MANAGED CARE May 1998. ©1998 Stezzi Communications A group of physicians calling itself the “Terbutaline Strategy Group” has petitioned the U.S. Food and Drug Administration to reverse itself, after the agency mailed a “Dear Colleague” letter warning practitioners about use of terbutaline sulfate for prevention of preterm labor. The doctors worry that the FDA action could remove … Read more

On Aug. 21, President Clinton signed the Health Insurance Portability and Accountability Act of 1996 into law. HIPA is extremely significant for physicians and managed care organizations. I’m not referring to the portions of HIPA that gained the most press coverage–namely, the creation of an entitlement to (and mechanisms for) more affordable and portable health … Read more

The PBM’s new system guarantees net pricing for average prescription claims. Some experts are skeptical this will really affect drug prices. December 6, 2018 PBMs have come under scrutiny and fire the last few years, often taking the blame for skyrocketing pharmaceutical prices. Critics claim that PBMs pocket much of the drug rebate money pharma … Read more

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – 0002.washington.html 20-Jun-2003 16:09 8k 0002.uk.html 20-Jun-2003 16:09 17k 0002.qna_bodenheimer..> 20-Jun-2003 16:09 24k ../../../archives/0002/0002.outlook.pdf 01-Feb-2000 12:00 29k 0002.outlook.html 20-Jun-2003 16:09 2k ../../../archives/0002/0002.outlook.gif 01-Feb-2000 12:00 47k 0002.news_warning.html 20-Jun-2003 16:09 2k 0002.news_tenncare.html 20-Jun-2003 16:09 2k 0002.news_premiuminc..> 09-Apr-2003 23:27 1k 0002.news_premiuminc..> 01-Feb-2000 12:00 19k 0002.news_pharmacyco..> 01-Feb-2000 12:00 61k 0002.news_pharmacyco..> … Read more

A system in which individual insurance policies may be purchased for separate medical products and services is based on a medical options market and takes its cue from the financial sector Also available in PDF Imagine that the insurance world did not revolve around the aggregation of medical products or services but rather involved the … Read more

SYSTEMS & SOFTWARE “Turn on the TV!” said the caller on the morning of Sept. 11. Her directive led me to spend two days in front of the television, mesmerized by unbelievable destruction and ruin. Sometime during those 48 hours, after I was numbed by the repetition of the World Trade Center-collapse videotape, my eyes … Read more

Medicare+Choice, the system that was supposed to manage the health of the nation’s senior citizens, will be lucky if it manages to stay afloat into next year. Thanks mainly to the increasing cost of providing a prescription drug benefit, HMOs are exiting the program in droves. Only an act of Congress can save Medicare+Choice, experts … Read more

There’s a lack of competition among health insurers, according to the American Medical Association. A new survey by the physician group says that a vast majority of commercial health insurance markets are dominated by one or two health insurers and that 99 percent of health insurance markets are highly concentrated, according to results published in … Read more

By MARK D. ABRUZZO, J.D. In Managed Care’s November 1999 issue, Al Lewis, president of the Disease Management Association of America, wrote about potential pitfalls facing DM. One identified by Lewis was state privacy laws, a topic that merits further attention. When the Health Insurance Portability and Accountability Act became law in 1996, it was … Read more

Twenty million young adults between ages 19 and 29 were uninsured at some time during the past year, according to a recent survey by the Commonwealth Fund. Eighty-eight percent of young adults think it is important that Congress and the president pass health reform legislation that would assure affordable insurance for all and improve health … Read more

Researchers at the Massachusetts Institute of Technology (MIT) and Brigham and Women’s Hospital in Boston have designed a new type of pill that, once swallowed, can attach to the lining of the gastrointestinal (GI) tract and slowly release its contents. The tablet is engineered so that one side adheres to tissue, while the other side … Read more

Should consumers have the right to appeal, externally, coverage decisions made by their health plans? Many on Capitol Hill thought so last summer — but not enough to ensure passage of legislation mandating such procedures. Then a funny thing happened in November: The Democrats gained five seats in the House — and now Clinton supporters, … Read more

The insurer’s tracking effort helps physicians keep tabs on patients who may not be taking their drugs correctly When PricewaterhouseCoopers released the study “Advancing Healthcare Informatics: The Power of Partnerships” in September, it included some case studies of health plans that seem to be doing a good job of using the technology. One was Geisinger … Read more

Although the number of prescriptions filled for many high-tech specialty drugs for multiple sclerosis, rheumatoid arthritis, and cancer is relatively low, the cost of these drugs is significant, ranging from as low as $6,000 to as much as $350,000 a year. That’s right, a year. In Medco’s Drug Trend Report 2004, we read that the … Read more

The American Society of Clinical Oncology’s annual meeting had a slightly different twist this year. Usually the meetings, the largest gatherings of cancer doctors in the world, focus on studies of the latest cancer treatment. This year’s meeting, held in Chicago in early June, certainly featured plenty of treatment studies but also put the importance … Read more

To be able to qualify for the procedure, kids must carry both duplicates of their F508 deletion — probably the most popular hereditary mutation related to CF — or possess a minumum of one mutation from the CFTR receptor which reacts to treatment using Symdeko. Symdeko, Called Symkevi at Europe, Has a Mix of tezacaftor … Read more

Costly biologics have plan sponsors looking at benefit designs PhD, RPh: Given the high costs of specialty drugs, sponsors of health plans (especially self-funded ones) are gathering information on costs, benefits, and outcomes to determine what kinds of coverage to offer. More like this Will mobile devices and apps have a downside? Where do new … Read more

The legal challenges are underway, and cost-effectiveness questions will dog these trendsetters at the beginning. The FDA’s approval of the first U.S. biosimilar last month was a watershed event, resolving many questions about how the federal government agency is going to handle the approval process for biosimilars. But Sandoz’s Zarxio and other biosimilars still to … Read more

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

HPV vaccination and testing may render the screening test for cervical cancer obsolete. For women of a certain age, the Pap test is a yearly ritual to endure but also a chance to visit with their gynecologist and talk about the other lumps, bumps, and indignities of womanhood. And as uncomfortable as the exam may … Read more

Cigna can be a American global health professional organization located in Bloomfield, Connecticut. Its own insurance subsidiaries are leading providers of health, health, disability, life and accident insurance and associated services and products, the vast majority that can be offered through companies and other classes (e.g. governmental and appellate associations, unions and institutions ). Cigna … Read more

FEATURE Too Much Health Care Can Be Hazardous to Your Health Payers may rejoice at learning that at long last, the general public is being warned about overtesting and overtreating This article is taken from a chapter in the new book Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by … Read more

Many insurers have not yet updated their coverage policies since the FDA cleared this scanning tool in November 2011 A summary of ECRI Institute’s Emerging Technology Evidence Report Managed care leaders are striving to make evidence-based decisions about new and emerging health technology. Managed Care and ECRI Institute have joined in a collaboration to bring … Read more

A recent survey shows internists getting paid more per relative value unit (RVU) than physicians in family practice. The Resource-Based Relative Value Scale (RBRVS) is the prevailing model used today to describe, quantify, and pay for physician services. Medicare, Medicaid, and many private insurance companies use the RBRVS, and many practices and institutions enlist RVUs … Read more

Thanks, in part, to new federal guidelines, this “invisible player” is starting to be noticed. Can NPs do more than fill niches? Why should HMO executives care? Why should you care about the efforts of nurse practitioners to find more recognition and the determination of some physicians (including the downright truculent stance of the American … Read more

Are clinical duties holding you back from a bigger paycheck? If you’re a group practice medical director, maybe so. A Tampa, Fla., executive group says group-practice medical directors who focus full time on policy issues pull down $30,000 more in a year than do medical directors who retain some clinical duties. Part of the reason … Read more

Proponents see it as the step beyond disease management. Why wait until a patient becomes part of a chronically ill group? 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 … Read more

After seven Decades of promising to Redesign and replace the ACA, Republicans have yet to coalesce around a strategy, and much more celebration members Are confronting the implications of yanking coverage from almost 20 million Americans. Thus, many Republicans in the Home and Senate are fearful of moving to roll Obamacare overly fast when little … Read more

In a major coup, Kaiser Permanente has obtained the endorsement of the AFL-CIO as the HMO of choice for its 13 million members. In return, Kaiser formed a partnership with the AFL-CIO that will give 50,000 Kaiser employees who are AFL-CIO members unprecedented say in how to improve patient care and their work environment. “This … Read more

April 2, 2019 Approximately 250,000 People in the U.S. Live with PI ADMA Biologics, Inc. has received FDA approval for Asceniv™, Immune Globulin Intravenous, Human–slra 10% Liquid, previously known as RI-002. The intravenous immune globulin product is for treatment of primary humoral immunodeficiency disease (PI) in adults and adolescents aged 12 to 17 years. Asceniv … Read more

Some physicians are putting new emphasis on careful, active listening to patients. Organizations that don’t encourage this may be ignoring a tool for controlling costs, retaining enrollment and improving medical care. Listen to the patient: He is telling you the diagnosis,” Sir William Osler counseled his fellow physicians at the dawn of the 20th century. … Read more

Legislatures want medical-benefit practices applied to oral drugs provided under the pharmacy benefit, all to keep patients’ costs within reach A little more than four years ago, Oregon became the first state to pass a law requiring insurers to cover oral cancer drugs with a “no less favorable” out-of-pocket expense formula than members faced for … Read more

Dr. Don Berwick Considers That the Aim is Essential to the success of Healthcare reform during the upcoming couple of decades. This means better look after people, better health for inhabitants and lower health expenses. “The basic flaw in American health care would be fragmentation,” stated “Are they really going to keep on increasing costs … Read more

MEDICATION MANAGEMENT Pharmacists Experiment With Pharmacogenomic Management PGX testing improves therapy oversight by predicting nonresponders and identifying patients at risk for adverse drug responses Thomas Reinke Pharmacogenomics currently plays a very limited role in optimizing medication therapy, but the FDA and industry experts are confident that advances in genetic testing will uncover new linkages between … Read more

A group of physicians calling itself the “Terbutaline Strategy Group” has petitioned the U.S. Food and Drug Administration to reverse itself, after the agency mailed a “Dear Colleague” letter warning practitioners about use of terbutaline sulfate for prevention of preterm labor. The doctors worry that the FDA action could remove one of their most effective–and … Read more

New Jersey’s Department of Banking and Insurance last month sued PHP Healthcare, charging that the medical management company placed HIP Health Plans of New Jersey in a “financially hazardous” situation. PHP, through its New Jersey subsidiary, Pinnacle Health Enterprises, last year signed a 20-year management contract with HIP. After discovering that HIP had a negative … Read more

The man who heads McKesson Health Solutions, the third largest disease management program in the country, says it’s time to roll out a new model Emad Rizk, MD, joined McKesson in the newly created position of president of McKesson Health Solutions in 2003. In this role, he heads McKesson’s health care payer business, including the … Read more

When it comes to health care administrations, there is a wide gap between what executives of hospitals and insurance companies believe it costs and what consumers believe. Executives say that administration associated with health care claims and billing accounts for nearly 1 of 3 dollars that patients spend on health care. In contrast, more than … Read more

Two of the country’s leading nonprofit HMOs, Kaiser Permanente Northwest and Group Health Cooperative of Puget Sound, will be working more closely together than ever before, with an actual merger among the possibilities, officials of the companies have announced. The boards of directors from both companies could reach a decision by November. The combined company … Read more

Tennessee Gov. Don Sundquist has proposed a radical overhaul of the state’s managed Medicaid program. TennCare was close to collapse after some participating health plans experienced financial problems or threatened to pull out. Sundquist’s plan would boost premiums and transfer some risk to the state. Until now, health plans have borne all risk, and they … Read more

Name Last modified Size Description Parent Directory 04-Jan-98 21:46 – MC9609.compmon.gif 16-Mar-97 22:51 25k MC9609.compmon.shtml 16-Mar-97 22:51 1k MC9609.contents.shtml 16-Mar-97 22:51 4k MC9609.editorsmemo.sh..16-Mar-97 22:51 3k MC9609.employer.shtml 16-Mar-97 22:51 8k MC9609.ethics.shtml 16-Mar-97 22:51 7k MC9609.frog.shtml 16-Mar-97 22:52 7k MC9609.guidelines_sup..16-Mar-97 22:52 18k MC9609.incentives.shtml13-Aug-97 22:07 21k MC9609.legal.shtml 16-Mar-97 22:52 4k ../../archiveMC/9609/MC9609.news.chart.gif 16-Mar-97 22:52 10k MC9609.news.shtml 16-Mar-97 22:52 8k … Read more

Compensation growth for specialists fell behind that of primary care physicians in 2004 for the first time in several years, according to the Medical Group Management Association. Specialists reported only a 0.2 percent increase in compensation overall, compared to a 20.6 percent increase in overall growth over the previous five years. Primary care physicians reported … Read more

With diagnosis accounting for 10 percent of medical costs, there’s a big opportunity to save. Did someone say ‘diagnosis benefit manager’? The recession and the focus of the Obama administration on health care mean that saving money and improving health care quality are now high on everyone’s “to do” list. Anything that both saves money … Read more

