANAGED CARE January 2000. ©1999 MediMedia USA The Department of Health and Human Services extended the comment period for proposed privacy regulations to Feb. 17, giving groups time to determine whether unintended consequences would prevent coordinated care…. Only 5.9 percent of HMO members rate trust in their health plans “very high” in a National Research Corp. survey. … Read more

This knowledge won’t come cheap, as the system braces for new agents that could add another $42 billion to the nation’s drug bill. There are at least two sides to every story, including the one involving the PCSK9 inhibitors. Oftentimes, one side of a story can overshadow the other, and that seems to be the … Read more

Charges by lawmakers that insurers don’t spend enough on medical services lead to provisions in health reform bills in the Senate and House John Carroll MANAGED CARE January 2010. ©MediMedia USA Charges by lawmakers that insurers don’t spend enough on medical services lead to provisions in health reform bills in the Senate and House John Carroll As … Read more

PBMs: New Power and Influence They are bigger than ever. Specialty pharmacy drugs have made their bargaining power more important than ever. Do the P and B in PBM stand for power broker? Robert Calandra PBMs Just Say No to Some Drugs–But Not to Others Formulary exclusions give them added clout with drug companies in … Read more

Changes in reimbursement patterns for obesity drugs will take several years. Lifestyle changes remain the first approach. According to a recent survey, health plan pharmacy and medical directors remain skeptical about the value of obesity drugs. But drug companies are undeterred: The prevalence of obesity, and its dangerous comorbidities, encourage a demand by doctors for … Read more

Zika virus illness may appear as a consequence of both mosquito-borne or sexual performance of this virus. Disease while pregnant is an effect of esophageal brain abnormalities along with also other serious birth defects (inch ,two ). CDC has upgraded the meantime advice for men with potential Zika virus vulnerability who ) are likely to … Read more

Medicare beneficiaries may soon receive more information about the effectiveness of the health plans they’re enrolled in — or are considering joining. HCFA has proposed guidelines for a Health Plan Management System, based in part on the National Committee for Quality Assurance’s Health Plan Employer Data and Information Set, or HEDIS. Health plans would be … Read more

MANAGED CARE March 2005. ©MediMedia USA TOMORROW’S MEDICINE A single strand of nucleic acid may hold the key to treating the leading cause of severe vision loss and blindness resulting from age-related macular degeneration. Thomas Morrow, MD Age-related macular degeneration (AMD) is a chronic progressive disease of the macula that causes central loss of vision. This disease … Read more

BY JOHN A. MARCILLE Anyone who’s ever said that government should be run as a business doesn’t understand government — or business. Governments provide services. That’s a job as sloppy as collecting trash and one in which the bottom line isn’t the only consideration. The government/managed care analogy may not be seaworthy when tossed upon … Read more

Health plans are not fully using data that could improve the management of pharmacy for older patients, according to a study conducted by the PBM Prescription Solutions and published in the American Journal of Managed Care. The results could help MCOs prioritize specific medications and patients to target for interventions designed to reduce the use … Read more

Milliman and VBID Health are an advanced tool named MedInsight which may go via a claims database and also detect 4-7 presumably unsuccessful tests and procedures, based to Modern Healthcare. Modern Healthcare additionally said that it is scheduled to print a written report with R and about unsuccessful services (and spending) one of Medicare beneficiaries.” … Read more

New alliances are emerging in the field of medical research. Where does managed care fit in? And how does it affect the research agenda? Before White House affairs knocked national ones off the front page, the new year produced a flurry of debates about medical research. In his fiscal 1999 budget, President Clinton proposed a … Read more

Name Last modified Size Description Parent Directory 04-Jan-98 21:46 – 9709.behavioral.chart..27-Oct-97 00:32 22k 9709.compmon.pdf 26-Sep-97 03:04 16k 9709.compmon.shtml 26-Sep-97 03:04 1k ../../archiveMC/9709/9709.compmontop.gif 26-Sep-97 03:04 25k 9709.contents.shtml 28-Oct-97 01:42 5k 9709.editorsmemo.shtml 28-Oct-97 01:42 3k 9709.employer.shtml 17-Oct-97 02:18 9k 9709.ethics.shtml 14-Oct-97 23:27 8k 9709.hedisforms.shtml 05-Oct-97 21:56 13k 9709.legal.shtml 05-Oct-97 21:56 8k 9709.news.select.gif 03-Oct-97 02:18 28k ../../archiveMC/9709/9709.outlook.gif 22-Oct-97 … Read more

While researchers see flaws in the MA program, the federal government seems content to pay insurers billions of dollars in bonuses each year—at least for now. Health plans see MA as as a pretty attractive market for the most part, says Gretchen Jacobson of the Kaiser Family Foundation. Health insurers are never going to win … Read more

All the state-of-the-art health care literacy tools go for naught when faced with such ignorance   At a time when people make decisions about health care based on input from friends, family, physicians, the Internet, and a myriad of other sources, you can count Charlie Baker as a believer in the positive influence of a … Read more

Health plan premiums are headed up more steeply in the Southeast than in other areas next year, but the region will experience the slowest growth in per-capita medical costs. Pennsylvania-based Sherlock Corp., a managed care research and consulting company, reports that nationwide, employers expect premiums to rise significantly — 8.3 percent. Southeastern employers say their … Read more

Devices that selectively destroy the renal nerves that affect hypertension have gained international approval, and availability in the United States is not far off For more than three decades the National Heart, Lung, and Blood Institute has guided medical care for high blood pressure and raised awareness of the need for proper control. We know … Read more

January 2001 February 2001 March 2001 April 2001 May 2001 June 2001 July 2001 August 2001 September 2001 October 2001 November 2001 December 2001

The bipartisan attempt to work out an agreement to fix the Centers for Medicare & Medicaid Services physician payment schedule has fallen apart. This means that physician payments will be cut 10.6 percent on July 1 and probably another 5 percent or more on Jan. 1, 2009. “This would be the second time that Congress … Read more

Mark D. Abruzzo, J.D. The Illinois Supreme Court last fall followed a national trend of courts holding managed care organizations liable for medical malpractice under a variety of traditional legal theories. That court, in Petrovich v. Share Health Plan, ruled that HMOs can be liable vicariously for acts of their contracted physicians under theories of … Read more

Electronic Medical Records: High Hopes Meet Harsh Reality Nobody doubts that the electronic medical record will promote better medicine, but at what cost? And to whom? Providers fear that they will bear the weight. Accrediting Agencies Turn Attention To Consumer-Directed Health Plans If employers make decisions based on URAC’s and NCQA’s rating of traditional managed … Read more

“Postpartum depression is a severe illness which occurs when severe, can Be life threatening. Women might experience thoughts about hurting themselves or damaging their kid. Post partum depression may also interfere with all the maternal-infant bond. This approval marks the first time that the medication was approved to deal with post partum depression, providing a … Read more

Diabetic Medicaid Members May Need More Than Phone Outreach As if the worsening diabetes epidemic were not enough to worry about, this chronic condition also increases risk for complications like heart disease, stroke, and kidney failure. This is a major challenge for health plans managing the care of a growing population of Medicaid members, who … Read more

United HealthCare surveyed 20,000 family physicians, internists and cardiologists in 23 of its health plans to determine how their practice compares with nationally accepted protocols. The project, says United’s chief medical officer, Lee Newcomer, M.D., is not designed to find fault, but rather to provide physicians with information they may be able to use to … 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

Donald P. “Rocky” Wilcox General Counsel, Texas Medical Association POINT:COUNTERPOINT “States Failed To Protect Docs From Insurers” by Donald P. “Rocky” Wilcox “Patients Will Suffer; Greedy Lawyers to Blame” by Stephanie W. Kanwit States Failed To Protect Docs From Insurers Plaintiffs in the federal Racketeer Influenced and Corrupt Organizations (RICO) managed care consolidated class are trying to … Read more

MANAGED CARE November 2007. ©MediMedia USA Microsoft has entered the consumer health care market with a free personal health record on the Web («http://www.healthvault.com/»). HealthVault will store, collect, and distribute private health information that can be shared with a physician, a clinic, or a hospital. Information that can be shared includes what medications the individual takes and … Read more

Health plan officials are still trying to determine just how the final rules for the new Medicare prescription drug benefit will affect them, because it appears that government officials tried their best to address the competing concerns of all players. The Centers for Medicare and Medicaid Services unveiled regulations on Jan. 21 that would allow … Read more

The National Committee for Quality Assurance has given health plans a compelling reason to set up external-appeals processes for members who have exhausted internal avenues for redress. Beginning next year, HMOs seeking accreditation must have a third-party reviewer — an independent, NCQA-approved organization — in place. In the wake of expensive jury verdicts and under … Read more

What Happened to EBM? Evidence Based Medicine The drumbeat of EBM — Evidence Based Medicine — seems less vigorous in the wake of enthusiasm for new models of care — Medical Homes and Accountable Care Organizations — and reimbursement based on performance, outcomes, or episodes of care. A good definition of EBM from Sackett, et. … Read more

The Next Frontier: Patient Engagement Seeking the best return on shared-savings programs such as PCMHs and ACOs, health plans are investing cash and other resources to attract and hold patients’ attention Reformed UCR Calculations Not Without Problems Ingenix was criticized for understating UCR rates, but newer formulas also enrage members who get big balance bills … Read more

Key PBM Functional Areas Require Radical Transformation In large part, the growth of specialty pharmacy will require pharmacy benefit managers to become more active on behalf of payers and patients   The advent of the Medicare Part D program in January 2006 along with other government initiatives has commoditized the traditional pharmacy benefit management (PBM) … Read more

LOOKING FORWARD For other articles in the series, see listing at end Now that the hard part — forging quality-measurement systems for HMOs and point-of-service plans — has been done, the next step is to adapt these programs to the rest of the health care industry. Margaret E. O’Kane Twenty years ago, when fee-for-service practice … Read more

Medical group practices that are owned by hospitals or integrated delivery systems (IDS), or are just affiliated with them, are no more immune to cost increases and pressure on payment rates than are their physician-owned practice counterparts. New data indicate that total operating costs per full-time equivalent (FTE) physician in IDS medical group practices increased … 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

DM programs will have amazing patient-monitoring technology at their call. The challenge will be to make good use of the data. Steven S. Eisenberg, MD This article is excerpted from Chapter 6 of The Next Generation of Disease Management: 2009 and Beyond, edited by Jill Brown and Al Lewis. I am not a soothsayer but I … Read more

Don’t look now payers, but expect to be double-teamed by hospitals and physicians. With Medicare payments and the Prospective Payment System getting squeezed, the biggest revenue stream for both hospitals and physicians is — wait for it — you. And the need for hospitals and physicians to collaborate on care management to reduce costs is … Read more

With one Connecticut physician calling it “the biggest thing since the Beatles,” Viagra, Pfizer’s popular pill for impotence, has burst onto the scene like few others. Its popularity seems to have caught insurers off guard as they scramble to develop a yardstick for coverage. According to IMS America, which tracks pharmaceutical trends, physicians were writing … Read more

Steven Peskin, MD “You Can’t Outrun Your Past”…….. The title of a slide in a grand rounds presentation by Dr. David Kountz, senior VP for medical and academic affairs at Jersey Shore Medical Center and professor of medicine, UMDNJ-Robert Wood Johnson Medical School. The subtext is that the impact of being black in our society … Read more

MANAGED CARE October 2003. ©MediMedia USA Urinary tract infections (UTIs) can be managed safely and conveniently over the phone with low recurrence rates and a low incidence of other gynecological complications, researchers reported on Sept. 14 at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Chicago. UTIs result in nearly 8 million visits annually to … Read more

Insurers can expect spending on traditional medications to remain relatively flat over the next few years, but watch out for specialty drugs because that’s where costs will soar, according to the 2013 Drug Trend Report by Express Scripts, released in April. Spending on traditional drugs will climb about 2% annually until 2016, while spending on … Read more

Researchers at Merck have found a way to return antibacterial efficacy to agents that have lost their ability to kill certain types of bacteria. In a paper published in Science Translational Medicine, the team describes a search for molecules capable of interfering with one of the main defense mechanisms that bacteria have developed to resist antibacterial … Read more

Meaningful use or not, electronic medical records are not delivering on the promise of improving care management John Carroll Back in 2009, the newly installed Obama administration included a $27.3 billion carrot for health care providers in a special provision of the economic stimulus bill that lawmakers hoped would trigger an IT revolution in health … Read more

Managed Care’s full collection of Compensation Monitor articles on physician and health plan executive compensation Chief medical officers of HMOs have highest incomes in the Northeast, but their mean incomes are only about $200 more than the average total compensation of CMOs from the next most prosperous region — the West North Central area consisting of Iowa, … Read more

How Patient-Centered Medical Homes May Change U.S. Medicine These re-engineered versions of the primary care practice have been discussed since 1967. Has their time come at last? Steven R. Peskin, MD, MBA, FACP Will the New Fat-Fighter Drugs Be More Worthy of Coverage? Diet and exercise are increasingly seen as only the first steps in … Read more

Imagine winning the lottery. But before you get too carried away, also imagine you have 10 kids and lots of poor relatives. Now you have some sense of what it’s been like for states to decide how to use $8 billion in tobacco settlement money. According to a July survey by the National Conference of … Read more

PLAYERS Those who make deals between buyers and insurers are used to perks and tidy commissions. The Internet and defined contributions may threaten that. When Tom Elkin decided to sign on as CEO of a start-up, not-for-profit HMO in California five years ago, he had every reason to feel confident in his knowledge of the … Read more

The physician lobbying organization wants insurers to stop contributing to the growth of limited-care offices in chain stores John Carroll At the end of the American Medical Association’s recent annual gathering in Chicago, it dispatched the delegates back to their home states with a fresh set of marching orders. This year, the physicians’ lobbying agenda … Read more

Turning to the Internet to help identify its high-risk members and monitor their care, Humana has embraced a Rhode Island company’s new personal-health assessment tool. Offered by QualityMetric Inc., the online service (www. amIhealthy.com) allows anyone with a personal computer to create a unique health profile that tells what the results mean, and what a … Read more

Submitted by Steven Peskin MD on Mon, 2012-03-12 23:56 So many gaps, so little time…. That would be a ready conclusion from the extensive body of literature on gaps in patient care, medical errors, and patient safety. A recently released in-depth report from the American Medical Association,  Research in Ambulatory Patient Safety, chronicles gaps related to … Read more

Taking aspirin three or more times every week is related to greater survival rates in breast and bladder feeding, new studies have shown. 1 theory for different survival levels placed forwards into the cohort study, released in JAMA Network Open, is the fact that aspirin is also well known to obstruct the cox2 enzyme, that … 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 … Read more

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 medical and pharmacy directors have the opportunity to help reinvent how health care … Read more

BY JOHN LA PUMA, M.D. Confidentiality in managed care is not a misnomer, but it is in question. Confidentiality usually involves keeping private any information learned from or about the patient. It can sometimes be ethically breached, and in some cases must be–suspected child or elder abuse, gunshot or other suspicious wounds, communicable diseases, and … Read more

