his paper has been peer reviewed by appropriate members of Managed Care’s Editorial Advisory Board. Also available in PDF EXECUTIVE SUMMARY Pneumococcal disease is a common cause of morbidity and mortality in the pediatric population. Pneumococcal infections, which account for most serious bacterial disease in infancy and early childhood, are a major cause of acute … Read more

The CMO of Blue Cross and Blue Shield of Minnesota is hopeful that the goal of true population management is near. Two and a half years ago, Blue Cross and Blue Shield of Minnesota launched a 10-year population health management program with American Healthways that may come to be seen as the point at which … Read more

Implementing the New HEDIS Hypertension Performance Measure This monograph, written in 2000 by Cary Sennett, MD, PhD, is a description of the National Committee for Quality Assurance’s HEDIS hypertension measure, as promulgated that year. The material also includes a discussion of the importance of hypertension control and the need to monitor providers carefully. The implementation … Read more

In this study, outpatient management was effective in controlling nausea and vomiting during pregnancy and was associated with a reduced need for hospital or emergency room treatment as well as reduced costs. Full text of this article is available in PDF. ABSTRACT Purpose: Nausea and vomiting during pregnancy (NVP) can create a significant clinical, psychological, and … Read more

The evolving modality of PDT gives patients with premalignant lesions of the esophagus reason to hope. Managed care must update existing policies. Much has been written about Barrett’s esophagus and the resultant dysplastic changes that may degenerate into adenocarcinoma of the esophagus. Until now there has been little to offer patients suffering from this premalignant … Read more

Coupled with high Medication Costs in a environment of cost containment, Drug formulary approaches, specially in healthcare, have grown to be more reliant on pharmacoeconomic tests to evaluate the worth of fresh services and products. Within pharmacoeconomics, costeffectiveness investigation could be the most widely used method. Advances in diagnosis are very likely to enhance the … Read more

In a recent survey, primary care physicians (family practitioners, internists, and pediatricians) were asked about their attitude toward pay for performance (P4P), in which physicians are financially rewarded for achieving positive outcomes and high patient satisfaction scores. Only 7.3 percent endorsed the concept fully, while 40.6 percent indicated it is “a good idea but data … Read more

The New Team in Town: Primary Care Submitted by Steven Peskin MD on Fri, 2012-06-01 23:54 The May 17 New England Journal of Medicine 200th Anniversary edition article The Evolving Primary Care Physician highlights key structural, financial, and cultural challenges that confront primary care in the United States. Some of these include training and education that emphasizes ever greater … Read more

The adage that while most Americans take a dim view of Congress as an organization, they rather like their own congressman took a beating last November. Still,there is a reason that such statements are called truisms. Americans still appear satisfied with their health care coverage, according to a Wall Street Journal/Harris Interactive poll. This particular … Read more

Applying the principles of industry to the practice of medicine has occurred to a number of people at different points in their careers. It hit David Nash in high school. MANAGED CARE September 1997. ©1997 Stezzi Communications WHAT TOMORROW WILL BRING Applying the principles of industry to the practice of medicine has occurred to a … 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

References to maximum allowable prices in contracts between plans and PBMs need to be scrutinized, since things are not always what they seem For most of the world, the letters MAC conjure up a Big Mac — the inviting super-sized hamburger that people love but enjoy at their peril. But for health plans providing prescription … Read more

Formulary decision makers will probably be disposed favorably toward Xeljanz, the first Janus kinase inhibitor approved for rheumatoid arthritis In November, the FDA approved Xeljanz (tofacitinib) a novel nonbiologic medicine for rheumatoid arthritis (RA). It is the first Janus kinase (JAK) inhibitor for this disease. The Janus kinases are signaling pathways that affect RA’s painful, … Read more

When Donald M. Berwick, MD, CEO of the Institute for Healthcare Improvement (and recently the director of the Centers for Medicare & Medicaid Services), calls something a game-changer, notice must be paid. Newspapers across the country report it and online discussions cite articles in prestigious medical periodicals such as the New England Journal of Medicine(http://sn.im/nemj-brody) … Read more

Abstract Purpose: To provide an overview of prescription and dietary supplement omega-3 fatty acid (OM3-FA) products and considerations for clinical use. Design: Narrative review. Methodology: The PubMed database was searched for cardiovascular-related investigations focused on eicosapentaenoic acid (EPA) and/or docosahexaenoic acid (DHA) (limit: English-only articles). Additional regulatory information on prescription and dietary supplements was obtained … Read more

Is the Patient Access to Responsible Care Act, affectionately known as PARCA, dead? Let’s say its heart still may be beating, but faintly. Its chief proponent in the House, Georgia Republican Charles Norwood, did little to satisfy the naysayers with his revisions to the bill. Norwood recently redrafted PARCA to:   Remove language that could … Read more

These tools, often adopted by other industries, can help insurers improve health care delivery A healthy workforce is critical to the success of an organization or a society. Properly managing the delivery of health care is thus an important function of modern health care systems. However, health care delivery today is rife with waste and … Read more

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

Formularies are an established part of the managed care arsenal now, but they are still not universally accepted. Even now, not all HMOs, for example, have formularies, and many formularies are still advisory. In our cover story, beginning on page 23, Contributing Editor Jean Lawrence writes about the pressures on health plans to control pharmaceutical costs … Read more

White House report proposes several ways to lower drug prices The Trump administration has outlined policy changes it says will lower drug prices, but some experts are skeptical that the actions will accomplish that goal, according to a FierceHealthcare article. The White House’s Council of Economic Advisers (CEA) issued a 30-page report that offers a slew of … Read more

A consortium of employers is paying the pharmacy benefit manager a new administration fee but taking all rebates and discounts. Pass-through pricing agreements between the pharmacy benefit manager Medco Health Solutions and employers involved in a national coalition led by Towers Perrin are proof that transparency in PBM contracts is taking hold, the organizations say. … Read more

For many Americans, medical health insurance coverage to prescription medication costs is composed of a medication formulary describing the necessary copayment for each covered medication. Spending drugs balances for at least 10 percent of spending on personal healthcare at the U.S., and before lately, was climbing faster than healthcare spending in general. Insurance plan for … Read more

The caveats: About 40,000 Americans are newly infected every year. And HIV infection is still among the top 10 leading causes of death among Americans between the ages of 25 and 44. There’s still no cure and no vaccine. People still die from it. It’s still being transmitted in alarming rates in some areas of … Read more

Nearly 52 percent of doctors are familiar with the term “accountable care organization” and half of those say that their practice is already participating in one or expects to, says a working paper by UnitedHealth Group. “[I]nterest in participating was notably higher among PCPs — 55 percent of PCPs familiar with the term were pursuing … Read more

As is always the case when I return from working abroad, it takes me longer, metaphorically speaking, to unpack my bags. I was ostensibly in Brazil to teach and consult about innovations in our population health management movement in America. But, as I expected, I was surely the greater beneficiary of teachings from leaders of … Read more

NEWS AND COMMENTARY 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, … Read more

Survey finds more prior authorization, cost shifting by large employers in 2016 The National Business Group on Health is out with its health benefits survey of large employers and what they are expecting in 2016.  The group received answers from 140 employers that collectively employ 7.6 million people. Here are five of the key findings: 1) Rate … Read more

Discounts in average wholesale price for brand-name drugs in retail pharmacy increased from 14.5 percent in 2003 to 14.8 percent in 2004. Overall, the AWP discount increased by 3 percentage points from 1995 to 2004, according to the Prescription Drug Benefit Cost and Plan Design Survey Report, 2005 edition, from the Pharmacy Benefit Management Institute. … Read more

Programs that include a pharmacology benefit reap rewards for the health plan and the member. So why isn’t there 100 percent buy-in? Martin Sipkoff One in five Americans smokes. That percentage has stayed about the same since 2004, which is bad news because for the seven years before that the number of smokers dropped annually. … Read more

As physician compensation goes, taking on risk contracts is like wading into a cold pool on a hot day: It’s chilly at first. Overall, compensation drops as physicians take on their first risk contracts. For primary care physicians, the water warms up after a while: Income levels bounce back as the share of practice revenue … Read more

Democratic Rep. Pete Stark of California will introduce legislation to remedy a defect in last year’s Balanced Budget Act that could cost the government $1 billion this year. The miscue, discovered by HCFA, is overpayments to HMOs resulting primarily from inaccurate projections of Medicare inflation. HMOs are likely to balk…. In an unrelated matter, an … Read more

Not So Much of a Reach: Let Sick Pay Less for Drugs The idea is radical and simple: Those who need medication the most should pay the least. There is evidence that this is cost-effective. Martin Sipkoff Consumer-Directed Care Bets Against Human Nature How many patients have the intelligence and skills to choose on the … Read more

BY MARTIN KOHL Although no one seems to know how to word them, there is general agreement among physicians, attorneys, legislators and managed care executives on one thing about the emerging science of genetic medicine: Development of laws to head off discrimination against patients on the basis of their genetic information is a positive, necessary … Read more

Weighing the risks and benefits of any treatment to decide whether it is worth pursuing takes a kind of knowledge that most in health care lack One of the most effective things that humans can do to ensure a long life at high function is prevention. Preventing a problem before it occurs is not only … Read more

The accepted insurance model is to provide care intended to make sick people well. This might include screening, and some preventive actions such as immunizations. But there are new arguments that small investments in persuading people to live healthier lifestyles will result in large reductions in cost in later years. Not many people receive congratulatory … Read more

Some doctors say that far from cutting waste, online visits create it. Others are signing up and giving it a try. John Carroll Contributing Editor Roy Schoenberg spent a big part of January in Hawaii, but he wasn’t working on his tan. Schoenberg, a physician, was on a mission to boot up a health care … 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

Personal responsibility is the cornerstone of morality, and the building of every temple of modern bioethics has begun with that first stone. Similarly, disease prevention and health promotion are the foundations of managed care, and those concepts depend on people taking responsibility for their own health. In the 1990s, this means special attention to common, … Read more

Everyone Uses E-mail Now (Except Doctors and Patients) Here’s how the process works today, who pays for it, and when and why it makes sense The doctors in GreenField Health’s primary care network learned years ago that e-mail could often satisfy a regular patient’s need for medical advice. Appointments, examining-table manners, and waiting rooms were … Read more

The cost-effectiveness of prevention is undeniable, yet vaccination rates for everything but influenza decline   Adults are notoriously lax in being vaccinated, even for influenza. “There’s a large body of evidence that supports the importance of adult vaccination,” says Michael Belman, MD, a WellPoint medical director. “We believe it is part of our responsibility to … Read more

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

Physicians and executives worried about liability are starting to pay some serious attention to ethics. Physicians know that ethical breaches could cost them something more than patients and money: their reputations for professional integrity. Can lawsuits be avoided when there is barely office time to write out selective serotonin reuptake inhibitor prescriptions, much less discover … Read more

Americans are going to emergency departments for traumatic brain injuries in record numbers. What’s behind the increase? What are obstacles to care? The CDC, the World Health Organization, and a string of prominent U.S. medical organizations have repeatedly and unequivocally declared traumatic brain injury (TBI) a major public health problem. Yet that’s where certainty about … Read more

Everybody else always knew that they weren’t really invincible, and now they seem to be grasping that fact as well. More than 70% of people 30 and younger say that having health insurance is very important to them, according to a poll by the Kaiser Family Foundation (https://tinyurl.com/insured-youth). These have historically been called the “young … Read more

Joseph Burns Contributing Editor Health plans are the pioneers of coordinated care, says Karen Ignagni, president and CEO of America’s Health Insurance Plans, and have led the way in health care through innovation. Therefore, they are not likely to go out of business; it’s more likely that they will continue to innovate, she says. “To … 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

Resistant strains hinder drug development March 24 marks the day in 1882 when German microbiologist Robert Koch announced he had discovered Mycobacterium tuberculosis (Mtb), the bacterium that causes TB. Today, more than a century later, TB remains one of the world’s deadliest diseases, according to a new report from the National Institute of Allergy and … Read more

Name Last modified Size Description Parent Directory 30-Sep-2000 10:40 – 9808.washington_thom..> 29-May-2000 11:54 2k 9808.washington_tele..> 29-May-2000 11:54 1k 9808.washington_take..> 29-May-2000 11:54 2k 9808.washington_some..> 29-May-2000 11:54 1k 9808.washington_medp..> 29-May-2000 11:54 2k 9808.washington_gord..> 29-May-2000 11:54 1k 9808.washington_desp..> 29-May-2000 11:54 3k 9808.truce.shtml 29-May-2000 11:53 24k 9808.states_texas.shtml 29-May-2000 11:53 2k 9808.states_statesde..> 29-May-2000 11:53 3k 9808.states_kentucky..> 29-May-2000 11:53 1k 9808.states_inewyork..> … Read more

Evaluating Quality of ‘Medical Tourism’ For Heart Surgery: Measures That Matter Michael Schlosser, MD Felix Lee, MD There are some success stories. Lowe’s pioneering flat-rate deal with the Cleveland Clinic for heart surgery has shown both cost savings and quality improvement. Other large employers, notably Walmart and PepsiCo, have followed suit, signing contracts with self-described, … Read more

The disagreement within completing the Supreme Court seat formerly held by Ruth Bader Ginsburg has attracted renewed awareness of the chance of this Affordable Care Act (ACA) currently being chased under the courtroom struggle at California v. Texas,” now scheduled to be viewed briefly following the election this November. The expansion of Medicaid has been … Read more

Aetna’s announcement that it would purchase the health care operations of New York Life Insurance Co. wasn’t much of a surprise, but it sparked concern on Wall Street and in doctors’ offices. The $1 billion merger transfers the care of 2.2 million people–1.5 million of whom are enrolled in New York Life’s managed care unit, … Read more

New understanding of the causes of peptic ulcer disease offers a dramatic opportunity for cost saving with improved quality. But disease management for ulcers is still in its infancy. If managed care is giving you figurative ulcers, at least it offers the promise of helping you treat real ones, too. Many physicians are now aware … Read more

Blue Cross Blue Shield of Montana has hired a third-party patient advocacy company to look into disputes. Looks good for patient satisfaction. Too often, health plans are portrayed as playing a shell game with benefits, hiding just what covered services members are entitled to. As any executive who attends social gatherings knows, this impression is … Read more

Boutique medicine is dysfunctional, but probably not unethical — so long as the lucky patients understand that they’re not necessarily paying for better care. Michael S. Victoroff, MD MANAGED CARE October 2004. ©MediMedia USA Boutique medicine is dysfunctional, but probably not unethical — so long as the lucky patients understand that they’re not necessarily paying for better … Read more

King’s Attorney Tells Managed Care How It Would Have Been If He’d Won What many health plans like about the Affordable Care Act is that it’s going to expand the marketplace, handing insurers millions of new enrollees. The Supreme Court’s ruling today against King in King v. Burwell ensures that that should still be the case. Of … Read more

TOMORROW’S MEDICINE Breakthrough drugs for fighting cancer race toward approval, but the ubiquitous question persists: How can we afford them? Few of us think about the fact that billions of our cells die each day. They die because they are “old” and need to be refreshed (red blood cells), are not needed, or are a … Read more

The writers would like to extend their sincere appreciation to many Men and Women who left this test Potential. We’re indebted for the more than 9,000 poll respondents around the nation and beyond who reacted into the provincial poll which has been used to amass a substantial number of data in service of this test … Read more

Enrollment snags could be just the start of political and regulatory headaches facing health plans and pharmacy benefit managers Medicare Part D, the most significant change in the health care delivery system in decades, resembles a giant squid. The marketing tentacles of 10 national and dozens of regional health plans and pharmacy benefit management companies … Read more

That could replace Obamacare using an agenda that climbs back aid to the poor and blows off a taxation upon the wealthy, however, the bill’s fate was thrown into question because several senators expressed doubt. Four Conservative lawmakers said they weren’t able to encourage it in its existing form, which makes Republicans in short supply … Read more

Back in 2013, Florida deployed a Statewide Medicaid Managed Care longterm Care Program system, also regarded as a nursing home diversion program, to meet the needs of their older residents. Under this application, Medicaid eligible seniors that require long-term care supports may get assistance within their home, in the area, or even in assisted living. … Read more

What are some of the common characteristics of health plans that have high scores from the National Committee for Quality Assurance? Frank Diamond The annual ranking of health plans by the National Committee for Quality Assurance and U.S. News & World Report has garnered interest beyond the managed care industry. Integral to the rankings published … Read more

As states continue to pass laws intended to restrict abortion, some groups see telemedicine as a way to provide access for the procedure. A recent study by a group led by Planned Parenthood and one conducted by Gynuity Health Projects, which provides research and technical assistance on reproductive health issues, found that medication abortions—two pills … Read more

Yes, health care is a business, but altruistic plans would like to cooperate with others. The Leapfrog Group has set up a simple mechanism to do this. Jerry Salkowe, MD, vice president for quality improvement at MVP Health Care, spent part of a recent weekend entering information about the insurer’s quality incentive program into a … 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