Despite pressure to cut state agency budgets, Georgia’s Medicaid program is expanding benefits and increasing payments to HMOs by 5 percent. Gov. Zell Miller has instructed all state agencies, including the Department of Medical Assistance, which oversees Medicaid, to trim spending by 5 percent for the fiscal 2000 budget that takes effect next July. Two … Read more

Insurers may not need to look any further than existing claims data to build useful payer-based health records. Neil Versel Ask hospital or medical practice executives why their organizations do not have electronic medical records and the most likely answer will be the high cost. A more detailed answer might be that health plans and … Read more

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. How much should I spend to collect old receivables?” a reader of our newsletter recently asked. “Isn’t hiring extra staff to follow up on these accounts … Read more

This past March, health care providers, health plans, and other organizations subject to HIPAA regulations were given some breathing space in their race to meet the Oct. 16, 2002, deadline for compliance with the HIPAA electronic transactions rule. The Centers for Medicare and Medicaid Services (CMS) — the agency within the Department of Health and … Read more

Harvard Pilgrim Health Care has striven methodically to become superior in cardiac care. Its numbers tell the story. By Lola Butcher Contributing Editor The statistics for cardiovascular disease and stroke can seem overwhelming: 1 in 3 American adults has at least one type of cardiovascular disease; more than 1.2 million will have a heart attack … Read more

Drug-resistant organisms, or Even so”Super Bugs,” are an Increasing Public health hazard because”lastresort” therapeutics-employed just when other drugs don’t kill an infection-are a failure. A University of Georgia-led researcher could be the first ever to test numerous breeds of a few of their very reckless super-bugs proven to science and also a lastresort antibiotic used … Read more

New IT systems promise to reduce medical-loss ratios, improve the health status of populations, and transform relations with members. Outsourcing IT functions places the personnel burden and responsibility for regulatory compliance on the contractor. These are interesting times for information technology (IT) departments in MCOs. Many IT departments have faced severe budget pressures over the … Read more

The brand new product is really a fixed-dose combination pill comprising sofosbuvir, a medication approved in 2013, also velpatasvir, a brand new medication, also is the very first to ever take care of all six big kinds of hepatitis C virus.” There are six different hepatitis C virus Genotypes–distinct sets of this herpes virus. Knowing … Read more

The average copayment for preferred brands has cracked the $14 mark, while third-tier copayments average near $30. Four of every five health plans offer a three-tier benefit. SOURCE: SPRING 2000 MANAGED CARE FORMULARY DRUG AUDIT, SCOTT-LEVIN, NEWTOWN, PA.

By Marsha Bertrand We all know we’ll eventually face death, but most of us never consider the possibility of becoming disabled. Statistics show, however, that the probability of long-term disability during a person’s working years is double the probability of death during the same period. Of those who are disabled, one in three will be … Read more

The 37-year-old has a title: executive vice president of Optum. But she wears many hats, including running a division that sells affordable hearing aids. You’d never guess that Lisa Tseng, MD, (pronounced “Zeng”) is an only child. Tseng was born in Taiwan and grew up in Los Angeles, but she never wanted for company. “I … Read more

WASHINGTON INITIATIVES The maternity stay rules will be out “any day now,” says HCFA. They await clearance by the Office of Management and Budget. HCFA promulgated the rules under the Mothers’ and Newborns’ Health Protection Act, which took effect this year. The law requires group health insurance plans that offer maternity benefits to allow 48-hour … Read more

A second multistate drug-purchasing effort is forming, this time in the Southeast. Led by West Virginia Gov. Bob Wise, the group-buying effort includes Alabama, Georgia, and the Carolinas. Washington State is also participating in the talks, which have thus far consisted of two meetings, most recently on April 30. The states are interested in pooling … Read more

Treatment is noninferior to Stribild   February 16, 2017 FacebookTwitterLinkedInEmailTeilen Positive 144-week data have been reported from two phase 3 studies of Genvoya (elvitegravir 150 mg, cobicistat 150 mg, emtricitabine 200 mg, and tenofovir alafenamide 10 mg, Gilead Sciences) for the treatment of human immunodeficiency virus-1 (HIV-1) infection in treatment-naïve adults. Through week 144, Genvoya … Read more

Mary Hennings remembers the good old days, when working for an HMO meant you were with the white hats, the folks who were curbing all the greedy excesses of modern medicine, paying for regular checkups, and really trying to keep people healthy. But when Hennings, associate director for administration at Harvard University Health Services, went … Read more

Hawaii, Nevada and Oregon Left plans to Use Their Own Independent market places and rather depended upon the national market place, Healthcare.gov. The encounter Therefore rattled says that seven Decades after, just 11 of The remainder use the national market place or perhaps a federal-state venture. Oregon and Pennsylvania–are still creating their very own market … Read more

Steve Miller, MD, now at Cigna, and Alan Adler, MD, recently retired from Independence Blue Cross in Philadelphia, reflect on their roles as medical directors and the current state of American health care. Steve Miller, MD, has hit the medical director trifecta. He’s held the post at a hospital, a PBM, and now an insurance … Read more

MANAGED CARE February 2000. ©2000 MediMedia USA Any way you cut the numbers, capitation is the most prevalent form of payment by Medicare HMOs for both primary care physicians and specialists. Almost 8 in 10 primary care physicians who contract with Medicare HMOs receive at least some compensation via capitation; as for HMOs, 85 percent pay primary … Read more

Five years ago, Managed Care published my first ethics column, and became the first medical publication to recognize that medical ethics was a needed, missing part of managed medical care. Dozens of conferences, hundreds of articles, and millions of hallway discussions later, managed care ethics is part of daily medical life. Has ethics made a … Read more

Has the gatekeeper system forced primary care physicians to treat patients with illnesses that are complex beyond their expertise? A quarter of primary care doctors worry about the care some of their sickest patients receive because, they say, in some cases it might be better delivered by a specialist. In the New England Journal of … Read more

The expense associated with drug misuse is getting a close look from health plans, which are fighting cost battles on two fronts: a double-digit rise in pharmacy expenses and an upturn in medical costs, which have accelerated as utilization reductions have become difficult to sustain. Plans are leaning more on consultant pharmacy and technology for … Read more

MANAGED CARE September 1999. ©1999 MediMedia USA Physicians providing most services in an office setting will benefit from the Health Care Financing Administration’s fee schedule for next year. Office-based physicians will receive slightly higher fees, up to a 1-percent increase, while most hospital-based doctors will see fee reductions of up to 1 percent. The changes are based … Read more

As health care grows as a share of business costs, enlightened execs are urging plans to work with them in keeping employees at their posts and performing at 100 percent. Overseeing the employee benefits department as a financial executive in a previous job taught Frank Gatti a lot about health care. That knowledge is serving … Read more

COVER STORY Should Uncle Sam Insure Us All? Don’t let silence on Capitol Hill fool you: Thanks to the ever-growing number of uninsured Americans, even during a boom, single payer is not a dead issue. Even physicians are curious. Why Physicians Will Embrace Technology Informaticist Ross D. Martin, M.D., says HMOs can improve outcomes and … Read more

Rates of use for three advanced imaging modalities — magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) scans — increased rapidly between 2000 and 2004. Jean M. Mitchell, PhD, professor of public policy at Georgetown University, examined claims data for physician and outpatient services for people with health insurance coverage from … Read more

CMS proposed new protections for Medicare beneficiaries in Medicare Advantage and prescription drug plans by providing more regulation on door-to-door marketing and cold-calling, as well as new proposed requirements pertaining to broker/agent commissions. The proposal goes beyond what the health care insurance industry recently endorsed as necessary regulatory changes to the program for development. “This … Read more

In my Saturday morning Torah study, we focused on Jacob’s “settling in” with his family. After years of struggle, Jacob becomes complacent, comfortable. We discussed whether Jacob’s complacency — his relative inaction — contributed to the animosity that led Joseph’s brothers to sell him into slavery and to report to their father that his then … Read more

Democrats are running on Medicare for All—or extending the seniors’ program to the merely middle-aged—or resurrecting a ‘public option’. Republicans say Medicare expansion would mean government intrusion and inefficiency. But politics aside, how would these Medicare expansions work? Sometimes it matters politically. Other times it doesn’t. But in this intensely partisan season, health care—and more … Read more

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

How Capitation Turned Red Ink to Black at Harris Methodist Health Systems It would be wrong to say that capitation has become the obligatory payment system under managed care, but it is used by many plans. Through their contracting organizations, however, physicians can translate capitation into other forms of payment. Here’s how three organizations faced … Read more

Formulary managers need to make head-to-head comparisons of dabigatran and other anticoagulants used to treat atrial fibrillation Sometimes it can be hard for a new medication to become established when its competition is a drug with an illustrious history. Warfarin, the stalwart clot fighter, began life as rat poison, causing fatal bleeding. Its safety in … Read more

For many affected by vitreous degradation, surgery was the only treatment until the development of ocriplasmin Thomas Morrow, MD Unless you have been involved in ophthalmology specifically, you have probably never heard of a sight-threatening condition called vitreomacular adhesion (VMA). There is limited epidemiologic data about this progressive, commonly asymptomatic disease, and the precise incidence … Read more

Though the common perception is “consumer advocate,” an ombudsman can help doctors and health plans get to the bottom of members’ problems. When managed care enrollees have administrative or coverage problems, health plans offer various forms of help, depending on the plan – and the member’s persistence. But there’s another option, one that often involves … Read more

Autonomy, Innovation, and medication access could possibly be in stake combined with personalized medicine. Could all stakeholders be fulfilled and may cost be a variable?  The Intent behind relative efficacy research would be to give advice which helps clinicians and patients pick the very most effective medical care option. Cost is never to be taken … Read more

The word, enteral, describes nourishment administered via the Gastrointestinal tract. It could be administered orally or via tubing feeding. Oral supplements are nutrition support Solutions Offering an effective and noninvasive method for people to fulfill their nutrition needs or boost their nutritional intake. People who take ONS could also be able to eat regular food … Read more

Health Plans Can Learn From VHA Turnaround While plans, hospitals, and physician groups talk the talk, the Veterans Health Administration is walking the walk Maureen Glabman How Much Trouble Does Health Care Marketing Cause? Whether for drugs, imaging, surgery, or emergency services, direct-to-consumer advertising sparks lively debate MargaretAnn Cross Why Market Competition Will Not Mend … Read more

Michael S. Victoroff, M.D. “Welcome, Herr Beethoven. As the human resources director of the Vienna Orchestra, I have been honored to meet many talented applicants for the position of apprentice composer. Your aptitude tests show you to be one of the most gifted young people we have seen in many seasons.” “Thank you, Maestro.” “Your … Read more

Quite a few predictions have predicted shortages of healthcare providers, especially in light of the expected growth inpatient requirement caused by this Affordable Care Act. Yet these predictions might possibly be erroneous since they often don’t enable changes in the way in which primary care is given. We examined the effect of just two emerging … Read more

By Patrick Mullen Editor Signs abound that the National Committee for Quality Assurance is emerging as a more public player in the ongoing effort to define and measure quality in managed care. Fans of baseball’s Detroit Tigers recently heard Health Alliance Plan of Detroit, a half-million-member HMO that is part of the Henry Ford Health … Read more

The Medintranet is constantly being improved. The developers continue to make the system more user friendly and efficient. Currently, it offers the ability for physicians and other medical professionals to share their personal notes via the web site. This is very beneficial, since everyone has different ideas on how to write their notes. You will … Read more

Aetna U.S. Healthcare promises a vigorous appeal of a California jury’s record $120 million award to the widow of a man who sought coverage of experimental treatment for a rare stomach cancer. While calling David Goodrich’s death a tragedy, Aetna denied the implication that its actions shortened his life; Aetna says the progression of his … Read more

Employers see a way to reduce lost productivity   A growing number of employers are providing insurance coverage for telemedicine services that enable employees to connect with a doctor by phone using both voice and video. One limitation of these phone-based services, however, is that physicians can’t always obtain basic vital signs, such as blood … Read more

Main OA is OA with out a transparent cause. Secondary osteoarthritis has certain aetiology, for example endocrine system disease, bodily structure abnormality, including arthritis and rheumatoid arthritis. OA is seen as a decrease in articular chondrocytes and degradation of matrix. Clinically OA patients suffer with gradually growing pain, joint stiffness, and joint swelling, and decreased … Read more

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

Very different processes. Genetics denotes the enzymes that a man or woman has been born with which can be inherited from previous generations. Genetic tests can help determine if someone has inherited gene mutations which might raise the possibility of cancer. Genomics describes the molecular makeup of a cyst. Advanced level genomic testing might help … Read more

Consultants predicted it would be a major business. Large employers and insurers were experimenting with it. But medical tourism has not lived up to the heady expectations. The ACA and moderation of increases in health care costs cooled off interest. Besides, who really wants to go to an unfamiliar place for health care? Denver businessman … Read more

Health plans hope to rein in utilization by raising pharmacy copayments. Whether the scheme works or backfires depends on how it’s implemented. Main story Sidebar: The intricate relationship between costs and compliance Chart: Pharmacy cost and utilization trends Chart: Comparing spending for direct-to-consumer advertising with pharmaceutical utilization trends Chart: Medication compliance rates for selected illnesses few items from the … Read more