While the United States has been in turmoil over how to tame its excessive health care bill, the Brits have their own problems — different, but in some ways the same Back in 2000 I wrote an article for Managed Care (“Health Care Reform in the U.K.: Managed Care by Another Name”) charting the health … Read 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 Senior Contributing Editor Once upon a time, we believed that if you stay outside when it’s windy and cold, you’ll get sick; that women should rest … Read more

HMOs and Alternative Medicine Nontraditional medicine is making inroads into managed care. Patient demand has spurred most HMOs to pay for some therapies. But where should health plans draw the line? Patient Satisfaction: The Indispensable Outcome Sure, you give medical groups patient-satisfaction reports, but there are excellent reasons for the practices to gather their own. … Read more

This designation has been allowed based on statistics from the PhaseII NOBILITY analysis from adult patients with proliferative lupus nephritis which revealed Gazyva, in conjunction with standard of care, revealed enhanced efficacy in comparison to placebo and standard of care in attaining total renal response at the same year. “New treatment plans are wanted for … Read more

Whether a person is likely to develop diabetes, cancer, schizophrenia, or stroke will be reasonably well predicted, and tests can also determine whether a patient will respond to a given therapy. That’s the good part. Don’t miss the sidebar to this article: Roll over, Beethoven — your genetic profile’s in At GHI in New York City, … Read more

An executive with the nation’s second-largest health care buyer discusses issues raised by HMOs’ financial losses, direct contracting and the challenges of building better information systems. Margaret T. Stanley is the kind of customer that managed care executives listen to carefully. As health benefits administrator for the California Public Employees Retirement System (CalPERS), she’s in … Read more

Legislators are being urged to reward companies that provide programs for their workers, but success has been mixed Wellness When it comes to encouraging wellness programs, government is starting to get into the act. On Capitol Hill and in statehouses from Maine to California, legislators are sponsoring measures to encourage private sector employers to embrace … Read more

Patients’ failure to adhere to medication regimens is a major problem. The factors that beget nonadherence are complex and interwoven. Patients’ ability to understand their treatment routines or the reasons for them, side effects, financial barriers, simple forgetfulness — or any combination of these and myriad other determinants — can influence adherence to therapy. Removing … Read more

L.A. Care, a California Medicaid HMO, is rewarding physician groups that excel at preventive care. Those that exceed some HEDIS benchmarks, for instance, could receive performance bonuses…. Regence BlueShield will pay $30 million to settle suits over denial of claims for alternative therapies covered under Washington State law…. The Journal of the National Cancer Institute … Read more

Authors call for increased education of both patients and caregivers Most patients lack basic knowledge about the risks of radiation exposure from X-rays and other diagnostic imaging tests used to detect cancer, according to a survey published in the Journal of the American College of Radiology. Researchers contacted 5,462 oncology patients who had undergone diagnostic imaging … Read more

It ain’t necessarily so… Physician rallies to raise awareness of the skyrocketing costs of malpractice premium insurance have blamed many parties, including government, the insurance industry, and especially lawyers. Long the butt of jokes, malpractice and trial lawyers find themselves coming under fire from one of the strongest lobbying groups in the country — physicians. … Read more

Patient satisfaction remains an important characteristic of a health plan, particularly at open enrollment time. WilsonRx’s annual survey tells the tale.   …Tricare. Tricare, the health plan run by the U.S. Department of Defense, is the best health care insurer in the nation, followed closely by Kaiser Permanente, CareFirst Blue Cross Blue Shield, AARP, and … Read more

Even the once-weekly, single-dose automobile injector apparatus can be a greater version of a z’s Bydureon – that your British bunch gained from BristolMyers Squibb straight back in 2013 – and also originally required a six-step prep and administration procedure. But, a Z ‘s Latest model of the goods has been believed to”help improve the … Read more

From the real history of medicine, biologicals are rather new services. Biologicals developed in the 1980s produced a direct effect in nephrology, oncology, as well as other therapeutic locations. The expiry of intellectual property rights on originator biologicals established the potential of growth of’follow-on biologic’ services and products, dependent on the originators. The EU at … Read more

News and Commentary The median deductible required by employers for individual coverage in PPO plans jumped to $1,000 in 2008 from $500 last year, according to the “National Survey of Employer-Sponsored Health Plans” issued by Mercer. Back in 2000, only about half of employers imposed a deductible for PPO coverage, and the average deductible at … Read more

A growing number of health plans are adding these clinics in retail stores to their networks and are realizing savings   Retail health clinics. All the major health plans are adding them to their networks. Busy families are demanding simpler ways to deal with routine health problems, and some of them are turning to the … Read more

Health care economists and others imagine a society in which managed care had never been invented. Almost everyone has played the “what if” game as in What if World War I had never happened or What if you had married your high school sweetheart. If “what if” ever became a successful board game, such as … Read more

Finally, it seems that there is a way to manage patients with multiple chronic conditions properly. Understanding and technology converge. It’s as if that relative — the one who people thought would never be able to hold down a job and who long ago packed his belongings into a 1958 Edsel and sputtered off toward … Read more

Employees, don’t be surprised when your annual explanation of employer benefits includes not only the 401(k) plan and 10 paid holidays but also a financial incentive program to better manage your health. A survey of 453 large employers found that half currently use incentives to encourage their workers to participate in health improvement activities such … 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

Unicompartmental joint operation doesn’t require storing various joint fittings to accommodate each patient’s anatomy Unicompartmental joint operation doesn’t require storing various joint fittings to accommodate each patient’s anatomy Many of us remember a Dennis the Menace movie where Dennis breaks the two front teeth off of a set of Mr. Wilson’s dentures and replaces them … Read more

The age of health reform places increased emphasis on pro­viders, and it might behoove insurers to find the informal ways that some physicians are connected. Often doctors have “a history of working with each other, and likely have evolved natural communication channels,” says “Variation in Patient-Sharing Networks of Physicians Across the United States,” which was … Read more

Doctors maintain that they simply do not have all the tools they need to make value-based care happen, even if they wanted it to happen. Health insurance executives counter that the situation is not that bad. Primary care physicians (PCPs) and health care executives hold starkly different views on value-based care, according to a recent … Read more

As anyone who has watched the field with some regularity knows, cancer immunotherapy is a tough field to hoe. Provenge is the only therapeutic vaccine for cancer to make it all the way to U.S. Food and Drug Administration approval, and it’s struggling to gain market share. Many more — see GVAX, Canvaxin, and FavID … Read more

Managed care always couched its emphasis on prevention with the caveat that diagnostic tests should be conducted according to generally accepted national practice guidelines. A new study seems to indicate just how costly preventive medicine can be when not tied to a disciplined approach. Unneeded medical tests directly cost the health care system millions of … Read more

A federal agency fashioned to oversee drug research might inhibit the creation of new medications. The quest for profit in itself may generate benefit. A response to Managed Care’s Q&A with John Abramson, MD The economic incentives inherent in a free-market system do not necessarily result in research bias, say some observers. And in any … Read more

Within this season’s standing, Modern Healthcare honored front line healthcare workers with the very best area, together with Modern Healthcare’s Ginger Christ writing that front line healthcare workers have”become the heroes with the outbreak.” Christ noted , thus far,” CDC quotes more than 2.2 million healthcare workers have contracted the publication coronavirus and almost 900 … Read more

Patients who change health plans may face adverse clinical and financial effects as a result, according to a new study. Researchers at the University of California — Davis found that “the first year of insurance was associated with a higher risk of not get-ting a mammogram, a higher risk of avoidable hospitalization, greater likelihood of … Read more

Forrester Research predicts that Internet-based companies that help people manage their employer-sponsored benefits will become a force by 2005. Bradford Holmes, a senior analyst at Forrester, says the so-called e-health plan industry will chew off 3 percent of HMO profits this year; by next year, 24 percent of companies could offer at least one e-health … Read more

Neither Anthem Inc nor even Cigna Corp may regain any harms over the collapse of their businesses’ projected $54 billion merger, also a Delaware judge ruled Monday. The arrangement by vice-chancellor Travis Laster of the Delaware Chancery Court uses more than three decades of hard fought litigation, culminating at a last-minute chair trial this past … Read more

Name Last modified Size Description Parent Directory 04-Jan-98 21:46 – 9701.ace.shtml 21-Mar-97 15:41 8k 9701.besthmo.shtml 21-Mar-97 15:41 18k ../../archiveMC/9701/9701.compmon.gif 21-Mar-97 15:41 51k 9701.compmon.shtml 21-Mar-97 15:41 1k 9701.contents.shtml 21-Mar-97 15:41 3k 9701.editormemo.shtml 21-Mar-97 15:41 2k 9701.ethics.shtml 21-Mar-97 15:42 7k 9701.genetics.shtml 21-Mar-97 15:42 18k 9701.guidelines.shtml 21-Mar-97 15:42 4k 9701.legal.shtml 21-Mar-97 15:42 7k 9701.lessons.shtml 21-Mar-97 15:42 10k 9701.news.shtml … Read more

Legislation and regulation So How Much Would Medicare for All Really Cost? Good Question. The estimates range from $13.5 trillion to $47.6 trillion. The variables include the generosity of the benefit and forecasts for reining in health care expenditures. Legislation and regulation Residencies for Sale The closing of Hahnemann Hospital in Philadelphia leads to a legal … Read more

Obstructive sleep apnea along with its associated breathing Disruptions are connected to greater risk of hypertension, obesity, heart failure, and Type2 diabetes, stroke and melancholy in the event the disease advances in seriousness. The conventional test for identification of this ailment is polysomnography, by that a technologist monitors an individual’s brain waves, heartbeatand breathing patterns, … Read more

Starting to believe in earnest about the upcoming steps in his livelihood. City Hospital has been a teaching hospital for both residents and medical students and related to the state school’s academic gym. Struggling to make a business conclusion, Dr. Bryant switched into 1 of the Closest teachers, Dr. Gabriel, for several career advice, telling … Read more

A Historical Perspective on Where We Are Submitted by David Kibbe on Tue, 2012-01-17 23:57 David KibbeHealth and Human Services (HHS) just released data on 2010 health expenditures, reporting that we, as a nation, have now reached the $2.6 trillion mark, consuming 17.9% of our GDP. Reaching that new mark required 3.9% annual growth vs. … Read more

Kaiser Permanente takes on patient safety initiatives in the outpatient setting While Michael Kanter, MD, is optimistic about patient safety efforts gaining traction around the country, one area that’s been overlooked is outpatient care, he says. As medical director of quality and clinical analysis for the Southern California Permanente Medical Group, Kanter has helped launch … Read more

Spring fever must have settled in early around here. You may notice two baseball references in our magazine and another in our online blog. The thought of baseball can warm the heart on a cold, snowy day. The blog item refers to a new forum where clinical executives can gather, kind of like the bar … Read more

Forty-nine states now offer managed care plans to beneficiaries of the 30-year-old federal-state Medicaid program, and statehouses look hopefully to managed care as a way to harness fast-growing Medicaid costs. The Medicaid market offers opportunity for managed care plans, but it poses special challenges, too. Here’s what six leaders of the health care community had … Read more

Losing that revenue will not overtake Shire (the business quotes Feiba earnings will account for approximately 5 percent of its own 20 17 earnings) however it a huge selection of millions of dollars which the Irish drug maker isn’t thinking about letting go with a struggle. Lawsuit against Roche’s Genentech asserting the provider’s creation of … Read more

The goal is to keep oncologists from relying on drug markups to keep their incomes high, but it’s slow going As the costs of treating cancer escalate, health plans are putting new energy into managing one of the most difficult categories of health care. The going is slow, but major changes in the way oncology … Read more

Robert M. Goldberg is a co-founder and vice president of the Center for Medicine in the Public Interest (CMPI). There has been a lot of discussion of the Food and Drug Administration’s decision to revoke approval for the use of Avastin in metastatic breast cancer. Most of it takes at face value FDA Commissioner Margaret … Read more

Peer pressure doesn’t end in high school, or even med school, for that matter. Researchers at the University of Southern California found that the natural inclination of doctors (and other clinicians who work in primary care practices) to be the best can be channeled to attack one of medicine’s more intransigent problems: inappropriate prescribing of … Read more

Urgent Care Finds Its Place In the Age of ACOs Plans and health systems are collaborating with walk-in centers to keep patients out of the ERs. Investors like what they’re seeing. Richard Mark Kirkner An Accounting of ACOs Where they are, what they are, and how many there are Peter Wehrwein Managed Medicaid Braces for … Read more

It’s 2018 and I have a settlement for you personally –it is the right time to become seriously interested in public wellbeing. In the beginning this could seem as though we’re re treading old earth. Afterall, we’ve mentioned public health for years today. But whilst it’s 1 thing to maintain discussing managing inhabitants, it’s just … Read more

Open wide. When one is reaching for a metaphor to describe the Affordable Care Act’s effect on health care, that’s a good start, lending itself to an image of a python about to swallow something bigger than its esophagus, or a dentist with instruments of torture. Insurers should be very concerned, as our cover story … Read more

First fixed-dose beta blocker/ARB combo in the U.S.   Byvalson (nebivolol/valsartan, Allergan) 5 mg/80 mg tablets have won FDA approval for the treatment of patients with hypertension to lower blood pressure. Byvalson is the first fixed-dose combination (FDC) of a beta blocker (BB) and an angiotensin II receptor blocker (ARB) available in the United States. … Read more

Anti Viral Treatment has Turned into HIV to a Controlled chronic Disorder however, also the development of drug-resistant breeds threatens to sabotage progress made thus far. Due to the fact the worldwide roll out of alcoholism treatment started in 2001, the incidence of immunity has jumped by 11 percent to 29 percent. Doubledigit levels of … Read more

Now that the value of hospitalists is well established, attention turns to those whose only duties are in intensive care Joan Brookhyser, MD, is on a mission to change the face of health care in Nevada. Much to her surprise, her opportunity is coming from the largest HMO in the state. In the last two … Read more

MANAGED CARE August 2003. ©MediMedia USA “Problem recognition” is what Cigna appears to be going through, as the company’s stock continues to fall and analysts predict that a turnaround may take longer than originally hoped. “The company is still getting to the bottom of how bad the problems really are, and we remain unsure as to when … Read more

An important voice in health care policy, who is also a practicing primary care internist, sees the group model as both efficient and high quality. Generally speaking, if you have 100 physicians who are practicing clinicians, you’re going to have a few whom you would call physician leaders … who have a sense that they … Read more

Three Drugstore Giants Expand Their Health System Partnerships One goal is improved adherence and medication outcomes, something that insurers have striven to achieve for a long time   The large national drugstore chains are stepping up their efforts to expand pharmacist professional services and their in-store clinic services. The in-store retail clinics operated by CVS … Read more

Ronald Reagan has demonstrated just how a prior president tried to convince the prime ministry to discontinue the Falklands war as British troops were progressing on Port Stanley. The record shows Thatcher was decided to provide a devastating success . Avenge British reductions. Her reply to the reassurance abandoned the president stammering to the trans … Read more