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

Accordingly, numerous wellbeing frameworks have started to cooperate with an assortment of CRM stages that have created work processes and capacities to address the interesting difficulties of patient commitment and empower framework wide consideration traffic signal. For instance, Piedmont Medical care, a wellbeing framework serving in excess of 2 million individuals across Georgia, cooperated with … Read more

Infliximab Biosimilar Is Noninferior to Remicade in Phase 3 Crohn’s Disease Study A 54-week, phase 3 trial has met its primary endpoint, demonstrating that, at six weeks, the efficacy and safety of treatment with Inflectra (infliximab-dyyb, Pfizer/Celltrion Healthcare) was similar to that of treatment with Remicade (infliximab, Janssen) in patients with moderate-to-severe Crohn’s disease (CD), … Read more

The impact of this debilitating disease has been largely underestimated, yet new biologic agents offer significant clinical benefit to those afflicted. Professor, Department of Dermatology, Eastern Virginia Medical School, Norfolk, Va. Download PDF INTRODUCTION Plaque psoriasis, also referred to as psoriasis vulgaris, afflicts upwards of seven million Americans (Koo 1996). Because psoriasis is a cutaneous … Read more

Spend Money on Healthy People! The accepted insurance model is to provide care intended to make sick people well. This might include screening, and some preventive actions such as immunizations. But there are new arguments that small investments in persuading people to live healthier lifestyles will result in large reductions in cost in later years. … Read more

In tracking the salaries of primary care physicians and specialists over a decade, the Medical Group Management Association has documented similarities and differences in trends based on specialty. In 1990, median incomes for gastroenterologists and general surgeons, for instance, were $188,133 and $172,952, respectively. By 1999, the median incomes for those specialties had increased $76,367 … Read more

Health care is a bright spot on a somewhat grim snapshot of the well-being of America’s children, according to a study by the Annie E. Casey Foundation. The Kids Count report (http://tinyurl.com/kids-study), which relies on a trove of data from state and federal agencies, says that children in 2010, the last year for which the … Read more

Twenty-eight states mandate some form of insurance coverage for off-label pharmaceutical use, and the trend is accelerating. In 1997, 11 states implemented off-label coverage provisions. Such laws typically forbid coverage denials based on grounds that an indication has not been approved by the Food and Drug Administration. SOURCE: STATELINE, SCOTT-LEVIN GOVERNMENT AFFAIRS, NEWTOWN, PA., 1998 … Read more

Research Published Monday finds Similar Security and Efficiency for one Type of biosimilar drugs, complex drugs meant to function as near-copies of a number of their priciest prescribed medication available on the current market, but emphasizes the need to find out more on the merchandise. Biologics are medications derived or made from cells with Cuttingedge … Read more

It might take a short time longer to uncover whether MIPS is having CMS’s self-depicted impact to “drive improvement in care cycles and wellbeing results, increment the utilization of medical care data, and diminish the expense of care.” Already presuming that cost decrease is impossible, Medpac suggested scratching MIPS inside and out.

With acquisition costs so low, pharmacies are almost giving away generic statins. How this affects the structure of the pharmacy benefit is yet to be determined. In its heyday, Lipitor had caché. It was the Gucci or Coach of statins: Patients asked for it by name and physicians loved to prescribe it. It was able … Read more

FDA Handling of Avastin Discourages Innovation Avastin cancer drugs evidence FDA 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 A. Hamburg’s 69- page decision in which she … 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. Regina E. Herzlinger, Ph.D., is the first holder of the Nancy R. McPherson Professor of Business Administration Chair at the Harvard Business School. An … Read more

Natalizumab has received FDA approval. But as with all approved treatments, questions remain about efficacy and clinical importance compared to existing therapies. Since the mid-1990s, there has been revolutionary advancement in the understanding of the pathophysiology and treatment of multiple sclerosis. On November 23, the FDA issued an approval letter to Biogen Idec for natalizumab, … 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

Costs this year will be higher than inflation for all medical plan types, more than 4 percentage points higher than the change in the Consumer Price Index (rising at a yearly rate of 5.6 percent in July), and higher than the annual increase in earnings (2.8 percent in July). This pattern is similar to 2007 … Read more

Tools for Taking the Measure of Cancer Drugs Ed Silverman Tuning in to Telemedicine With videoconferencing, text messaging, email, and the good old phone call, a treatment method that “spent many years in the desert” has now reached an oasis of acceptance—and savings may result. Susan Ladika Cost, Outcomes Mixed for Tele-ICU ICUs are expensive, … Read more

Educating consumers might not be the way toward better outcomes after all, suggests a study of COPD self-management that’s raising some eyebrows. Patients in an intervention group were given four 90-minute seminars designed to help them spot the symptoms of a COPD flare-up. They were also given an action plan on how best to respond. … Read more

Pricing plans are all very utilized for several motives, however, the ones reasons may alter from company to business. Deciding upon the most suitable cost tag for a item will permit one to maximise income in case that is exactly what you would like todo. In contrast to what most people think, pricing plans are … Read more

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

TOMORROW’S MEDICINE Two-Pronged Approach Holds Promise Against Peripheral Arterial Disease Cost will be a concern because it involves two separate procedures performed with two sets of catheters The American Heart Association estimates that between 8 million and 12 million Americans suffer from peripheral arterial disease (PAD). The condition can be present without symptoms (40% of … Read more

Health plans are using the Internet more intensively to provide services to physicians as well as members. A study by Cap Gemini Ernst & Young shows a big increase over the course of a year in the number of physician hits on HMO sites to get information on claims status, clinical guidelines, and many other … Read more

Clinical studies in other diseases ongoing Genentech has announced the results from two phase 3 studies that evaluated the efficacy and safety of lebrikizumab in people with severe asthma. In the LAVOLTA I trial, lebrikizumab reduced asthma exacerbations and improved lung function, but not as significantly as in its phase 2 trials. In the LAVOLTA … Read more

Clinician executives who want to relieve stressed-out physicians, and perhaps help stave off doctors leaving the profession, can start by encouraging the recruitment of nurses, physician assistants, nurse practitioners and other ancillary caregivers, according to a survey by Cejka Search and Physician Wellness Services (PWS), a company that helps doctors manage stress. “Physicians surveyed indicated … Read more

Previous Hereditary research from pediatric cardiomyopathy Contains Dedicated to pathogenic versions for analytical functions, together with restricted data assessing genotype-outcome correlations. We researched if cognitive version burden equates with worse outcomes. Pathogenic variations alone are not correlated with MACE in cohort. The clear presence of VUS independently or along with pathogenic variants weren’t correlated with … Read more

NEWS AND COMMENTARY 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 … Read more

Out-of-pocket spending on health care went virtually unchanged from 1990 to 1997, thanks in large part to employers’ conversion from indemnity plans to managed care. Consumer spending for medical care actually fell 27 percent, though that was more than offset by a 28-percent rise in premium expense. Out-of-pocket spending on prescription drugs dropped 8 percent. … 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

Name Last modified Size Description Parent Directory 26-Jul-2000 21:05 – ../../../../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

Workers’ compensation continues to make up a significant fraction (9 percent of members’ cases) of HMO activities, though the share of HMOs that participate in workers’ compensation programs has slipped a bit. Almost two thirds of HMOs offer workers’ comp treatment networks or plan workers’ comp services, which HMOs say reduced potential treatment costs by … Read more

Abstract Purpose: Understand current provider approaches to the evaluation of various partnerships under accountable care contracts and create a framework to help accountable care organizations (ACOs) better assess their partnerships. Design: Study included (1) an in-depth literature review of materials describing high-value health care organizations as a foundation for draft framework development, (2) an expert … Read more

Directions and warning labels for some pharmaceuticals are starting to contain what the Wall Street Journal describes as “tailor-made ads” for patients who pick up prescriptions at the drug store. The paper reports that the number of pharmacies using such ads, so-called “health newsletters,” has increased from 3,000 to 17,000 in three years…. The push … Read more

The National Committee for Quality Assurance, which has long wrestled with how to measure the quality of PPOs, has settled on a way to begin. Late this year, NCQA will track member satisfaction; next year, it will unveil a full accreditation program for PPOs, which are less centralized than HMOs. NCQA will examine core systems, … Read more

Less Carrot, More Stick? How Some HMOs Go Too Far There’s a line between encouragement and coercion that doctors say some health plans ignore. Given physician defensiveness, can any approach to DM work? Does capitation make effective buy-in nearly impossible? Show Me The Outcomes! Valid outcomes studies in disease management are elusive. Which are good? … Read more

For-profit vs. not-for-profit Some not-for-profit health plans have long looked down their noses at their for-profit cousins, claiming superiority of priorities. Quality Compass could give the not-for-profits fuel for their arguments. While generalizations about quality of care are difficult to state definitively, for each of six key HEDIS measures that we checked out, the average … Read more

There’s a new blue-ribbon commission in town — called the Forum for Health Care Quality Measurement — and it’s expected to try to come up with a response to a recommendation by President Clinton’s now-defunct advisory group on health care: to figure out, once and for all, how to measure quality and report the results … Read more

Companies pay greater than only the salary of the employees. Learn more about the principal factors that will help calculate the true yearly expense of one’s work force. Just how much can a member of staff price? This informative report addresses a number of those elementary considerations you want to understand when hiring some one … Read more

PBM reports show spend grew by 2% in 2018 Adam J. Fein, the drug price and supply chain expert consultant, said this morning that his review of 2018 reports by four large PBMs shows that drug spending by those PBMs grew by 2% last year. “Once again we find that drug spending is not skyrocketing–contrary to what you … Read more

Very Previous December Aetna, in cooperation together with all the non-profit Advance Care Planning (ACP) Choices, started a pilot which finetuned Aetna’s Compassionate Care software, which’s been in existence for around 15 decades ago This modification entailed aiding Medicare benefit beneficiaries for making conclusions concerning healthcare. Founded in Pennsylvania, Maine, and Illinois, your time and … Read more

A study by HECON Associates, a Maryland-based market research group, supports the claim that when prescription drugs become available over the counter, consumers face increased out-of-pocket costs. The study focused on four drugs that recently became available over the counter. Researchers compared OTC costs with what consumers would pay in a mixed managed care/ indemnity … Read more

Managed care’s spread parallels the growth of the study of ethics in medical care. Ethicists help plans focus on essentials when making policy decisions. It’s almost like playing “Who Wants To Be a Millionaire?” when medical ethicist Leonard M. Fleck challenges an audience of health plan executives to answer hypothetical questions about whether insurers should … Read more

When I asked Senior Editor Frank Diamond to do this month’s cover story on risk adjustment, I was intrigued by the concept. Measure the sickness of populations — even individual patients — so that payers, plans and providers can set rates more scientifically. I knew there was considerable dispute about how advanced this “science” was, … Read more

Finding and keeping good employees is essential to maintaining a healthy practice. Too often, physicians don’t take a diagnostic approach to judging applicants. These tests can be done in the office: No referral needed! A primary care physician orders scores of tests every week. These tests are useful because they tell more about a patient’s … Read more

The ongoing debate on whether health plans pay more for drugs when using a mail-order pharmacy owned by a PBM or when the mail-order pharmacy is not owned by a PBM (e.g., Aetna, WellPoint) may be closer to resolution. The Federal Trade Commission finds that prescription drug plan sponsors generally pay lower prices for drugs … Read more

Employers Want More Cooperation From Plans: A Conversation with Larry S. Boress The head of the Midwest Business Group on Health says insurers must pick up where PPACA left off Self-insured employers that have been pushing for lower health care costs and improved quality for years were let down when health care reform lost sight … Read more

16 FDA-approved Biosimilars Shaded rows indicate products on the market as of Jan. 14, 2019 Biosimilar trade name (nonproprietary name, manufacturer) Indications Reference product trade name (generic name, manufacturer) 1 Herzuma (trastuzumab-pkrb, Celltrion and Teva) Dec. 2018 Treatment of HER2-overexpressing breast cancer Herceptin (trastuzumab, Genentech) 2 Truxima (rituximab-abbs, Celltrion) Nov. 2018 Treatment of CD20-positive, B-cell, … Read more

Developed States utilize various ways to give worldwide policy. Some count upon the government, like in an singlepayer strategy. Other states be determined by private insurance and also a third set of states, like the United States, possess an assortment of both. From the U.S., the argument Over the strategy required to give coverage was … Read more

Insurers say opening up clinics in drugstores will make health care more convenient, more timely—and potentially less costly. But will it also bring unwanted commercialization and fragmentation? As health insurers and drugstores join forces to create clinics within the stores’ spaces, they’re betting that their gamble to provide easily accessible medical care will pay off … Read more

System Helps P&T Committees Get Pharmacoeconomic Data They Need The Academy of Managed Care Pharmacy is testing a plan to have drugmakers submit evidence-based outcomes analyses when seeking formulary inclusion. Jack McCain PPO Performance Hard To Gauge; Comparisons to HMOs Not Reliable It’s long been said that PPOs, by their varied nature, can’t be held … Read more

On a scale Which measures That the user-friendliness of various Every Day Technologies, physicians rank Google at the very top. Microwave ovens are not much behind, followed closely by ATMs. As stated by the analysis, which joins the inadequate grade to painful levels of doctor burnout. “today, they are usually a diversion of physicians’ attention … Read more

Medical and pharmacy directors at health insurance plans have to always be on the lookout for what employers want. That’s been the nature of the managed care industry and of our entire health care system for decades and still is, for the most part. That qualifier is important. You may have noticed that change is … Read more

Although 3 out of 4 primary care physicians support the use of financial rewards as an incentive for better medical care, the majority would rather not make quality assessments readily available to the public, according to a recent survey by the University of Chicago Medical Center. Physicians in the survey view public reporting as potentially … Read more

Regeneron, Sanofi offer price reductions Alirocumab injection (Praluent, Regeneron Pharmaceuticals/Sanofi) reduced the risk of major cardiac events by 15% among patients who had suffered heart attacks and other coronary events in the ODYSSEY OUTCOMES trial. The two companies immediately announced that they were willing to offer price breaks on the costly medication. ODYSSEY OUTCOMES results … Read more

Medical directors have been hard-pressed to come to a consensus on just how — or whether — this new wrinkle in the managed care business fits in. About two years ago, James Fanale, MD, the chief medical officer at Blue Cross and Blue Shield of Massachusetts, sat down with a group of physicians who had … Read more

The physician-author of “Overdosed America” says that health plans have a logical role in actively assessing the medical literature.inShare Tweet Widget (link is external) In 1991, universities and not-for-profit facilities conducted four-fifths of the clinical research in the United States. Today, most of that research has been moved to for-profit research companies — giving drug … Read more

Are looking for tactics to keep those costs in order so that as manageable as you can. Preventive health and fitness and health benefits are intended to help improve or maintain employees’ behaviour to attain better health and also to decrease health threats. By preventing health issues or lowering their prevalence among employees, businesses aspire … Read more

The U.S. Food and Drug Administration Now Enlarged the approval of Imbruvica for its treatment of elderly individuals with chronic graft versus host disease. This could be the first ayurvedic treatment for its cure of cGVHD. CGVHD can be a lifethreatening illness that could occur in patients As soon as they get a stem cell … Read more

Outpatient Treatment of Deep Venous Thrombosis In Managed Care Venous thromboembolism constitutes a clinical spectrum encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE). These are responsible for substantial morbidity and mortality. An exciting advance in this area of medicine involves the outpatient treatment of stable patients with DVT. This therapeutic approach, which has been … Read more

The Formulary Files 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 … Read more

A pair of new physician-owned HMOs in the Sunshine State represent a growing trend. Can these doctors meet the challenges of the market without becoming just like what they oppose? David Volz Two groups of physicians in Florida have put a new twist on the old saying, “Beat them at their own game.” Frustrated with … Read more

Things are far from rosy, but there is a rise in cooperation between plans and physicians. Can peace be far behind — or is it a lull in the fighting? Michael D. Dalzell Senior Editor Though pockets of “prepaid health care” existed long before 1973, this year really is the silver anniversary of managed care … Read more

Clinical and Economic Outcomes of the Cincinnati Pharmacy Coaching Program for Diabetes and Hypertension ABSTRACT Purpose: Value-based insurance designs (VBID) have been developed by health insurance companies and used by employers to allocate health care resources appropriately and to lower patients’ out-of-pocket costs for services related to chronic conditions. The purpose of this study was to … Read more

A few years ago, experts predicted that HMOs would be lining up exclusive “teams” of primary care physicians, specialists and hospitals. Today they don’t agree whether that prophecy was wrong or has simply been delayed. I hate to look into a crystal ball,” jokes Eugene S. Schneller, professor at and director of the School for … Read more