John Marcille I’m really excited about this issue. Major change is afoot in the managed care industry, and we are writing history’s first draft. Take our cover story. For many years we’ve been reporting on pay-for-performance programs, and I always felt that, as well-intentioned as proponents of these efforts were, something was amiss. Does it … Read more

The Federal Employees Health Benefits program has been touted as the way managed care is supposed to look. Expanding it, however, may not be feasible. Frank Diamond Senior Editor The Federal Employees Health Benefits program has so often been held up as an example of how the managed care industry should operate, that praising the … Read more

In a few weeks, the calendar will tick over and, if we’ve solved our Y2K problems, we’ll be seeing a calendar year none of whose digits will be the same as this year. It will look new (even though we know it’s really the last year of the second millennium) and may invigorate us. A … Read more

Pharmacy & Therapeutics Society works with Institute of Medicine and Leapfrog Group to improve processes. Jack McCain Contributing Editor The original mission of pharmacy and therapeutics committees may have been to select drugs for formularies of health care institutions or health plans, but members of P&T committees also are strongly positioned to expand their central … Read more

Of those earliest in a collection of Mental Health Parity assessments on health insurance in Delaware. Tests performed by the Delaware Department of Insurance found 1000s of mental health parity offenses, leading at $597,000 in penalties up to now. The tests are ongoing and comprise every one of those four big insurers. The section works … Read more

California sets a precedent again, with a bold effort to regulate the HMO industry. While the new Department of Managed Health Care is facing down 50,000 consumer gripes monthly, director Daniel Zingale intends to keep administrative red tape from overwhelming plans, patients, providers, and his department. Sniping at HMOs seems to be a national pastime, … Read more

More than half of 31 HMOs in New York state failed to properly respond to telephone requests for information they are legally required to provide, according to Attorney General Dennis Vacco. The state’s Managed Care Consumer Bill of Rights, enacted last year, includes a requirement that plans provide subscriber contracts and member handbooks upon request. … Read more

Pharmaceutical makers invest enormous sums in R&D – but they also reap enormous profits. States are impatient with the appearance that creates. Bob Carlson Contributing Editor MANAGED CARE July 2001. ©MediMedia USA Pharmaceutical makers invest enormous sums in R&D – but they also reap enormous profits. States are impatient with the appearance that creates. Bob Carlson Contributing … Read more

Despite the strong economy, Medicaid enrollment may be slowly rising after a three-year decline. The challenges for serving this population are huge. When you think of Medicaid and member enrollments, does the word “rising” come to mind? Probably not. Medicaid enrollment has been steadily declining for three years. However, a new study by the Kaiser … Read more

Widely heralded as tomorrow’s nearly universal method of paying doctors because of its potential for limiting costs, capitation now accounts for some reimbursement of nearly half of all primary care physicians, according to a recent report. But it lags behind with specialty physicians, with whom fee-for-service payment remains predominant.

For the control and treatment of bleeding episodes occurring in adults and teenagers 12 decades old and elderly with hemophilia A or B with inhibitors. Sevenfact comprises an ingredient extracted in fleas that are genetically engineered. People who have hemophilia can bleed for a long period than many others after trauma or operation. They might … Read more

This key clinician executive has a lot of responsibility as CMS gets set to distribute 2015’s bonus payments Nan Myers Linkedin Share ButtonTweet WidgetShare on FacebookGoogle Plus One The difference one star can make in the Five Star Quality Rating System for Medicare Advantage Plans could come to millions of dollars in bonuses for a … Read more

As the medical home concept grows, many in health care will have to define new roles MANAGED CARE September 2011. ©MediMedia USA As the medical home concept grows, many in health care will have to define new roles Add diverse experience as a clinician, health plan executive, and consultant to his current role as vice president and … Read more

The Study covers the Accounts September, October and November. Those months watched Bayer report much more critical traumas but fewer deaths compared to in the former quarter, even though events covered at the monthly spread sheets originate from older societal networking articles. There’s not much connection between every time a written report is processed so … Read more

Whether it marked decisive support for managed care or a simple reluctance to authorize abrupt change, voters in California and Oregon turned down several ballot initiatives Nov. 5 that would have placed crippling restrictions on managed care plans. California residents resoundingly rejected two highly publicized initiatives that called for the imposition of extensive regulations and … Read more

With the big physician practice management companies retrenching from stock crashes, and as hospitals nurse debts from unprofitable physician practice acquisitions, the volume of practice sales is slowing. But PPMs and hospitals that are still buying practices are learning from past mistakes. According to the Center for Healthcare Industry Performance Studies, buyers are now more … Read more

John Marcille Political parties gain and lose power, but one chronic reality remains: Nobody has yet figured out what to do about ever-increasing health care costs. This may be a theoretical conundrum for some, but clinical executives are expected to come up with answers, or at least approaches. Our cover story focuses on how employers want … Read more

Type Title Name Story 5 Threats To Value-Based Insurance Design webadmin Story Just What the Devil Is Population-Based Care? webadmin Story Accountable Care Organizations Give Capitation Surprise Encore webadmin Story Consumer-Directed Health Care: Too Good To Be True? webadmin Story Alzheimer’s Drug Pipeline Is Robust, and Usage Is Quickly Expanding webadmin Story Reviewing the Evidence … Read more

Former Speaker of the House Newt Gingrich is the founder of the Center for Health Transformation (www.healthtransformation.net) and the author of Saving Lives & Saving Money. The dominant model of the 21st century will be more choices with better quality at lower cost. This is already true in nearly every segment of the market and … Read more

We Want your help to protect patients out of Fresh anti-patient The regulations enables insurance providers to pocket our co-pay assistance, maybe not rely towards our annual allowance. Combine patients from throughout the united states by do it. Guideline set up which makes it possible for carriers and pharmacy benefit managers to buy paid TWICE … Read more

It’s one of the few areas where plans can economize effectively. BlueCross & BlueShield of North Carolina is one of many insurers that are changing members’ and prescribers’ behavior. Last year, BlueCross & BlueShield of North Carolina tailored a new offer of generic drugs that was designed to break a critical — and costly — … Read more

MANAGED CARE June 2006. ©MediMedia USA Patient advocacy groups work overtime to kill legislation that businesses felt would have provided less costly coverage for their employees John Carroll In the end, some of the most influential public support for opposition to a Senate bill backing low-cost association health insurance was drummed up by a red push-up bra. … Read more

EDITORS’ MEMO From the Staff of Managed Care Trade publishing is isolationist in nature. Here at Managed Care, we intently watch the worlds of health, business, insurance, and public policy in our constant endeavor to bring you news, information, and analysis that you can use in your work life. The “great beyond” is brought to … Read more

Liraglutide, used to lower HbA1c levels, can also aid with weight reduction. Should health plans cover it for this use? The Food and Drug Administration’s Endocrinologic and Metabolic Drugs Advisory Committee has recommended approval of an existing antidiabetic agent for use also as a weight-loss drug. While other antidiabetics can knock off a few pounds … Read more

Tafasitamab (MOR208) is a Investigational monoclonal antibody directed against the antigen CD19 that’s widely expressed in the face of B cells. It’s thus thought of as a possible target for the treatment of B cell malignancies, such as for instance non-Hodgkin’s lymphoma (NHL), including diffuse large B cell lymphoma, in addition to chronic lymphocytic leukemia. … Read more

The USPSTF concludes with moderate certainty which viewing for MDD in adolescents aged 12 to 18 years comes with a moderate online benefit. The USPSTF concludes that evidence on screening for MDD in children aged 11 decades or younger is not sufficient. Lescents aged 18 decades or younger who don’t own a diagnosis of MDD. … Read more

Anthem Blue Cross & Blue Shield of Indiana focuses on improving communications between minorities and their physicians By Frank Diamond This is how a doctor’s visit should go. A patient goes into the exam room and, according to Grace Ting, director of health equity and cultural and linguistic programs at Anthem Blue Cross & Blue … Read more

We pay docs more — sometimes very much more — than other countries do Primary care physicians (PCPs) in the United States earn the highest incomes — higher than in five other developed countries, reports a new study in Health Affairs. But that scale is relative, given the costliness of the overall U.S. health care … Read more

PBMs that educate physicians on the safety and efficacy of generic drugs or provide them with generic drug samples to increase the use of generics get higher satisfaction ratings than those that don’t. Employers that perceive that their PBM’s goals are aligned with their goals gave PBMs an average rating of 8 (on a 10-point … Read more

International Financial Reporting Standards require things to mainly existing consolidated financial statements. After the Relationship of control is closely identified, the invest or consolidates all regulated stuff and poses financial statements for that whole set as though it had been one monetary unit. Since the practice of organizing and issuance of consolidated financial statements occupies … Read more

Not every patient who is significantly harmed through an adverse event or negligence resorts to a lawsuit. Surprisingly few do. One Harvard University study found that 1 percent of hospitalized patients were harmed, but not even 3 percent of them filed a malpractice claim. Not every suit can be avoided, but understanding the role of … Read more

Per the Balanced Budget Act and Medicare, expect changes in payment rates for Medicare HMOs beginning in a couple of years. The budget legislation mandated that the Health Care Financing Administration implement a risk-adjusted payment system for all Medicare+Choice plans. HCFA says it will be ready with the new risk-based payment methodology by 1999 that … Read more

Electronic prescribing needs standardization before it’s adopted by the masses. Start with the format of formulary databases. Tony Schueth Getting four competitors in a room to agree on a set of standards for a formulary database is no easy task, but that’s exactly what the National Committee on Vital and Health Statistics, the public advisory … Read more

Doravirine is just a publication non-nucleoside reverse transcriptase inhibitor suggested for your combo treatment of human immunodeficiency virus Type1 disease ) The suggested dose is 100 mg daily. This review outlines the pharmacokinetics of both doravirine, the effect of inherent things, and its own medication –drug interaction profile. Steady-state geometric means of AUC0–24, C24, also … Read more

Charts While mergers and acquisitions in health care slowed last year, such activity in 1998 was still brisk — it was the second-most-volatile year of the decade. Significant increases occurred in the number of dental and medical-specialty practices and institutional pharmacies that traded hands. HMOs are merging steadily, largely because of the industry’s realization that … Read more

The Swiss medication and diagnostics giant Roche has decided to buy the gene therapy company Spark Therapeutics for $4.8 billion, significantly more than twice Spark’s stock exchange value of roughly $2 billion until the sale was announced. The top price indicates Roche’s decision to combine with the growing gene therapy field, also if profits from … Read more

Swiss drug maker Novartis AG on Wednesday said it knew concerning disagreements in statistics it submitted to labs since it sought endorsement of its $2 million receptor therapy Zolgensma, however postponed advising government before it completed an internal evaluation. The FDA said that the company was conscious of these issues for up to two weeks … Read more

Year:  2011  |  2010  |  2009  |  2008  |  2007  |  2006  |  2005  |  2004  |  2003  |  2002  | 2011 January Cover Story UnitedHealthcare’s Bold Effort to Deal with Cancer Drug Costs ACOs Will Depend on HIEs, With an Assist From Plans Vision Plans Hope to Gain Access To State Insurance Exchanges Can Self-Management Programs Ease Chronic Conditions? Managing Fibromyalgia: Supporting self-management brings … Read more

Dangling Dollars Health plans are using financial incentives to encourage members to pick lower-cost providers. Some worry that cutting checks will crowd out quality. Joseph Burns New Era of Health Care Spending Could Roll Into the Good Times The slowdown in increases often happens during and shortly after recessions, but this time the trend may … Read more

Deny the increasing importance of the Internet at your peril, says the noted health care futurist. Faster connections, smarter applications are needed. For nearly two decades, health futurist, author and lecturer Jeff Goldsmith has specialized in forecasting trends in medical technology, payment, and health policy. Goldsmith is president of Health Futures in Charlottesville, Va., and … Read more

In a new study published in the New England Journal of Medicine, empagliflozin (Jardiance, Eli Lilly) reduced the risk for new-onset or worsening kidney disease by 39% compared with placebo when added to standard of care in adults with type-2 diabetes (T2D) with established cardiovascular (CV) disease. These findings were part of the landmark EMPA-REG OUTCOME … Read more

Employers want to do everything within the law to make workers change their lifestyles, and they expect health plans to help Wellness It must have seemed like a pretty good idea at the time. Tribune, owner of newspapers and other media outlets, launched a program this year in which employees and any of their dependents … Read more

Physicians know that grades are coming–for number of patients seen, length of hospital stay, formulary compliance and patient satisfaction. But it is not only managed care plans, patients, physician groups and state agencies that grade physicians. It is also the marketplace. In an especially perverse market twist, Massachusetts has now made public its physicians’ malpractice … Read more

People without health insurance will go where they will to get treated. That’s one of the findings of a study on complementary and alternative medicine (CAM) released by the Center for Studying Health System Change. “High Cost of Medical Care Prompts Consumers To Seek Alternatives” uses data from the National Health Interview Survey that show … Read more

Diabetes can be a set of conditions characterised by elevated blood sugar or glucose levels which lead to flaws in your overall body’s power to develop or utilize glucose levels. 4: Insulin is a hormone which enables the glucose get into your human body’s cells to offer energy. Using Type 1 ) diabetes, the human … Read more