With nearly 8 million Americans covered by health savings accounts (HSAs) with high deductible health plans (HDHPs), the Internal Revenue Service (IRS) announced various inflation-adjusted amounts for 2010 contributions. The maximum annual HSA contribution for individuals is $3,050 (up $50 from 2009). Family coverage is now set at $6,150 (up $200 from 2009). The minimum … Read more

Pepsi promises that work-site clinics won’t take business away from health plans. Employees at the Pepsi Bottling Group, a $10 billion company with more than 35,000 employees in the U.S. and Canada, are responsible for making, selling, and distributing Pepsi beverages. If a salesperson or a truck driver is out sick for a day, soda … Read more

Case management, utilization management, and quality improvement staff members can play an important part in promoting improved care for patients Linkedin Share Button (link is external) Tweet Widget (link is external) Share on Facebook (link is external) Case management, utilization management, and quality improvement staff members can play an important part in promoting improved care … Read more

A recent court settlement may affect the way the PBM industry makes profits, but could it also lead to higher drug costs? A recent $38.5 million settlement with 28 state attorneys general by CVS Caremark will cost the large PBM more than cash. Coupled with previous settlements in the industry, it will enhance a current … Read more

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 all those articles about golden parachutes during … Read more

Pharmacy issues may greatly affect members’ perceptions of their health plans, suggests a survey of 38,000 enrollees who requested prescriptions for specific drugs. Denied what they wanted, these members were twice as likely to want to leave their health plans as were those who got the drug they requested. The percentage of members who rated … Read more

Insurers recognize the clinical importance of off-label prescribing, but criteria are needed to avoid overutilization Martin Sipkoff Off-label prescribing is common, but steeped in contradiction. It is legal, unless a drug company or physician talks too much about it. It is conventional, but based more on anecdote than evidence. Health plans often pay for off-label … Read more

A High Stakes Game For Health Care’s Major Players Peter Wehrwein For Insurers, a Battle Between 2 Futures Both presidential nominees have big plans for changing the health insurance world, but hurdles are many and victory on November 8 is only the beginning. Here’s what may be in store. Joseph Burns For Both Parties, Drug … Read more

Color chart Interstudy Publications has released market-by-market comparisons of provider benchmark data, such as inpatient days and physicians per thousand. When it comes to hospitalization, patients in cities have long spent less time in hospital beds than those in smaller markets. New data suggest this is still true for Medicare and Medicaid members — but … Read more

MANAGED CARE March 2005. ©MediMedia USA DTC’s reputation as a bully may be largely overstated. There’s little evidence that sales of specific drugs increase. Martin Sipkoff Contributing Editor A recent Food and Drug Administration survey found that very few patients see their doctors because of direct-to-consumer advertising and a separate Harvard study found that patients rarely mention … Read more

Smaller purchasers are less likely than larger ones to use health plan report cards, but to say they don’t care is unfair. More information about providers would help. Main story As size goes, so goes quality [charts] Enlightenment starts from the bottom up Your whole life’s work judged in a mouse click [from MANAGED CARE’s physician … Read more

The latest data on median gross charges, which are the charges, at undiscounted rates, of all services provided (also called productivity), indicate that primary care physician productivity is still increasing faster than compensation. Back in 2002, the opposite was true — compensation was growing slightly faster. According to the “Physician Compensation and Production Survey” issued … 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

ASH continues to Urge for Decent Reimbursement and Coverage for Chimeric antigen receptor tcell therapy. Regrettably, ASH proceeds to listen to from associates about the substantial negative financial effect on associations of supplying CAR T therapy to Medicare beneficiaries as a result of insufficient settlement. The Society has heard anecdotally that associations are reluctant to … Read more

By drawing on the expertise of pharmacy benefit managers, managed care plans can teach plan sponsors and brokers the value of pharmacy, and in the process, add to their business. Todd Gibson Recent research shows that pharmacy benefit managers are a powerful but often untapped resource for educating insurance brokers, those who facilitate the deals … Read more

National Academy for State Health Policy team Eskedar Girmash and Sarah Lanford, that work from Dallas and Houston throughout the ordeal, were power for seven days as temperatures dropped to single digits plus so they lost usage of water. At the very least 58 people died attempting to remain warm, and significantly more than 13 … Read more

The innovations that we list here are not unfamiliar, but don’t underestimate them. As they mature, they will have strong effects. In 1995, Harvard business school professors Clayton Christensen and Joseph Bower put “disruptive technologies” in the business lexicon by introducing the term in a seminal article in the school’s journal. The phrase described what … Read more

When biologics go off-patent, copycat products could lower oncology expenditures by the millions, if not billions. But the discounts and future market share are far from certain. In a classic Dick Van Dyke Show episode, the late Mary Tyler Moore accidentally gets her big toe trapped in a hotel bathtub faucet spout, and the elderly … Read more

Compensation increased at a comparatively small rate from 2000 to 2001 for both primary care physicians and specialists, according to the Medical Group Management Association. The rate of increase for all primary care was only 1.2 percent — about half the previous year’s change, and one third of the 3.4 percent increase in 1998–99. The … Read more

More timely stroke care can improve patient outcomes After more than four decades of decline, progress has slowed in preventing stroke deaths, according to the latest Vital Signs report by the Centers for Disease Control and Prevention (CDC). In fact, stroke death rates have increased among Hispanics and people living in the South. The report … Read more

Women health care executives earned $84,900 on average in 2000 while their male counterparts earned $104,300, according to the most recent survey conducted by the American College of Healthcare Executives. That is a $19,400 difference — 19 percent less overall. So says “A Comparison of Career Attainments of Men and Women Healthcare Executives: Findings of … Read more

Analysts say chances of a Medicare drug benefit passing the Senate are slim. The Senate began debate on competing bills after the House narrowly passed a Republican-backed prescription benefit proposal. Delaware Sen. Bill Roth, chairman of the Finance Committee, champions S2836, trying to find middle ground between the GOP’s subsidized private-insurance plan and the president’s … Read more

Physicians who get most of their income from managed care spend less time caring for those without sufficient or any insurance coverage, suggests a study published in the Journal of the American Medical Association. According to the results, developed by the Center for Studying Health System Change, physicians who get less than 20 percent of … Read more

It’s not often that we go to press hoping that late-breaking developments contradict one of our articles. Still, this month’s cover story by Managing Editor Frank Diamond on how the recession roils the managed care industry contains unwelcome data. We wouldn’t mind getting caught overstating the case (well, we wouldn’t mind too much, anyway), if it meant … Read more

With UM played out and copayments for brand-name drugs nearing most members’ pain thresholds, plans are exploring a new pharmacy frontier. After years of struggle as bit players, generic drugs finally have marquee power. Their supporters in the government and private sectors say generics perform so well they make older actors look tired and vastly … Read more

One of the big managed care issues placed on hold as a result of Sept. 11 was the push for a patient-rights bill. Now, a major backer of that legislation, the AMA, has decided to take up a cause that hits closer to home. The AMA is renewing a push for a law that would … Read more

Kaiser Permanente of Northern California reached a contract settlement with its nurses that gives them a new watchdog role in quality of care. The deal gave nurses a 12-percent pay boost over four years, but more importantly, answered their claims of medical negligence by giving them a stronger voice in management. The pact with the … Read more

Relations were already poisoned by the time a PPM had bought a thriving group. But where things started to go downhill is a matter of conjecture. “If this story had sex in it, every major movie company would be after us to write a screenplay,” quips George Makol, M.D. “There are excessive CEO bonuses, greed, … Read more

Digitally, the VA Leads the Way 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. Quality Counts: So Why Not Offer Physicians Bonuses? Plans will have to … Read more

Health plans have much at stake as Congress moves to lay down the do’s and don’ts about use of info gathered via genetic testing. Managed care governmental affairs and medical directors have been monitoring federal genetic testing legislation for several years, but now, Hill insiders say, with the unanimous passage of the Genetic Information Nondiscrimination … Read more

In a few days our August issue will be out with a story about the implications of the Supreme Court’s King v. Burwell decision on health and health insurance coverage for the LGBT community. The article by contributing editor Joseph Burns (definitely follow Joe on Twitter  @jburns18) has a sidebar on transgender health issues. So a perspective … Read more

Recent data issued by the Centers for Medicare and Medicaid Services indicate that generic medication accounts for nearly 60 percent of the drugs dispensed to people in Medicare Prescription Drug Plans and Medicare Advantage plans. Dispensing of generics has increased among private third-party payers — growing 9 percent over the past year, according to the … Read more

Attention all employees: Employers have a clear interest in expanding initiatives to help workers manage their personal health effectively, according to United Benefit Advisors’ 2007 Employer Survey. The survey asks employers about the extent and effectiveness of their current and planned wellness and disease management programs, the range of employee benefits offered, the various employee … Read more

Harvard’s Regina E. Herzlinger says entrepreneurial geniuses will give restless baby boomers what they want: a delivery system in which consumers can choose coverage the same way they shop for cars. Patrick Mullen Regina E. Herzlinger, Ph.D., is the first holder of the Nancy R. McPherson Professor of Business Administration Chair at the Harvard Business … Read more

Study to show how telehealth solutions may encourage associated overall health initiatives and improved treat patients with multiple chronic situations, Royal Philips along with Arizona-based Banner Health now announced results showing substantial reductions in both patient health expenses and hospitalization prices. As Area of the total tele-health program in the among the largest non profit … Read more

New treatment approaches offer hope   Approximately two million Americans are hooked on prescription opioids or heroin, and an overdose of pain pills kills 91 people every day. Approximately 20 years ago, pharma companies invested heavily in alternative treatments and “failed miserably,” Dr. Nora Volkow, director of the National Institute on Drug Abuse, told Medical Xpress. Now, … Read more

This study is the first to estimate costs and medical resource use associated with restenosis involving bare metal stents in managed care percutaneous coronary intervention patients. Mary Ann Clark, MHA Department of Health Economics and Outcomes Research, Boston Scientific Corp., Natick, Mass. Full text available in PDF ABSTRACT Purpose: The epidemiology of coronary restenosis after percutaneous … Read more

General practitioners in the United Kingdom make an average of £55,000 (about $108,000) each year, but incentives for improved quality, achieving clinical goals, and better services — including better appointment systems — can result in bonuses amounting to £47,000 ($92,000), according to a new contract between the National Health Service and the British Medical Association. … Read more

“Breaking news alert! Hospital X and hospital Y announce they are merging.” At this point, you have heard the same breaking news story over and over again—the number of hospital mergers continues to rise. And the benefit? Likely none, and there is significant research to support the claim that hospital mergers are often anticompetitive. Nor … Read more

Medicaid plans in some states will expand, putting pressure on plans’ primary care networks Before the Affordable Care Act was enacted, state Medicaid programs were required to provide coverage to certain categories of low income people, such as children, pregnant women, the disabled, and the elderly. Childless adults under age 65 who were not pregnant … Read more

Mercy health system has had direct contracts with employers for 20 years and added Boeing employees in 2016. Tracy Riordan, MD, Mercy’s clinical vice president, says that “having a direct contract is helpful because we can bring all the parties together frequently throughout the year.” The meetings help the parties spot trends and make adjustments. … Read more

Mary V. Mason, MD, MBA Senior vice president and chief medical officer, Centene Corp. Amy Poole-Yaeger, MD Vice president of medical affairs, Centene Corp. Cathie R. Krueger, RN, BSN Manager of clinical policy, Centene Corp. Kara M. House, MBA Vice president of business process optimization, Centene Corp. Brad Lucas, MD, MBA Vice president of medical … Read more

With UM played out and copayments for brand-name drugs nearing most members’ pain thresholds, plans are exploring a new pharmacy frontier. Martin Sipkoff After years of struggle as bit players, generic drugs finally have marquee power. Their supporters in the government and private sectors say generics perform so well they make older actors look tired … Read more

The next stage of payer-provider collaboration will add true value Emad Rizk, MD Payers and providers have typically worked separately from one another and, over time, have become deeply rooted in their individual business and technology models. Although few would question the importance of greater collaboration, two barriers have traditionally stood between the desire to … Read more

Alpha-L-iduronidase breaks down glycosaminoglycans — and it just may lead to breakthroughs in treatment for other lysosomal storage disorders. Thomas Morrow, MD It is unlikely that many people paid attention to the miracle that occurred last year with the approval and release of laronidase (alpha-L-iduronidase). Alpha-L-iduronidase is just an enzyme, and enzymes typically do not … Read more

The American Medical Association and the Pharmaceutical Research and Manufacturers of America are fine with the AMA’s policy restricting physicians from receiving gifts from pharmaceutical sales representatives — they just want to see it better implemented. A source told the Wall Street Journal that drug company executives “want their employees to adhere to the [AMA’s] … Read more

In the debate on trimming Medicare spending growth, private insurance has been held up as a model the federal program should emulate to tighten its belt. But a recent report shows that for several years, at least as far as payments to physicians went, Medicare kept the lid on better than the private sector. Annual … Read more

John Marcille Ever since I started covering health care 20 years ago, managed care companies — HMOs back then — have had little respect from the public. I am sorry to have to point you to a new report that has managed care companies at the bottom of a list of industries in consumers’ eyes. … Read more

Also available as PDF The Medical Group Management Association tracked 30,835 providers, mostly physicians, and 1,609 specialty groups to gauge how their salaries grew between 1994 and 1998. Despite a dip in 1997 — and the spread of managed care — specialists’ salaries increased a bit faster than primary care physicians’ salaries over that span. … Read more

MANAGED CARE November 1999. ©1999 MediMedia USA Federal programs face an average 9.3-percent increase in health-benefit premiums next year. The government pins the blame largely on the accelerating cost of prescription drugs. A new report by the Employee Benefit Research Institute named an interesting component of prescription-drug cost hikes. According to EBRI, the number of new prescriptions … Read more

The reform law will have little effect on medical and prescription costs for 2011, but other factors will push costs up 10 percent or more, says the 2011 Segal Health Plan Cost Trend survey. The Patient Protection and Affordable Care Act will have a modest effect: Preferred-provider organizations and point-of-service plans will have slightly higher … Read more

The alternate payment version is just a non traditional financial arrangement which rewards medical care providers that deliver cheap, supreme quality maintenance. Today we’re confronting the risk that pharmaceutical makers and carriers will probably adopt APMs like a payment system in a few instances. As pharmaceutical manufacturers face rising public anxiety over value and prices, … Read more

The “gatekeeper” model for controlling health care utilization is inherently flawed, argues this physician, who says substituting a more flexible system could save money as well as improving health care. Managed care holds the promise of providing better-quality health care to patients while at the same time reducing costs to the individual, to the employers … 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

Docs can see where the beads are placed Mount Sinai Hospital is the first center in the U.S. to use a new cancer treatment consisting of luminescent chemotherapy-filled beads injected into tumors through the wrist. The minimally invasive treatment, using M1 LUMI beads (BTG plc) filled with doxorubicin, is available for patients with inoperable and … Read more