One in six Americans has no health insurance, but that rate is even higher in the Southwest. According to Health Insurance Coverage 1998, a Census Bureau report released in October, nearly 1 in 4 Texans and Arizonans and about 1 in 5 Californians, Nevadans, and New Mexicans is uninsured. Why does the Southwest — tourist … Read more

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

Insurers are playing ‘small ball’ and not showing leadership, says the former congressman. And some ‘spin-dry’ inpatient providers are doing more harm than good in combating the opioid epidemic. Meanwhile, Kennedy, who chronicled his own harrowing mental health and addiction struggles in a 2015 memoir, says he has been sober for more than six years. … Read more

Don’t dismiss this development in Web communication. Blogs — the best of them — conduct serious and extensive discussions of health care policy and provide important new information. Blogs have been around for almost a decade now, yet many professionals in health care have failed to recognize their value. Judicious reading of some of them … Read more

BY MARTIN KOHL Sometimes even the best-laid treatment plans can crash upon a pharmacy counter, where dangerous — even deadly — combinations of prescription drugs are too often dispensed. Pharmacists don’t want to make errors, Michael Cohen, president of the Institute for Safe Medication Practices, an advocacy group in Warminster, Pa., concedes. “But,” he asks, … Read more

Medicare needs a financial fix, and needs it badly. That fact hasn’t escaped the attention of any headline-browser in recent months. President Clinton and Republican congressional leaders have agreed on the outlines of a budget agreement that would cut the growth of the $170 billion annual program by $115 billion over five years. But the … Read more

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

Justices overturn six-month waiting period In a pivotal ruling, the Supreme Court has cut the time it will take for copycat versions of biologic drugs to reach the marketplace, according to a Reuters report. The decision could yield billions of dollars in sales for drug companies. The justices, in a unanimous 9-to-0 vote, overturned a … Read more

The Spike in U.S. kiddies taking drugs to get attention-deficit hyper activity disorder is with a negative side effect, a new analysis implies: more kids and adolescents are over dosing on those medication. Nation Wide, U.S. Poison Control Centers received significantly more than 156,000 calls regarding accidents to ADHD drugs among youth 19 yrs of … Read more

Manager of the Centers for Disease Control and Prevention, as she clarified that the rising flu activity which is swept over the USA. In accordance with Schuchat, last week introduced Currently 5 3 pediatric deaths that this year have been credited to the influenza. Jernigan stated that pediatric deaths in previous influenza seasons Have ranged … Read more

The government’s $75-million, 10-year project to put every American’s vital information on electronic health records faces a hurdle long known to health plan officials — the possible lack of physician buy-in. That’s one of the conclusions that might be gleaned from an issue brief by Mathematica Policy Research. In its literature review, researchers note that … Read more

According to the tenth annual review of physician recruitment incentives conducted by Merritt, Hawkins & Associates, a physician recruitment company, primary care and family physician compensation offers have remained essentially flat from 2002 to 2003. What has changed in recruiting incentives is the increased number of Merritt clients that also provide relocation packages, offered in … Read more

Women who are enrolled in Medicare HMOs and who are diagnosed with breast cancer are more likely to be diagnosed at an earlier stage than women covered by fee-for-service Medicare, according to research in the Journal of the American Medical Association. A National Cancer Institute/Health Care Financing Administration study of 22,000 women with breast cancer … Read more

As part of an effort to overturn the merger of Pennsylvania Blue Shield and Blue Cross of Western Pennsylvania, internists have filed a court complaint against the state insurance department, seeking a ruling on whether the physicians have a legal basis for fighting the merger. The legal skirmish comes as a Dec. 6 deadline approaches, … Read more

Research says PA can help make treatments safer and more cost-effective, but data sharing must improve Thomas Reinke Contributing Editor Health plans walk a fine line when it comes to requiring prior authorizations (PAs). Such rules can promote safe and cost-effective use of medications, but they can also be an administrative burden for everyone involved … Read more

If it has to do with the Triple Aim formula — reducing health expenditures, improving health effects and improving individual experience — that the federal dialog was squarely focused the initial two regions of the equation. But on Capitol Hill, the many”repeal and replace” efforts are overlooking the most obvious focus on replying that which … Read more

For-profit, investor-owned health plans are setting the growth pace these days, and some nonprofit plans are switching to for-profit status to keep up with the competition. But are the two kinds of plans really so different? Tune your dial to National Public Radio, flip to Harper’s May cover story, or read the New England Journal … Read more

Halaven is a injectable chemotherapy Medication Developed by Eisai for its treatment of unresectable or metastatic liposarcoma patients who previously received anthracycline-based Chemo Therapy. Eisai filed the brand new drug program for Halaven for its Treatment of liposarcoma into the US Food and Drug Administration,” Europe Commission and also Japan at July 2015. It submitted … Read more

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 A. Hamburg’s 69- page decision in which she claims that the “objective” evidence of benefit did not exist to … Read more

A consortium of employers is paying the pharmacy benefit manager a new administration fee but taking all rebates and discounts. Pass-through pricing agreements between the pharmacy benefit manager Medco Health Solutions and employers involved in a national coalition led by Towers Perrin are proof that transparency in PBM contracts is taking hold, the organizations say. … Read more

Insurers need to know the rules for Medicare Part B and Part D coverage, but they are not always easy to find or interpret DO, MGH, MBA, AGSF, CMD Increasingly, the coverage of biologics is becoming more complex. Is it a Medicare Part B or Part D covered benefit? Pharmaceutical or medical? Although historically biologics … Read more

By using Managedcaremag.com (as defined below), you agree to the following Terms of Use, which constitute an agreement (“Agreement”) between Managedcaremag.com and you. IF YOU DO NOT WISH TO BE BOUND OR DISAGREE WITH ANY TERMS AND CONDITIONS BELOW, PLEASE EXIT THE Managedcaremag.com WEBSITE. YOUR SOLE REMEDY FOR ANY DISSATISFACTION WITH IT, OR THESE TERMS … Read more

Neuroendocrine tumours (NET) and gastro intestinal stromal tumours can be within approximately 4 to 5 per cent of cases, but these percentages are somewhat high in women. Every sixth episode event one of every third episode case one of men affects the gut entry (cardia). For years, a constant decrease in the mortality and incidence … Read more

Because asthma flare-ups cost employers a great deal in lost work time and burden health plans with preventable hospital stays, it was natural that 15 managed care organizations joined 12 major employers in a three-year study evaluating asthma care outcomes. The project, sponsored by the Managed Health Care Association, a Washington, D.C.-based group representing more … Read more

MANAGED CARE September 1999. ©1999 MediMedia USA The AMA has come out with its strongest condemnation of online prescribing, recommending that action be taken against physicians who prescribe based solely on a patient’s answers to an online questionnaire.The AMA contends that this practice “falls below a minimum standard of medical care.” State and federal agencies are paying … Read more

By assisting doctors, insurers can get all the payment that they are due, but that too often is lost Health insurers participating in managed Medicare have never experienced as wide a gap between actual and potential payment as currently exists. Simply stated, Medicare managed care payments from the Centers for Medicare & Medicaid Services depend … 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 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 during their periods; … Read more

Researchers utilize gene activity signatures to identify candidates Research from King’s College London reveals a new method of repurposing existing drugs as novel treatments for depression using laboratory studies of brain cells. The results reflect a growing movement toward repurposing drugs that have been developed for one condition to tackle another. This approach effectively bypasses … Read more

A review of studies conducted in managed care settings that used a variety of strategies to reduce prescription drug cost and improve the quality of medication use finds that the dissemination of education materials to physicians by itself has little or no effect on cost or quality. Researchers at Harvard Medical School and Harvard Pilgrim … Read more

But following the medication launched this past month patients detected Teva’s generic isn’t so far less costly compared to Valeant Pharmaceuticals International’s branded medication. After Teva announced the launching of its generic Hafrun Fridriksdottir, head of international R&D in Teva, said its own generic trientine hydrochloride capsules were first contained to a U.S. Food and … Read more

By Frank Diamond Senior Editor If this were a general news magazine, our tale would begin by focusing on someone who had recently won a huge settlement against an HMO. It might be Teresa Goodrich, whose husband died of stomach cancer and who sued Aetna U.S. Healthcare because the plan denied David Goodrich access to … Read more

A recent court settlement may affect the way the PBM industry makes profits, but could it also lead to higher drug costs?   Martin Sipkoff 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 … Read more

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

Name Last modified Size Description Parent Directory 26-Jul-2000 21:05 – ../../../../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

By Jean Lawrence Contributing Editor The average injured employee is a 34-year-old male blue-collar worker with a musculoskeletal injury such as a wrenched back or shoulder. A couple of years ago, he might have gone straight to a chiropractor, had his mental anguish confirmed by a psychiatrist and settled in for a long convalescence, broken … Read more

Everything is relative, but there’s been what many experts describe as substantial growth for a lot reasons John Carroll Contributing Editor Of all employers, noted Mercer, close to 1 in 4 now offers a CDHP to staffers, and the bigger the company, the more likely CDHPs figure in the mix. More than a third of … Read more

Probe follows uproar over price hikes for allergy drug Mylan is facing a U.S. antitrust investigation over whether it blocked generic competition to its controversial EpiPen epinephrine autoinjector, according to a Bloomberg report. The company has received a request for information from the Federal Trade Commission (FTC) as part of a preliminary inquiry. The FTC … Read more

Our inaugural innovation issue! Utilization review, formularies, medication—they are still the stuff of managed care. It’s the reason that managed and care, when together, are still dirty words in many circles. But managing care in the still-young 21st century now also means managing people, not just their health care—and what they eat, where they live, and how they … Read more

The proliferation of clinical practice guidelines gives health plans plenty of models for developing their own. Which guidelines are better than others can depend on their creators’ methods and motives. Blue Cross Blue Shield of Massachusetts had a problem. Clinical awareness of sleep apnea was coming of age. Its physicians wanted to know what to … Read more

A Conversation with David Lansky, Ph.D. David Lansky, Ph.D., has served as president of FACCT — the Foundation for Accountability — since the not-for-profit organization was created three years ago. FACCT defines its mission as helping consumers make better health care decisions. Paul Ellwood and other members of the Jackson Hole Group pushed for the … Read more

Test Prospective PBM Before Signing Contract How to select, then monitor a pharmacy benefit management company, from a consultant and former HMO director of pharmacy services. Tim Sawyers, R.Ph., M.B.A. Where Society Failed, Can Health Plans Succeed? By engaging patients and forming strategic alliances, plans can gain immediate cost and clinical benefits — despite conventional … Read more

The secret to the success of PFFS is as old as gold. Will beneficiary satisfaction force Congress to keep the faucet turned on? Frank Diamond Managing Editor MANAGED CARE May 2007. ©MediMedia USA The secret to the success of PFFS is as old as gold. Will beneficiary satisfaction force Congress to keep the faucet turned on? Frank … Read more

The ARCHES research, presented at the 20-19 ASCO Genitourinary Cancers Approximately 18 percent of ARCHES patients had completed before docetaxel chemotherapy inside this hormone-sensitive atmosphere. Common cancer for both men, leading in 174,650 newly-diagnosed cases and a estimated 31,000 deaths throughout 20-19. Nearly all deaths in prostate cancer response from metastatic illness. Prostate cancer is … Read more

With the Obama administration moving quickly to take the reins at Medicare, officials recalled a draft of the 2009 Medicare Advantage and Part D call letter, signaling that changes are probable. “Some of the Medicare advocates as well as folks on the Hill like California Democrat Pete Stark have called on the Obama administration to … Read more

The war on cancer was declared in 1971 with passage of the National Cancer Act. We were putting men on the moon so beating cancer forever in a relatively short time seemed plausible. Though fantastic strides have been made, that’s not quite how things worked out. Consider a study in the July issue of Preventing … Read more

In primary care, a productive interview is extremely important but hard to achieve as visits become shorter. The Bayer Institute offers some advice. WORDS AND ATTITUDES As managed care increasingly imposes changes on health care delivery, many are concerned about how this will affect communication between clinicians and patients. Today, patient satisfaction is used widely … Read more

The program is not for everyone, but patients who qualify appear to have superior outcomes and lower costs See accompanying article: Hospital at Home: Compelling Findings, But Replicable in Other Systems? for reactions to hospital at home model A concept that challenges the conventional wisdom that the hospital is the best site of care for acutely ill … Read more

HMOs place great stock in disease prevention, but some highly recommended services go uncovered. Plans and purchasers often don’t agree on priorities. Some 130 years ago, the Union Pacific Railroad stood out when it helped to complete the first transcontinental rail line — no small feat, accomplished through the sweat, toil, and dedication of 20,000 … Read more

Inappropriate prescription drug use is a national health epidemic, according to the national laboratory chain Quest Diagnostics. A Quest study analyzes a national sample of about 76,000 urine specimens (donor identities withheld) that were taken last year. It finds that more than 60 percent of respondents were not taking drugs in accordance with doctors’ orders. … Read more

HMOs seem to be tightening capitation payments to physicians in an effort to bolster sagging profits, according to a recent survey of 466 provider groups by National Health Information. The survey also suggests that primary care doctors are becoming more adept at protecting themselves in the capitation game, buying stop-loss insurance at a much greater … Read more

Some managed care companies begin to take a hard look at what’s behind the explosion in costs for radiological services High-tech CT, MRI, and PET imaging machines make it possible for physicians to ferret out tumors, uncover ligament damage, and pinpoint blocked arteries, but they are not cheap. That is why radiology costs are soaring, … Read more

Cannabis is an amazingly famous substance utilized for both sporting and remedial purposes around the planet. However, before you feel free to blend weed in with different substances, read this survey of cannabis drug connections. Cannabis contains more than 100 distinctive cannabinoid compounds, however the ones we know the most about are THC and CBD. … Read more

The Joint Commission Published an R-3 Report, Too The standards would be caused by an 18-month standards analysis job that contained an emphasis on the judicious prescribing of opioids. The job was part of a federal effort to cover the opioid emergency from the U.S., that was made to make sure physicians assess and treat … Read more

Primary care physicians did not see much change in their compensation last year compared to 2002, according to a survey by Sullivan, Cotter & Associates, a consulting company that specializes in physician compensation. That was not the case with specialists, whose compensation soared (cardiologists, anesthesiologists) or dipped (oncologists, hematologists, pathologists). The data were collected mainly … Read more

In 1995, Dr. Steven Rosenberg published an article in the New England Journal of Medicine (NEJM) that fueled the start of an industry. In a randomized, controlled trial, he showed that an investing in proactive disease management (DM) activities could decrease the cost and improve the quality of life for patients with congestive heart failure. … Read more

People coping with hiv1 illness are at greater risk for cardiovascular illness compared to seronegative adults. Treatment of dyslipidaemia using statins was hard in people with HIV due to a heightened possibility for drug interactions thanks to rival cytochrome P450 metabolic process between statins and popular antiretroviral agents. Neither pitavastatin nor pravastatin be determined by … Read more

Research says PA can help make treatments safer and more cost-effective, but data sharing must improve. Health plans walk a fine line when it comes to requiring prior authorizations (PAs). Such rules can promote safe and cost-effective use of medications, but they can also be an administrative burden for everyone involved — doctors, pharmacists, PBMs, … Read more

MANAGED CARE July 2004. ©MediMedia USA Mergers and acquisitions have allowed hospitals to call the shots in negotiations with health plans the last several years. Now, there’s indication that the party may soon be over, thanks to the intervention of employers. The California Public Employees’ Retirement System has managed to keep HMO premium increases in line with … Read more

More Medicare Advantage Plans Offering Post-acute Discharge Care The growth in Medicare Advantage (MA) enrollment since the passage of the ACA in 2010 has been nothing short of remarkable. Enrollment in such plans has doubled since the law’s enactment despite significant cuts in payments to MA plans embedded in the law. The baby boom generation’s … Read more

By Linda Wolfe Keister Contributing Editor Persuading physicians and patients to change their thinking about ulcers and to comply with new treatment protocols has been a major challenge since 1983, when Australian physicians Barry Marshall and Robin Warren first advanced the notion that the Helicobacter pylori bacterium might be involved in the development of peptic … Read more

Is the Patient Access to Responsible Care Act, affectionately known as PARCA, dead? Let’s say its heart still may be beating, but faintly. Its chief proponent in the House, Georgia Republican Charles Norwood, did little to satisfy the naysayers with his revisions to the bill. Norwood recently redrafted PARCA to: Remove language that could be … Read more

So, my friend is headed downtown for his total-body MRI. “How come?” say I. His wife, a radiologist, has arranged a special deal, way less than the $2,500 price her group offers the retail public. Whole-body MRI. Wow. “Why not?” says he. “It doesn’t cost my insurance anything. It’s just preventive medicine at the next … Read more

Deciding Factor: How Much Health Care is Discretionary? Defining discretionary health care is no easy task, but it may be imperative for ‘consumer’ health plans seeking to get patients more involved MargaretAnn Cross New Tools to Detect Fraud Rely on Discovering Patterns The ability of the computer to find unexpected — and often unwelcome — … Read more