Creating a customer base that’s aware of the link between cost and services has become the next big challenge in managed care. It’s a daunting task. Educating consumers to the point where their wise choices rescue a health system whose costs have spiraled beyond managed care’s control is a neat concept. Give employees the money … Read more

Widespread adoption of this technology is inevitable, yet physicians still resist. Various coalitions and initiatives are trying to make adoption easier. Health plans and pharmacy benefit management companies are moving as quickly as possible into the brave new world of electronic prescribing, pushed hard by employers and the federal government. Pharmacists are moving even faster, … Read more

iGlarLixi offers a viable and very much endured treatment choice for patients with type 2 diabetes requiring extra glycemic control, with equivalent or improved security results than its different parts. Due to its straightforward routine and low pace of antagonistic impacts, iGlarLixi may improve adherence and, thusly, helpful results. Accomplishing and keeping up glycemic control … Read more

Genetic advances could spawn incredible improvements in health care. Given public demand, they also pose what may be unmanageable issues of resource use. At the dawn of the 21st century, we stand on the cusp of the fourth great age of healing: genetic medicine. There are striking similarities between this and the other three. Genomics … Read more

Though health plans preach it, the phrase doesn’t resonate with many physicians. But practicing it is not as difficult as many fear. Michael D. Dalzell Senior Editor Population-based care” is the managed care mantra. But ask physicians what it means, and most grope for a definition. “If you find out, let me know,” jokes Peter … Read more

By Anthony L. DeWitt, J.D. The AMA apparently believes that physicians have little bargaining power, and has drafted a model managed care medical services agreement to redress this situation. The AMA describes some contracts drafted by health plans as “contracts of adhesion,” binding physicians to terms that are almost too onerous to bear. In explaining … Read more

Pfizer Is working to grab marketshare together with Inflectra, the very first biosimilar into Johnson & Johnson’s blockbuster immunology med Remicade, however today the provider has an additional copy-cat boasting an FDA approval. But now that the new med, Ixifi gets got the FDA’s financing , The drug maker has been”evaluating our tactical possibilities with … Read more

Thanks to lower-than-anticipated spending for Medicare, national health expenses will grow more slowly in the coming decade than previously thought. Still, the nation’s health care bill is expected to double to nearly $2.2 trillion by 2008.$2.2 trillion by 2008. The Health Care Financing Administration predicts that Medicare spending will rise only 4.5 percent from 1997 … Read more

The camera never lies, goes the adage. A growing number of physicians and health care providers are using that bit of wisdom to cut costs while making patients’ lives better. BRUCE GOLDFARB Two-way video communication has been a science fiction staple for generations. As this technology evolves from the incredible to the practical, telemedicine is … Read more

The president of the American Medical Association ponders her organization’s influence on the evolving health care industry and such hot-button issues as doctors’ unions and the Patient Bill of Rights. When the American Medical Association selected Nancy W. Dickey, M.D., to be its president in June, it marked a dramatic departure from the Marcus Welby-like … Read more

Introducing electronic prescribing systems and coupling them to formulary decision support (FDS) systems allows clinicians to prescribe preferred medications more frequently, according to a study involving two large Massachusetts insurers. Researchers at Brigham & Women’s Hospital found that those who used e-prescribing showed a 3.3 percent increase in prescribing tier 1 (generic) medications. The researchers … Read more

Hospital readmissions can adversely impact patient and cost outcomes. Predictors of all 30day Re Admissions are primarily diagnosed with medical claims statistics. Listed below are results of someone questionnaire developed as a portion of frequent hospital quality assurance routines. Twothirds of patients reported good release experiences but were readmitted. Onethird of patients discharged had a … Read more

John Garamendi, California’s insurance commissioner, thinks some insurers have the potential to gouge the consumer, and wants to mandate a high medical loss ratio John Carroll John Garamendi has long been a thorn in the side of the managed care industry in California. The state insurance commissioner has not only wrested multimillion-dollar agreements for free … Read more

Formal disease management is one of the more vibrant areas of health care, with drug manufacturers, health plans and independent companies all greatly interested. Here’s a plan for putting such a program together. As the health care delivery market struggles to reform itself, size and efficiency become important issues for providers of care. Engaged in … Read more

Pharmaceutical companies still hold important cards when it comes to negotiating prices, but that may change with new ways of measuring value. CMS, large employers, policymakers, and health plans are determined to move from a volume-based delivery system to one based on value. The focus of this transformation largely has been new payment mechanisms that … Read more

A major insurer’s proposed innovation in Florida — a system in which capitation would have been shared by a group of specialty networks — has been withdrawn after what the HMO says is a lot of misunderstanding. “Put up or shut up.” That’s the message Tampa specialist physicians got not long ago from the area’s … Read more

Health plans and employers are convinced that improving quality will save money. This time, they think they’ve got the data. Lola Butcher Two years after launching an ambitious effort designed to transform the health care marketplace, some of the nation’s biggest employers are focused like a laser beam on a big number. They assembling a … Read more

It seems that everyone is jumping on this bandwagon, with physician specialists even participating. Will the big PBMs come to dominate this market too? As the population ages, specialty pharmacy is becoming a unique, profitable, and invaluable delivery system. Plans are increasingly turning to specialty pharmacies to provide the expertise they lack. “Specialty pharmacy is … Read more

John Marcille Fallout from the Medicare Modernization Act promises to rain down for years to come. Among many other things, the MMA created the Citizens’ Health Care Working Group to encourage Americans “to engage in an informed national public debate to make choices about the services they want covered, what health care coverage they want, … Read more

MCOs should consider adding pharmacist-managed anticoagulation clinics to the benefits of their members because both patients and physicians show a high level of satisfaction. Authors Algha D. Lodwick, R. Ph., is an anticoagulation pharmacist at St. Mary-Corwin Medical Center, Pueblo, Colo. Terrie A. Sajbel, Pharm.D., is a clinical pharmacist at Colorado Mental Health Institute at … Read more

Help-wanted : 911 Dispatcher. Applicants have to be readily irritated by 911 callers; telephone communication and swearing an advantage. Preference will be given to applicants in a position to whine in their workload whilst receiving calls. Punctuality and decent attendance aren’t mandatory, however working overtime is indispensable. The successful candidate should be expecting to get … Read more

DAY BY DAY, PHYSICIAN STRIKES BECOME LESS ‘UNTHINKABLE’ The president of the Union of American Physicians and Dentists pulls no punches in describing the conflict between physicians and insurers. After launching the Union of American Physicians and Dentists in 1972, founder Sanford Marcus, M.D., met with George Meany, president of the AFL-CIO, seeking an affiliation. … Read more

With Congress debating renewal of the Mental Health Parity Act, it can be argued that Sept. 11 added urgency to expanding access to behavioral services. Madeleine A. Estabrook Sidebar: Counseling in the aftermath of terror As a nation, we are dealing with enormous emotional trauma from the events of Sept. 11, 2001, and anxiety over what … Read more

Not long ago, managed care plans sought to reduce the rate of C-section births in the U.S. Now, C-sections are going up — and plans are going along. If you wake up to ABC’s Good Morning America, you may remember a recent story featuring UCLA urologist Jennifer Berman, MD, a frequent contributor on the “Healthy … Read more

Policy experts see the Canadian system as an example but differ on the significance. Meanwhile, some U.S. providers are cashing in. Marlene Piturro, PhD, MBA Interesting things happen to two adjacent countries with dissimilar health care funding and delivery mechanisms: Differences in access and cost of care create individual and institutional anomalies. A case in … Read more

Name Last modified Size Description Parent Directory 01-Mar-2005 11:31 – ../../../archives/0004/0004.compmon.gif 01-Apr-2000 12:00 46k 0004.compmon.html 09-Apr-2003 23:31 2k ../../../archives/0004/0004.compmon.pdf 01-Apr-2000 12:00 31k 0004.contents.html 09-Apr-2003 23:31 4k ../../../archives/0004/0004.cover.jpg 01-Apr-2000 12:00 10k 0004.daimler.html 09-Jun-2003 11:44 11k 0004.diamler.html 09-Jun-2003 11:44 12k 0004.editorsmemo.html 09-Apr-2003 23:31 3k 0004.ethics.html 09-Apr-2003 23:31 8k 0004.finger.html 09-Jun-2003 11:44 14k 0004.ipas.html 09-Jun-2003 11:44 24k 0004.legal.html … Read more

In Recent decades, there’s been a greater focus on placing patients in the middle of medical care research and evaluating medical attention so as to better their experience and make sure that research is both powerful and of utmost importance for its usage of medicinal products and solutions, therapy, or health products and services. This … Read more

Strategic pricing doesn’t have to be a race to the bottom. Before I explain why, let me share a little context. CMS’s recent requirement to post charges online has increased the need for hospitals and health systems to have a comprehensive pricing strategy. Many health systems I work with often think being more transparent—either through … Read more

It’s a Jungle Out There: The New Health Insurance Ecosystem 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. Jan Greene AHIP Ship Sails Rough Seas The trade association has … Read more

As if the worsening diabetes epidemic were not enough to worry about, this chronic condition also increases risk for complications like heart disease, stroke, and kidney failure. This is a major challenge for health plans managing the care of a growing population of Medicaid members, who tend to overutilize emergency rooms for routine or non-urgent … Read more

The Senate approved a bill that requires federal-employee health plans to cover prescription contraceptives. The introduction of the arousal drug Viagra — and its subsequent (but often limited) coverage by many health plans — spurred women’s groups to press Congress to pass legislation mandating reimbursement for contraceptives. The Senate passed the measure 91–5, and the … 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

The Trump administration’s plan to place more power in states’ hands regarding what needs to be covered and what doesn’t falls as a blessing for some, a curse for others. The ACA says that plans sold to individuals and small businesses must cover 10 essential benefits: • ambulatory patient services • emergency services • hospitalization … Read more

The pros and cons of each weigh heavily, but ultimately, a melding may benefit patients and primary care physicians According to the Disease Management Association of America, disease management “is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant.” There are six components: Population … Read more

Would you pay $25 a month for direct primary care that provides for convenient office hours and appointments and any medical services a physician can provide in the office? “There are a lot of people who don’t make much money and who pay twice that amount for their cell phone,” says John W. Saultz, MD, … Read more

Under health reform, consumers will be the new buyers in public and private exchanges, meaning care management programs will need a sharper focus on return on investment Joseph Burns Contributing Editor Success in any retail business comes from offering buyers what they want. Given that insurers will be selling to new retail buyers in the … Read more

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

Michael D. Dalzell NEWS AND COMMENTARY The practice of caring for behavioral health patients in non-inpatient programs continues to grow, but a new study shows patients treated on that basis are getting dramatically less time with therapists.The 1997 annual survey of the National Association of Psychiatric Health Systems, which represents mental health and drug abuse … Read more

A majority of patients in consumer-directed health plans do not understand their coverage options and about 20 percent will skip preventive care because of cost, even though the services are free or very inexpensive. Those are some of the findings in a study by Kaiser Permanente Northern California, which found that “consumers rarely understood that … Read more

In the era of the $10,000-a-month drug, clinical pathways are the best hope for reining in costs and getting patients the care they need, says the vice president for clinical strategies at Anthem. Why did you choose cancer as a specialty? Was there a personal connection? It was a combination of factors. I decided to become … Read more

Genetically engineered adenovirus doubles survival rate in subjects with end-stage disease A genetically engineered adenovirus vaccine designed to treat patients with colon cancer has more than doubled the survival rate, with little or no toxicity, in subjects with end-stage disease, with some subjects still alive more than five years after receiving only the vaccine. The … Read more

The Stark II regulations hang over physician practice activity like the proverbial Sword of Damocles, ready to drop onto ignorant or careless physicians who work with, or refer services to, certain providers. These days, a doctor who chooses to ignore the Stark II rules is, almost by definition, a careless doctor. Physicians who do not … Read more

Managing High-Cost Technology: Brave New World, Old-Fashioned Fear Advances are coming at a furious rate. Health plans find it difficult to separate the cost-efficient from the rest. John Carroll A Conversation with Howard J. Berman: Not-for-Profit Advocate Calls for Managerial Rigor Boards and managers need to perform better for this sector to continue offering the … Read more

The Patient Protection and Affordable Care Act gives the FDA the authority to approve these long-awaited medications after rigorous review Pharmaceutical benefit managers have spent the last decade honing their strategies for managing drug prices. Once a generic is introduced that can be safely swapped for a brand drug and prices start to plunge, drug … Read more

The “gatekeeper” model for controlling health care utilization is inherently flawed, argues this physician, who says substituting a more flexible system could save money as well as improving health care. See also: Trying Out Alternatives to the ‘Gatekeeper’ System Managed care holds the promise of providing better-quality health care to patients while at the same time … Read more

Nobody likes a braggart. We’re all weary from the hype that has come to be expected from everyone from car salesmen to movie studios to presidential candidates. We’re more in danger of tuning out than of being taken in. Yet there should always be a respectful audience for craftsmen who take quiet pride in their … Read more