The slowdown in increases often happens during and shortly after recessions, but this time the trend may continue as the American economy perks up About a decade ago, economists noticed something strange about the rate at which health care spending increased: the relentless climb started to level off. Then came the economic slowdown of 2007—some … Read more

Effective treatment has really helped suppress the outbreak, but practical remedies happen to be evasive. Being analyzed: a”sterilizing cure” that eradicates HIV from your system, and also a”functional cure” that efficiently lowers the viral load so that it can’t be transmitted or advancement into AIDS. Due to its Intricate character and construction of HIV, finding … Read more

Risk Adjustment: Immature System Heads for Big Time Health care stakeholders will be watching when HCFA installs a risk-adjustment methodology for Medicare+Choice. Could such a system work in the private sector? Who would gain? Lose? A New Model For Managing Care At least in California, HMOs are becoming superfluous, says one physician who sees them … Read more

Financially, did health plans do better last year than in 1998 — or worse? The answer may depend on whom you talk with and the indicators you consider. The rating company A.M. Best says for the first nine months of 1999, profitability of 9 of the 15 largest publicly traded MCOs improved over the same … Read more

Rightsizing following the tele-health burst; adapting to changing clinical trials; supporting digital connections that facilitate doctor burdens; calling for an unclear 2021; palliative wellness centers for growth; and even building a more resilient and responsive supply series for longterm wellbeing. This is based to a fresh yearly report from consulting and research giant PwC qualified”Top … Read more

How Health Plans Are Building Electronic Patient Records Computerized clinical records can give a health care plan a competitive edge by improving patient care, but implementation is challenging and the technology still evolving. Some institutions are well on their way to having the automated patient record; many have miles to go. Why Managed Care Is … Read more

Should the National Committee for Quality Assurance take over part of the job of overseeing health plans? It seems to be working in some states. For years, the National Committee for Quality Assurance has been steadily pressing the frontiers of its accreditation work, picking up the official duties of state regulators and Medicaid agencies by … Read more

Hal Hoffman’s work led to the discovery of the genetic basis of an autosomal dominant disease and to creation of a prototypical orphan drug We seldom describe a single contemporary practicing physician in the United States as a pioneer, but that term would truly describe Hal Hoffman, MD, a pediatric allergist in San Diego who … Read more

Name Last modified Size Description Parent Directory 28-Aug-2000 11:10 – ../../../../archiveMC/9711/QNA.1.GIF 17-May-2000 12:21 1k 9711.compmon.shtml 17-May-2000 12:19 1k 9711.outlook.shtml 17-May-2000 12:20 1k 9711.editorsmemo.shtml 17-May-2000 12:19 2k 9711.contents.shtml 17-May-2000 12:19 4k 9711.news.shtml 17-May-2000 12:20 7k 9711.legal.shtml 17-May-2000 12:20 7k 9711.washington.shtml 17-May-2000 12:21 8k 9711.employer.shtml 17-May-2000 12:19 8k 9711.ethics.shtml 17-May-2000 12:20 8k 9711.states.shtml 17-May-2000 12:21 8k ../../../../archiveMC/9711/9711.compmon.ext.gif … Read more

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 Key Trends Since 2006” that there was barely a … Read more

This is barely a blip on the screen and yet, just the fact that it’s being discussed in some places points to dissatisfaction with HMOs’ programs. Even the slightest tremor in disease management can now move millions of health care dollars. And here’s one just tickling the seismograph: faint indications that employers are considering contracting … Read more

Download supplement The basis of this supplement is the 2003 Medical Director Colloquy, a forum for interaction between top medical managers and a nationally renowned faculty of medical and business professionals. Decision makers in managed care have a range of critical concerns relative to dyslipidemia treatment efficacy, cost, and options. This supplement allows readers to … Read more

PCORI Won’t Be NICE Some hope that the Patient Centered Outcomes Research Institute (PCORI) might evolve into something like the United Kingdom’s National Institute for Health and Care Excellence (NICE). Not going to happen, says David B. Nash, MD, MBA, the founding dean of the Jefferson School of Population Health at Thomas Jefferson University in … Read more

WellPoint Chairman Leonard Schaeffer and other health plan leaders believe they can help with a chronic societal issue The fact that 48 million Americans are without health insurance has indisputable economic and social consequences. Bad debt, disproportionate use of emergency medical services, lack of preventive care, amplified morbidity and mortality rates, loss of productivity — … Read more

Could avian flu give rise to a pandemic that might rival the fearsome Spanish flu? Is the nation – let alone any individual MCO – ready? These days, the phrase “blue flu” usually is applied to walkouts by police officers, but it just as readily could be used to describe the frightful influenza pandemic of … Read more

Publishing a magazine with the modest name Managed Care gives us the opportunity to examine a constantly evolving organism — every month. The cover of the inaugural issue of Managed Care, published in the spring of 1992, proclaimed, “Managed Care Comes of Age.” Today, the same can be said for this publication. As we mark our tenth anniversary, we … Read more

Ten medical societies representing specialists have filed suit in federal court to block the Health Care Financing Administration from enacting a new Medicare payment formula. HCFA says the formula compensates all physicians more fairly, but specialists, who could lose upward of a billion dollars over three years under the plan, say the scheme is illegal. … Read more

John Baldacci, the unchallenged Democratic candidate for governor in Maine, thinks he has a sure-fire winner at the box office this fall: universal health care. By all accounts, he has good reason to expect popular support. In a nonbinding referendum in Portland last fall, a tiny band of health care activists wound up persuading 52 … Read more

Not too long ago, retail health clinics were viewed with wariness—and worse—by other health care players. Now their value is recognized. Richard Mark Kirkner Linkedin Share ButtonTweet WidgetShare on FacebookGoogle Plus One The low cost and easy access of the “doc-in-a-box” concept has been well documented. Where once someone with an ear infection or bad … Read more

As the charge of handling patients continues to grow, endurance in the usa is just starting to fall. However there was mounting evidence the artificial intelligence (AI) will reverse the downward spiral into growth by automating the machine’s labyrinth of laborintensive, unsuccessful administrative jobs, a lot of which may have little to do with curing … Read more

Medicaid Overhaul Includes an MLR Rule A 653-page rule handed down yesterday by CMS definitely represents one giant step for Medicaid managed care, and a step taken (for the most part) in the right direction, according to one industry insider. Jeff Myers, president and CEO of the Medicaid Health Plans of America (MHPA), told us last week to expect … Read more

The government last month reinforced the firewall between the soon-to-be launched health insurance exchanges and the managed care industry. Through the exchanges, which open in October, health plans will compete for the business of people who are not covered by employers or other sponsors. Consumers may call on “navigators” to help them choose their coverage, … Read more

As the influenza season approaches, managed care patient access to Tamiflu (oseltamivir) from Roche Laboratories and Relenza (zanamivir) from GlaxoSmithKline, the two medications indicated for influenza, looks relatively open. To be specific, when combining the following formulary statuses — non-formulary/covered, on formulary/approved/first or second tier, and prior authorization — over 90 percent of managed care … Read more

Managing Cancer Treatment Begins Before Diagnosis Health plans are increasingly involved in promoting the lifestyle changes that help their members avoid cancer, and are increasingly involved in clinical trials if prevention fails Martin Sipkoff Plans Put Greater Emphasis On Cancer Management Increasingly, health plans are providing disease, case, and utilization management when a beneficiary receives … Read more

Daily direction of grade activities for its 4.2 million associates at the Southern California Kaiser Permanente Region, for example HEDIS outcomes, JCAHO core measures, Leap Frog poll benefits, peer review, hospital grade and performance improvement, patient safety, hazard management, population care management, technology assessment and installation of new technology, implementation and creation of evidence-based recommendations, … Read more

Pushback on Zaltrap’s Price Highlights Sensitive End-of-Life Issue When a respected provider organization took a stand against the costly new cancer drug, it was both surprising and encouraging   When a respected provider organization took a stand against the costly new cancer drug, it was both surprising and encouraging Not a single therapy approved by … Read more

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. It may be time to take a break, for just a moment, from criticizing drug manufacturers for their price gouging and other sins and allow them to take a victory lap … Read more

Gee, was it something she said? Our little corner of the Twitter-verse lit up a few months ago when we looked at how insurers might have to reinvent themselves under the Affordable Care Act, and the article included an interview with Regina Herzlinger, PhD, of the Harvard Business School. All she did was contend that … Read more

As we learn which supplements are truly beneficial, is limited coverage of specific products in the works? A desire to take control of their own health care, added to dissatisfaction with rising drug costs, is driving consumers to buy dietary supplements. Also known as nutraceuticals, they include vitamins, minerals, and botanical and herbal remedies. Other … Read more

Over the next three years, more than 85 percent of drug costs will be driven by six broad therapeutic categories, according to Medco’s Drug Trend Report. The PBM expects drug costs for plan sponsors to increase between 3 percent and 7 percent annually during the next three years. The projection, interestingly, is based on the … Read more

The static approach overseen by United States Pharmacopoeia shortchanges beneficiaries and benefit plans 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 Services (CMS) gears up to approve … Read more

Low adherence to remedies in psoriasis reduces treatment outcomes and raises the entire healthcare expenses. Regardless of the vast utilization of biologic agents, patients’ adherence to such drugs have been broadly researched. Goal: the goal of this analysis is to quantify adherence into the biologic medication in a population of patients treated for psoriasis vulgaris … Read more

The passing rate for africanamericans fell 25 per cent in 1999 to 2015, according to another CDC Critical Evidence report published now. However, disparities still persist between whites and blacks. Even though blacks as friends are alive longer, their own life expectancy remains 4 years than that of whites. The total disparity in passing rates … Read more

Research has pointed to ways that falls can be prevented, but logistical and financial barriers get in the way. A bad fall can become that disastrous inflection point of old age, the swerve into dependence, expensive care, and declining health. Numerous studies have suggested modest and inexpensive ways that falls can be prevented. Late last … Read more

When it selected the person who would become only the fourth CEO in Kaiser Permanente’s history, it may have seemed that the health plan reached beyond its own culture. George C. Halvorson, after all, is not a homegrown Kaiser product and, unlike David M. Lawrence, MD, the man he replaces, he is not a physician. … Read more

Last December’s approval of sofosbuvir (Sovaldi) ushered in the era of interferon-free treatment for hepatitis C (HCV). But sofosbuvir’s final labeling — recommending co-administration with pegylated interferon in patients with genotypes 1 and 4 — meant that the days of interferon and its harsh side effects were not quite over for a subset of people … Read more

Specialists’ compensation has risen steadily in recent years, according to the Medical Group Management Association. The MGMA surveyed 960 member practices and found that of 17 selected specialties, 14 saw compensation increases last year. The highest gains occurred in anesthesiology (14.6 percent) and urology (12.2 percent). Meanwhile, primary care physicians enjoyed only modest gains in … Read more

Governors and legislators look to borrow whatever they think might work well for their own constituencies In one respect, it was business as usual at this year’s summer meeting of the National Governors Association in Charleston, S.C. The problem of the uninsured figured prominently. But two of the governors, New Mexico’s Bill Richardson and Michigan’s … Read more

  Iressa: We didn’t know what we didn’t know Gefitinib (Iressa) received FDA approval in 2003 as third-line treatment for metastatic non–small-cell lung cancer (mNSCLC). In phase 3 trials, the tyrosine kinase inhibitor shrunk tumors in only 11% of the efficacy population, but the change in that 11% was dramatic enough to warrant approval. When … Read more

News about financing the massive Medicare Part D program is good these days — or at least better. The Medicare prescription drug benefit is expected to cost $30.5 billion this year, CMS Administrator Mark McClellan told the Senate Special Committee on Aging on Feb. 2. That’s 20 percent less than the government’s previous estimate of … Read more

With 9% of hospital charges attributable to pregnancy, delivery, and neonatal care, there is considerable opportunity for savings   The idea of staying in a hotel room for several weeks instead of a hospital room appealed to a pregnant woman who needed bed rest because she was experiencing complications. And paying for the hotel reduced … Read more

Multiple sclerosis? Or autologous mesenchymal stem cells to get still another orthopedic hint? Been astonished by a petition for a expensive brand new targeted medication which got FDA approval months prior to suggested from the proper PDUFA program for FDA conclusions? Undoubtedly, you want to minimize surprises such as these. Yet how does your company … Read more

When it comes to assessing the performance of HMOs, the Joint Commission on Accreditation of Healthcare Organizations is the new kid on the block. But it doesn’t take many minutes of conversation with President Dennis O’Leary, M.D., to sense a kind of institutional restlessness with this role. After all, the Joint Commission has been accrediting … Read more

Pay-for-performance programs are gaining in prevalence — nowhere more so than among HMOs. More than half of 252 HMOs surveyed said they implement P4P programs in contracts with physicians and hospitals. Of the 126 HMOs with P4P programs, nearly 90 percent had programs for physicians and 38 percent had programs for hospitals, according to the … Read more

This month I want to share with you some late-breaking news about upcoming changes to the Stark law that affect all physicians and, indirectly, most other providers. The Omnibus Budget Reconciliation Act of 1989 (“Stark I”) disallowed physician referral of Medicare patients to clinical laboratories in which the physicians or members of their families had … 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

The two basic primary care specialties are fairly evenly matched when it comes to base salaries paid by HMOs, according to an annual salary survey. When the figures are broken down by profit status, plan model, enrollment size and geographical regions, there are interesting variations, but no clear winner overall. Color charts   also available in PDF … Read more

Michael S. Victoroff, MD Also available in PDF The data from the 2000 census should give us a thrill of ambivalence. I’m talking about the part where they gave us more freedom to pick our race. The choices are now wider, but their value is narrower than ever, medically speaking. Until 1997, we asked Americans … Read more

Repeal and replace, part deux: A return to the dark days of unaccountable care? Michael D. Dalzell Repeal and replace: Maybe not so fast, maybe not all of it Robert Calandra MACRA: A soft opening seems in store Susan Ladika Drug prices: Pedal has been to the metal. Time for some brake? Timothy Kelley Care … Read more

The Health Insurance Portability and Accountability Act of 1996, originally the Kennedy-Kassebaum bill, dramatically increases the risks that all health care providers face when they fail to pay attention to reimbursement and self-referral rules. To ensure adherence to HIPA, every provider and managed care organization should create an internal compliance program, including mechanisms for investigating … Read more

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. Anna Boyle is struggling to figure out how to care for her mother. After a string of health issues put Doris Boyle in and out of Boyle’s care for … Read more

Waiting for the Unicorn: Another Study Questions Whether ACOs Will Appear Frank Diamond Remember when many predicted that accountable care organizations (ACOs) will save health care? A study by the Health Research and Educational Trust (HRET) states that “ACOs are entities willing to be held accountable for the costs and quality of care for a defined … Read more

  Do Health Plans Have a Role In Limiting Antibiotic Resistance? The CDC calls antibiotic resistance the world’s most pressing public health threat, saying it requires collaborative action from all stakeholders: physicians, hospital administrators — and health plans   Joseph Burns Here’s how health plans can improve the use of antibiotics Scott A. Flanders, MD … Read more