SNAPSHOT Quality improvement studies don’t learn from their mistakes Quality improvement programs for physicians can work, but most do not because those who operate such efforts fail to learn from past findings, according to a study in the Journal of General Internal Medicine. Researchers performed meta-regressions for trials involving audit and feedback published as of … Read more

To Describe Issues with chronic obstructive pulmonary Disorder newly initiated on Longacting muscarinic antagonists or Double LAMA/long-acting β2-adrenergic agonist treatment. This pilot/preliminary investigation was a retrospective Cross-sectional analysis of topics with COPD from the Optum Effect National Managed-care Benchmark Database. Issues with a minumum of a single LAMA prescription at the indicator period were contained … Read more

Tomorrows Medicine New drugs and devices that are shaping health care’s future. TOMORROW’S MEDICINE Multidrug Resistant HIV Drug Lauded, But Clinical Foundation Not Very Deep THOMAS MORROW, MD It is safe to say that few people read a June 5, 1981, report in the CDC’s Morbidity and Mortality Weekly Report that described five cases of a … Read more

Joseph Flood, MD, FACR Charles Mihalik, PharmD, RPh Renee R. Fleming, RPh, MBA Bruce E. Strober, MD, PhD Deborah R. Zucker, MD, PhD Full text in PDF Prologue On Sept. 29, 2006, an expert panel of physicians, pharmacists, and thirdparty payer representatives met in Chicago to develop a consensus on the appropriateness of therapeutic interchange … Read more

Name Last modified Size Description Parent Directory 26-Jul-2000 21:05 – ../../../../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

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

CMS will test incentives for ambulance providers and dispatchers to keep nonemergent patients out of the ED. Limited experience shows it works. Overcrowding in the ED is so well documented, it veers on the edge of cliché. And just as there is no single reason for the congestion in America’s EDs, there is no single … Read more

BY NEIL CAESAR, J.D. Alert! Please share this column with your practice consultants, CPAs and any other advisers who look over your claims submission, records documentation and contracting activities. Inadvertently, they may place you and themselves in serious trouble! The good news is that physicians can use the attorney-client privilege to shield internal assessment of … Read more

They play a key role in the new payment models. But coordinators aren’t coordinated, and patients are getting annoyed—and worse. Health policy wonks have been sounding the alarm for decades that the American health care system won’t get better until it is less fragmented and better coordinated. Vulnerable patients stay sick because the system is … Read more

CCM is the consideration coordination that is outside of the customary office visit for patients with different (at least two) ongoing conditions expected to last at any rate a year or until the passing of the patient, and that place the patient at huge danger of death, intense fuel or decompensation, or practical decrease. It … Read more

The use of electronic health records has come a long way since 2010, but EHRs cannot stand alone, warns a PwC report. The next challenge is integrating mobile health devices into the EHR and the provider–patient relationship. The consulting company interviewed 1,000 physicians and physician extenders—nurse practitioners, physician assistants—to discover how they use digital technology … Read more

New research indicates that another common mosquito may be able to carry the Zika virus, according to a Reuters report. The mosquito species Aedes aegypti is considered to be the main transmitter of Zika infections, but scientists in Brazil have announced that they were able to infect another species, Culex quinquefasciatus, with the virus in … Read more

Patients with advanced melanoma Seemed to See Long-lasting Re-mission with single-dose pembrolizumab started 3 weeks before operation, according to study results released in Character Medication. In addition, researchers discovered that immune reactions can summit as soon as seven days following initiation of both pembrolizumab (Keytruda, Merck). “Knowing considerably sooner if individuals are reacting to PD … Read more

By John La Puma, M.D. Practice-based research has a long and honorable history. Well before there was an NIH or an IRB, there were practicing community physicians making observations. For example, in our own practice, more patients than ever are overweight or obese. Neither diet pills nor conventional weight loss programs seem to help for … Read more

Juluca is really a fixed-dose pill comprising two previously approved medication to address teenagers using hiv1 ailments whose virus is now suppressed to a stable regimen for a minimum of 6 weeks, without a history of treatment failure without a understood substitutions associated with immunity into the respective elements of Juluca. “Limiting The amount of … Read more

Like beginning skiers that are overly excited to race the intermediate mountain, healthcare players at Colorado have found capitation a more slippery-slope than they’d anticipated. Despite all these failures, Ryan highlights, many healthcare teams desire to proceed to provide guide contracting via capitation lacking any insurance license. That leaves consumer urges dreading financial meltdown will … Read more

It costs $156,000 a year and anyone who suffers from cancer or knows somebody who does or did (that is, everybody) will most likely argue it is worth every penny. That’s an obstacle most payers will likely be happy to take on (after all, the people who staff insurance companies have also been touched by … Read more

Telemedicine has different aspects, and one is the seemingly simple connection of a doc and a patient. When the stars are aligned, such an encounter can save money and time. Emergency physician John Wilkinson returns home from a busy nine-hour shift in a high-traffic hospital. The 63-year-old doctor changes out of scrubs into an Aloha … Read more

High Caesarean section rates. Too many babies in the NICU. There are indications that maternity and newborn care in this country is far from ideal. Some payers are betting that bundled payments for obstetricians will create incentives to make changes and reduce low-value care. The wait has been long, but the push is finally on. … Read more

Better Ways to Pay Providers Paying for coordinating care and for packages of services — bundling and episodes of care — may be the best bet for a modification of the unfettered fee-for-service system Tom Reinke Hospitals Asked To Account For Errors on Their Watch CMS and states may stop paying for specific hospital-acquired conditions. … Read more

The US Food and Drug Administration has declared the first treatment of its kind for those who have advanced level breast-cancer whose microbes have a particular genetic mutation. It is Specifically for innovative breast cancer patients — post menopausal men and women — whose microbes have the PIK3CA mutation and so are hormone receptor favorable … Read more

A handful of leading PPOs have agreed to test the National Committee for Quality Assurance’s first tool for measuring PPO quality of care. NCQA modified its Consumer Assessment of Health Plans Survey, which it has used as part of HEDIS to report member satisfaction with HMOs. The revisions to the survey will allow PPO enrollees … Read more

When the Florida Legislature gathered this year, it took up matching Senate and House bills that set out to roll back 52 state mandates on what health plans were required to offer their small-company members. The bills’ backers had some powerful support. The Florida Chamber Federation trumpeted its position by releasing a new study that … Read more

It’s one thing to encourage efficiency on the technical side, but do you really want your radiologist to read 50% more scans or X-rays per hour? John Carroll Contributing Editor Just like every other payer in the country, Medicare has been looking for the best approach to reining in the high cost of imaging. And … Read more

The Food and Drug Administration declared now a brand new medication to treat pediatric and adult patients aged 12 decades and older with Homozygous Familial Hypercholesterolemia, the most infrequent & most acute kind of FH.This is welcome news, as as people who have HoFH usually are unable to satisfactorily lower their ldlcholesterol with available treatments … Read more

As providers scramble to form accountable care organizations, insurers take steps to either participate, or limit ACO market power Thomas Reinke Contributing Editor Hospitals, physicians, and insurers suddenly find themselves in a furious round of corporate speed-dating as these major stakeholders explore realignments and forge new alliances in the face of health care reform. The … Read more

Labor Unions For Physicians: An Idea Whose Time Is Coming? Managed care administrators needn’t have Socialist-realist nightmares of massed doctors on the march — not yet. But some physicians have reacted to today’s business pressures by organizing labor unions. Trading Your Independence For a Guaranteed Salary Doctors who sell to practice management companies like Florida’s … Read more

The 35-year-old clinical head of the arrangement’s office of clinical strategy and innovation appraisal has wide interests, yet he’s especially enthused about health since it “integrates with the evidentiary segment of my position-assessing the logical writing to help proof based medication.” His take: Depend less on dynamic patient cooperation. He’s effective, attractive, and appears to … Read more

When Contemplating Connecting a Clinic or starting your ownPersonal remember The traditional expression”place, place, place” This isn’t only about that office or intersection room you can pick, but likewise the town and condition at that you clinic. An official report by Medscape lists a few of their very best and worst towns and countries to … Read more

Robert Wachter, MD, is a professor and associate chair of the Department of Medicine at the University of California–San Francisco. A prolific writer and blogger, his most recent book is The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. In April, Wachter topped Modern Healthcare’s list of the 50 most influential … Read more

Anthem’s vice president of provider alignment solutions wants providers to know that the spigot of upside-only risk arrangements will not stay open forever. Providers who take on downside risk are more likely to put “the pedal to the metal,” acknowledges Mai Pham, MD, Anthem’s new vice president of provider alignment solutions. The country’s second-largest health … Read more

At a glance Union Carbide Corp. Danbury, Conn. Goal: To improve drug compliance and realize savings for employees and employer Strategy: Emphasizes patient education Number of employees and retirees covered: 35,500 Number of covered individuals taking medications to lower cholesterol or to treat hypertension or diabetes: 9,000 Number of eligible individuals with compliance problems: 5,000 For as long as physicians … Read more

Subscribe to Our Newsletters Monthly table of contents Be notified as each issue of Managed Care is available online. Biweekly newsletter Recent topics have included: Doug Jones and the ACA, Epic misses a White House meeting, and man caves for man-flu sufferers CVS-Aetna deal may trigger merger mania, Johns Hopkins criticized for lack of asthma … Read more

July was a good month for Florida Medicaid Director Bob Sharpe. Pharmaceutical makers were cooperating with Florida’s new Medicaid formulary-and-rebate program, and Pfizer’s two-year, $33 million dollar initiative to improve the health status of Florida Medicaid enrollees was off to a flying start. Then on Aug. 7, Pharmaceutical Research and Manufacturers of America (PhRMA) filed … Read more

Hemlibra could be utilised in most age classes, and also can currently be used in multiple dosing selections for several suggested people with haemophilia A, for example people with factor VIII inhibitors. This acceptance is based on results from the critical HAVEN 3 and also HAVEN 4 studies. From the HAVEN 3 analysis in people … Read more

This page also available in PDF The Health Care Financing Administration confirms that the big upturn in medical inflation almost everyone expects hasn’t yet hit. But the rate of spending in the private sector has increased three years in a row, as health plans try to shore up margins. Color charts SOURCE: HEALTH CARE FINANCING … Read more

Ten HPV-positive girls were treated holistically using the infusion, AHCC Five achieved a negative HPV test effect — three with supported eradication after quitting AHCC — with all both responders continued on the analysis. Currently, There’s no effective medication or nutritional supplement to deal with HPV, That will be connected with over 99 per cent … Read more

MANAGED CARE June 2006. ©MediMedia USA Despite the higher costs of SSRIs, compared to older antidepressants, limiting members’ access can lead to undertreated depression Martin Sipkoff In a practice that is perhaps best described as penny wise and pound foolish, many health plans and pharmacy benefit management companies fail to include several selective serotonin reuptake inhibitors (SSRIs), … Read more

The oldest medical ethical tension is one between a physician’s altruism and self-interest. But how much should a capitated managed care physician be paid? The facts Defined as a flat “fee per head per time,” capitation is a way of sharing financial risk, something that many physicians now want to do. A plan’s capitation rate … Read more

The articles in the group have proven that despite the importance there’s a paucity of policy and research regarding how physicians work, the way they need to be determined, what size they need to be, and how change can be handled. This report assesses the principal differences in our understanding of the long term of … Read more

Group appointments get rave reviews by many physicians. Not a substitute for individual care, they can improve access and reduce overall utilization. The group appointment — where a doctor sees up to 20 patients at a time — is gathering steam. The man who has done a great deal to promote the idea says it … Read more

Type Title Name Story What the Primary Care Physician Shortage Means for Health Plans webadmin Story How Doctors Are Paid Now, And Why It Has to Change webadmin Story Transparency Called Key To Uniting Cost Control, Quality Improvement webadmin Story Specialty Pharmacy Management Will Become More Intense webadmin Story Inter-Rater Reliability Testing For Utilization Management … Read more

Lance Poulsen’s lawyer would like everyone to know that his client has done nothing improper or illegal. Meanwhile, the company Poulsen founded and led until recently — National Century Financial Enterprises — operates under bankruptcy court protection. Seems that Poulsen scoped out a niche industry in the 1990s. He heard the cries of hospitals and … Read more

Several large HMOs that have experienced financial turmoil in recent times appear to be either recovering or downright healthy. Earnings for Aetna U.S. Healthcare, the nation’s largest HMO, rose 40 percent during the fourth quarter of 1998, while costs remained stable in its commercial lines and increased only moderately in its Medicare business. Aetna had … Read more

Ten HMOs, covering more than 500,000 members, are in serious danger of collapsing, according to Weiss Ratings Inc. Of the 10 HMOs all rated E-minus (“very weak”), two — PriorityPlus of California and Rio Grande HMO, of Texas — have over 100,000 members. Weiss counts 14 health plans that have failed this year. Only one … Read more

Presidentelect donald-trump introduced two massive healthcare decisions Tuesday. Verma involves the project with extensive Medicaid experience. The expansion, called the Healthy Indiana Plan 2.0, moved in to effect early last season, also Verma’s participation inside may possibly prove crucial as Congress and the Trump government, for example, vicepresident select, make conclusions concerning the future Obamacare. … Read more

About 1 of every 14 Medicare enrollees is looking for new coverage this month. Call it fallout from Black Friday — Oct. 2, the deadline for health plans to decide whether to renew Medicare contracts with the Health Care Financing Administration. Citing unprofitable reimbursement, 43 HMOs and 22 other plans exited Medicare, while 52 HMOs … Read more

Nancy Wilson Dickey, M.D.   Nancy Wilson Dickey, M.D.: “There’s a lot of dissonance in the messages people get that contributes to their perceived need to change health care.” We talk about the miracles and we take them for granted, but we don’t often talk about the costs: developing the technology, the scientific research, or the … Read more

Tomorrow’s Medicine Devices that selectively destroy the renal nerves that affect hypertension have gained international approval, and availability in the United States is not far off Thomas Morrow, MD 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 … Read more

In their decision to uphold tax subsidies for policies sold on the federal health insurance exchange established by the Affordable Care Act (ACA), the Supreme Court Justices showed a keen understanding of the history of various state health reform measures and how insurance markets operate in general, invoking terms like community rating, adverse selection and death spiral. The … Read more

Population management claims: The Seven Rules of Plausibility provide means to test the claims of population management vendors. July 20, 2012 AL LEWIS President, Disease Management Purchasing Consortium Everything in life has an “80–20” rule. Example: 20 percent of the population accounts for more than 80 percent of income; 80 percent of a ball club’s … Read more

The Health Care Financing Administration has given Medi-Cal, the California Medicaid program, the go-ahead for automatic placement of Los Angeles beneficiaries into HMOs beginning Jan. 1, six months later thanoriginally planned. Approval was delayed last March until Los Angeles County solved problems with its L.A. Care managed care program. Those problems included inaccurate educational materials … Read more

Too many HMO executives are swayed by vendor data compiled using flawed methodology. Keep your eye on the denominator. Frank Diamond Senior Editor MANAGED CARE June 1999. ©1999 Stezzi Communications QUALITY CONTROL Too many HMO executives are swayed by vendor data compiled using flawed methodology. Keep your eye on the denominator. Frank Diamond Senior Editor When Rick … Read more

Massachusetts can no longer require Medicare HMOs to provide unlimited prescription drug benefits. District Court Judge Richard Stearns decided that the federal law creating the Medicare+Choice program supersedes a state law barring prescription-benefit limits. The ruling pleased HMOs, which had been fighting for the right to reduce drug benefits, a move they said was needed … Read more

High-deductible insurance hasn’t been a big draw, but plan sponsors have found a few ways to make it attractive Lower-than-expected enrollment in the new consumer-directed health plans (CDHP) prompts many observers to worry that the concept is not catching on with workers. But some employers find employees flock to their CDHP option. What is their … Read more

The question facing health care organizations today is daunting: “How are we going to efficiently and effectively care for millions of new patients, many with chronic illnesses, and many who have never had access to routine health care in the past?” At Franciscan Health System in Tacoma, Washington, we face the same problems as other … Read more

When physicians think it is acceptable to withhold care from lawyers involved in malpractice suits, does it signal a breakdown of the social order? The AMA House of Delegates proceedings usually make my molars ache — that’s why I don’t follow them — but I could not escape the news coverage this June, when a … Read more

Health plans are taking steps to implement this promising payment system, but it sure ain’t easy About 40 health plans are implementing bundled payment programs and working to overcome the logistical problems inherent in changing how providers are paid. The system is attractive in part because in theory, it allows payers to control costs while … Read more

First new treatment in more than 20 years   The FDA has approved edaravone (Radicava, Mitsubishi Tanabe Pharma America, Inc.) for the treatment of patients with amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s disease. In the United States, the only other approved ALS medication, generic riluzole, modestly slows disease progression in some patients. … Read more