Another campaign promise, children’s health care, continues to show up on legislative priority lists on both sides of the aisle. In what has been described as “an uninsurance epidemic,” 23 million children reportedly lacked health insurance for at least a month in 1995 or 1996. Massachusetts Democratic Sen. Edward M. Kennedy and Utah Republican Sen. … Read more

Managed care means many things including, in our capitalist society, managing to outperform your competitors. How? Information that can give you an edge is easier to obtain than you think. Information fuels managed care. It dictates mergers and acquisitions, determines reimbursement rates and defines strategic goals, helping to preserve and expand market share. But many … Read more

Studies by Cigna and Humana challenge some long-held assumptions about high-deductible plans John Carroll Contributing Editor When the University of Minnesota offered Steve Parente, PhD, the choice between a traditional health plan and a high-deductible plan linked to a health savings account, he went the HSA route. It wasn’t an easy choice. A family member … Read more

Improved outcomes with new biologic agents are prompting physicians to integrate them into therapy for psoriasis patients. Continuing Education Full text of this article is available in PDF (includes self-test for continuing education credit) The advent of biologic response modifiers for the treatment of psoriasis is bringing a dramatic shift in the way that dermatologists … Read more

About 75 million nonelderly Americans went without health insurance during some period in the last two years, which means that the problem is much worse than commonly thought, according to a new study. The study — prepared by Families USA for the Robert Wood Johnson Foundation — uses data collected by the Census Bureau. The … Read more

Some employers in Kansas City see extended value in a locally based variant of the online health record, and health plans are playing along Lola Butcher A half-century ago, a pair of Midwestern brothers changed the accounting world when they started H&R Block, the first tax-preparation firm. Now, their company is hoping to change the … Read more

Features COVER STORY UnitedHealthcare’s Bold Effort to Deal with Cancer Drug Costs Oncologists may no longer mark up the cost of specialty drugs. If the plan works, you can bet that other insurers will adopt something similar. DIGITAL | HTML Q&A A Conversation with Allan M. Korn, MD: It’s Time to Get Aggressive On Patient Safety The … Read more

Name Last modified Size Description Parent Directory 26-Jul-2000 21:05 – 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_gatechart..> 06-Jul-1999 09:06 16k 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..> … Read more

What happens when a group-model plan folds? It’s sink or swim for salaried physicians who never had to worry about the business side.   UPHEAVAL IN ALBANY For the past 19 years, Gary Kronick, M.D., had few worries. His practice, set up just outside Albany, N.Y., offered everything he desired upon leaving Philadelphia’s Hahnemann University … Read more

You might not expect to hear the term “smoosh” from the lips of one of health care’s most erudite observers. But he would argue that the rest of the industry’s vocabulary should be as clear. UNDERSTANDING HEALTH CARE’S ECONOMICS Managed Care didn’t reach far afield for this month’s interview, literally or figuratively. Alan Hillman, M.D., … Read more

The CDC calls antibiotic resistance the world’s most pressing public health threat, saying it requires collaborative action from all stakeholders: physicians, hospital administrators — and health plans We have entered the post-antibiotics era. “There are patients for whom we have no antibiotic treatment options,” says Arjun Srinivasan, MD, associate director for the Healthcare Associated Infection … Read more

After 14 Decades of marriage, Lots of vacations and Also Two children, Shalini Felt she wanted in life. She moved off on solo holidays, and took up meditation and yoga and realized she needed more. She’d more to provide. And in 38, she Couldn’t squander it By sitting in your home and waiting patiently for … Read more

Are You Prepared For the Next Recession? There are things HMOs and physician groups can do now to help them see through tough times. Don’t Let DM Vendors Set the Bargaining Table Health plans can position themselves even before talks begin by getting all the information they can on the population they wish to target. … Read more

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

The combination of a neprilysin inhibitor and an ARB rescued neprilysin inhibition from obscurity. Heart failure has been with us for a long time. It was described in ancient Egypt, Greece, and India. The Romans figured out that it could be treated with foxglove, the source of digoxin. Some notable developments over the last several … Read more

Anand Natampalli and Daniel A. Schulte Tweet Widget(link is external) Few examples highlight the differences between the analog and digital worlds as traditional taxi cabs vs. the ride-sharing company Uber. Anand Natampalli In most cities, hailing a taxi means stepping out to the curb and then hoping a driver stops. You take whatever you get, … Read more

Medical directors at health plans saw a 7.2 percent rise in mean direct compensation from 2003 to 2005. Average pay increases for physician executives in recent surveys ranged from 5 percent to 7 percent. What is surprising is that when compared to the larger group of all physician executives surveyed, medical directors at health plans … Read more

Each time a mobile station moves round an invisible network, the channel could want to modify its present association from 1 AP to another AP in the event the signal reception degree of this currently associated AP gets overly low or still another AP provides a higher signal degree or capacities. This action is referred … Read more

Infected with Zika virus, most babies born to women infected with Zika virus while pregnant could have birth defects and/or develop health issues in their morning. Infected feces or might be transmitted through sex. Because of this, the Centers for Disease Control and Prevention advises that expectant mothers should not traveling to areas in danger … Read more

House Call Revival, Digital-Style 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. Maureen Glabman How Plans Can Improve Outcomes And Cut Costs for Preterm Infant Care Ten percent of newborns are admitted to … Read more

The Declaration of Independence, that audacious document, contains the remarkable phrase: “All men are created equal.” No one believed it for a moment, not even Thomas Jefferson, who quickly, in the next phrase, cites the “Creator” as the basis of this equality. Only in the eyes of God can this be true, for certainly, in … Read more

Product provides superior seroprotection versus Engerix-B Positive results have been reported from HBV-23, a phase 3 trial of the investigational hepatitis B vaccine Heplisav-B (Dynavax Technologies Corporation) compared with a currently marketed vaccine, Engerix-B (hepatitis B vaccine [recombinant], GlaxoSmithKline), in more than 8,000 adults 18 to 70 years of age. The Heplisav-B cohort received two … Read more

The practice of caring for behavioral health patients in non-inpatient programs continues to grow, but a new study shows patients treated on that basis are getting dramatically less time with therapists.The 1997 annual survey of the National Association of Psychiatric Health Systems, which represents mental health and drug abuse hospitals and networks, indicates that outpatient … Read more

While there has been much discussion about the need to reduce medical errors, little attention has been given to how health insurers can help. Patient safety and medical errors have become the focus of increasing attention from the public, policymakers, and accreditation agencies. While most of the epidemiology and interventions that have been developed are … Read more

The newly approved product produces 8 mg of naloxone to the rectal cavity. The FDA had approved 2 mg and 4 mg naloxone nasal-spray solutions. Naloxone is a medication Which Can Be handled by people with Or without clinical practice to decrease opioid symptoms. When naloxone is treated fast, it might counter the opioid overdose … Read more

Most types of prostate cancer progress slowly and, increasingly, men with very moderate or moderate forms of the disease make the same choice as the author. When my urologist told me my prostate biopsy came back positive, I wasn’t surprised. My father had prostate cancer, and my two older brothers had prostatectomies when they were … Read more

Genetic explanation to get a syndrome characterized by various bothersome and difficult-to-treat outward symptoms, including nausea and light headedness, skin itching and flushing, gastrointestinal ailments, chronic pain, and joint and bone issues. Many men and women who undergo these symptoms that are diverse have raised amounts of tryptase — a protein from the bloodstream frequently … Read more

There is insufficient evidence that atypical antipsychotics are effective in treating eating disorders, substance abuse, and insomnia — medical conditions that these drugs were not approved to treat — according to a new Rand study. Other off-label conditions do respond, though. Evidence supports the effectiveness of some atypical antipsychotics in reducing symptoms of generalized anxiety … Read more

The authorities states that associations and other institutions which store or process patient healthcare advice has to report cyber breaches into HHS. However, the guidelines are muddy, and a number of the oddest cyber-attacks have yet to be attracted into light, the WallStreet Journal reports. The paper targets strikes by hackers using ransom-ware, which will … Read more

Email is among the very frequently used techniques of communicating, but its usage in healthcare continues to be rare. Where email communicating was utilised in healthcare, its own intentions have comprised clinical communication between healthcare professionals, however, the consequences of working with email in this manner aren’t wellknown. To gauge the ramifications of email for … Read more

Southern and western states struggling with mushrooming illegal immigrant populations are quietly finding ways to provide health services to them, sometimes in the face of federal laws that prohibit such activity. The Christian Science Monitor reports that this development is part of a larger trend to grant certain public benefits to undocumented aliens. U.S. law … Read more

Employers are going to want more Web-based health benefits packages this year, predicts Forrester Research. The consulting company says that these plans are characterized by online access to services, a decision-support mechanism, and benefit designs that have higher deductibles matched with a new form of spending account, funded all or in part by the employer. … Read more

Dr. Do-Good and Mr. Bottom-Line How medical directors reconcile the contradictory demands of physician and executive roles. Health Plans Begin To Address Chronic Care Management As with so much else in health care, observing protocols, analyzing data, and rethinking benefit designs are important. Will New Benefit Design Harm Some Patients? In the past, reducing demand … Read more

Abstract Background: The high rate of 30-day hospital readmissions among Medicare patients highlights a glaring care gap in the treatment of elderly patients. To improve quality of care, increase patient safety, and reduce the associated costs of these readmissions, transitional care programs are being implemented to facilitate continuity of care from hospital to home with the … Read more

A shift toward value-based reimbursement, which only a couple of years ago seemed very slow in the making, may unseat the entrenched fee-for-service (FFS) payment model in five years, according to experts. Health care usually moves glacially, but that’s not what’s happening here. Managed Care reported in 2013 (/archives/2013/8/twilight-fee-service) about FFS medicine’s inertia. The use of … Read more

Paying clinicians to reach a fixed performance target might produce little gain in quality, according to a study in the Journal of the American Medical Association. Physician group quality reports were evaluated by PacifiCare Health Systems for its California and Pacific Northwest (Oregon and Washington) networks. Three measures of clinical quality were compared — cervical … Read more

In this era of tight margins, many health plan executives may be deciding that while offering purchasers customized benefit packages is a nice touch, it is unprofitable. InterStudy Publications’ National HMO Census indicates that a third of HMOs are moving toward standardization of benefits and are choosing to differentiate themselves on some basis other than … Read more

Perhaps goodwill is too much to ask for. However, peaceful coexistence can certainly help all players reach their mutual goal — a smooth relationship that helps to get the job done. Subjugated groups early on learn the value of passive resistance. Even groups that feel, without much objective justification, that they are subjugated quickly adopt … Read more

Provide some exceptional advantages with their clients, benefits which do have to do with success in life compared to medical care. These generally include life training to assist them with instruction and career targets, transportation, totally free cellular phones and temporary complimentary fitness center memberships. Additionally, it Represents an increasing acknowledgment inside the medical industry … Read more

It might not be the road to totally overcoming the fractured nature of the health care system, but it should lead to better collaboration Driven by the pervasive understanding that health care needs to change if we are to attain accessible, high-quality care at an affordable cost, payer and provider organizations are coming together in … Read more

“I am definitely excited about where primary care is going,” says the founding dean of the Jefferson School of Population Health, and the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy at Thomas Jefferson University. Here he speaks with John Marcille, editor of Managed Care, and Sonja Sherritze, editor of P&T, about … Read more

Released from the Journal of Child and Adolescent Psychopharmacology, a brand fresh study compared with rates for its most frequent psychiatric disorders in kids with incidence prices. Researchers at Columbia University Irving infirmary used statistics from a federal prescription database to test annual prescriptions for stimulants, antidepressants, and antipsychotics for 6.3 million kids and younger … Read more

We publish opinion pieces by outside writers in the Viewpoint department of our website and in our monthly print publication. We decide which pieces to publish based on our judgment of the value they will have to our readers. We believe readers want clear exposition, an original point of view, and lively writing. Pieces that … Read more

Radiology benefit management programs and the launch of new guidelines may slow utilization Lola Butcher Contributing Editor As the use of radiology benefit management (RBM) programs becomes more common, two radiology organizations have published guidelines they say are intended to improve the relationships between payers and physicians. The American College of Radiology and the Radiology … Read more

A comparison of health care costs in patients with diabetes who do not initially respond to oral therapy suggests that it might be appropriate and clinically beneficial for providers to consider adding another oral agent, rather than up-titrating the current medication, particularly beyond intermediate dose levels Girishanthy Krishnarajah, MPH, MBA/MS Bristol-Myers Squibb, Princeton, N.J. Monali … Read more

The entire managed care industry is desperate to cut costs and is beginning to turn toward a controversial method to do just that. Ed Silverman MANAGED CARE June 2005. ©MediMedia USA The entire managed care industry is desperate to cut costs and is beginning to turn toward a controversial method to do just that. Ed Silverman With … Read more

By Jean Lawrence Contributing Editor Receiving capitation payments for nonexistent patients. Billing for three fee-for-service encounters when the patient only came once. Selling a $200 wheelchair for $5,000. Crimes, right? Stealing? Fraud? Most people agree that taking payment for a service not rendered or a substandard product is wrong. But how about: Reporting three encounters … Read more