At a glance Medstat Quality Catalyst http://www.medstat.com/ Ann Arbor, Mich. Goal: Provide comparative information on quality of different types of health plans without relying on plans’ self-reported data, which can be perceived as biased Strategy: Survey 50,000 benefits managers, enrollees and physicians in six metropolitan areas, using lists of employees and physicians provided by employers. Add 15 … 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. “There’s no … Read more

Former President Ronald Reagan said that the “most terrifying words in the English language are: ‘I’m from the government and I’m here to help.’” His ideological progeny, the current occupant of the White House, seems to be operating under the same assumption as the race to create association health plans (AHPs) picks up speed. President … Read more

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – ../../../archives/0003/0003.compmon.gif 01-Mar-2000 12:00 59k 0003.compmon.html 09-Apr-2003 23:29 3k ../../../archives/0003/0003.compmon.pdf 01-Mar-2000 12:00 40k 0003.contents.html 09-Apr-2003 23:29 4k ../../../archives/0003/0003.cover.jpg 01-Mar-2000 12:00 10k ../../../archives/0003/0003.dmpharma.gif 01-Mar-2000 12:00 17k 0003.dmpharma.html 09-Jun-2003 11:44 15k 0003.editorsmemo.html 09-Apr-2003 23:29 3k 0003.legal.html 09-Apr-2003 23:29 6k 0003.news_aetna.html 09-Apr-2003 23:29 2k 0003.news_americans…> 09-Apr-2003 23:29 2k 0003.news_employers…> … Read more

Congress enacted national legislation that allow individuals expressing into the FDA actual concerns regarding the safety, scientific, or legal dilemmas about a commodity anytime before, or later, its economy entrance.12 Under those regulations, any individual or entity, for example a pharmaceutical business, might file a citizen petition with the FDA asking that the FDA require … Read more

Medicare demonstration projects and reform legislation should lead to ‘no outcome, no income’ policies, this population health expert says When David B. Nash, MD, MBA, calls health care reform legislation a full employment act for the faculty and graduates of Thomas Jefferson University’s two-year-old Jefferson School of Population Health, he means it. Physicians will need … Read more

First swallowable, gas-filled weight loss balloon in U.S. The FDA has given the green light to the Obalon Balloon System (Obalon Therapeutics), a nonsurgical, fully reversible device for weight loss. The swallowable intragastric balloon system is indicated for temporary use to facilitate weight loss in adults with obesity (i.e., a body mass index of 30 … Read more

Q&A: The Status Quo Must Go! Call it “thinking out of the box” or “pushing the mental envelope” or whatever the buzz words of the day might be: Donald Berwick, M.D., is an outspoken advocate of finding new and better ways to deliver health care. His organization promotes them. And a lot of people are … Read more

It is customary to think of this payment method as a cost-control mechanism, and it is, but it can raise quality of care too   Why don’t we make more payments for entire episodes of care instead of paying for each step? Shouldn’t we pay for results, not for process? The concept of a bundled … Read more

If You Think like Most Americans, the Very Thought of a ER Trip is Really a Frightful Proposal; maybe perhaps not merely on account of the unexpected crisis nasal circumstance but outside of an awareness of worry to be over charged for products and providers. Medical maintenance prices for emergency services be seemingly rising every … Read more

The secret to medication adherence might be found in doctors’ notes, if patients are given online access to those notes, says a study in which three health systems offer expanded transparency. Beth Israel Deaconess Medical Center in Massachusetts, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Washington offered patients online access to notes … Read more

Kappa opioid receptor agonist treats uremic pruritus during hemodialysis The FDA has granted breakthrough therapy status to CR845 (Cara Therapeutics), a peripherally acting kappa opioid receptor agonist, for the treatment of moderate-to-severe uremic pruritus (UP) in patients with chronic kidney disease (CKD) undergoing hemodialysis. A breakthrough therapy designation is granted to expedite the development and … Read more

The Internet is becoming a vehicle for black-market sales of prescription drugs. Government officials are cautioning consumers they may be risking their lives — while warning doctors they may be risking their careers — by participating. For those who want pharmaceuticals not yet approved for sale in the U.S., whose HMOs will dispense only a … Read more

When it comes to unnecessary treatment, hospitalization is still a fat cow despite shorter inpatient stays forced by managed care, a Milliman & Robertson study suggests. Using physician consultants, the actuarial company conducted random inpatient chart reviews to determine which services were medically necessary. From that, M&R derived the appropriateness of an admission, as well … Read more

Texas Says HMOs More Troubled Than Thought HMOs lost $1.25 billion in 1998 — 45 percent worse than the industry’s performance in ’97, according to an analysis by A.M. Best, the insurance rating agency. The 600 HMOs studied had a collective revenue increase of nearly $1.2 billion, despite the profitability decline. Though 1999 began with … Read more

CARE FOR POPULATIONS Although four fifths of the nation’s children are fully immunized, tens of thousands of adults die each year from diseases preventable by vaccination. According to the Institute of Medicine, 11,000 children are born daily in the U.S., and every one must be vaccinated against such diseases as measles, mumps, rubella, polio, and … Read more

As anyone who has watched the field with some regularity knows, cancer immunotherapy is a tough field to hoe. Provenge is the only therapeutic vaccine for cancer to make it all the way to U.S. Food and Drug Administration approval, and it’s struggling to gain market share. Many more — see GVAX, Canvaxin, and FavID … Read more

Daphna Gans Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California–Los Angeles David A. Ganz Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California–Los Angeles; VA Greater Los Angeles Healthcare System Wendy Senelick Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University … Read more

What went wrong between Penn State and Geisinger, and what lessons should be learned? Medical Director-Care Coordination at Geisinger Health Plan, Danville, Pa. Full text available in PDF ABSTRACT The failed merger between Geisinger Health System and Hershey Medical Center is an instructive case study. The advantages of merging include: 1) support of financially threatened … Read more

As more and more patients are finding their coinsurance or copayments to be beyond their means, payers are weighing the options Ed Silverman For nearly two years, Alka Vakil has witnessed a sobering trend — more people are walking into her busy pharmacy to fill prescriptions, but are failing to follow through and pay for … Read more

Howard Salmon Rick Carter Managed care contracts are most practices’ lifeblood now, and it’s a buyer’s market. Demonstrate your quality-improvement systems and show health plans hard data if you want your group to land the best contracts. MANAGED CARE June 1997. ©1997 Stezzi Communications Managed care contracts are most practices’ lifeblood now, and it’s a buyer’s market. … Read more

Potential for Profit, Potential for Real Change Now, online outlets are alternate retail sites. But if they can help physicians and plans solve medication compliance problems, they will be formidable. Direct Contracting: Why It Hasn’t Grown Burgeoning legions of managed care detractors would love to see this practice spread, but it would take some high-maintenance … Read more

Despite the aging baby boomer population entering their most risky years for atrial fibrillation, a new report called AF Stat: A Call to Action for Atrial Fibrillation, says most states lack public health programs, initiatives, or quality measures related to the management of this condition. Private insurers, consider yourselves warned. Patients with atrial fibrillation use … Read more

For the first time, HEDIS data will be included. Health plans will have to focus on results as well as systems to pass muster. Frank Diamond Senior Editor The National Committee for Quality Assurance didn’t have to reach far to grab what it considers a useful tool to improve its evaluation of health plans. Its … Read more

CMS Takes the Lead In Oncology Payment Reform Only Medicare has the heft and reach to make cancer services more value-based, and recent reforms aim to do just that. Insurers keep close watch. Thomas Reinke ASCO’s Model for Cancer Payment Reform Active Surveillance Helped Me Avoid Prostate Surgery For Now Most types of prostate cancer … Read more

Biologists seek to correct flaw in how bacterial susceptibility is tested When a patient is prescribed the wrong antibiotic to treat a bacterial infection, it’s not necessarily the physician who is at fault. The current antibiotic assay––standardized in 1961 by the World Health Organization and used worldwide––is potentially flawed. So says University of California–Santa Barbara … Read more

Reducing paperwork, coordinating guidelines, and credentialing physicians are three areas being explored without damping the competitive spirit. Too much paperwork is a perennial physician complaint, the American Medical Association says. Doctors hate filling out forms. In Philadelphia, even a $225 incentive couldn’t entice more than 50 percent of physicians who saw pregnant women enrolled in … Read more

In 1971, college campuses were in turmoil over the war in Vietnam and social norms were undergoing seismic changes. Against this backdrop, Lewis F. Powell Jr., a corporate lawyer whom President Richard Nixon would soon nominate to the Supreme Court, sent a confidential memo to Eugene Sydnor Jr., chair of the education committee of the … Read more

Managed care reform–a.k.a. the patient bill of rights–is definitely a priority for Democrats, but is it at the top of their health care agenda? Look for the Senate Labor and Human Resources Committee to give at least equal weight to legislation to protect the confidentiality of medical records. As mandated by the Health Insurance Portability … Read more

Whether for drugs, imaging, surgery, or emergency services, direct-to-consumer advertising sparks lively debate Pharmaceutical companies are spending more than $4 billion a year on direct-to-consumer advertising, and it is working. Patients ask for the medications they see on TV and in magazines, and physicians prescribe them. Health systems are also lining freeways with billboards boasting … Read more

The general stabilization in per-capita medical claims cost — what services cost the health plan before the member is charged — for the managed care industry has not, for the most part, spilled over to biologics, according to a survey by the Segal Co. The consulting company’s ninth annual survey of health insurers, PBMs, and … Read more

I scarcely recognize the 340B drug discount program once I browse the pharmaceutical industry’s criticisms relating to it. It is said that 340B has become too large, is without transparency and oversight, and that is in dire need of reform. Having spent a lot more than ten years dealing using the app at the Health … Read more

Doctors in fee-for-service primary care saw their salaries increase more from 1997 to 1998 than their subspecialist and surgical peers, but they worked hard for it. Ernst & Young’s annual Physicians Benchmarking Survey of salaried physicians in group practices and integrated delivery systems reports that “Compensation for primary care … is advancing faster under fee-for-service reimbursement than … Read more

As hospitals drive growth in programs and health plans take a back seat, this new subspecialty comes into its own Sharon Baker Increased emphasis on improving quality and patient safety in hospitals, growing pressures to reduce costs, and new limits on residency work hours have all led to an explosion in the number of physicians … Read more

The Cancer Moonshot—a bold effort to accelerate progress in cancer research—is a once-in-a-lifetime opportunity for the cancer community and our nation to come together around a single disease that touches all of us. It aims to make more therapies available to more patients, while also improving our ability to prevent cancer and detect it at … Read more

A typical health plan can expect endocrine and diabetes agents to amount to six to eight percent of total utilization costs, with spending on these agents to increase between 11 and 15 percent in 2005. While spending for insulin and oral hypoglycemic agents was on the rise from 2000 to 2003, according to figures compiled … Read more

The problem is outpacing insurers’ resources and perhaps even their commitment. Can the chronic care model help? Martin Sipkoff Contributing Editor Diabetes is creating an escalating economic crisis for our health care system. Health plans use a handful of approaches, but “many insurers remain unaware of the scale of the problem,” says Thomas Bodenheimer, MD, … Read more

In 2006, health care spending averaged $7,026 per person. By 2017, that will shoot up to $13,101. Three-alarm warnings about the rise in health care spending have become routine in Washington D.C., yet, they rarely linger past the 24-hour news cycle. When government officials at the Department of Health and Human Services rolled out the … Read more

A program relying in part on patient education, fluid management, and decreasing the length of incisions, not only helped patients recover faster from elective colon and rectal resection, but also drastically cut down on their use of patient-controlled opioid analgesia. That decreased from 63.2% to 15% of patients, according to researchers as Oregon Health and … Read more

Are employers interested in disease management? Are physicians interested in improving quality of care? Are patients interested in any of this? A provocative discussion. THE FACULTY James N. Astuto, Regional Health Care Manager, GTE Corp., Atlanta Nancy Wilson Dickey, M.D., Immediate Past President, American Medical Association Thomas C. Hawkins, M.D., Medical Director, Customers and Product Management, Harvard Pilgrim … Read more

Competitors are coming together to see if they can leverage blockchain’s magic to solve big problems. Provider directories are among the first use cases. Mike Jacobs works in technology engineering at Optum, UnitedHealth Group’s technology and health care services unit. Kyle Culver has a similar job at Humana. UnitedHealth and Humana are competitors, but now … Read more

The FDA’s Antimicrobial Drugs Advisory Committee has backed the approval of bezlotoxumab (Zinplava, Merck), an experimental drug for the treatment of the most common cause of hospital-associated infectious diarrhea. The panel voted 10 to five, with one abstention, that the drug was effective in preventing a recurrence of Clostridium difficile infection (CDI), which causes inflammation … Read more

An exercise in “point-counterpoint” at a recent disease management meeting showed dramatic swings in views Prepared by the NMHCC Workgroup on Outcomes Assessment in Disease Management *Four members of the National Managed Health Care Congress (NMHCC) Disease Management Outcomes Workgroup debated the pros and cons of six different issues before a group of knowledgeable listeners, … Read more

By Peter Wehrwein Until recently, even the most ardent critics had to admit that with the advent of managed care in the early ’90s, the relentless and seemingly uncontrollable rise in the nation’s health bill finally slacked off. Say what you will about gag orders, market-driven health care and drive-through deliveries, the bottom line was, … Read more

After Purchasing a shocking 25% share from the brothers business, the Shark Tank panel Have mentored the group, helping them experience re branding and also Re packing of these miracle merchandise. ” that the Warriors had been quick to provide up their hard earned money to rear the entrepreneurial group. “We’re not surprised. Probably the … Read more

Small discounts in youth measles vaccinations at the United States would produce significant huge gains in the amount of measles cases as well as at related community health outlays, according to another study by investigators at the Stanford University School of Medicine and also Baylor College of Medicine Medicine. A5 percentage fall from the number … Read more

Sensing an invasion of their territory, MCOs are jumping into a market forged by a group of upstarts. The development renews a fundamental debate about the juxtaposition of consumer involvement, cost containment, cost shifting, and quality of care. Dalton, Ga. is a town built on carpet. Some 80 percent of the carpeting produced in the … Read more

While small, innovative entrepreneurs across the nation certainly make their contribution, the U.S. economy is still very much influenced by those giant standbys, the Big Three car manufacturers, which have been known to come up with a few innovations of their own. That’s why it might behoove health plan executives and others to pay attention … Read more

The recent approval of Aubagio (teriflunomide) provides an opportunity to conduct head-to-head trials in this expanding treatment category Thomas Morrow, MD Multiple sclerosis, a debilitating immune disorder that affects the brain and spinal cord, was probably first described around 1200 in a young Icelandic woman named Halldora who suddenly lost her vision and mobility but … Read more

Even the U.S. may possibly be somewhat wary in terms of approving biosimilars, however the others of the planet appears to get jumped in with both feet. The international market for biosimilars will grow from $5.95 billion annually to $23.63 billion by 2023, based on your study by ResearchAndMarkets. The main reason is straightforward enough, … Read more