An ambitious effort is underway to end “ICU delirium,” the sudden and intense confusion some patients experience in the unit and which often lasts long after discharge, reports STAT. Anywhere from a third to 80% of ICU patients are overcome by delirium during their visit to the ICU. Wes Ely, of Vanderbilt University Medical Center in … Read more

And then there was none? Iowa is close to being the first state unable to offer an ACA plan if Medica follows through on recent pronouncements that it might quit the exchange next year. Aetna and Wellmark Blue Cross and Blue Shield have already said that they weren’t coming back. Yesterday, Medica released a statement … Read more

New oral treatment options and outcome measures may help patients with type 2 diabetes to achieve better results while reducing associated costs. George E. Dailey III, MD Senior Consultant, Division of Diabetes and Endocrinology at Scripps Clinic; Clinical Professor of Medicine, University of California – San Diego Full text available in PDF Abstract: Type 2 diabetes … Read more

Of the 3.3 million low-income beneficiaries who have Medicare Part D coverage, 65 percent (2.2 million) will have to choose a new plan in 2010 or face paying a premium if they decide to remain in their current plan, according to a recent Henry J. Kaiser Family Foundation report, “Part D Plan Availability in 2010 … Read more

Insurers are proceeding cautiously, but the large insurers are speeding up their approvals. Kymriah (tisagenlecleucel) and Yescarta (axicabtagene ciloleucel) cost $373,000 to treat adults with advanced lymphomas, while Kymriah costs $475,000 to treat acute lymphoblastic leukemia in children and young adults, according to Kaiser Health News. Many patients experience serious side effects require ICU care. Treatment … 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

Unimpressive performance combined with the dangerous shortcomings of older medications keeps insurers wary. Two new medications approved this summer are pharma’s latest attempt at a wonder weight loss drug in a class where the performance of past agents has been awful. Several, most famously fenfluramine and sibutramine, were yanked for major safety reasons. Only a … Read more

Furthermore, modelers are inclined to additional consolidate computerized advancements into how the two patients and workers interface with and inside clinical spaces. So what highlights should medical services architects keep an eye out for in 2018? Planner Jason Carney, accomplice at Conditions for Wellbeing Engineering, imparted his perspectives to Business Property Chief, featuring the business’ … Read more

Next Generation ACOs Must Defy FFS Gravity This new assault by CMS on fee for service comes loaded with dynamic tools and more inviting benefits for patients and providers. Will that be enough?   Four years after CMS introduced the Pioneer program, it has launched Next Generation, its new demonstration program that will boldly take … Read more

Will Automated Records Be Worth Their Price? How Plans are Building Electronic Patient Charts Computerized clinical records can give a health care plan a competitive edge, but implementation is challenging. Some institutions are closing in on the automated patient record; others have miles to go. Why Managed Care Is Getting A Bad Rap Open a … Read more

Since the ’90s, health insurance benefit coverage has become increasingly standardized. Coverage rules used to be entirely up to state insurance regulations and laws. When states did not specify rules, insurers had latitude to set details like cost sharing and other limits for the policies they sold. The ACA, signed into law in 2010, and … Read more

As health plans and other organizations refine criteria for the practice, consumer advocates voice some concerns.   When Health Plan of Nevada first told physicians to prescribe double-strength tablets of three medications so that members could split the pills before taking them to cut costs, some vocal consumers objected to the move. The HMO’s public … Read more

A medical ethicist says it’s time to acknowledge that limited resources will cover limited services Voicing the idea of rationing health care services is a political deathtrap, or so ethicist Leonard Fleck, PhD, has been told. Fleck, a professor of philosophy and medical ethics at Michigan State University, served on a committee that recommended to … Read more

With Majority Leader Bob Dole’s pledges of quick action ringing in the air as he left the Senate, health insurance reform was stymied for weeks by Senate opposition to so-called medical savings accounts. The House and Senate didn’t even agree to appoint conferees until late July, when informal negotiations produced agreement on a compromise test … Read more

Comes a new twist in the recent uproar about how pharmaceutical companies are spiking costs for variations of medicines that have been around for decades. Little children often have a difficult time swallowing pills or they run the risk of an adverse reaction to a pharmacist’s ad hoc compounded liquid version. So it figures that new … Read more

Contributing Editor In police lingo, ‘SWAT’ stands for Special Weapons And Tactics. It’s an apt metaphor for the team of workers a physician’s office can assign to Solve Worrisome Account Troubles. In police lingo, ‘SWAT’ stands for Special Weapons And Tactics. It’s an apt metaphor for the team of workers a physician’s office can assign … Read more

QUALITY IMPROVEMENT Leading-edge health plans and medical delivery systems are shelving their diverse interests in search of common methods of betterment. Bob Carlson Contributing Editor As a group, they tend not to get into the fine points of Continuous Quality Improvement, Total Quality Management, ISO or Six Sigma. And more than a few avoid the … Read more

The economic impact of Sept. 11 and the ensuing anthrax scare is still being calibrated, but it appears that health insurance premiums will increase even more than already had been predicted. USA Today reports that the terrorist attacks have led to increased physician and emergency room visits, as well as more prescriptions for antianxiety medication. … Read more

Type Title Author Story How much return does that PhD provide? webadmin Story Can Amylin Analogue Lead To Better Diabetes Control? webadmin Story Nurse Practitioners Inch onto the Field webadmin Story Less Pain, Lower Costs: Can Integrative Medicine Do Both? webadmin Story Don’t Let a Fee-for-Service Mind Set Distort Your Approach to Capitation webadmin Story Tumor … Read more

With investors moving their money from health care to technology over the last few years, the cash stash that some for-profit systems had enjoyed has shriveled. A new InterStudy Publications report says HMOs relied heavily on investor funds during the 1990s to cover medical and operational expenses, and premiums alone were not enough. The resulting … Read more

Despite last year’s fiasco at Penn State and growing concern about the effectiveness of such programs, employers are still believers Reports about wellness programs have occupied this space many times. Why shouldn’t they? Employers demand, insurers supply. Jaan Sidorov, MD, a consultant, former health plan medical director, and member of our editorial advisory board, says, … Read more

This Employee Benefit Research Institute official sees little change in the level of health benefits so long as unemployment remains low Medicare is inexorably going broke, but don’t expect our political leaders to do much about it until the last possible minute, which may arrive as soon as 2013. As Paul Fronstin, PhD, points out, … Read more

At a letter into the European Haemophilia Consortium, Roche has shown this certain patient expired in a phase 3 analysis of this bispecific antibody emicizumab. The passing was regarded as irrelevant to emicizumab, however, with case after similar acute effects (SAEs) along with different representatives, it’s included with questions regarding the protection of the experimental … Read more

More on Less In April of last year, I wrote about the first release of recommendations from the American Board on Internal Medicine Foundation in conjunction with nine medical societies as part of a campaign: Choosing Wisely. The campaign aims to draw attention to and call into question commonly ordered tests like chest x-rays before … Read more

Some insurers are taking tentative steps toward developing global provider networks for corporate clients Until this year, the 27,000 people working for the Hannaford Bros. supermarket chain were on the hook for several thousand dollars in coinsurance if they needed a costly hip replacement. Yet the company was responsible for the lion’s share of the … Read more

Insurers are largely happy with what they’ve seen. They’re creating new benefit packages and expect more business in the next one to three years. Since the beginning of this year, XLHealth has been carefully testing a new market in Baltimore and seven Maryland counties. Spreading the word through local doctors and nurses, the disease management … Read more

Whatever problems the ACA might have, health care company CEOs shouldn’t be the ones complaining (and they really aren’t very much). Why? Because they’ve been handsomely compensated since the ACA was signed into law in 2010, as a nice bit of reporting by Bob Herman at Axios showed yesterday morning. Herman used SEC filings for … Read more

WHAT’S OLD IS NEW The per-visit cost of a house call is high, but used judiciously, this practice can lower overall medical costs — not to mention provide better care. Ed Rabinowitz During a physician house call, a patient complained of pain and swelling in her leg. Risa Lavizzo-Mourey, M.D., chief of geriatric medicine and … Read more

MANAGED CARE March 2006. ©MediMedia USA In a notable departure from the commercial marketplace, the most common pharmacy benefit structure among Prescription Drug Plans (PDPs) and Medicare Advantage-Prescription Drug plans (MA-PDs) under Medicare Part D is a four-tier structure, according to the report “Understanding the 2006 Medicare Part D Marketplace.” The report says that at least 51 … Read more

Care Variation Reduction Going Nowhere? Used Strategically, a HEIP Might Help When mapping the concerns among health system C-suites over the past few years, efforts to reduce unwarranted care variation have remained near the top. The ongoing concern over this variation was reflected in the results from the Advisory Board’s latest Annual Health Care CEO … Read more

Insurance regulators in Maryland and the District of Columbia approved, with conditions, the merger of Blue Cross Blue Shield of Maryland and Blue Cross Blue Shield of the National Capital Area. The move creates the largest health insurer in the region. Regulators stipulated that the two plans continue to be charitable institutions and safeguard assets … Read more

Complex formula treats urban and rural areas differently When regulators recently issued detailed rules on accountable care organizations, managed care experts paid particularly close attention to the antitrust policy laid out by the Department of Justice and the Federal Trade Commission. While Congress set up ACOs to help shift the payment system for Medicare away … Read more

Their argument in California is that insurers should spend a minimum of 85 percent of their revenue on services John Carroll The California Medical Association (CMA) says it has found more than $1 billion that can be spent on health care in the state. And it’s all in the hands of a short list of … Read more

The identification and treatment for iron deficiency can be a key public health objective. This analysis directed to produce an overview of using biomarkers to estimate the iron source inpatients given iron replacement therapy. A retrospective longitudinal real estate analysis of a cohort of patients undergoing iron replacement therapy has been conducted with data from … Read more

Despite the popular notion that crowded emergency departments (EDs) are filled with the uninsured, a recent study in the Journal of the American Medical Association suggests that perception is unsupported. A literature review by Manya F. Newton, MD, MPH, a Robert Wood Johnson Clinical Scholar candidate at the University of Michigan, and colleagues spotlights assumptions … Read more

Plans and PBMs are divided about sharing drug prices with clinicians. Is it better to have an administrative committee determine the formulary? MargaretAnn Cross Contributing Editor When Edmund Pezalla, MD, MPH, joined Prescription Solutions as vice president and medical director three years ago, the company’s pharmacy and therapeutics committee evaluated the price the pharmacy benefit … Read more

The cumulative costs of care for people with Alzheimer’s disease will exceed $20 trillion (today’s dollars) from 2010 to 2050, assuming the absence of disease-modifying treatments (therapies that affect the disease, rather than just the symptoms). These daunting data are presented in the Alzheimer’s Association’s “Changing the Trajectory of Alzheimer’s Disease: A National Imperative.” The … Read more

Medical care individuals face an urgent conundrum. On the 1 hand, while not quite every industry of the US market finds itself under enormous strain from COVID-19, they’re doing better financially as they were prior to the crisis began, since requirement for clinical procedures plummets. However, the flip side, the prognosis for 2021 and outside … Read more

Mental Health Parity: A Year Later, Are We There? The crisis some employers feared that the Mental Health Parity Act would bring about hasn’t happened. But neither has an avalanche of care. Follow the Shrinking Managed Care Savings The industry takes credit for saving money. But now, with premiums and costs likely to rise, HMOs … Read more

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

Organizations such as NCQA are grading managed care plans on many aspects of care and making the results public. Health plans, in turn, are evaluating physicians. Here are some suggestions for making the grade. The forms discussed in this article can be downloaded below With health plans measuring ability to serve patients, avoidance of unnecessary costs … Read more

Congress told the Department of Defense to create a uniform formulary for all the services, and cover all FDA-approved drugs. Tony Berberabe Associate Editor If an army does indeed move on its stomach, it is because many times it is crawling toward the medicine cabinet. Like the private sector, the Department of Defense is faced … Read more

Researchers expect stem cells will be effective in the cure of several health ailments and conditions. But un-proven stem cell treatments could be dangerous –thus get most the reality in the event that you should be thinking of any therapy. But do not think the hype. Therefore watch out for potentially dangerous procedures–and also confirm … Read more

MANAGED CARE September 1999. ©1999 MediMedia USA Q&A This physician and his backers are making a $100 million bet that electronic patient records, and widespread access to them through the Internet, are not far away for most practices. Mark Leavitt is well into his third career, that of health care technology executive. The CEO of MedicaLogic Inc., … Read more

First, Do No Harm — To the English Tongue Electronic Enrollment Can Save Expense and Grief The time lag between when an employee makes a coverage choice and when the plan receives notification from the employer’s personnel office can result in expense and problems for patients, physicians and the plan. How Plans Do — and … Read more

Texas has become the first state to post on the Internet information about complaints filed against HMOs and other insurers. The Internet Complaint Information System, launched by the state’s Department of Insurance, also includes complaints against auto and property insurers. The web site, http://www. tdi.state.tx.us/consumer/icis/ icis1.html, is the first of its kind. It contains information … Read more

The study concluded that a Lot of antibiotics Such as ciprofloxacin Led into the epidemic of acute diarrhea due to C. difficile that struck visitors from 2006 onwards. The epidemic has been ceased by significantly reducing utilization of ciprofloxacin and relevant antibiotics. Inappropriate widespread and use Over-prescribing of fluoroquinolone Compounds like ciprofloxacin infact enabled C. … Read more

Pharmacy and medical cost increases for health plans have been relatively steady, according to data collected by Towers Perrin from 2006 through 2008, with the costs associated with account-based health plans (CDHP with HRA or HSA) mirroring traditional health plans, despite their growing presence. Overall, the top 10 percent of companies (by rate of increase) … Read more

only as abstracts. Indications The PillCam is indicated for observation of the small bowel mucosa in adults and children age 10 and up. Typically, physicians will order the PillCam for people with suspected cancer of the small intestine, Crohn’s disease, obscure GI bleeding, iron deficiency anemia, malabsorptive diseases such as celiac/sprue disease, irritable bowel syndrome, … Read more

Insurers must spend at least 80 to 85 percent of premiums on direct care for patients, as well as on efforts to improve quality of care, according to new regulations from the Department of Health and Human Services (HHS). The regulation, the medical loss ratio (MLR) provision of the Patient Protection and Affordable Care Act, … Read more

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Health costs are rising. UM has played out. Finding efficiencies in health care will be more challenging than ever, but three models offer a glimpse of the future. Michael D. Dalzell Managing Editor Sidebars WellPoint: Shifting decisions — and risk — to members Humana: A paperless health plan American Healthways: Care enhancement: holistic healing Haven’t you heard?” asks … Read more

When a plan member is treated after an auto accident or other mishap that results in an award to the member, the plan should be reimbursed, but often, it doesn’t happen   As Congress shaped a new pension law in late July, it jettisoned a hotly debated provision in the House bill that would have … Read more

Unable to find an acceptable suitor for HIP Health Plan of New Jersey, state officials on March 31 closed the deeply indebted HMO they seized late last year and are liquidating its assets. Regulators ordered other HMOs in the state to accept HIP’s 144,000 commercial subscribers without regard to existing medical conditions. Last month, a … Read more

Cost pressures that plans associate with rising drug expenditures result partly from their own largesse. Solutions: Restore consumerism and forge a common agenda with drug companies. Sidebar: A new legal pitfall in DTC advertising Jim Hoyes is under no illusions. As vice president for managed care at Sanofi-Synthelabo Inc., the pharmaceutical maker, he and his … Read more

Although lower income in rural areas is often cited as an obstacle to recruitment of physicians, one study suggests rural and urban areas do not differ significantly — at least, in terms of income. Moreover, after adjusting for differences in cost of living, hours on the job, specialty, and other factors, rural doctors on average … Read more

A hidden menace lurking in the technical world of information exchange is correctly identifying patients and matching them properly to their records. When matching goes wrong, two things can happen, neither of them good: Either there are two or more records for the same person, which can make it harder to access vital information, such … Read more

The retreat from tightly managed care in recent years has left casualties on the insurance battlefield: people with low incomes and chronic illness. So says a report by the Center for Studying Health System Change titled “Patient Cost Sharing: How Much Is Too Much?” For many, the study implies that that question has already been … Read more

Maryland legislation Requires hospitals to set a physician-credentialing process with bi-annual proper re-appointments. Regulations provide special standards for re appointment procedures, for example documentation and analysis of the doctor’s operation, for example, physician’s”attitudes, collaboration, and capacity to operate with other individuals ” The doctor contested Maryland’s physician-credentialing regulation and Support for”private behavior” with a person. … Read more

Physician assistants broke into the rank of the 10 most sought-after providers for the first time in 2013, according to Medicus Firm, a physician placement company. Medicus bases its findings on hiring activities in more than 200 hospitals and group practices nationwide. The demand for nonphysician providers will increase as the strains on primary care … Read more