Salaries of medical directors and associate/assistant medical directors have risen by more than 30 percent over the last 10 years, according to the 2007 Cejka Search/American College of Physician Executives Compensation Survey. In 1997, medical directors earned an average of $175,000; associate/assistant medical directors earned an average of $160,000. In 2007, salaries of medical directors … Read more

Feds ready rapid-response teams Mosquitoes that transmit the Zika virus live in nearly all of the continental United States, according to new maps released by the Centers for Disease Control and Prevention (CDC). The maps show that two breeds of virus-carrying mosquitoes—Aedes aegypti and Ae. Albopictus—can be found as far north as Michigan, New Hampshire, and Washington … Read more

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

Patient-advocacy groups and some physicians are lobbying legislatures to hobble this common technique to control drug costs Over the past decade, health plans have designed increasingly sophisticated drug formularies to push their members to the most cost-effective therapies that can treat their ailments. In some cases, new tiers have been added that increase members’ out-of-pocket … Read more

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

A health plan’s systematic approach to dealing with common chronic illnesses is on the edge of remarkable outcomes. Physician buy-in can be slow, but is crucial. The challenge many health plans and integrated health systems face — transforming the delivery of care into a systematic approach that is based on the best medical evidence — … Read more

Care targeting pain and symptoms has caught the eye of insurers. Faced with a limited ability to raise premiums, health plans must continue to advance cost-effective health care delivery. Palliative care, which focuses on relieving the pain, symptoms and stress of a serious illness, is an important opportunity for implementing such care. In recent years, … Read more

Women hold a 30 percent greater share of physician executive jobs than they did 10 years ago, according to the “2007 Physician Executive Compensation Survey” conducted by the American College of Physician Executives and Cejka Search. Forty percent of those women held the title of medical director. Thirty percent is a large increase, but the … Read more

LOBBYING FRONT The wild calls for patients’ rights at the House of Delegates meeting did not prevent the chief executive from suing the board of trustees. Contributing Editor Health Secretary Tommy Thompson was playing to a tough Chicago house. His message was simple: Congress needs to soften the legal blows delivered to managed care under … Read more

Regeneron’s aflibercept (Eylea) injection in patients with diabetic macular edema demonstrated greater improvement in visual acuity than either of two Genentech biologics, bevacizumab (Avastin) and ranibizumab (Lucentis). In the National Institutes of Health-sponsored Diabetic Retinopathy Clinical Research Network comparative effectiveness study, the median number of aflibercept injections was one fewer than either of the comparative … Read more

Providers that once feared insurers’ retribution are finding strength in numbers and compensation in class action litigation Health insurers are under siege, and it’s not from stockholders upset over cratering equity prices. Lawsuits are coming at the plans from places they haven’t come before at a rate they have never seen before. “Volume has increased … Read more

In the perhaps biggest sign yet that premiums are poised to soar, the California Public Employees’ Retirement System has granted the health plans it contracts with an average 9.7-percent rate hike for next year. It’s the highest increase since CalPERS accepted a 12-percent boost in ’92. CalPERS is the nation’s second-largest health care purchaser. Kaiser … Read more

Coverage often straddles the line between the pharmacy and medical benefit, but a properly constructed formulary can bridge the gap F. Randy Vogenberg, RPh, PhD Specialty drugs and other new drug technologies are the fastest growing sector of the prescription drug market primarily because of price inflation and increased utilization. Manufacturers have justified the high … Read more

Rationing, canceled treatments, and fearful patients A severe shortage of immune globulin is forcing doctors nationwide to cancel patients’ lifesaving infusions. Immune globulin helps protect patients from infections, and is used in many medical conditions, including seizures, leukemia, auto­immune diseases, organ transplants, acute muscle illnesses and nerve disorders.  “It is miraculous,” said John Boyle, president … Read more

Under health reform, consumers will be the new buyers in public and private exchanges, meaning care management programs will need a sharper focus on return on investment Success in any retail business comes from offering buyers what they want. Given that insurers will be selling to new retail buyers in the coming years through public … Read more

January Measurement and rating An in-depth look at quality measurement of providers and health plans Also: Spotlight on real-world evidence February Sexual health STDs, coverage of treatment of erectile dysfunction, and other issues at the crossroad of sexual health and managed care March Biosimilars Also: Update on generics April Telemedicine May Cancer Also: Spotlight on real-world evidence in … Read more

The pharmacokinetics of epidurally administered medication has become the topic of several research studies, yet drug concentration at the epidural space has not been quantified. The analysis has been undertaken to describe the epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidurally administered opioids on the grounds of measurement of chemical concentration at all these bubbles … Read more

Yes, we’re going to have a new president this month. Yes, despite the obvious election distractions of the last two months, health care regulators — at the direction of President Clinton — have kept busy. And, yes, that handiwork might just provide a preview of the type of patient-rights legislation a sharply divided Congress might … Read more

Biotech companies, often younger and smaller, fare better It’s shaping up to be a bumper year for drug approvals, with U.S. officials clearing twice as many novel medicines as in 2016, yet returns on research investment at leading pharmaceutical companies are down. In fact, projected returns at 12 of the world’s top drugmakers have fallen … Read more

New England’s austere countryside appears the exact same on both sides of the Connecticut River separating Vermont in New Hampshire. However, Medicaid beneficiaries are greater in Vermont. Vermont liberally funding its Medicaid application. It offers improved benefits, such as dental treatments, and pays health practitioners significantly more than New Hampshire’s application does. This attracts more … Read more

Childhood hypertension has turned into a substantial public health problem owing to greater incidence in the latest decades. All these concerns have contributed to a upgrade of tips about youth hypertension by the Western Society of Urology at 20-16 and the American Academy of Urology at 20 17. This review emphasizes the essential progress in … Read more

The We’re adding a new warning to this medication tags for several olanzapine-containing services and products which clarifies that this acute affliction called Medication Reaction with Eosinophilia and Systemic signs and symptoms. Patients Accepting olanzapine-containing services and products that create an illness with a rash and swollen lymph nodes swelling or swelling at the face … Read more

Women hold a 30 percent greater share of physician executive jobs than they did 10 years ago, according to the “2007 Physician Executive Compensation Survey” conducted by the American College of Physician Executives and Cejka Search. Forty percent of those women held the title of medical director. Thirty percent is a large increase, but the … Read more

MANAGED CARE September 1999. ©1999 MediMedia USA DELIVERY MODELS Lessons have been learned from early PHOs, which lacked direction and had misaligned interests between hospitals and physicians. MargaretAnn Cross At St. Joseph’s Health System in Atlanta, physicians and hospital administrators are working together to contract with managed care companies, design protocols for medical care, and get ready … Read more

Do more with less — that’s what we all must learn. In the physician’s office, when patients share their doctor’s time, everyone benefits. Bob Carlson Contributing Editor Shared medical appointments improve patient access, enhance patient and physician satisfaction, and increase practice productivity, all without adding more hours to a physician’s work week. There is even … Read more

The use of transgenic goats to produce a recombinant form of human antithrombin is much more efficient than using mammalian cell cultures Few Americans have missed the white-mustached celebrities on billboards and television with the catchy phrase “Got Milk.” Another series of commercials shows “happy cows” being used to produce milk for cheese. The milk … Read more

Latest Issue Table of Contents, March 2013 Download from App Store Read Digital Edition Download in PDF Resources Terms & Conditions for Using This Site Contact Us Disease Management Forum Call for Manuscripts Subscribe Address or Subscription Changes Rate Card and Production Requirements BPA Statement Classifieds Site Map Popular Content How Doctors Are Paid Now, … Read more

Managed care take a bite out of fraud? Hardly. It has merely changed some of the techniques of stealing and corner-cutting.   Undertreatment Endangers Patients Receiving capitation payments for nonexistent patients. Billing for three fee-for-service encounters when the patient only came once. Selling a $200 wheelchair for $5,000. Crimes, right? Stealing? Fraud? Most people agree … Read more

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

Formulary restrictions discourage adherence to medications   Money saved up front through tight formulary management, might be spent several times over later because of poor outcomes that will boost overall costs, according to a study in the Journal of Managed Care Pharmacy. Studies published in 1993 or later are included in this systematic literature review … Read more

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

Paul Terry PhD

LEGAL FRONT The recent U.S. Supreme Court decision offers a nice breather, but executives should not let down their guard, as an Illinois ruling shows. Neville M. Bilimoria, J.D. 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 … Read more

This analysis analyzed that the lead financial lack of restless legs syndrome among patients treated with dopamine agonists utilizing a sizable united states of america managed care record. Patients have to own or 1 prescriptions to get a DA between 1/1/2005 and 12/31/2007; continuous registration for > or =6 weeks earlier and or =12 weeks … Read more

January Behavioral health February Women’s health March Value-based care Also: Real-world evidence April Medicaid managed care Vulnerable populations May The cost of cancer June Drug pricing and management Diabetes July General interest August Innovations in managed care Heart disease September Health care quality Nursing October Policy and politics Autoimmune disease November Success stories—What is working … Read more

I wince when I recall the first opinion column of mine that ever saw print. It was in the University of Chicago’s student newspaper, the Maroon, and it admonished left-leaning students about the habit some of them had of using an extreme-right political label as a casual term of disapprobation. It was just as unfair, … Read more

NIH Launches Study of Breast Cancer Genetics in Black Women Findings could inform breast cancer disparities   A study funded by the National Cancer Institute (NCI), part of the National Institutes of Health, is investigating how genetic and biological factors contribute to the risk of breast cancer among black women. This collaborative research project will … Read more

Sign for many transcatheter heart valves to incorporate patients with acute aortic valve stenosis (a portion of their heart’s aortic valve which limits blood circulation into aorta, your body’s key artery) that are at elevated risk for death or serious complications linked with open-heart operation to restore valves. Nevertheless, the method of fit a transcatheter … Read more

Cadillac or Yugo care for the poor? Fee-for-service or managed care? The states have a lot on their minds as the Medicaid monster grows and grows. For the Florida legislature, the Medicaid budget has become the monster that has repeatedly savaged every attempt to tame it. Florida was one of the first states to bring … Read more

Are some managed care companies operating a little too close to the margin? A surprising 22 percent of the HMOs examined recently by the National Association of Insurance Commissioners failed a test run of the risk-based capital formula NAIC is considering as a standard for managed care organizations’ minimum capital reserves. Last June, the NAIC’s … Read more

John A. Marcille We hope that the big “2009” on our cover caused you to pause. To be sure, it’s an odd benchmark, even if it is a half-decade away. Goalposts placed five years apart hold a certain credence for those of us who spent our childhoods doing school drills in which we hid under … Read more

Now announced additional investigations of results in the ECHELON-1 and ECHELON-2 front-line phase3 trials of ADCETRIS®. ADCETRIS is a antibody-drug conjugate led to CD30, a defining mark of ancient Hodgkin lymphoma and expressed in the face of many kinds of peripheral tcell lymphomas. The ECHELON-1 study highlighted a Student upgrade of this stage 3 Clinical … Read more

Discrimination and Health Status Diabetes discrimination heart disease Hypertension race Is Executive Vice President and Chief Medical Officer of MediMedia, USA, which publishes Managed Care “You Can’t Outrun Your Past”…….. The title of a slide in a grand rounds presentation by Dr. David Kountz, senior VP for medical and academic affairs at Jersey Shore Medical … Read more

Performing well on some newly introduced HEDIS 2000 measures may be a real challenge for some health plans. The National Committee for Quality Assurance tells Managed Care that four HMOs field-tested the measure controlling high blood pressure, and compiled weak scores of between 32 and 42 percent…. PacifiCare of California has released publicly its second … Read more

Sharon Selman*, Diane Hayes*†, Lawrence A. Perin*‡, Winifred S. Hayes*§ *Hayes Inc.; †School of Medicine and Biomedical Sciences, State University of New York at Buffalo; ‡Aviano Air Force Base, Italy; §Johns Hopkins University School of Hygiene and Public Health This paper has been peer reviewed by appropriate members of Managed Care’s Editorial Advisory Board. Also … Read more

We know Watson, the supercomputer, for its vast fund of knowledge and thinking prowess when machine bested man, defeating the all-time Jeopardy champ for games won, Ken Jennings (74), and Brad Rutter, Jeopardy’s highest money winner ($3,470,102), and winning against Jennings in a head-to-head Tournament of Champions. Now, Watson is flexing her considerable problem-solving muscle … Read more

The outgoing mayor of Springfield, Mass., is taking on the FDA over his plan to buy medications at a discount from Canada. John Carroll Michael Albano is just a few months away from wrapping up eight years as the mayor of Springfield, Mass. He isn’t running again and has no great ambition for some other … Read more

With the nation’s economy in recession, it probably comes as little surprise that many companies are scaling back executive bonuses for year-2001 performance. However, if health care bonus packages are any indication, then the industry itself would seem to be more immune to the effects of the economy than most other businesses. A survey of … Read more

The Financial Crisis If the health sector were like most other economic areas, having good cash flow and low exposure to investment losses would be enough. It’s not. Peter R. Kongstvedt, MD Health insurers and managed care plans (I’ll refer to both as payers) are affected by the financial crisis differently from hospital systems, physicians, … Read more