New Hepatitis C drugs: A balancing act of costs and benefits In the rapidly evolving market for hepatitis C virus treatments, much more effective medications with higher price tags will require careful cost-benefit analyses, says F. Randy Vogenberg, PhD, RPh. More like this More Will Be Expected of Pharmacists Costly biologics have plan sponsors looking … Read more

November’s pronouncement by a National Institutes of Health panel that acupuncture is an effective treatment for certain conditions, including postoperative dental pain and chemotherapy-induced nausea, won applause from acupuncture practitioners but did little to increase the likelihood that managed care companies would expand coverage of the procedure. In fact, one physician group, the American Academy … Read more

Name Last modified Size Description Parent Directory 04-Jan-98 21:46 – 9712.compmon.ext.gif 09-Jan-98 01:59 9k ../../archiveMC/9712/9712.compmon.gif 05-Jan-98 00:34 53k ../../archiveMC/9712/9712.compmon.pdf 05-Jan-98 00:35 18k 9712.compmon.shtml 07-Jan-98 23:50 2k 9712.contents.shtml 05-Jan-98 00:32 3k ../../archiveMC/9712/9712.copay.charts.gif 05-Jan-98 00:34 44k 9712.copayment.shtml 07-Jan-98 23:42 14k 9712.diabetes-nss.shtml06-Jan-98 00:42 16k 9712.diabetes.shtml 06-Jan-98 00:40 16k 9712.diabetes.shtml.LCK04-Jan-98 22:15 1k 9712.editorsmemo.shtml 05-Jan-98 00:32 3k 9712.employer.shtml 05-Jan-98 00:32 … Read more

Shock over the significant expense of malignancy care has zeroed in on soaring medication costs, including the $475,000 sticker price for the country’s first quality treatment, Novartis’ Kymriah, a leukemia treatment supported in August. In any case, the complete expenses of Kymriah and the 21 comparative medications being developed — known as Vehicle Immune system … Read more

On the theory that capitating primary care can lead to unnecessary referrals, a group of California physicians has decided to pay fees to primary care and to capitate specialists. It seems to work. Pacific Communities Management Services Organization Harbor City, Calif. Capitation is often characterized as a means of cutting physicians’ compensation, but there’s a … Read more

Manufacturing issues sink ZS-9 application The FDA has issued a complete response letter (CRL) regarding the new drug application for ZS-9 (sodium zirconium cyclosilicate, ZS Pharma/AstraZeneca), an investigational medication being developed for the treatment of patients with hyperkalemia. The CRL refers to observations arising from a pre-approval manufacturing inspection. The FDA also acknowledged the receipt … Read more

By Bob Carlson They were providing managed care before anyone called it that. But to make it through the turbulent late 1980s and early ’90s, Group Health Cooperative of Puget Sound, Harvard Pilgrim Health Care and Kaiser Permanente all but reinvented themselves. With varying degrees of success, these three exemplars of not-for-profit, integrated managed health … Read more

CFS is one of a number of diseases with an uncertain etiology and a substantial effect on patients but with few or no verified treatments By William Atkinson According to the Centers for Disease Control and Prevention, chronic fatigue syndrome affects between 1 and 4 million Americans. At least one fourth of these are unemployed … Read more

A brand new study signals which large doctor practices could have difficulty moving into your payment system which rewards quality of healthcare over level of services provided. The study included data from the very first year of an application conducted by the Centers for Medicare and Medicaid Services and called as the Doctor Value-Based Transaction … Read more

John Marcille 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 MANAGED CARE April 2012. ©MediMedia USA The UC-Berkeley health care economist says the cost-control and performance-improvement methods we’ve been developing for years can work, … Read more

Chart While most beneficiaries fared all right, a sizable portion of those forced to change coverage because of HMOs’ 1998 exodus from Medicare experienced disruptions in care and loss of benefits. In addition, Kaiser Family Foundation researchers found that those experiencing the most problems were those in poor health and those of low socioeconomic status. … Read more

Harvard panel hears about person-centered approaches to care The per-patient cost of hospital care declined 19.4% for aging patients enrolled in a project that provided home-based services, according to a report from HealthLeaders Media. Now an interdisciplinary panel is examining ways to build and pay for a “critical pathway to improved care.” When seriously ill patients seek … Read more

Antibiotics do not increase the risk for complications in first year Surgery has been the standard treatment for appendicitis for more than a century. Millions of appendectomies are performed annually in the world, more than 300,000 in the U.S. alone. Studies have been carried out over the years to determine whether nonperforated appendicitis could be … Read more

Americans are hungry for medical information, and they’re getting more of it than ever. Some are even retaining consultants who specialize in helping them get the most from doctors and health plans. It’s 1955, standard Norman Rockwell medical-office setting. The white-coated general practitioner pours a few pills into a bottle, hands them to the patient … Read more

Not quite. In a politically driven system of management, the inevitable result was that market forces were ignored — to disastrous effect. STAFFORD, ENGLAND — The experience of health care reform in the U.K.’s National Health System should, if nothing else, help to illuminate (for Americans who are disillusioned with their own system) that pitfalls … Read more

Seniors oppose cutting the Medicare Advantage (MA) program to fund the Medicare physician payment fix, and believe cuts to MA will hurt them, according to a study jointly conducted by Ayers, McHenry & Associates and the Feldman Group on behalf of America’s Health Insurance Plans. This opposition was voiced by enrollees in traditional Medicare and … Read more

Having Your appendix out May Purchase between $2000 and $180,000. Hospitals, people also have heard , often indicate the price tag on cotton swabs and regular xrays by 300 or even 400 per cent, with the majority of patients unaware to why their medical care invoices are therefore large. As a reply to the hidden … Read more

Copayments, rather than coinsurance, apply to the majority of workers covered by health plans that have three or more drug tiers, according to a recent Kaiser Family Foundation report. Percentages vary slightly across drug types, mostly because some plans have copayments for some drug tiers and coinsurance for others. For members in plans with three … Read more

Evithrom may minimize some of the antibody production associated with bovine proteins, but the possibility of human viral infection exists Thomas Morrow, MD Few of us stay awake at night thinking about our clotting system. This system consists of a number of proteins that interact in a complex manner to create an actual physical mesh … Read more

For the second straight year, California Gov. Pete Wilson cited the prospect of rising health costs as he vetoed a host of managed care reform bills passed by the state legislature.In the weeks after the end of the legislative session, Wilson vetoed seven managed care reform bills, including three that would have tightened regulation of … Read more

Trillium Health, formerly called AIDS Care — an early participant in attempts to combat HIV from Rochester — is poised to start a brand new front in that struggle. It really is but one of six treatment providers within a country pilot program to begin out people at elevated risk of contracting HIV to a … Read more

The Panel voted 14-4 to urge that the medication, SER120, be prescribed for certain patients with nocturia, thought as awakening to urinate a couple of times per nighttime. Even the FDA isn’t obliged to follow along with its own advisory panel recommendations, but on average does this. Allergan Is seeking approval to advertise the medicine … Read more

What regulators will be focusing on as they scrutinize the Anthem–Cigna and Aetna–Humana deals. Prisms are one of the oldest tools ophthal­mologists use to examine misaligned eyes. The prism bends light rays but does not focus them and lets the doctor measure, in millimeters, the deviation between two eyes. In trying to get a read … Read more

Washington Watch If you thought a lot of time and money was spent on Y2K readiness, you ain’t seen nothin’ yet. Complying with the new rules for electronic transaction standards under the Health Insurance Portability and Accountability Act (HIPAA) is expected to exceed Y2K in terms of dollars and work hours. Some estimates peg the … Read more

In a strategy that wellness specialists greeted as colorful and eccentric, Federal regulators declared Monday that for the subsequent six years they’d cover ny state hospitals never to coach physicians. As the national authorities for several years compensated farmers to Let fields lie fallow, 4 1 of ny nation’s teaching hospitals is likely to be … Read more

I-Spy 2 is a new private-public collaboration that combines personalized medicine and novel clinical trial design to develop lifesaving new breast cancer drugs. It’s a partnership between heavy-hitters like the Food and Drug Administration, the National Institutes, and major pharmaceutical companies, and is led by the Foundation for the National Institutes of Health…. About 66 … Read more

Minnesota-based HealthPartners works with local leaders in a successful initiative to improve health care in a developing African country. REACHING OUT It’s a lush, agriculture-rich land in the Great Lakes region of East Africa. Once a British colony, it is now a country of 23 million welcoming, beautiful people who are inspiring and optimistic in … Read more

UPCOMING MEETINGS Healthcare IT & Analytics Summit 2019 Newport, RI July 10-12, 2019 The Government Health Care Congress Washington, DC July 16-17, 2019 Integrate 2019 Philadelphia, PA July 22-23, 2019 2019 Population Health Management Forum for Payers & Providers San Diego, CA July 25-26, 2019 2019 Star Ratings & Quality Management Forum San Diego, CA … Read more

Radiology is the name of the game in physician recruitment today, with income offers increasing by an average of nearly $50,000 over previously recorded levels, according to the national physician search company Merritt, Hawkins, & Associates. Tracking 2,043 physician recruitment assignments it conducted from April 1, 2000 to March 31, 2001, Merritt Hawkins saw average … Read more

MANAGED CARE February 2006. ©MediMedia USA Spending on information technology products and services will grow at a brisk clip, according to Datamonitor, a business information company. Through 2010, Datamonitor expects that the payer market for health care IT will expand by a 7 percent compound annual rate over five years. The company expects slightly more market expansion … Read more

The first time I encountered cost-effectiveness research was during a stint at the Harvard School of Public Health in the early ’90s (the injection of T.H. Chan into the school’s name came much later). I was a journalism fellow there and then worked as a writer and editor. The details have slid outside my recall, … Read more

BPCI Advanced signals a willingness among Medicare providers to redesign care and take on risk. Commercial payers are watching closely. “We can never go back again, that much is certain,” wrote Daphne du Maurier in her 1938 novel Rebecca. Eighty years later, Du Maurier’s observation is just as fresh when looking at the uptake of value-based … Read more

HMOs and Alternative Medicine Public fascination with alternative medicine gives health plans a can’t-miss business opportunity. Science may determine whether plans’ interest lasts. Patient Satisfaction: The Indispensable Outcome Surveys say a lot about quality and are continuously conducted by HMOs and accrediting bodies. The authors suggest medical groups follow suit. Extricating Yourself From the Hospital … Read more

The young industry must clear some hurdles in the near future. Medicare stratification, disability management, and federal restrictions are worrisome. Then there’s that new law in California. To paraphrase the immortal words of Dan Quayle, there is an irreversible trend toward more disease management — but that could change. All the DM pieces are starting … Read more

Thomas Morrow, MD 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 … Read more

Debate rationing I read with great interest the interview with Leonard Fleck, PhD, in the August edition of MANAGED CARE. Fleck is entirely correct regarding the discussion of an honest broker to assess the effectiveness of diagnostic and therapeutic interventions. Health plans cannot provide coverage decisions and care paths and enforce them. If they do, … Read more

That its profound learning system may identify prospective treatments for fibrosis. This system, called jelqing tensorial psychologist learning, or GENTRL for short, surely could locate six assuring treatments in only 21 days, one which demonstrated promising effects in an experiment involving mice. The investigation was published at Nature Biotechnology, and also the code to its … Read more

HMO profits soared 81 percent in 2002, according to Weiss Ratings. The industry earned $5.5 billion, compared to $3 billion in 2001…. About 6 in 10 of 1,206 Americans polled by the Kaiser Family Foundation report that they are somewhat worried that the amount that they pay for health care will increase. They also worry … Read more

Kaiser Permanente has settled a wrongful-death lawsuit, brought by the family of a Texas man, for an eye-popping $5.3 million. The family claimed Ronald Henderson’s heart attack was the result of a Kaiser cost-cutting plan that left him untreated for heart disease. Kaiser lawyers argued that Henderson was an overweight smoker who did not obey … Read more

Physicians and hospitals have always been subject to liability claims, but now health plans are becoming vulnerable too. Adverse events cannot be eliminated, but there are many ways to reduce liability exposure. Not every patient who is significantly harmed through an adverse event or negligence resorts to a lawsuit. Surprisingly few do. One Harvard University … Read more

Sales hit the billion-dollar mark as pharmaceutical companies have used the Orphan Drug Act to their advantage. Insurers are beginning to push back. In November 2010, David Mitchell was diagnosed with multiple myeloma. At the time, he thought the relatively rare bone marrow cancer—about 30,000 cases are diagnosed each year—would be the proverbial death sentence. … Read more

Better outcomes and lower costs—in the long run. But payers were not impressed with the oncology medical home. The rapidly rising cost of cancer care was on every payer’s mind when the buzz started building about a nine-physician oncology practice on the outskirts of Philadelphia. Since 2004, Consultants in Medical Oncology and Hematology had been … Read more

Kaiser Permanente has launched a computerized surveillance system designed to alert public health officials to possible disease outbreaks. “It will be an extremely efficient way to monitor bioterrorism,” Eric Koscove, chief of the emergency medicine department at Kaiser Permanente Santa Clara, tells the Contra Costa Times. The Internet-based system, which was developed at Sandia National … 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

But discontinuation rate is high, and Wall Street is unimpressed by sales of the new class of migraine medications. E​arly real-world data about the first drugs specifically designed to prevent migraines shows they have had an impact on reducing the use of opioids and triptans to combat acute migraine attacks. That’s good news in a … 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

Authors find significant differences in ICU use and length of stay   In an analysis of practice patterns at 37 major nonprofit U.S. children’s hospitals, researchers have found that intensive care unit (ICU) usage was 254% higher for asthma patients when comparing the lower eighth to the upper eighth of hospitals. The retrospective study was … Read more

The Country’s largest nursing home Drugstore, Omnicare Inc., has Consented CVS Health Corporation, which will be based in Rhode Island, acquired Ohio-based Omnicare at 2015, approximately half a year later Omnicare stopped the behavior which gave rise to the payoff. “daily, older nursing home residents suffering from dementia “kick-backs to entities making medication tips undermine … Read more

John Muir, the famous naturalist, wrote: “When one tugs at a single thing in nature, he finds it attached to the rest of the world.”  It’s a concept that’s long overdue but now fully ensconced in the field of population health management.  Employee health management (EHM) practitioners, in particular, are coming to understand that the … Read more

Is managed care dying — or evolving? While few think managed care is going away, there’s sharp disagreement on the form it will take in the future. No doubt, MCOs are less restrictive than at one time. Paul Ginsburg, head of the Center for Studying Health System Change, told a Robert Wood Johnson Foundation conference … Read more

America criminal justice process would be the largest on the planet. Under some sort of pest control from the USA, for example 2.2 million incarcerated in national, state, or regional prisons and jails. Even the U.S. is really a global pioneer in its rate of incarceration, dwarfing the speed of every other state. U.S. criminal … Read more

Though the legislation isn’t comprehensive and won’t be a burden, some health plans will need to scramble to build specialist provider networks John Carroll For an estimated 113 million Americans, the $700 billion congressional bailout bill carried a sweetener in the form of a mental health parity bill that is designed to evenly balance the … Read more

Research has pointed to ways that falls can be prevented, but logistical and financial barriers get in the way. Elizabeth Eckstrom, MD, Oregon Health & Science University A bad fall can become that disastrous inflection point of old age, the swerve into dependence, expensive care, and declining health. Numerous studies have suggested modest and inexpensive … Read more

EFFICIENCY “Advanced access means that if somebody wants an appointment, you offer the appointment for today.” It’s not that difficult to implement. The longer the wait for an appointment, the better the doctor, right? Not any more. Not when happy patients start telling friends and neighbors about the excellent doctors who can see them the … Read more

Mentors and support groups can help you avoid being fired. And if the worst does happen, they can facilitate your comeback. Most chief executive officers who work in health care say they will retire soon and expect it will be a struggle to replace them due to a shortage of qualified candidates. Enter the physician … 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

Citing strong opposition from hospitals, Blue Cross of California has abandoned its plan to separate them by copayment tiers. Hospitals say the use of differing copayments to identify them as high- or low-cost facilities gives the wrong impression about quality.