Only 11 of the not-for-profit health plans are still operating, and the program that would cushion them from financial losses is in trouble. Will it be fixed? As the demise of the not-for-profit, consumer-operated and oriented plans, or co-ops, quickened in the weeks leading up to the current ACA open enrollment period, a couple ideas … Read more

Large blood pressure Ought to Be treated Sooner with Life Threatening changes And in certain patients using drugs — in 130/80 millimeter Hg as opposed to 140/90 — in line with this first comprehensive brand new high bloodpressure tips in over a couple of years. Scientific Sessions conference in Anaheim, the greatest world wide cardiovascular … Read more

Private insurers who participate in Medicare Advantage have received guidelines from the Centers for Medicare and Medicaid Services that they must meet if they want to bid on Medicare insurance business this year. The guidelines protect sicker beneficiaries from discriminatory out-of-pocket charges for the health care services they need. …. Employers remain confident that employer-based … Read more

With videoconferencing, text messaging, email, and the good old phone call, a treatment method that “spent many years in the desert” has now reached an oasis of acceptance—and savings may result. Sure, Cigna spokesman Joe Mondy is paid to talk about telemedicine—even to sing its praises now that the insurer has a contract with MDLIVE … Read more

Physicians are more likely to buy in if they see better outcomes — and financial rewards that go with them. Perhaps nowhere in medicine does the friction between physician and HMO translate into lost revenue more noticeably than in disease management, where lack of doctor buy-in is a perennial complaint. The author, a former medical … Read more

The time lag between when an employee makes a coverage choice and when the plan receives notification from the employer’s personnel office can result in expense and problems for patients, physicians and the plan. Electronic enrollment, now being used by some employers and health plans, can reduce errors and provide greater efficiency and speed than … Read more

The randomized controlled trial reigns supreme, but the FDA is working on ways to incorporate real-world evidence into its approval processes. Second of two parts The FDA is laying groundwork that will play a major role in determining the future of real-world evidence. In just a few years the use of RWE has expanded dramatically, … Read more

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

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. As scientific understanding of the mechanisms involved in chronic pain increases, … Read more

Streamlining the American health care system frees up resources to extend coverage to more people Lola Butcher As health plans, medical associations, and government agencies struggle to reach the holy grail of evidence-based medicine, some of the nation’s largest employers are emerging to give them a boost. The National Business Group on Health — a … Read more

The IRS has given health insurers extra time to make incentive payments to providers and still claim them as deductions. HMOs now have more than 21Ž2 months from the end of their tax year to make the payments…. Employer-sponsored coverage seems to be eroding, according to a study by the Center for Studying Health System … Read more

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 contracts are most practices’ lifeblood now, and it’s a buyer’s market. Demonstrate your quality-improvement systems and show health plans hard … Read more

Emad Rizk, MD Creating truly transparent management systems is in the interest of payers and providers, and is achievable MANAGED CARE February 2009. ©MediMedia USA Creating truly transparent management systems is in the interest of payers and providers, and is achievable Emad Rizk, MD For two decades, network management has existed in an increasingly challenging environment. Efforts … Read more

Prison accused of killing inmates slowly Frank Diamond Managing Editor There are few issues that unite the political polarities these day, but there seems to be consensus emerging about this: We dump too many people in prison, including dumping them on a former coal ash landfill, a situation sparking controversy in a corner of Pennsylvania. … Read more

For-profit or not-for-profit: Does it matter? Can Your HMO’s Documents Pass the Readability Test? Why can’t patients understand managed care information? Too often, printed materials baffle them because authors don’t take into account literacy level, reading skills, thinking style or short-term memory. Taking Back the Power? Will Physicians Reclaim Control of Medical Care? Phyllis Maguire … Read more

Outlook According to researchers, health spending growth will slow over the next 10 years, both private and public. Per-enrollee private health insurance benefit growth peaked in 2001, but per-enrollee premium growth did not peak until 2002. In addition, the number of people with private health insurance will begin to increase again in 2003. This projection … Read more

A review of outcomes data for Medicaid participants enrolled in managed care organizations (MCOs) suggests that financial incentives may affect the preventive care that primary care physicians (PCPs) provide to enrollees. The lead author, Troy Quast, PhD, an assistant professor of economics at Sam Houston State University in Huntsville, Texas, and other researchers compared two … Read more

The insurer hopes to give businesses of between 50 and 400 employees more flexibility under defined contribution Officials at Horizon Blue Cross Blue Shield of New Jersey think that they might have found a niche customer base. The public health insurance exchanges opening in October will include the Small Business Health Options Program (SHOP) through … Read more

Despite the seeming Gordian knot of regulations associated with Medicare Part D, health plans figure the benefit-to-risk ratio is squarely in their favor. Martin Sipkoff The labyrinth of regulations notwithstanding, health plans are surprisingly engaged in Medicare Part D. The Centers for Medicare & Medicaid Services received hundreds of applications by the March 23 deadline … Read more

In his 20 years as a health care lawyer, Jeffery M. Alexander has seen the rise, and often fall, of all manner of health care organization. A member of the Health Care Practice Group of the Providence, R.I., office of Brown, Rudnick, Freed, & Gesmer, Alexander has devoted much of his focus recently to physician … 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

CMS and Insurer Spoke about what Had to be Achieved to better Speech The societal determinants of health for your beneficiaries. This caused your policy, executed this past year from CMS, which permits the supply of everyday care utilizing non-skilled health care providers, the sort of services usually awarded in assisted living facilities. Cigna– HealthSpring … Read more

John A. Marcille This magazine, Managed Care, is based in Trenton, N.J., outside of Philadelphia. This affords staff the opportunity to patronize Philly’s major league sporting events, an historically dubious perk at best. To be a Philadelphia sports fan is to learn every connotation of long in the term long-suffering. Then, this year, came the … Read more

For all the hoopla created by passage of the Affordable Care Act (ACA), an analysis by Avalere Health of the ACA’s effect on employer-sponsored insurance (ESI) suggests a minimal effect overall. “That’s the bottom line,” says Miryam Frieder, a senior manager at Avalere Health. “But below the surface there are bigger changes, with employers dropping … Read more

Hospitals now face stiff penalties and some health plans see this as a way to attain a long-sought goal A little more than two years ago, Victor Caraballo, MD, the senior medical director at Independence Blue Cross in Philadelphia, set out to hit the brakes on the flow of unnecessary readmissions to area hospitals. By … Read more

Applying the ACO Frame to Medicaid runs Directly into a Struggle: the disproportionate Effect of socioeconomic factors on health in the Medicaid Populace. Bad health effects one of low carb inhabitants are usually exacerbated by shaky housing and employment, transport difficulties, and insufficient access to food that is wholesome. Insert at a high incidence of … Read more

By measuring the inflammatory marker CD154, Pleximmune promises to predict the risk of organ rejection in liver and small-bowel transplant procedures This is a test: Write down the first thing that comes to your mind at the mention the word ‘transplant.’ I’ll bet no one reading this column thought about pediatric liver or pediatric small- … Read more

MEDICATION MANAGEMENT Cancer Agents Taken Orally Pose Adherence Problems Despite Ease of Administration The regimens can be complex. PBMs use education, outreach, split fills, and other techniques to help with adherence. Oral chemotherapy drugs have transformed cancer care. Agents such as imatinib (Gleevec) opened the door to long-term remission in chronic myelogenous leukemia (CML). Since … 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

Companies have hit the wall in terms of how they’re going to provide health benefits to employees, thanks to the largest two-year increase in costs since 1990, a new survey finds. According to a poll by Mercer Human Resource Consulting, employers nationwide expect health care costs to rise 14.6 percent in 2003, a little less … Read more

Those who make deals between buyers and insurers are used to perks and tidy commissions. The Internet and defined contributions may threaten that. John Carroll PLAYERS 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 … Read more

Retail pharmacies are less likely to dispense specialty drugs than in the past, according to the Pharmacy Benefit Management Institute’s 2009–2010 Prescription Drug Benefit Cost and Plan Design Report. In 2007, nearly 37 percent of employers surveyed said their plan benefit design allowed retail pharmacy to dispense specialty drugs, but that dropped to 28 percent … Read more

MANAGED CARE June 2000. ©2000 MediMedia USA Good morning, cyberdocs: If you’re in Illinois and you contract with First Health Group PPO, you might want to spend a little more time answering patients’ E-mails. There’s gold in that keyboard.First Health Group says it will soon begin to pay physicians $25 for each clinical E-mail conversation with a … Read more

It’s survival of the biggest because of IT, data collection, and other factors. But the health insurance market is also full of nooks, crannies, and niches that are friendly to small fry and newcomers. It’s hard not to gawk when the giants that stalk the earth join forces and become even bigger, and fewer, and … Read more

A recent study conducted by the Urban Institute and the Center for Studying Health System Change suggests that despite recent gains in Medicaid physician payments from 1998 through 2003, the relative attractiveness of Medicaid payments has not improved much. Published in the June issue of Health Affairs, the study reports that on average, Medicaid fees … Read more

A new law that makes employers extend health benefits to about a million uninsured Californians will be watched carefully. Opponents of the law, signed by Gov. Gray Davis two days before the recall vote that ousted him, vow to challenge it in the courts. “The California Chamber [of Commerce] agrees that uninsured Californians need help, … Read more

The United Kingdom is proving hospitable to UnitedHealth Group and Aetna, and there is business to be had elsewhere in Europe and on other continents While we live in a well-developed global economy for international trade in most goods and services, including prescription drugs and sophisticated medical equipment, when it comes to the health insurance … Read more

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

One of the key downsides of market-based health care  — that if your costs regularly exceed your income you go out of business  — is not typically associated with the National Health Service in the U.K. That is about to change. It has just been announced that the three hospitals that constitute the South London … Read more

SYSTEMS & SOFTWARE Should You Use E-mail in Clinical Practice? Joyce R. Ochs When the American Medical Association published e-mail guidelines for doctors last year, it was a tacit acknowledgment that the ubiquitous medium had found a place in the mainstream of medical practice. The issue today is no longer whether to do it (it’s … Read more

Many are calling this attempt at universal coverage a failure, but health plans, physicians, and policymakers in Massachusetts say “Not so fast!” It’s hemorrhaging money. It falls short of universal coverage. It demands too many sacrifices from health plans. It places too much of a burden on primary care physicians. Its coverage mandate is too … Read more

As Another safety Step from the Appearing Zika virus Outbreak, ” the U.S. Food and Drug Administration now issued fresh direction for prompt execution providing tips to decrease the possible transmission threat for Zika virus in human cells, cells, and cell as well as tissue-based services and products (HCT/Ps). The assistance covers contribution of HCT/Ps … Read more

Here’s how the process works today, who pays for it, and when and why it makes sense John Carroll Contributing Editor The doctors in GreenField Health’s primary care network learned years ago that e-mail could often satisfy a regular patient’s need for medical advice. Appointments, examining-table manners, and waiting rooms were — frequently — all … Read more

Valeant Pharmaceuticals has received a complete response letter (CRL) from the FDA regarding the company’s new drug application (NDA) for latanoprostene bunod ophthalmic solution 0.024%, an intraocular pressure-lowering single-agent eye drop for patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). The concerns raised by the FDA pertain to a current good manufacturing practice (CGMP) … Read more

Features COVER STORY Changing Payment Methodologies Force Physicians Into Larger Groups Health insurers will soon find themselves working with provider organizations that have vastly improved utilization management skills DIGITAL | HTML Q&A Renewing Calls for Better Cost Profiling of Providers: A Conversation With Ateev Mehrotra, MD, MPH The information that many plans use needs to be open to … Read more

Compared to two decades increased in the USA between 2002 and 2015, using a 4.8% rise annually for type two diabetes and also a 1.9% rise annually to type 1 diabetes, researchers reported at the February 14, 20 20, dilemma of CDC’s Morbidity and Mortality Weekly Report. The speed of growth varied among racial/ethnic minority … Read more

Medications that lower cholesterol and manage diabetes account for $38.1 billion — the single largest category Martin Sipkoff A recent analysis by the federal Agency for Healthcare Research and Quality (AHRQ) of the spending patterns of adult Americans on prescription drugs found that in 2006, medications affecting metabolism, accounted for $38.1 billion — the single … Read more

The Trump Administration has create its hottest prescription to take to to slash non-prescription prescription medication prices: Advertisers wish to telephone drugs”rebates” exactly what they state they will have become –“kick backs” — and also crack back on the mad increase of profit-reaping middle-men from the drug enterprise. The discounts still are around to patient-consumers. … Read more

It’s probable that one will become the dominant judge: NCQA or URAC. After it happens, will vendors undergo less scrutiny by individual plans? DISEASE MANAGEMENT For years, the pioneers in the disease management business had to back up almost every promise made at the bargaining table with some form of performance guarantee. DM was too … Read more

The American age-adjusted incidence rate for prostate cancer peaked in 1992 at 237.4 per 100,000 men with the advent of widespread PSA screening and has been falling fast ever since. Incidence Cases per 100,000 men In 2012, the U.S. Preventive Services Task Force came out against PSA screening, citing evidence that a “substantial percentage” of … Read more

BY FRANK DIAMOND Senior Editor HMO executives trying to encourage physicians to follow clinical practice guidelines sometimes sound like parents trying to persuade their teenagers to tidy up a bedroom. “What we’ve got here,” as the warden said in Cool Hand Luke, “is a failure to communicate.” Just talk to John Wallendjack, M.D. As vice … Read more

Thanks to recent Supreme Court rulings, manufacturers of generic drugs are in a good position to continue expansion of their market share Martin Sipkoff Laws are evolving in favor of the generics industry as the demand for generics grows. Several recent Supreme Court decisions in particular are having a significant effect on the industry — … Read more

Leading With Its Heart Program Geisinger’s “warranty” for CABG surgery has gotten a lot of attention, but is it transplantable? Frank Diamond The Managed Care Forecast Here are some of the challenges that health insurers face this year Peter Kongstvedt, MD Now Is the Time for Pharmacy Performance Incentives We’ve made strides in increasing the … Read more

John La Puma, M.D. A respected young physician appeared on Oprah earlier this year to offer some common-sense advice about preventive medicine. But the advice wasn’t called disease prevention or health promotion. It wasn’t couched in health plan terms of coverage, copayments, primary providers, or capitation. It barely mentioned the “health care system.” No words … Read more

Treatment improves physical function in adults with active disease Positive results have been reported from a phase 3 study investigating tofacitinib (Xeljanz, Pfizer) for the treatment of patients with psoriatic arthritis (PsA). The study evaluated the efficacy and safety of tofacitinib 5 mg and 10 mg twice daily (BID) in adults with active PsA who … Read more

Lab Benefit Managers Seek To Stem The Rising Tide of Genetic Tests As genetic testing gets more costly and complex, health plans call on yet another intermediary for help in curbing excessive utilization. But is adding a new middleman really the answer? There are more than 140,000 genetic tests currently in use, and lab companies … Read more

Demystifying Pathways in Oncology High costs mean a sea change in cancer management is urgently needed, and these tools can chart the way without eroding the physician’s role William J. Sullivan, MBA High costs mean a sea change in cancer management is urgently needed, and these tools can chart the way without eroding the physician’s … Read more

The internationally known health care economist says we have been heading in the right direction all along — we just have to tackle problems in the right order Health care economist Uwe E. Reinhardt, PhD, is bullish on health care. The decline in the growth of health care costs looks as if it is permanent, … 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

FDA Lifts Partial Clinical Hold on Pidilizumab Drug treats hematologic malignancies   The FDA has lifted its partial clinical hold on the investigational new drug (IND) application for pidilizumab (MDV9300, Medivation, Inc.) in hematologic malignancies and has confirmed that the pivotal phase 2 trial in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), … Read more

Part of what made the Institute of Medicine’s report on medical errors so appalling was its conclusion that error prevention requires not fancy technology, but a systems overhaul that “makes it easy to do things right and hard to do them wrong.” In a simple example, the IOM said accidental deaths have been prevented by … Read more

Physicians find men lack interest in seeking medical care if they can’t get coverage for erectile dysfunction. When it comes to seeing their doctor, many men will figure out a way not to. Men have fewer routine encounters with the medical system as young people. They worry they’ll find out something is wrong and they’re … 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 Contributing Editor Here’s a question it seems everyone wants to answer: Will high-cost medications bust the budget or provide a return on investment? On one side, we have … Read more

A Special Section: Doctors Taking Back the Power? Will Physicians Reclaim Control of Medical Care?  20 A couple of years ago, experts began saying physicians would reclaim some of the clout lost to HMOs in early managed care. We focus on four innovative physician groups to see if the prediction is coming true. They Made The … Read more

First PD-L1 inhibitor to garner agency approval The FDA has given the green light to atezolizumab (Tecentriq, Genentech) for the treatment of patients with urothelial carcinoma, the most common type of bladder cancer. Atezolizumab is the first product in its class (programmed death-1/programmed death ligand-1 [PD-1/PD-L1] inhibitors) approved to treat this type of cancer. Atezolizumab … Read more