When Tim Stezzi and Tim Search launched Managed Care in 1992, the backlash against its eponym was in full swing. Hundreds of bills had been introduced in state legislatures the year before to curb the perceived excesses. Utilization review was being questioned, gatekeeping disparaged. “It…

Machine learning is currently Out pacing humans in regards to forecasting certain ailments such as cardiovascular problems and diabetesand the ones calculations are very likely to become more accurate with all the capacity to variable privately data recorded on smart phones and wearables. Comparatively, recommendations employed by cardiologists to predict someone’s risk of cardiovascular illness … Read more

It has long been known that a small percentage of health plan members account for a disproportionately large percentage of medical costs. What has bedeviled health plans for an equally long time is how to identify these members before they generate large claims and how best to keep them from actually becoming so costly. The … Read more

Year:  2011  |  2010  |  2009  |  2008  |  2007  |  2006  |  2005  |  2004  |  2003  |  2002  | 2010 January Cover Story House Call Revival, Digital-Style Inpatient Rehab Facilities Benefit Post-Stroke Care States Collect Valuable Data On Hospital Prices and Performance How Plans Can Improve Outcomes And Cut Costs for Preterm Infant Care Not Your Father’s Cadillac Plan Higher Copayments and Deductibles … Read more

Medicaid, enacted in 1965, is currently costing over $200 billion per year. With rapidly rising health care costs, including prescription drugs, state Medicaid budgets are feeling the strain. Like its effect on private insurance, prescription drug costs had the highest growth rate among Medicaid services, increasing approximately 19 percent over the past several years. To … Read more

Financial security in the face of rising debt for medical school is important when a resident decides on a specialty — and a new study shows just how much a career in primary care is at a disadvantage. Researchers at Dartmouth Medical School developed a financial model that compared net income to expenses, taking into … Read more

THE AGENDA: In case you haven’t noticed, we have an new activist president and secretary of health and human services. They’ll be dealing with a Congress that’s just itching to make some changes to health care. On the burner are patients’ rights, managed care reform, and a Medicare prescription plan. That ought to hold everybody’s interest … Read more

Prevention remains the mainstay of managed care, and this issue looks at it from different angles. The story explores how dental care affects overall health. Though the evidence is inconclusive, some major health plans have integrated dental and health benefits in unique ways. Dental health is seen as a factor in managing diabetes, coronary artery disease, … Read more

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

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – 0002.washington.html 20-Jun-2003 16:09 8k 0002.uk.html 20-Jun-2003 16:09 17k 0002.qna_bodenheimer..> 20-Jun-2003 16:09 24k ../../../archives/0002/0002.outlook.pdf 01-Feb-2000 12:00 29k 0002.outlook.html 20-Jun-2003 16:09 2k ../../../archives/0002/0002.outlook.gif 01-Feb-2000 12:00 47k 0002.news_warning.html 20-Jun-2003 16:09 2k 0002.news_tenncare.html 20-Jun-2003 16:09 2k 0002.news_premiuminc..> 09-Apr-2003 23:27 1k 0002.news_premiuminc..> 01-Feb-2000 12:00 19k 0002.news_pharmacyco..> 01-Feb-2000 12:00 61k 0002.news_pharmacyco..> … 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

POPULAR CONTENT TODAY’S POPULAR CONTENT Type Title Author Story Getting in Some Practice With Private Insurance Exchanges webadmin Story Inpatient Rehab Facilities Benefit Post-Stroke Care webadmin Blog entry You’ve Got to Believe: The Evidence on Positive Thinking in Cancer Outcomes Steven Peskin MD Story Patent cliff: Billions to be saved — starting now webadmin Story … Read more

Two prominent members of Congress have taken off the kid gloves to attack Health Care Financing Administration Administrator Nancy-Ann DeParle for delaying implementation of several portions of the Balanced Budget Act of 1997. Rep. Bill Thomas of California, chairman of the House Ways and Means Health Subcommittee, criticized DeParle for delaying the per-episode home health … Read more

Regulators in three states have imposed hefty fines on HMOs in the last two months for a wide range of infractions. North Carolina’s insurance department fined Durham-based Doctors Health Plan a record $500,000 for 51 violations. The HMO was cited for illegally requiring members to get prior authorization for out-of-network emergency services. The plan also … Read more

By John La Puma, M.D. Managed care has been faulted for a lot in medicine: the deepening cynicism of providers and consumers, the loss of control and choice in health care, the replacement of medical ethics with law, regulation and business ethics. What managed care is designed to do, however, is cover all of us. … Read more

STATE INITIATIVES The Minnesota Physician-Patient Alliance last month charged the state’s three largest HMOs with spending up to 38 percent of total expenses on administration and other non-medical items. The HMOs–Blue Plus, Medica and HealthPartners–contend that the number is actually about 10 percent, and claim that they are highly efficient. Part of the discrepancy is … Read more

The least insured of the major medical services is the pharmaceutical benefit, according to the Pharmaceutical Research and Manufacturers of America. A PhRMA report says that for those under 65 who had health coverage in 2000, private insurance paid 60.2 percent of the cost of prescriptions while patients paid 37.2 percent. More than 70 percent … Read more

Should a new (and cheap) test for chronic lymphocytic leukemia be a component of prior-authorization protocols? Tomorrow’s Medicine Technology, the focus of this column, has virtually exploded in the past several years. Most managed care decision-makers have focused on the cost of the new therapeutic regimes, with particular interest in the latest budget busters, namely … Read more

The backlash has helped push a Patients’ Bill of Rights forward, challenging the very nature of cost containment. Ironically, enrollees may be shortchanged. Frank Diamond Senior Editor When the Senate passed the Patients’ Bill of Rights on June 29, many politicians and reporters were quick to see this as a major victory for the downtrodden … Read more

That seems to be the upshot of the debate over funding children’s insurance and Medicare Advantage If the House Democratic leadership gets its way this fall, the debate over the future of Medicare Advantage will focus on the need to chop government support of that program so that legislators can do right by the children … Read more

I love my colleagues in Information Technology. I also love greasy doughnuts. Why then, do I not love it when I.T. people bring in a big crate of greasy doughnuts to reward each other for their hard work? They only do this occasionally. Still, my latest way to chide them about it was to put a recent … Read more

Just the Instance, Released from the journal PLOS Neglected Tropical conditions, could be the very first to connect Zika virus without harm to endothelial tissues beyond the central nervous process. Thus Much, delivery defects related to all the rapidly dispersing Zika virus are nearly entirely restricted to Brazil and connected with microcephaly, a state where … Read more

Fewer drug and biologic approvals in 2013 The number of specialty drugs and biologics making it to market slipped from 25 in 2012 to 13 last year. Cancer continues to be a hotbed of specialty drug development. Of the 13 specialty drugs and biologics approved last year, nine carry oncology indications and hefty price tags. … Read more

The health plan’s New Hampshire subsidiary rolls out its Compass SmartShopper program to small employers this month Frank Diamond As wellness programs across the country demonstrate, nothing motivates quite like money. Tie that to information, and insurers might yet create the educated consumer. That’s the idea behind a program by Anthem Blue Cross & Blue … Read more

Immediately dividing, Nevertheless Jelqing stem cells are a Significant source of cancer. However a new study shows that older cells play a vital role in initiating cancer a finding which may upend how scientists consider the roots of this disorder. Have discovered that older cells are able to revert to behaving a lot more such … Read more

We may never know the identity of the public relations genius who decided that “downsizing,” itself euphemistic, was too blunt a word to describe corporate layoffs. Presumably to assuage the readers of news releases and annual reports, he or she coined the replacement term “right-sizing,” so that victims of the process might hear the sweet … Read more

A Conversation With Jonathan T. Lord, MD Not many companies’ organizational charts list a ‘chief innovation officer.’ At Humana, it brings visibility to a high-tech strategy for reducing care fragmentation. Jonathan T. (Jack) Lord, MD, joined Humana in 2000 as chief medical officer. Today, as senior vice president and chief clinical strategy and innovation officer, … Read more

If this is so they are screened to find pancreatic cancer within a previous, possibly more curable stage. Additionally, their loved ones may opt to get analyzed to master whether they take the mutation. Approximately 10% of pancreatic cancer possess a behavioral routine, also Typically the causative genetic defect isn’t understood, even though some mutations … Read more

Operating a medical care firm includes all sorts of acute risks. Afterall, with other people’s own lives and wellbeing on both hands is really a critical issue. When most patients are thankful for its help and many days have become rewarding of a healthcare provider, medical care companies of all sizes has to think about … Read more

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

Originally touted as an affordable way to expand insurance coverage to more people, high deductible insurance plans paired with health savings accounts (HSAs) are not working out that way. A report from the Government Accountability Office (GAO), the investigative arm of Congress, has found that HSA enrollees were much wealthier than people who were covered … Read more

F. Randy Vogenberg, RPh, PhD P&T committees will have to consider the economic fallout from their decisions as health reform advances, says F. Randy Vogenberg, RPh, PhD, principal of the Institute for Integrated Healthcare and a member of Managed Care magazine’s Editorial Advisory Board. That will be an adjustment. F. Randy Vogenberg RPh PhD’s blog … Read more

Generally accepted clinical practice guidelines (CPGs) offer little help to physicians who are treating elderly patients with multiple chronic conditions, according to a recent study in the Journal of the American Medical Association. In terms of medication dosage, for instance, following the CPGs for a hypothetical 79-year-old woman with nine chronic diseases could get downright … Read more

Crohn’s Many patients have alternating periods of relapse and remission using 1 / 2 patients needing operation over a decade of identification. The best way to treatment has developed from control of symptoms into preventing development of this illness. Thus, treatments that firmly preserve long‐term remission are very essential. Treatment tips such as Crohn’s disease … Read more

In a study involving more than 60 health information exchanges, the Government Accounting Office (GAO) found that sharing electronic personal health information about patients between providers and the exchanges improved the quality of care. Health information exchanges are entities that facilitate the electronic sharing of patients’ health information among providers. The exchanges reported that they … Read more

Where do new diabetes treatments fit in? Randy Vogenberg, PhD: The differences among the latest diabetes medications are seen as less than dramatic, creating questions about the costs and benefits of the various new treatment options. Meanwhile, patient compliance remains a concern. More like this Costly biologics have plan sponsors looking at benefit designs Will … Read more

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

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

Washington Watch The recent Fifth Circuit Court decision on Texas’s statute allowing patients to sue HMOs for denial of physician-recommended care is helping to clarify where state and federal interests in patient rights lie — and what Congress could do to spell out those interests. However, health-industry insiders question whether the ruling — or anything … Read more

Would you be interested in joining an email discussion group on NCQA Accredition and HEDIS Standards? The goal is an open exchange of information to assist organizations in meeting these standards. To join, simply enter your Name, Organization, Title, and Email in the areas indicated, then click on the button to subscribe.  

Simple, production-based formulas for paying physicians won’t help a medical group or HMO thrive in today’s largely capitated world, says a physician recruiter. Instead, you need a “physician incentive program.” See also the probing Q&A posed by Richard Lerner, M.D., of the University of Massachusetts Medical Center to author Mark Smith. We haven’t reached the … Read more

For these two medical directors, the next logical career step was CEO.     On the one hand, they come into the job versed in the substantive side of the business. Presumably, by virtue of their training and experience, they understand what it takes to deliver patient care and are versed in the health care … Read more

Usage of Magnetic Resonance Imaging scans now and later on. With all the Nucleus Profile Plus Implant, cochlear implant recipients have more easy usage of 1.5 and 3.0 Tesla MRI scans without needing to clear away the interior magnet or make use of a mind wrap.1 The brand new implant is assembled off Cochlear’s Nucleus … Read more

Physicians often find that to survive and prosper under managed care, they must meet new requirements whose necessity they may not, in their secret hearts, concede. We all know that there is a certain amount of suspicion of capitation, utilization review, length-of-stay limits and–well, you get the picture. We know, too, that some physicians are … Read more

Available, it’s tough to tell exactly how effective the 12step model is. Nevertheless, the prominence with such a treatment in addition to success stories out of recovering addicts indicate it’s beneficial. At the minimum, the 12step version Offers reinforcement, support And liability for those that genuinely wish to overcome their dependence. The allocation version in … Read more

For so several decades, the underlying thesis of information tech was that there’s”a lot of” advice for people to manage. Technology’s occupation, then, is to confront the ideal advice out with the embarrassment of wealth. From the mid-2000s, the remedy for the problem will be Internet 2.0. I am increasingly convinced, but our problem isn’t … Read more

Some plans swear by the benefits of obtaining an “excellent.” Others say that customers care much more about cost. When the Quality Improvement Committee at Dean Health Plan in Madison, Wis., gets together, a recurring topic is whether to continue to pursue accreditation by the National Committee for Quality Assurance. The health plan earned full … Read more

Health Plans Cautiously Optimistic as ACOs Enter Prime Time Leaders of managed care and of many provider organizations find that they can work together better than ever before A Conversation With Herb Fritch: A Steady Approach to Medicare Advantage Physician buy-in and an innovative payment model will keep Cigna’s HealthSpring on course in a changing … Read more