History has vindicated Paul Ellwood’s prediction of a price-competitive health care market. Is he right again in saying the current trend away from integration will be reversed? 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 … Read more

Atrial fibrillation patients are often noncompliant with warfarin but newer drugs have better safety and side effect profiles We are now at a turning point with stroke prevention in patients with atrial fibrillation: Warfarin sodium no longer stands alone. This means that managed care may be able to vastly reduce the cost of paying for … Read more

MANAGED CARE currently sponsors the Disease Management Forum, an e-mail discussion group with approximately 1100 members. Membership is drawn from across the spectrum of healthcare professionals — managed care executives, medical directors, physicians, developers, vendors, consultants, pharmacists, nurses, case managers, and quality professionals. The list is moderated by MANAGED CARE’S editors. Follow the link below for … Read more

Beneficiaries must soon choose between competing managed care companies, pay a $100 monthly premium, and be careful about heading over to the ER With Medicaid rosters swelling and the tap for special federal subsidy payments now shut tight, Florida has taken the lead among states looking to managed care companies to shoulder the immense task … Read more

A funding impact analysis can be a economic appraisal which impacts the fiscal consequences of embracing a brand new intervention. A funding impact analysis is normally performed along with a costeffectiveness investigation. A costeffectiveness analysis assesses whether an appraisal offers value comparative to a present intervention. By way of instance, a costeffectiveness analysis can signify … Read more

While much cities and parts of this united states brace to get a spike of coronavirus patients during the upcoming couple weeks, physicians are reluctant to ready. And the tools that they must show to will vary, based upon the demographics of these patients that they serve. “We’re doing what we could to organize ” … Read more

It seemed a good idea to sell the practice to a hospital, but it didn’t work out. When a doctor wants or has to leave, there are things to negotiate. Mark D. Abruzzo, J.D. Caught in the riptide of change, hospitals in many regions have ventured into the private practice of medicine in the past … Read more

FDA Handling of Avastin Discourages Innovation Submitted by Robert Goldberg on Tue, 2011-11-22 19:20 Avastin cancer drugs evidence FDA Robert M. Goldberg is a co-founder and vice president of the Center for Medicine in the Public Interest (CMPI). Robert M. Goldberg, PhDThere has been a lot of discussion of the Food and Drug Administration’s decision … Read more

What can be lost in the hullabaloo over consumer-directed health plans are the facts that only a relatively small amount of people have so far signed on, and some experts remain skeptical about the ultimate effectiveness of these benefit packages. Forinstance, a Commonwealth Fund report says that CDHPs might actually worsen outcomes (and therefore be … Read more

There have been small accomplishments, and wheels have been churning for more forceful action — that is, they were until Sept. 11. Michael Levin-Epstein Contributing Editor REGULATION Managed care organizations are giving thumbs up to pending regulatory and funding changes in the Medicare+Choice program that would help it achieve parity with fee-for-service plans. But no … Read more

World’s first hybrid closed-loop system for patients with type-1 diabetes   Medtronic has announced the U.S. launch of the MiniMed 670G system––the world’s first hybrid closed-loop system for patients with type-1 diabetes (T1D). It is the only insulin pump approved by the FDA that allows personalized, automated delivery of basal insulin, the background insulin needed … Read more

Two vaunted ideals of health care, experts say, should be perfectly aligned. And they almost are. Health care doesn’t lack for big ideas, even if their definitional boundaries do sometimes get fuzzy. Take “population-based medicine” and “patient-centered health care,” for example. Both are phrases we hear and read every day, and maybe even believe in. … Read more

An affordable option for integrated health care bridging private U.S. insurers and Mexico’s social security system would save American employers money while providing better care to Mexicans who work in the U.S. but whose families live in Mexico, according to a study. The Mexico-USA Cross-Border Health Insurance Initiative, a joint project of the Academy for … Read more

The Centers for Medicare and Medicaid Services will make the Part D reporting process more difficult and complex In 2008, the Centers for Medicare and Medicaid Services conducted an extensive evaluation of the medication therapy management (MTM) component of its Part D program. Then it decided to increase access to MTM for Part D beneficiaries … Read more

The estimates range from $13.5 trillion to $47.6 trillion. The variables include the generosity of the benefit and forecasts for reining in health care expenditures. As the former chief economist at the International Monetary Fund, Simon Johnson has done his share of broad-scale economic forecasting. Now a professor at MIT, he and other experts were … Read more

The managed care reform bill sponsored by Republican Rep. Charles Norwood of Georgia is gaining momentum–at least, within the halls of Congress. Norwood allies have polled, informally, rank-and-file House Republicans and found growing support for his Patient Access to Responsible Care Act, or PARCA. Tangible evidence: The bill has more than 200 co-sponsors. But in … Read more

Recommendations for ovarian, breast, and pancreatic cancer. The NCCN Clinical Practice Guidelines in Oncology or Genetic/Familial highrisk Assessment: Breast, Ovarian, and Pancreatic, Version 1.2020 comprises several upgrades –including brand new and expanded sections on hazard assessment and direction linked to three big cancer types–while keeping an even more conservative way toward analyzing clinics where in … Read more

Most emotional health investigators are based up on qualitative procedures of information selection. Whilst these kinds of processes are usually viewed as reputable and qualitative techniques are most frequently viewed as far much more legitimate. Inspite of the worth of qualitative procedures of information group, but lots of investigators denigrate their usage. Qualitative study can … Read more

Physicians often complain that they get the brunt of the managed care backlash because patients identify them as “part of the system.” A new survey by the Medstat Group, a consulting firm, may lend credence to physicians’ perceptions — but also suggests that physicians have some control over influencing this perception. Medstat surveyed health plan … Read more

When we all show signs of the same syndrome, we may not easily admit that it is a problem. What about a prevalent practice that kills? Michael S. Victoroff, MD OK, I’ve had it. I’ve got to ventilate about drivers with cell phones. Safety often doesn’t receive due attention as an aspect of health care. … Read more

Sur-prise medical Statements occur when a patient receives Attention at an Out-of-network centre, or by a out-of-network provider for an innetwork centre. Tackling the excessive invoices was a important health priority for Congress this past year, but has been pushed into the legislative acts way-side because Washington’s attention was held hostage by the COVID-19 pandemic … Read more

CVS Health’s profits jumped over 50 Percent as Optional procedures the Organization giant’s Aetna health plan pays were delayed amid the spread of their Coronavirus breed Covid-19. CVS Health Leader officer Larry Merlo stated the Organization’s Diversified company portfolio which features drugstores, retail practices in addition to medication and health benefits will be helping the … Read more

Consensus is building that episode-based bundled obligations may create large Medicare savings, and also the Center for Medicare & Medicaid Innovation’s Bundled Payment Initiative supports this idea. The app creates potential financial benefits by lowering the historical price of time-defined episodes of maintenance, given through a reduction. Even though bundled obligations can decrease waste primarily … Read more

BY TIMOTHY KELLEY Overconfidence is rarely the danger in monthly magazine publishing, but I keep D.H.’s letter taped to my wall to guard against it, just in case. D.H. is the Washington State physician who took the trouble to write us, “I find your publication singularly worthless and do not wish to ever receive it … Read more

MANAGED CARE September 1999. ©1999 MediMedia USA Congress this month will take up a bipartisan managed care reform bill, perhaps the first this year to truly worry the insurance lobby. The bill, sponsored by Georgia Republican Charles Norwood and Michigan Democrat John Dingell, has 65 cosponsors, and is supported by the AMA. It was introduced in the … Read more

Tele Medicine Because the population ages, the elderly individuals are becoming more and more concerned with this practice. This is really a story report on both the books and Web regarding telemedicine projects over the area of geriatric areas in France. Since the start of the 2000’s, several telemedicine trials and projects centered on chronic … Read more

Too Many Books: How To Tell the Best Cooks? So many clinical practice guidelines are issued by various groups that even locating a base of reference can be a task. For health plans, finding guidelines on which to base their own–protocols that promote high quality care, encourage physician buy-in and yet still keep a lid … Read more

Health advocacy groups are reluctant to conserve U.S. research bureau around the chopping block from Congress. A proposition by the corresponding Senate poll, approved 25 June, could be just marginally less type, doubling AHRQ’s $364 million funding by 35 percent. People that would like to trim or eradicate AHRQ assert that its work complies with … Read more

United Kingdom’s Reforms Look Familiar Can managed care function in a politically driven system? When Cooperation Makes Sense Working together on noncompetitive things can benefit HMOs. COVER STORY Mobilization on the Hospital-HMO Front The Balanced Budget Act and market pressures have hospitals crying “uncle.” Still, HMOs have to look somewhere for savings. Poor IT Systems … Read more

The “right … to petition the government” has come a long way in over 200 years, and health care organizations are not shy in exercising it. “Those who are organized, have the most money, the most influence, the most mobilized memberships are the ones whose viewpoints are being most heard.” Cynthia Berry rises at 6 … Read more

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 billion. The … Read more

Now that the hard part – forging quality-measurement systems for HMOs and point-of-service plans – has been done, the next step is to adapt these programs to the rest of the health care industry. By Margaret E. O’Kane Twenty years ago, when fee-for-service practice was dominant, medicine was unlike any business. There was no oversight … Read more

Why are so many HMOs getting out of the managed Medicaid business? Wall Street analysts have wondered about that for several months, and now, apparently, so is President Clinton. He ordered Health and Human Services Secretary Donna Shalala to determine the reasons why health plans are withdrawing from Medicaid managed care programs — and how … Read more

Employers would have to “pay or play” in some proposals for how to boost coverage for the uninsured. The idea can be found in a report, “Cost and Coverage Analysis of Ten Proposals to Expand Health Insurance Coverage,” by the Lewin Group, undertaken for the Economic and Social Research Institute. All the proposals would boost … Read more

Yet quotes for the financial effect of pain vary. But that is simply the cash emptied from U.S. organizations due to growth lost from employees from the pain. It merely contained arthritisback pain, aggravation , along with other musculo skeletal pain; additional sorts of chronic pain were excluded. Even though taking a look at pain’s … Read more

In our employer-driven health care system, you might think that 1997 should have been a banner year in terms of reducing the number of uninsured. After all, a robust economy launched the Dow Jones Industrial Average past two milestones: 7,000 in February and then, only four months later, 8,000. Meanwhile, inflation and unemployment were negligible … Read more

Whether you’re stepping up to this position or already hold it and are looking to make a shift, get ready for tumult—and big potential rewards. When it comes to medical directors, the old saying applies: If you’ve seen one, you’ve seen one. Generalizing about this broad category of administrative pros is like characterizing “creatures” from … Read more

As the worlds of business and medicine become more intertwined, physicians who pursue advanced degrees in business are rewarded financially. Among members of the American College of Physician Executives surveyed by Cejka & Co., a St. Louis-based consulting and search organization, median incomes for doctors with business-oriented master’s degrees were higher than those of physicians … Read more

Amazon.com used to be about books. Now it’s about the future of health care. That the online bookseller has diversified into areas such as prescription drug sales is just part of the story. The real message from this Internet upstart, which has shaken traditional booksellers like Barnes & Noble to the core without ever owning … Read more

Nearly 12 million patients a year are misdiagnosed, and half of those cases could lead to serious health problems, according to a meta-analysis in the journal BMJ Quality & Safety. Researchers looked at three studies: one of misdiagnosis in primary care settings, and one each for colorectal cancer and for lung cancer that examine screenings … Read more

Unmet Needs in the Management of Plaque Psoriasis This Clinical Brief reviews the numerous unmet needs among with patients with psoriasis, a chronic and debilitating disease. In the absence of a cure, these patients seek a treatment that improves the signs and symptoms of their disease. Highlights: Patients with moderate or severe psoriasis have been … Read more

Privacy proposals will be one of the most prevalent — though not the most hotly debated — issues related to health coverage in state houses this year, according to a survey by the Health Insurance Association of America. Prescription drug coverage, prompt-payment mandates, and so-called “legislation by body part” aren’t far behind.of America. Prescription drug … Read more

Insurers know that the new tests can be valuable, but have trouble evaluating them and may not even know exactly which ones they are paying for While much has been written about the promise of new molecular and genetic diagnostic tests, they also bring a tidal wave of complexity, cost, and quality issues for health … Read more

The government joins health plans, providers, employers, and pharmaceutical companies in seeking to establish DM’s value The industry is evolving, with a nice boost from Uncle Sam Disease management’s legitimacy got a shot in the arm when the Centers for Medicare & Medicaid Services awarded multimillion dollar contracts to nine vendors last December. The “Medicare … Read more

BY PETER WEHRWEIN Andrea Niemi was motivated, no question about that. Bothered by weight problems most of her life, the 46-year-old St. Paul, Minn., lawyer two years ago had joined a health club that was about six blocks from her home. She had gotten herself into the kind of five-, sometimes six-days-a-week work-out routine that … Read more

Chest X-rays do not save lives when used to screen for lung cancer, according to a 20-year study reported in the Journal of the National Cancer Institute. Mayo Clinic/NCI researchers found that imaging led to no reduction in mortality, but revealed many “clinically insignificant” tumors, inviting potentially unnecessary treatment…. “California, open your Golden Gate?” Only … Read more

Dwindling of Employer Plans Would Reshape the Industry Analysts predict the change may save businesses $3 trillion and add to health plans’ risk business, but others doubt that big employers will willingly cede their health insurance role John Carroll Doctors Aren’t Grasping For Cost Transparency Tools Saving health care dollars requires information, and health plans … Read more

  Log In Username or e-mail address *  Password *  Forgot Password? Create new account   STAY IN TOUCH! NEWSLETTERS AVAILABLE: P&T; and drug management daily news Editor’s letter (bimonthly) Managed Care table of contents (monthly)