Companies that control their health care costs by aggressively managing their benefit programs and making effective use of account-based health plans, such as health savings accounts and health reimbursement accounts, will pay an average of 12 percent less in premiums this year than will less aggressive companies, according to the 2009 Towers Perrin Health Care … Read more

When the Florida Legislature gathered this year, it took up matching Senate and House bills that set out to roll back 52 state mandates on what health plans were required to offer their small-company members. The bills’ backers had some powerful support. The Florida Chamber Federation trumpeted its position by releasing a new study that … Read more

April 2011 Poor Transitions of Care Can Be Corrected Now With hospitals facing penalties for readmissions, there perhaps has never been a better time for insurers to address this vexing problem Frank Diamond Geisinger’s Embedded Nurses Improve Transitions Frank Diamond A Conversation With Peter J. Pronovost, MD, PhD: His Program Reduces Bloodstream Infections Across the … 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

The long-held approach to predicting seasonal influenza vaccine effectiveness may need to be revisited, new research suggests. Currently, seasonal flu vaccines are designed to induce high levels of protective antibodies against hemagglutinin (HA), a protein found on the surface of the influenza virus that enables the virus to enter a human cell and initiate infection. … Read more

In a system where people will soon shop for their benefits on exchanges, plans that offer the best customer service will have the edge The author is chief medical officer of Cigna. Jeff Kang, MDIt’s been said that in the digital world, your competition is only a mouse click away. Which is why business has … Read more

Who Will Fund Tomorrow’s Breakthroughs in Medical Research? The managed care industry has been blamed for slowing the flow of research funding. The true story is more complex. Needed: Strategies To Get Physicians To ‘Buy in’ to Disease Management Disease management programs can’t succeed without the full support of physicians. But how do you obtain that … Read more

Sexual Harassment: Health Care, It Is #YouToo SUSAN LADIKA Women make up most of the workforce, but men are in positions of power. Sexual harassment and abuse are common and deep-seated problems in American health care. Women in health care are speaking up and forcing executives and physicians to face the issue. Bundled Payment for Bundles … Read more

The recent U.S. Supreme Court decision offers a nice breather, but executives should not let down their guard, as an Illinois ruling shows. HMOs should not delude themselves about the U.S. Supreme Court’s June 12 ruling that patients cannot sue a health plan just because it offers physicians financial incentives that are intended to limit … Read more

Minneapolis-based HealthPartners is rolling out the next phase of its Partners for Better Health Program, an outcomes-based initiative to promote quality improvement. New measures include outcomes standards for reduction of heart attacks, depression, and diabetes-related complications in its 660,000 members. HealthPartners says it will work with its providers and members to achieve, by 2005, 50-percent … Read more

Two trends are apparent in the National Committee for Quality Assurance’s annual report on health plans. In the eyes of the organization, here’s the bad trend: The rise of consumer-directed health plans, which do not yet measure and report on quality. Only about 21.5 percent of the industry reports publicly on its performance. (For more … Read more

Color charts Also available in PDF Even bullish markets don’t excite skittish consumers who worry that quality may be traded for profit. How much is this perception reinforced when once-thriving stock declines, as has happened to some large, publicly traded HMOs recently? The total stock value of the HMO industry grew 13-fold between January 1987 … Read more

For all the talk of consolidation in the HMO industry, research suggests that the number of HMOs in the country is rising — not falling. The number of HMOs grew by 16 percent from 1995 to 1997 — the largest gain since the boom years of the 1980s. The rise corresponds with the sharpest gains … Read more

Discovered the mobile switch which fosters the game of semen cells in order they are able to go to your egg. The finding might lead to fresh alternatives for male contraception in addition to treatments for infertility leading to issues with semen mobility. In the reproductive system, older sperm are effective at Limited motion. This … Read more

STATE INITIATIVES The Texas approach to managed care continues to make news two years after the state passed the nation’s most comprehensive HMO and patient-protection legislation. The swiftness, civility, and consensus with which reforms came about stand in contrast to the partisan posturing that has resulted in talk but no action at the federal level. … Read more

Submitted by webadmin on Thu, 2012-05-31 08:03 Brad Wilson Employers and consumers, driven by the sting of higher premiums and out-of-pocket payments, are more engaged than ever in the conversation about rising health care costs. While the math is simple —overall costs equal the cost per unit multiplied by the number of units — the … Read more

Name Last modified Size Description Parent Directory 28-Aug-2000 11:10 – 9808.news_whatstheri..> 29-May-2000 11:52 1k 9808.news_newdrugs.s..> 29-May-2000 11:52 1k 9808.washington_gord..> 29-May-2000 11:54 1k 9808.washington_tele..> 29-May-2000 11:54 1k 9808.news_wheres.shtml 29-May-2000 11:52 1k 9808.news_headlines…> 29-May-2000 11:52 1k 9808.states_kentucky..> 29-May-2000 11:53 1k 9808.washington_some..> 29-May-2000 11:54 1k 9808.compmon.shtml 29-May-2000 11:52 2k 9808.washington_medp..> 29-May-2000 11:54 2k 9808.states_texas.shtml 29-May-2000 11:53 2k 9808.washington_take..> … Read more

With PPO enrollment nearing 100 million, HMOs are getting a healthy dose of competition. Is the PPO here to stay — or just a temporary distraction? Michael D. Dalzell Senior Editor With PPO enrollment nearing 100 million, HMOs are getting a healthy dose of competition. Is the PPO here to stay — or just a … Read more

Insurers will be judged on how well they find and serve groups whose health outcomes have historically lagged Frank Diamond Insurers will need to do a better job of finding and serving minorities under a new standard that’s on track to be added to the National Committee for Quality Assurance’s health plan accreditation program. “Our … Read more

For years, health plans have touted their extensive provider networks as a key selling point to employers and employees alike. But the promise of easy access to local care sometimes fell short — especially when members found that doctors on the list were shunning new managed care patients. Over the past year, though, a potent … Read more

Valeant anticipates the seven medications, which now accounts for significantly less Than $100 million in annual earnings, to get paid significantly more than $1 billion over the next five decades. These services and products figure to become an integral portion of the organization’s turnaround plans. Yet, it’s also reflective of this bruised condition of Valeant’s … Read more

Bereft of his own connections, President Trump recruited from conservative think tanks to fill health care positions in his administration. Many of them have Koch brother connections, and their agendas often run counter to Trump campaign rhetoric—and his impulses. Before he joined the Supreme Court in the ’70s, Lewis Powell was a corporate lawyer who … Read more

By Greg N. Korneluk You already know the benefits of practicing preventive medicine. By applying those principles of prevention to the management of your practice, you will be in a position to thrive and survive in a managed care environment. If you start by taking just 30 minutes to review critical aspects of your practice … Read more

This year’s proposed mergers between Aetna and Humana, and Anthem and Cigna are expected to be just the start, as consolidation of all aspects of the health care industry continues apace in 2016. Antitrust regulators are expected to decide next year whether to let the health insurance behemoths get even bigger. If the deals, worth … Read more

For the first time since Medicare’s creation, the cost to operate the program declined — 1 percent from fiscal 1998 to 1999. Medicare spending totaled $212 billion in the Treasury Department’s preliminary fiscal ’99 estimates — down from $213.6 billion in 1998. The decrease added fuel to the fire for health plans, which have been … Read more

John Carroll Contributing Editor The Patient Protection and Affordable Care Act will bring in new members, and states will look to managed care to control costs MANAGED CARE June 2010. ©MediMedia USA The Patient Protection and Affordable Care Act will bring in new members, and states will look to managed care to control costs John Carroll Contributing … Read more

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

You’ve Got to Believe: The Evidence on Positive Thinking in Cancer Outcomes Submitted by Steven Peskin MD on Sat, 2011-12-10 19:41 Steven R. Peskin, MD, MBA, FACP is executive vice president and chief medical officer of MediMedia USA, which publishes Managed Care Mark Herzlich, Boston College All American linebacker and now New York Giants rookie, … Read more

Selling coverage across state lines dusts off an old idea that has new legs. A cornerstone of the Republican replacement of the ACA and one that the party’s presumptive nominee, Donald Trump, has embraced, is to let individuals buy health insurance across state lines—that is, from a company licensed (sometimes called “domiciled”) in a state … Read more

A potential useful volume on ethics in critical care falls short of expectations, often skimming the surface of important debates I have been invited to review a publication from the Society of Critical Care Medicine titled Critical Care Ethics: A Practice Guide from the ACCM Ethics Committee, edited by Dan R. Thompson, MD, MA, and Heidi … Read more

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

By MARK D. ABRUZZO, J.D. Alternative dispute resolution refers to a variety of methods for resolving disputes without resorting to litigation. Arbitration and mediation are the most common methods of ADR, although there are variations. ADR is not used nearly as much in health care as in many other industries. However, significant changes, along with … Read more

Full text available in PDF ABSTRACT Purpose: To compare health care costs and their components in patients with chronic illnesses. Design: Quasi-experimental retrospective database analysis of an integrated state-Medicaid dataset. Methods: Nine chronic illnesses and 28 two-disease combinations were evaluated in 284,060 patients. Dependent variables were total cost and the component costs (hospital, physician, home health and medical … Read more

Managed Pharmacy MANAGED CARE January 2010. ©MediMedia USA Although effective treatments are available, helping patients cope is a minefield of administrative and legal barriers Martin Sipkoff The World Health Organization states that 85 to 90 percent of cancer pain can be controlled with drugs, but according to a study by the Institute of Medicine, “for many Americans … Read more

And Drug Administration declared the Lucentis® 0.3 milligrams prefilled syringe being a brand new way of restarting the medication to take care of most kinds of diabetic retinopathy. Back in April 20 17, Lucentis 0.3 milligrams became, and remains, the initial and just naturopathic medication to take care of most kinds of diabetic retinopathy in … Read more

The business hopes to launch this fresh treatment inside the USA first in 2018. Even the FDA decision has been encouraged with favorable efficacy and safety contributes to four completed clinical trials along with preliminary final results of two ongoing trials. Your choice also follows some blood products advisory committee inspection . “We’d like to … Read more

The acceptance is based on information from a stage 3 clinical trial application That evaluated the safety, efficiency and immunogenicity of this non-live vaccine in greater than 38,000 participants. At a pooled analysis, Shingrix was 90% effective at preventing herpes zoster, or shingles,” the release said. Additionally, it reduced the prevalence of postherpetic neuralgia, the … Read more

This paper discusses how Volume-Price supply of stock industry. The standard Distribution-like structures constituting different period have been studied, depending on what we propose a predictive version of Volume-Price supply in China stock exchange. The newspaper comprises three parts: First, the hypothesis that the Chinese stock exchange stock investing volume-price distributions will not comply with … Read more

Speaking of pharmaceutical costs, an analysis by Express Scripts/ValueRx, the pharmacy benefit management company, points to new products and increased prescription-drug consumption as factors behind soaring pharmacy expenses. According to the report, prescription drug costs rose 16.1 percent in 1997, the biggest boost in five years. That hike is led by newer agents, which accounted … Read more

The current debate over a single payer system calls to mind the parable of the blind men describing an elephant. Michael S. Victoroff, MD “And Moses said to Pharaoh, ‘Let my people go!’ And Pharaoh said, ‘You don’t seem to understand the implications of a ‘single payer’ system.’” When I was little, there was a … Read more

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The Accession of This Advisory Board Company’s Health Industry to UnitedHealth Group’s Optum lineup of services puts a much bigger bet on the dollar populace health enterprise. Managing inhabitants works in conjunction with health industry Efforts to change more obligations to hospitals and physicians apart from feeforservice medicine to value-based compensation that bases reimbursement how … Read more

A review of the available research identifies payment for services in the absence of high-quality scientific evidence and presents an opportunity to use evidence-based medicine to develop a clinical coverage guideline James P. Reichmann, MBA Michael S. Kirkbride, BSc, Pharm D Full text also available in PDF Abstract Objective: To examine the medical evidence regarding the … Read more

The good times keep rolling along for leading publicly traded HMOs, as earnings from the first quarter of 2003 indicate. A report in American Medical News cites lower medical expenses than anticipated, continued cuts in overhead costs, better data processing techniques, growing enrollment, and, of course, premium increases as reasons for the flow of black … Read more

Deciding Factor: How Much Health Care is Discretionary? Defining discretionary health care is no easy task, but it may be imperative for ‘consumer’ health plans seeking to get patients more involved Defining discretionary health care is no easy task, but it may be imperative for ‘consumer’ health plans seeking to get patients more involved If … Read more

Since the identification of this DNA double-stranded helix, the receptor for a target of therapy and, more over, using DNA for a medication have now already been chances. ‘Antisense’ can be employed by a few living organisms, namely viruses, to restrain gene replication. Only recently, using antisense DNA for a mechanism to restrain human anatomy … Read more

Will prescription drugs for gastrointestinal disorders go the way antihistamine medications did when the FDA approved a generic version of Claritin in 2002? It would appear so, according to “Gastrointestinal Market Outlook to 2010,” published by Business Insights, a research and business intelligence consulting company. Gastroesophageal reflux disease and peptic ulcer disease are among the … Read more

Firms and government officials comprehend NCQA whilst the nation’s leading independent critic of MCOs. While clients could be comfortable evaluating costs and benefits, they could perhaps well not be quite as comfy assessing quality. NCQA certification offers clients a target conclusion of a MCO general quality. Patients Health disparities and continuing health effects in contrast … Read more

The $50 million needed for regional collaborations was not part of the federal government’s budget. Not the end of the world, but not good either. John Carroll Back in the late summer, the buzz about David Brailer’s appointment as the nation’s newly minted electronic health record czar was drawing raves from advocacy groups that had … Read more

So far the discounts are meh. Physician and patient acceptance, not the usual bag of tricks, may determine market share and ultimate effect on prices.   All things considered, last year was a pretty good one for biosimilars in the United States and those who hope that the copycat products could help tame American drug … Read more

FEATURE An instance where the ubiquitous “more research is needed” very much sums up the debate Frank Diamond Managing Editor What’s an otolaryngologist to do? For years, no academic study of any real import asked about the challenges for adult patients undergoing tonsillectomy. Now, suddenly, two studies appear and they reach different conclusions, though they … Read more

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

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John A. Marcille As our recent hurricane experiences prove, what government does, or doesn’t do, matters a lot. Now, in health care, the prevailing wind may be starting to blow in the direction of tax reform. In our cover story, Contributing Editor Martin Sipkoff writes about how some lawmakers, including Senate Majority Leader William Frist, … Read more

It’s a common lament that all but the biggest companies buy health benefits primarily on the basis of price, not quality. New findings by the Washington Business Group on Health back up that assertion — eveneven though employers admit that they know better. Only a third of 360 employers who responded to a WBGH survey … Read more

John A. Marcille Pharmacy in managed care has edged its way forward as a major issue of the day, thanks in part to the long-overdue discussion of whether (and/or how extensively) to provide drug coverage for people in the Medicare program. The fact is, we rely increasingly on pharmacy to deal with health care problems … Read more

ERISA is a federal law which sets minimum standards for most voluntarily recognized retirement and health plans in private industry to give security for people in those plans. ERISA requires plans to provide participants with strategy Details Including important information regarding plan features and financing; sets minimum standards for participation, vesting, benefit accrual and funding; … Read more

BY NEIL CAESAR, J.D. The new rules of managed care require many physician groups to reassess their internal group practice structures. The dangers of ignoring this assessment may be greatest when a group is considering merging with other physicians or being acquired by a health system, an HMO, a management services organization or a physician … Read more

They’ve done it! The White House and Congress have had numerous big sit-downs on the budget and finally closed in on an “agreement.” The president and Congressional leaders have agreed to balance the budget by 2002 (for the first time since 1969)–helped in no small part by bullish predictions of future revenues. “A golden moment … Read more

It’s not just about wellness anymore. As our cover story shows, for the last three years, employers have been doing much more to improve worker health than simply offering an on-site weight-reduction program (not that there’s anything wrong with that). As we were going to press, a Hewitt Associates study made ripples in the mainstream media. “Nineteen … Read more

Patients who have multiple comorbidities and who take multiple medications may benefit most from a secure e-mail messaging system, according to a study conducted by the Kaiser Family Foundation that appeared in the American Journal of Managed Care. Members of Kaiser Permanente’s northwest region were given access to parts of their individual health records through a … Read more

Preliminary data imply that 20-19 are the sixth straight Recordbreaking season for STDs, even though CDC has expanded the deadline to local health authorities to publish their STD reports due to the COVID-19 pandemic. In accordance with Weinstock, the gains continued in to 20 20, together with Reported instances from the initial two months of … Read more

12 DM Trends You Should Know About The government joins health plans, providers, employers, and pharmaceutical companies in seeking to establish DM’s value Can a Health Plan’s Free EMR ‘Lite’ Be Useful to Doctors & Hospitals? Insurers may not need to look any further than existing claims data to build useful payer-based health records. Consumers … Read more