We begin by studying the several sorts of insurance fraud in addition to its scope and cost. Finally, we supply a highlevel summary of current antifraud activity. Provider Fraud at California Employees’ Compensation: Selected problems Workers’ compensation fraud is supposed to become one of many fastest-growing kinds of insurance fraud, allegedly costing businesses and insurers … Read more

The failure of health care reform to resonate with voters prompted the American Association of Health Plans to indulge in a bit of gloating — and to send a message to legislators with designs of taking up the health care issue again next year. Six days after the election, AAHP released a study suggesting that … Read more

Now that the value of hospitalists is well established, attention turns to those whose only duties are in intensive care Joan Brookhyser, MD, is on a mission to change the face of health care in Nevada. Much to her surprise, her opportunity is coming from the largest HMO in the state. In the last two … Read more

Two-way video communication has been a science fiction staple for generations. As this technology evolves from the incredible to the practical, telemedicine is proving useful for ensuring the quality of health care while reducing costs. But although sophisticated technology is within reach of the average person, managed care companies have been slow to embrace telemedicine’s … Read more

When a clinic run by pharmacy students implemented medication management with a closed formulary, it resulted in an average decrease in cost per prescription from $27 to $20. That was good news to the Sharing clinic, which serves the uninsured population of Omaha, Neb. Across the United States, approximately 59 student-run health clinics provide more … Read more

As a whole, the plan unceremoniously crashed and burned. But it still frames state and national debate about health policy, thus affecting the evolution of managed care. Michael Levin-Epstein When managed care executives are asked to “free associate” about the Clinton administration’s health care reform plan, two words invariably crop up: “Hillary” and “ill-fated.” As … Read more

The program showed significant improvements in all diabetes and hypertension-related clinical measures Debra Wertz, PharmD Director of health economics and outcomes research, HealthCore Likun Hou, MS Research analyst, formerly of HealthCore Andrea DeVries, PhD Director of research operations, health plan analytics, and strategy, HealthCore Leon Dupclay Jr., PharmD, PhD Director of health economics and outcomes … Read more

This may be one way to regain profitability, though getting permission from government regulators may take some doing. MargaretAnn Cross Contributing Editor Operating under laws that mandate about five dozen benefits and put a tight cap on how much of the cost of health care consumers can shoulder, Texas HMOs have been losing ground to … Read more

Washington Initiatives Attention home-health agencies: In a major policy shift, the Health Care Financing Administration no longer will treat as “new” any agency that otherwise would qualify as “old” if not for the fact that it changed its organizational status from freestanding to hospital-based (or vice-versa) after fiscal 1994. As a result, revisions to the … Read more

Home, (Not So) Sweet, Medical Home It was the hot topic at the DMAA annual conference because attendees could not agree on its viability Maureen Glabman Contributing Editor The “medical home” was not far from many presenters’ scripted notes at the disease management industry’s annual meeting. “It’s the hottest thing out there,” said one speaker, … Read more

Medicaid expansion often means a hollow benefit, says Scott Gottlieb, MD, a resident fellow at the American Enterprise Institute and a leading conservative expert on health care policy. And the exchanges are in trouble with little political support. But Gottlieb says there will be some reluctance for sweeping reform because of a “fatigue factor,” so … Read more

State legislatures and regulators are showing considerable interest in requiring managed care plans to provide continuity of care for patients with certain medical conditions. The aim is to avoid disruption in care when the physician can no longer see a patient because an employer changes health plans or because of an internal change in a … Read more

There are many genetic mutations attributable to the condition, but Kalydeco can significantly help a specific subpopulation of patients I can still remember the anguish on the faces of parents whose children were being treated for cystic fibrosis (CF) during my training at a children’s hospital in the late 1970s. They knew that we had … Read more

Now the Centers for Medicare and Medicaid Services (CMS) introduced philosophical rivalry and discussion in to industry for physician-administered along with different Section B medications which is going to lead to better prices and lower medication prices for patients. As a portion of this bureau’s ongoing activities to send President Trump’s asserts outlined in his … Read more

Some physicists, not to mention authors of science fiction, posit that there are an infinite number of universes with infinite numbers of you and me making infinite decisions that are somewhat different from the ones we’ve made that have gotten us to this point in this particular universe. Some versions of me probably write longer … Read more

The crisis some employers feared that the Mental Health Parity Act would bring about hasn’t happened. But neither has an avalanche of care. David L. Coleman Substance … or symbolism? In the year since the federal Mental Health Parity Act took effect, has there been any effect on patient care or on those who pay … 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

Diabetes researchers have believed that the Disorder starts when The immune system strikes insulin-producing beta cells from the pancreas. He and a group of investigators at his laboratory probed the complex biology of cells also made a discovery he thinks might possibly be used to protect against the beginning of the disorder in those who … Read more

Drug management under the medical benefit is lagging the pharmacy benefit. “At least 50 percent of drugs are dispensed under the medical benefit, and it’s often an area for financial opportunity, yet it’s the least managed,” says Brenda Motheral, MBA, PhD, executive director of the Pharmacy Benefit Management Institute. The 2013 Specialty Drug Benefit Report … Read more

Physicians will be able to keep better tabs on heart problems and diabetes, and even help relieve chronic back and leg pain HeartFlow’s Computed Fractional Flow Reserve (FFRCT) technology received de novo clearance for the evaluation of patients who show signs and symptoms of coronary artery disease (CAD). The technology combines noninvasive imaging and computational … Read more

Plans are increasingly concerned about the degree to which providers overcharge them to make up for losses from government programs When Blue Shield of California enters negotiations with providers each year, hospitals are pretty frank about why they need to raise prices, says David S. Joyner, senior vice president for network management. One of the … Read more

Recent court ruling means that beneficiaries should be notified about insurers’ decision-making powers Claims administrators have been put on notice by the Seventh U.S. Circuit Court of Appeals that employee benefit plans will need to spell out in precise detail their prerogative in making benefit decisions — or risk losing it. The court’s decision in … Read more

The Access to Life-Saving Medicine Act may be a first step to giving the FDA the legal authority to approve these drugs Martin Sipkoff More than 25 years after Hatch-Waxman, no legal pathway for approval of generic biologic drugs exists. But if that redoubtable Democrat, Rep. Henry Waxman of California, has his way, an abbreviated … Read more

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Improving cardiac surgery outcomes for both adults and children is the goal of 21 quality measures recently endorsed by the National Quality Forum. The measures spring from two NQF “endorsement projects”: Surgery Endorsement Maintenance 2010, Phase 1, and the National Voluntary Consensus Standards for Pediatric Cardiac Surgery. “NQF endorses national consensus measures in health care … Read more

Deaths of women from opioid addiction spiked 400%, according to CDC data. Alison Colbert of Duquesne University argues for a gender-specific approach. The 28-day inpatient rehabilitation period, the maximum that most health benefits plans cover, needs to be reconsidered, says Alison Colbert of Duquesne University. Alison Colbert likes to point out that until the 1990s, … Read more

Increasingly sophisticated imaging and lab tests, along with campaigns to encourage screening tests, have meant that cancers and many other conditions are discovered much earlier in the disease process. Catching a disease early can mean more effective and less costly treatment. But there’s growing recognition that moving disease recognition upstream can result in overdiagnosis—finding an … Read more

BY JOHN A. MARCILLE American global supremacy, following British global supremacy, is not the only reason that English is spoken around the world. It happens to be a tongue that, even without the grammatical elaborations of Latin, German and Russian, is able to convey detail and nuance. But many in health care seem to be … Read more

The Medicare Commission couldn’t cross the finish line. Patient-rights bills can’t seem to get to the starting line. So there’s not much chance of major health care legislation going far in this session of Congress, right? Wrong. Think privacy. Legislation to protect the confidentiality of medical records is front and center on Capitol Hill, with … Read more

Changing the way doctors are paid could save over $1 trillion in health care costs, but physicians can’t do it on their own. One of the ways health insurers can help is by joining together to facilitate payment reform, says a study by UnitedHealth Group. “The stronger financial incentives stemming from a multipayer initiative are … Read more

Combining Medicare fee-for-service payments with new incentive programs could help physician groups save money for Medicare and reach quality-of-care targets, according to the February 2008 Medicare Physician Payment report issued by the Government Accountability Office. The Centers for Medicare & Medicaid Services undertook a pilot program involving 10 physician group practices with more than 200 … Read more

Taking Members From Disconnected to Engaged To engage members and close care gaps, health plans are taking a closer look at member data sets and the analytics that can harness them. Health plans these days are investing time and resources in analytics and investigating new ways to more fully engage with their members. Why? Because … Read more

Go South, young doctor.” That seems to be where the opportunity lies in terms of compensation, according to the Medical Group Management Association. The MGMA surveyed 960 member practices to gauge compensation trends and found that median incomes for family practice (without OB), internal medicine (general), and pediatrics (general) were strongest in the South. For … Read more

Health plans are taking profitable cues from national retailers and providing members with coupons for newly available over-the-counter products. Blue Care Network (BCN) of Michigan is taking its cue from the retail ranks of CVS, Rite Aid, ShopRite, and Target by providing coupon savings to its allergy sufferers. It is a growing trend among other … Read more

John Marcille For years, we sometimes felt as if we spent our days trafficking in a dead language. We threw terms around such as accountable care organizations, pay for performance, meaningful use, and bundled payments. Now, as Managing Editor Frank Diamond’s cover story on page 14 points out, those phrases may soon become common rhetorical currency. “What … Read more

Also available as PDF One of the effects of managed care is greater responsibility for all participants in the health care industry — not just physicians. Hospital & Healthcare Compensation Service recently surveyed 195,410 employees of 381 hospitals in the nation to measure salary trends for nurse practitioners and physicians assistants for its Hospital Salary … Read more

Employer-sponsored health benefits for retirees could go the way of house calls and dial phones thanks to increasing health care costs. A study by the Kaiser Family Foundation and Hewitt Associates says that 10 percent of 408 companies with 1,000 employees or more plan to drop coverage for future retirees. Twenty percent say they plan … Read more

Researchers in Australia and the United States have determined The threedimensional arrangement of a cone snail venom insulin, showing these exceptionally efficient all-natural proteins called Con-Ins G-1 can operate faster compared to human insulin. The groups discovered that Con-Ins G-1 managed bind to individual Insulin receptors, signaling the possibility for its interpretation into an individual … Read more

The goal is to keep oncologists from relying on drug markups to keep their incomes high, but it’s slow going As the costs of treating cancer escalate, health plans are putting new energy into managing one of the most difficult categories of health care. The going is slow, but major changes in the way oncology … Read more

Key care has anchored our care delivery system, although Its Own Purpose and role keeps shifting. Throughout the hey day of this HMO age, it functioned as an usage Gate Keeper. More lately, principal care has functioned since the proverbial glue that Assessing patient clinical and information connections for people with diverse health needs. Or … Read more

Washington Watch Medicare reform is becoming one of the longest-running soap operas — even for Washington, a town known for its propensity to drag out policy debates. President Bush favors full-fledged reform, but chances for prompt action are extremely dicey. From time to time, the prescription drug issue complicates reform efforts. Bush’s feelings about tying … Read more

The push to mandate this electronic tool is increasing in intensity, but dealing with costs and coming up with standards remain obstacles Electronic prescribing is the holy grail of medication safety. “Its two-fold potential is very significant,” says J. Lyle Bootman, PhD, dean of the College of Pharmacy at the University of Arizona-Tucson, and a … Read more

As enrollment increases in consumer-directed health plans, some insurers find a little guidance goes a long way A swim coach helps swimmers minimize their turn times. A hitting coach helps baseball players develop a powerful swing. A health coach helps . . . well, that depends on whom you talk to. Insurers, consultants, and employers … Read more

If the future can be extrapolated from the recent past, the HMO market will be dominated increasingly by plans of the independent practice association model, according to data from a leading HMO directory. Such plans tend to be of more recent vintage, while staff- and group-model HMOs are older. Here is the national distribution of … Read more

High-Cost Drugs: Where’s the ROI? For specialty medications, weighing cost and benefit can be frustrating. Some can dramatically reduce future costs. Others, not so much. Joseph Burns Health Plans, Patients Struggle To Pay for High-Cost Drugs Beneficiaries and physicians can be surprised and dismayed to find that in some drug classes in some plans, there … Read more

Manufacturers Square Off Over Naming of Biosimilars Argument about safety reflects biosimilars and brands jockeying for market share John Carroll When a small-molecule drug goes generic — as that little purple blockbuster Nexium (esomeprazole magnesium) will next year — manufacturers use the same name for the active ingredient when they push out cheaper knockoffs. But … Read more

A proposal to levy a tax on health care insurance meets a chilly response from Capitol Hill, the Bush administration, AHIP, and pollsters. What a surprise. Should health insurance be a taxed benefit? According to the President’s Advisory Panel on Federal Tax Reform, the answer is yes. Led by two former senators, Connie Mack III … Read more

For more than two decades, a complex federal law has been interpreted to protect HMOs from malpractice liability claims. Now experts believe that protection could be in jeopardy. In the court of public opinion, these are not the happiest times for managed care companies. The news media routinely trot out horror stories about HMOs denying … Read more

The gender imbalance in health care leadership is a problem worth solving, experts say. That will require women willing to step forward—and men willing to back them. It has been said often and for a long time that women are the health care CEOs, CFOs, COOs, and CMOs of their families. But when it comes to … Read more

January Health information exchanges February Managed care and generational attitudes of physician; caregiving and long-term insurance March Health insurance April Biomarkers May Diabetes June “Convenience medicine”: Telemedicine, retail pharmacies, house calls and other topics July Autoimmune disease August Women’s health September Election 2016 October Cancer November Medical directors and officers December Year in review/year in … Read more

January 2014 February 2014 March 2014 April 2014 May 2014 June 2014 July 2014 August 2014   2010 2011 2012 2013 2014 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 1996 1997 1998 1999

As with other chronic diseases of aging, early diagnosis and pharmacologic therapy may reduce the costs for enrollees with Alzheimer’s disease David S. Geldmacher, MD University of Virginia Health System, Charlottesville, Va. Linkedin Share ButtonTweet WidgetShare on FacebookGoogle Plus One Full text available in PDF Abstract: Treatment of Alzheimer’s disease (AD) is a major public health … Read more

They are expected to survive and possibly even thrive no matter what form the health system takes under the Trump administration. When the dust finally settles on congressional Republicans’ seven-year quest to repeal and replace the ACA, who knows which parts of the law will survive and which won’t? But the ACO, a creature of … Read more

December 2007 How Doctors Are Paid Now, And Why It Has to Change Everyone knows about the perverse incentive of fee-for-service medicine, but that hasn’t had much effect on its use John Carroll Large Plans Do Well Under Part D, But Premium Hikes Cloud Future Profits should increase over the next two years for plans … Read more

More families are enrolling their children in state-funded public insurance programs like Medicaid and the State Children’s Health Insurance Program (SCHIP), says a new report from the Carsey Institute at the University of New Hampshire. The reasons are evident: job loss, coverage changes in private health insurance plans, and expanded access to public plans. The … Read more