Insurer throws support behind P4P program that promises “stunning” advances in cost-effectiveness Lola Butcher MANAGED CARE November 2007. ©MediMedia USA Insurer throws support behind P4P program that promises “stunning” advances in cost-effectiveness Lola Butcher Impressed with the results of a major hospital pay-for-performance program, the Blue Cross & Blue Shield Association is putting its strength behind a … Read more

Consumer-directed health care plans can work, say employers in a recent survey, if the right tactics are used to help workers manage their health and benefits better. Towers Perrin surveyed more than 120 major U.S. companies and found that many believe that CDHPs can help slow the growth of health care costs if they provide … Read more

How to select, then monitor a pharmacy benefit management company, from a consultant and former HMO director of pharmacy services. One of the more important decisions that a managed care organization makes is whether to run the prescription drug benefit itself or to outsource all or part of it to a pharmacy benefit manager. A … Read more

Rehabilitation at a skilled nursing facility lacks the intensity that most patients need, studies suggest For 750,000 people who suffer a stroke each year in the United States, quality physical medicine and rehabilitation are among the most critical components in overall management of those with residual disability. Everyone agrees that in post-stroke care, the goal … Read more

We have a story in the works here at Managed Care on the mega–health insurers that may soon be roaming the land. Yes, the deals may yet run into antitrust problems, but the way things stand now there will be three super-sized national companies: an Aetna-Humana behemoth, an Anthem-Cigna giant, and the already gargantuan UnitedHealthcare. Wharton health … Read more

How to select, then monitor a pharmacy benefit management company, from a consultant and former HMO director of pharmacy services. By Tim Sawyers, R.Ph., M.B.A. One of the more important decisions that a managed care organization makes is whether to run the prescription drug benefit itself or to outsource all or part of it to … Read more

In the aftermath of surprising news a dominant charter school is final at the conclusion of the college season, Washington, D.C.’s public instruction community is earnestly debating the dilemma of transparency. Most parents, educators, and instruction leaders are requesting: does D.C. compare to the others of the nation in regards to charter faculty transparency policy? … Read more

A straightforward method of identifying potentially non-urgent ED visits from administrative data can be employed to calculate population-based rates, which might be applied in the development of managed care programs James W. Davis, PhD Hawaii Medical Service Association (an independent licensee of the Blue Cross and Blue Shield Association) and the John A. Burns School … Read more

COVER STORY Health Plans Seek Leverage When Physicians Submit Extremely High Bills One doctor demands $39,000 for a child’s surgery; another bills $56,890 for a bedside consultation Joseph Burns Will Mental Health’s ‘Bible’ Make Believers of Insurers? When does a characteristic become a disorder? The next edition of the Diagnostic and Statistical Manual of Mental … Read more

There’s more money, but is it enough to reverse the grim five-year drought of managed care offerings? In Florida, it seems so. At 75, Ed Manny is a wanted man. Just about every day, insurance organizations tell him so — both by mail and phone. And many have plenty to offer: richer health benefits, lower … Read more

Financial analysts warn against judging FPA Medical Management’s slide into bankruptcy as the general direction of the physician practice management industry. Said one, wide variations in business strategy make generalizations unrealistic. The consensus about FPA is that it grew too fast. FPA has fallen hard; its stock price, which was around $40 a share last … Read more

BY MICHAEL D. DALZELL SENIOR EDITOR Stop us if you’ve heard this before: Medical inflation and utilization are out of control. Payers are looking for ways to rein in costs without sacrificing quality. The twist? This isn’t the United States. Other nations are grappling with similar problems, making the principles of managed care look attractive. … Read more

In hospitals nationwide, workarounds to compensate for medication shortages are daily routines for treating patients––and health experts say it’s not about to change any time soon, according to a report from WNPR News. Acute-care drugs in short supply nationally include antibiotics, antipsychotics, intravenous saline, and morphine. In Connecticut, hospital officials say they are turning to … Read more

Sometimes breaking old ground can be just as satisfying as breaking new. Take our cover story. The article looks at how the corporate cultures at Aetna U.S. Healthcare and Kaiser Permanente shaped their reactions to recent financial setbacks and positioned them for the future. What these two plans are looking at, experts believe, is a … Read more

Proponents see it as the step beyond disease management. Why wait until a patient becomes part of a chronically ill group? The 80/20 rule, or some variation of it, often pops up in financial matters. In philanthropy, it holds that 80 percent of a not-for-profit organization’s funds will be contributed by 20 percent of its … Read more

There’s still a way to go in reducing elective deliveries, and different insurance systems feel far different effects The successful 10-year effort led by the March of Dimes to lower the preterm birthrate is also a triumph for insurers in the thick of this societal change. For integrated health plans, though, it could be a … Read more

It’s unclear whether older Americans were more scared or bemused by the campaign rhetoric about Medicare. But in the wake of the election, Medicare is still scaring a lot of politicians. New data suggest that the Part A trust fund will run out of money in 1999, two years earlier than previous worst-case predictions. At … Read more

How physicians view biosimilars is one of the wildcards that will determine how popular the drugs become. Gastroenterologists are especially important group because anti-TNF biologics(link is external), infliximab (Remicade) and adalimumab (Humira) are commonly prescribed for inflammatory bowel disease. When the American Gastroenterologist Association surveyed 180 of its members, it found a willing but wary attitude … Read more

It is a heroic part of the American health system. Lives are saved, the dire consequences avoided. But the air ambulance industry is consolidating, prices are soaring, and insurers and providers continually fight over network issues. One consequence: Surprise billing that leaves patients owing tens of thousands of dollars. The news has been replete with … Read more

In California, multiyear “evergreen” HMO contracts are one ticket to greater operating autonomy for a large medical group created by a recent merger. TAKING BACK THE POWER? Brown & Toland Medical Group, a multispecialty independent practice association in San Francisco, has impressed HMOs with its cost-effective care and fiscally responsible physicians. As a result, it … Read more

Much while all eyes have been about healthcare reform legislation while in the governmental landscape, providers shouldn’t get rid of sight of their Triple Aim. No Matter if Republicans triumph in their own attempts To redesign and change the Affordable Care Act, providers must keep trying for much better quality for inhabitants of patients in … Read more

Telemedicine works in intensive care units (ICUs), no matter the size of the hospital or the region where it’s located, according to a huge study of the technology’s effectiveness. The study, published in the journal Chest, tracked about 120,000 patients from May 2003 to December 2006 in 56 ICUs, 32 hospitals, and 19 health systems. … Read more

If UnitedHealth Group’s effort to buy a large physician group proves successful, clinical execs will have even more oversight Frank Diamond People were caught off guard when UnitedHealth Group announced in early September that its OptumHealth services unit plans to buy Monarch HealthCare, a 2,300-physician group in California — people like Tommy Bohannon, vice president … Read more

One could take the view that by allowing provider-sponsored organizations to become a Medicare+Choice option, the federal government gave physicians, hospitals and other health care providers opportunity and encouragement to assume the responsibility of running a health care system, to integrate the insurance part with the clinical part in a more humane way, and with … Read more

Most doctors who are in the process of moving out of clinical practice and into the role of a physician executive either have obtained, or are in the process of obtaining, a post-graduate business degree, says Lois Dister, the senior vice president at Cejka & Co. She should know. Cejka conducts a physician executive compensation … Read more

On April 4, the American Board of Internal Medicine Foundation launched Choosing Wisely, a campaign to educate health care professionals and consumers about tests or procedures that should be questioned because of lack of evidence that they’re needed and/or because of evidence that says the tests or procedures should not be done in the context that is … 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

The Empire State’s approach to physician ratings quickly gains health plan support and consideration as a national answer In a matter of days, a single accord between the New York attorney general’s office and Cigna HealthCare over the way it handles physician rankings inside the state emerged as an industry standard that promises to resolve … Read more

A program by a Medicaid insurer keeps in touch with patients throughout their entire episode of care Like clinical executives everywhere, Andrew Bergman, MD, the chief medical officer of Amerigroup Maryland, says that he keeps an eye on emergency room utilization. But it’s of even more concern to Bergman since Amerigroup caters to a Medicaid … Read more

MANAGED CARE November 1999. ©1999 MediMedia USA New Jersey would become the fourth state to enact regulations governing distribution of weight-loss drugs, if a state Board of Medical Examiners proposal is approved. The proposal would require that physicians prescribing weight-loss pills embrace a holistic approach to care — take patients’ medical histories, check for diabetes and hypertension, … Read more

The $50 million needed for regional collaborations was not part of the federal government’s budget. Not the end of the world, but not good either. John Carroll Back in the late summer, the buzz about David Brailer’s appointment as the nation’s newly minted electronic health record czar was drawing raves from advocacy groups that had … Read more

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 the currents of logic, … Read more

The disease management industry worries about a bill sent to California’s governor that would allow medical information to be shared only when a physician authorizes DM services…. The American Osteopathic Association won’t follow the AMA’s lead. It voted not to form a doctor union…. In Washington, where insurers have been dropping individual policies, only one … Read more

Frank Diamond Forget about patients not refilling their prescriptions. Many don’t fill them the first time, according to a study in the Canadian journal Plos One (http://tinyurl.com/non-adherence-study(link is external)). New prescriptions were given to 232 patients from April to August 2010 at St. Michael’s Hospital in Toronto. Twenty-eight percent exhibited primary non-adherence at 7 days after discharge; … Read more

EMPLOYER UPDATE Sure, there may be some costs up front, but there is also an opportunity for health plans to profit as employers’ concern about this issue grows. MargaretAnn Cross Depression costs employers more than $51 billion per year in absenteeism and lost productivity, not including high medical and pharmaceutical bills. Yet there’s still a … Read more

Opdivo expected to supersede Avastin as standard of care for recurrent disease Glioblastoma multiforme (GBM) is a disease with some of the highest unmet needs in oncology, with patients having a median overall survival (OS) of between one and two years. The lack of effective therapies is primarily due to the inability of drugs to … Read more

At a national survey Taking a Look at That the 2018–1 9 Flu season, the Highest vaccination policy, in 98 percent, has been one of HCP at the mercy of workplace vaccination requirements. Yet, only 30 percent of HCP from LTC centers report that flu vaccination is called for with their own company. The cheapest … Read more

Defined Contribution: Magic Bullet? Defined contribution is a re-emerging health care reform idea. Its advocates say that it tackles reforms overlooked by other options, will tame costs, and will give employers incentive to stay in the game. When Is a Brand a Generic? In a Contract With a PBM When a health plan contracts with … Read more

In board rooms across the country, decisions are being made to battle, rather than run from, rising costs of care Reading the latest survey of health care benefits is like twisting Rubik’s cube. How is this going to work? One survey says: Employees value their employer-sponsored health benefits highly. Another says: Large employers — committed … Read more

What’s just really a tracheostomy? A tracheostomy opens the tooth and assists breathing. Or within a working room. Anesthesia (treatment drugs ) can be used before this task. Based upon his or her status, the tracheostomy could be permanent or temporary. Some patients having a tracheostomy can proceed home. One Major component in moving home … Read more

The other day, a lawyer called to ask me whether it was ethical for a doctor to accept a large bequest from a patient’s estate. He represented the daughters of an elderly gentleman, who moved from the East Coast to be closer to his children. After moving, the man located a new primary care physician … Read more

MANAGED CARE January 2004. ©MediMedia USA HEALTH PLAN 2009 Helen Darling Helen Darling is president of the National Business Group on Health (until recently, the Washington Business Group on Health). The group’s members are 185 of the nation’s largest private and public sector employers representing about 40 million workers, retirees, and their families. By 2009, there may … Read more

Think of P4O as P4P with its eyes on the prize. Unfortunately, even ordinary P4P is not yet widespread. Joseph Burns Contributing Editor For many years, managed care plans have used pay-for-performance programs to reward hospitals, physicians, and other providers for following guidelines and improving care processes, but few use P4P to improve clinical outcomes … Read more

FDA to Consider Expanded Label for Nivolumab (Opdivo) for Treatment of Hodgkin’s Lymphoma Patients Agency grants priority review   The FDA has accepted a supplemental biologics license application that seeks to expand the use of nivolumab (Opdivo, Bristol-Myers Squibb) to include patients with classical Hodgkin’s lymphoma (cHL) after prior therapies. The application included data from … Read more

CDC findings in U.S. territories are consistent with data from states and DC     In the U.S. territories, 5% of women who had confirmed Zika virus infection (ZVI) during pregnancy had a baby or fetus with ZVI-associated birth defects, according to a report in the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality … Read more

Employer-sponsored health care has evolved a lot over the past 20 or so years. Towers Perrin, in its annual Health Care Cost Survey, reviewed key trends in health care costs, enrollment, plan design, population health, prescription drugs, retiree medical benefits, and other areas from 20 years ago as a way to better understand future trends. … Read more

By Sharon Carter Everyone has heard about, or perhaps has been employed by, the medical practice that is a war zone–a workplace replete with personality clashes, blowups, criticism, sabotage and malicious gossip. It can be an emotional nightmare, not to mention totally counterproductive. And many doctors are stumped as to how to deal with it. … Read more

Steep discount programs encourage health plans to reduce, or even eliminate, copayments Price wars involving generic drugs are widespread, affecting insurers, retail outlets, pharmacies, and consumers. Although consumer and insurer attitudes about the value of generics have become increasingly positive in the last couple of decades, the pricing of generics was never truly competitive until … Read more

A trade association that represents 20 HMOs in Maryland filed a lawsuit last month against the state commission that sets hospital rates, alleging that the commission has let hospitals overcharge HMOs for services. In the lawsuit, filed in Baltimore Circuit Court, the Maryland Association of Health Maintenance Organizations argues that Maryland’s Health Services Cost Review … Read more

A handful of leading PPOs have agreed to test the National Committee for Quality Assurance’s first tool for measuring PPO quality of care. NCQA modified its Consumer Assessment of Health Plans Survey, which it has used as part of HEDIS to report member satisfaction with HMOs. The revisions to the survey will allow PPO enrollees … Read more

References to maximum allowable prices in contracts between plans and PBMs need to be scrutinized, since things are not always what they seem   For most of the world, the letters MAC conjure up a Big Mac — the inviting super-sized hamburger that people love but enjoy at their peril. But for health plans providing … Read more

The appropriate application of criteria for the use of palivizumab can save health plans a significant amount of money. Also available in PDF Introduction On June 19, 1998, the Food and Drug Administration licensed palivizumab, the first monoclonal antibody introduced into clinical practice for the prevention of an infectious disease — respiratory syncytial virus (RSV) … Read more

BY JOHN LA PUMA, M.D. Advance directives are among the most studied topics in medical ethics. They are a logical approach to an intimate subject. Nearly everyone recommends them, but relatively few patients–a maximum of 25 percent, and probably fewer–have them. Advance directives are controversial, and probably will become more so. There is keen interest … Read more

Peer-Reviewed Disease Management Specialist Pharmacists Make Adherence Matter Disease Management Medco’s ‘gaps in care’ approach saves $900 million by targeting 15 chronic conditions Carol Milano Its costs exceed $177 billion annually. It results in 125,000 deaths, nationwide. Nonadherence to medication is so prevalent that about half of the 3.2 billion prescriptions issued in the United … Read more

Health insurance plans need only bolster the following accepted guidelines to see a return on a very little bit of investment Bob Kirsch Heart failure results in substantial morbidity, mortality, and health care expenditures. There are 5.8 million people in the United States with heart failure, and this condition has one of the highest rates … Read more

Primary care physicians did not see much change in their compensation last year compared to 2002, according to a survey by Sullivan, Cotter & Associates, a consulting company that specializes in physician compensation. That was not the case with specialists, whose compensation soared (cardiologists, anesthesiologists) or dipped (oncologists, hematologists, pathologists). The data were collected mainly … Read more

President Bush’s plan to give prescription discounts to Medicare beneficiaries has created quite a storm. Under the plan, pharmacy benefit managers would administer a discount program for the 25 percent of beneficiaries without drug coverage. People would pay a one-time $25 fee to become eligible for savings of between 10 and 25 percent on prescriptions. … Read more

PDF version:  MC_1502_Naloxone_Autoinjector.pdf Abstract Background: Patient overdoses on prescription opioid analgesics in the United States continue to rise, resulting in increased emergency department and hospitalization costs. Opioid overdose is readily reversible with naloxone, a fast-acting opioid antagonist. A new naloxone autoinjector (NAI), Evzio, which does not require medical training to use, was approved by the FDA … Read more

Yet one more survey shows that health care costs for companies are increasing more slowly than in recent years. This one comes from Deloitte Consulting, which surveyed 316 employers representing about 2.5 million workers. Compared to the prior year, how did health care costs change for your organization this year? Source: 2005 Consumer-Driven Health Care … Read more