Amy K. O’Sullivan, PhD i3 Innovus Jane Sullivan, MPH i3 Innovus Keiko Higuchi, MPH Gilead Sciences Inc. A. Bruce Montgomery, MD Gilead Sciences Inc. Full text available in PDF ABSTRACT Purpose: To examine patterns of health care utilization and costs among cystic fibrosis (CF) patients with pulmonary infections. Design: Retrospective administrative claims database analysis. Methodology: We used administrative … Read more

By Peter Wehrwein Contributing Editor It sounds an awful lot like what HMOs are supposed to do: realize economies of scale, use covered lives to drive hard bargains, inject some reality into disease management and, perhaps most impressively, get physicians to practice high-caliber medicine while also keeping an eye on how much that care costs. … Read more

The U.S. Food and Medication Organization today endorsed the utilization of Vascepa as an adjunctive treatment to lessen the danger of cardiovascular occasions among grown-ups with raised fatty substance levels of 150 milligrams for each deciliter or higher. Patients should likewise have either settled cardiovascular sickness or diabetes and at least two extra danger factors … Read more

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

Using bevacizumab for Firstline care treatment for adult patients with advanced epithelial ovarian, fallopian tube, or primary esophageal cancer that come in partial or complete reaction to jelqing platinum-based chemotherapy and whose prostate cancer is connected with homologous recombination lack positive status characterized by a deleterious or guessed deleterious BRCA mutation, or genomic uncertainty. FDA … Read more

MANAGED CARE Taking On Too Much This issue of Managed Care was billed as being about Medicaid managed care and vulnerable populations. But as grumpy editors often say, that’s a topic not a story. And it didn’t take us very long to discover that the story was social determinants of health. Lola Butcher, a regular contributor … Read more

A pharmaceutical code of ethics — if it were ever hammered out — would have to arise from a detailed examination of the industry’s vision, mission and principles. It would likely cover methodology, safety, marketing and pricing. It would certainly cover communication with patients and the public. It would be aspirational instead of dutiful. It … Read more

The number of plan sponsors that will offer consumer-directed health plans that integrate pharmacy and medical benefits increased more than 16-fold, from 3 to 50, between January 2005 and January 2006, according to Medco Health Solutions. Medco says that the number of plan sponsors offering a pharmacy benefit in their consumer-directed health plans could reach … Read more

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

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

Hospital administrators oversee physician, nursing, and administrative staffs, and usually take the lead in budget preparation and financial reporting. They are important players who usually sit opposite health plan representatives at the negotiating table. The average base salary for hospital administrators rebounded in 2010 and 2011 after being flat for several years, according to Executive Compensation … Read more

Color charts Also available in PDF The demand for primary care physicians is lessening relative to the demand for specialists, according to information gathered by Merritt, Hawkins & Associates, a health care headhunting company. In 1996—97, Merritt experienced a 12-percent increase in searches for primary care physicians compared with the previous year, but for the … Read more

Sponsored by an educational grant from Zeneca Pharmaceuticals. To request a complimentary copy of the “Medicaid: Challenges and Opportunities for Managed Care Providers” video and CE program, please call (302) 886-4285. THE PARTICIPANTS: Rodney C. Armstead, MD, FACP, (moderator) is executive vice president/chief health officer of the Los Angeles-based Watts Health Foundation Inc., a national model … Read more

Why make mental health more mainstream? Because only 17% of American adults function with optimal mental health, says Eva Borden of Cigna. “We talk about it as if it’s them over there, but 83% of us have a need.” OK, so the Chinese word for “crisis” is not the same as the word for “opportunity,” … Read more

Bracing for an influx of enrollees, medical managers at some plans take creative approaches to fixing a decades-old problem Medical managers have long addressed the vexing and chronic problem of Hispanics getting less preventive care than any other ethnic or racial group. Now there’s even more incentive for health plans to solve it. Mirian Zavala, … Read more

The Department of Defense will provide health care services to Medicare-eligible military retirees in a managed care demonstration project called the Tricare Senior Project and receive reimbursement through Medicare. The goal is to provide cost-effective, high-quality care to military retirees and their families through military treatment facilities…. Implementation of the Health Insurance Portability and Accountability … Read more

The American Academy of Family Physicians likes the Clinton administration’s consumer bill of rights proposal, especially its call for choice of primary care doctors. But it doesn’t like the provisions dealing with increased access to specialists, treatment and medical care. AAFP likes the president’s plan to tax cigarettes and ban tobacco company advertising that appeals … Read more

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

On ICD-10, the Empire Strikes Back The force may be leaving the AMA as it seeks another ICD-10 delay. The politics are lining up so this may be at long last the year it gets implemented. Richard Mark Kirkner inShare Tweet Widget (link is external) The fifth episode in the Star Wars saga provides a … Read more

Plans are increasingly trusted with management of the ABDs — aged, blind, and disabled This summer California will mark the beginning of a new era for the Medicaid managed care business. After winning a waiver from the federal government last fall, the state’s aged, blind, and disabled beneficiaries — the ABDs, in the parlance of … Read more

The Private Sector Can, Should, and Will Help Solve the Problem of the Uninsured WellPoint Chairman Leonard Schaeffer and other health plan leaders believe they can help with a chronic societal issue Martin Sipkoff No Easy Fit For Specialty Hospitals Insurers worry that these facilities will ultimately increase costs at nearby community hospitals Ed Silverman … Read more

F. Randy Vogenberg RPh PhD “What we’re seeing with the transformation in the system of health care delivery today is a couple of different models emerging from the health plan and PBM perspective,” says F. Randy Vogenberg, RPh, PhD, principal of the Institute for Integrated Healthcare. Video F. Randy Vogenberg RPh PhD’s blog More like … Read more

Back in the not-so-good old days, when enemy soldiers besieged your castle, you’d just peer down on them from behind your battlements, counting on your stout fortifications to blunt their bolts and arrows. Within your walls, you had a deep well and a full granary. You could wait them out. You felt relatively snug and … Read more

Immunizations are a good deal for public health, but their growing number and rising costs pose a challenge for plans that must pay doctors for administering them Timothy Kelley MANAGED CARE July 2010. ©MediMedia USA Immunizations are a good deal for public health, but their growing number and rising costs pose a challenge for plans that must … Read more

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – ../../../archives/0002/0002.anticoag.pdf 01-Feb-2000 12:00 65k ../../../archives/0002/0002.compmon.gif 01-Feb-2000 12:00 37k ../../../archives/0002/0002.compmon.pdf 01-Feb-2000 12:00 26k ../../../archives/0002/0002.cover.jpg 01-Feb-2000 12:00 12k 0002.news_pharmacyco..> 01-Feb-2000 12:00 19k 0002.news_pharmacyco..> 01-Feb-2000 12:00 61k 0002.news_premiuminc..> 01-Feb-2000 12:00 19k ../../../archives/0002/0002.outlook.gif 01-Feb-2000 12:00 47k ../../../archives/0002/0002.outlook.pdf 01-Feb-2000 12:00 29k 0002.news_premiuminc..> 09-Apr-2003 23:27 1k 0002.news_pcps.html 09-Apr-2003 23:27 2k 0002.news_pharmacyco..> … Read more

American Cancer Society disputes study’s methodology The number of new cases of metastatic prostate cancer climbed 72% in the decade from 2004 to 2013, according to a study from Northwestern University. The report considers whether a recent trend of fewer men being screened may be contributing to the rise, whether the disease has become more … Read more

Use of so-called “gag rules” by managed care plans is under attack in many states. Bills to ban these rules — which prevent physicians from discussing treatment options, payment policies and other plan provisions with patients — have been introduced in at least 24 states this year, says Anne Markus of George Washington University’s Intergovernmental … Read more

Price transparency along with cost sharing limits are two ways health insurers can avoid adverse tiering, and the bad publicity (and possible litigation) that goes with it, according to a study in the New England Journal of Medicine (NEJM). Last May, two health advocacy groups filed a complaint with the Office for Civil Rights at … Read more

Commercial and public payers concerned by prolonged hospital stays will be considering this μ-opioid antagonist Thomas Morrow, MD Passing gas has been, except for teenagers and the more obtuse movies, a social faux pas. However, for patients who have recently had abdominal surgery, passing gas is actually a landmark event, a sign that their bowel … Read more

What’s bad news for most industries might be good news for managed care. In October 2000, Towers Perrin surveyed 221 large U.S. corporations representing about 7 million people (employees and dependents) to find out how much they were spending on health care. “Following a period of relatively modest growth in health care costs during the … Read more

In this era of tight margins, many health plan executives may be deciding that while offering purchasers customized benefit packages is a nice touch, it is unprofitable. InterStudy Publications’ National HMO Census indicates that a third of HMOs are moving toward standardization of benefits and are choosing to differentiate themselves on some basis other than … Read more

The health plan exodus from Medicare+Choice will affect 934,000 people in 2001 — more than were affected in 1999 and 2000 combined, according to the Health Care Financing Administration. Citing regulatory burdens and poor capitation rates, health plans pulled out of Medicare not just on a county-by-county basis this time, but in many cases, whole … Read more

CONTRIBUTING VOICES The future of population health management: get your game on Serendipity landed me across the table from a couple of enormously brainy people the other day. We sat having drinks overlooking the hubbub of New York’s Grand Central station. One was a seasoned corporate attorney, the other a superbly incisive CEO. I mentioned … Read more

Would you pay $25 a month for direct primary care that provides for convenient office hours and appointments and any medical services a physician can provide in the office? “There are a lot of people who don’t make much money and who pay twice that amount for their cell phone,” says John W. Saultz, MD, … Read more

Some heavy-hitting health care organizations think that the prior authorization process needs improvement, saying that it “can be burdensome for all involved—health care providers, health plans, and patients. Yet, there is wide variation in medical practice and adherence to evidence-based treatment.” The consensus statement was issued earlier this year by the American Hospital Association, America’s … Read more

Not too long ago, disease management was viewed with widespread suspicion. But the evidence mounts that well-designed programs make medical sense and can help patients as well as the bottom line. Peter Wehrwein Let’s say you’re a managed care executive trying to sell physicians on the idea that disease management is a good thing, for … Read more

Health care ranks fourth on a list of problems that the public thinks the government should tackle, according to the Kaiser Health Poll Report. The survey finds that views on health care’s importance differ by demographic group. Telephone interviews with 1,203 adults took place March 31-April 3, 2005. What’s on the public’s mind? Source: Kaiser … Read more

Some things presidential candidates promise are later forgotten. Blame our curiosity, then, for suggesting that one idea floated during the campaign merits examination: George W. Bush’s assertion that he would reform Medicare in the image of the Federal Employees Health Benefits Program. John F. Kennedy remarked that one of the most surprising things he discovered … Read more

Medicare’s pay-for-performance (P4P) program, the Physician Quality Reporting Initiative (PQRI), is falling short on bonus payments, according to a study in the Journal of the American College of Radiology. Not only that, but “There’s very little transparency in the process,” says lead author Richard Duszak Jr., MD, a radiologist at Mid-South Imaging & Therapeutics in … Read more

The greatly anticipated meeting between Medicaid and managed care that’s expected to take place in Florida has been delayed. The program, expected to shift 210,000 Medicaid recipients in Broward and Duval counties into health plans, was to have been launched on July 1. That date has been pushed back to Sept. 1 to give enrollees … Read more

Dyslipidemias, diseases of lipid metabolism, are all significant Risk factors for cardiovascular problems. Identification of kids with dyslipidemias can cause interventions targeted at diminishing their chance of CHD because adults. To Find out the advantages and limitations of signs about the Effectiveness of choosing, testing, and managing kids and teens with dyslipidemia at the length … Read more

CMS’s vision of a new kind of managed care organization fails to demand anything of patients while placing added pressures on providers Richard G. Stefanacci, DO, MGH MANAGED CARE July 2011. ©MediMedia USA CMS’s vision of a new kind of managed care organization fails to demand anything of patients while placing added pressures on providers Richard G. … Read more

MANAGED CARE July 2008. ©MediMedia USA Health plans should look into why medical centers that spend the most per capita don’t necessarily deliver the best care Frank Diamond Health plans need to find some way to insert themselves into the conversation when hospitals they contract with consider whether to launch building programs to add beds or attract … Read more

John La Puma, M.D. Money doesn’t buy health, never mind love. The United States spends more than any other country on health care, but our average lifespan is lower than most of those in Western Europe and Canada. Our major causes of death and disability are related to how much we smoke, how much and … Read more

Medicare Advantage’s Influence Felt in Accountable Care Model ACOs are providers while MA plans are insurers. Still, CMS’s Next Generation ACOs have a familiar look and feel.   It may not seem like such a big deal, but one of the important changes CMS made when it unveiled the Next Generation ACO program in January … Read more

A Conversation with Kathleen Montgomery, PhD She’s in the forefront of efforts to define the unique domain of doctors who become managers. One thing she knows for sure: Trustworthiness is everything. Appropriately, for someone whose research includes looking at physicians who cross professional boundaries to become executives, Kathleen Montgomery, PhD, is something of a boundary … Read more

Renewed Interest In Shared Decision Making Twenty years after SDM’s introduction, health plans are seizing on it to help patients choose their treatments. The lower costs for these patients are a welcome extra. Joseph Burns A Conversation with Suzanne F. Delbanco, PhD: Employers Enlist Health Plans In Campaign for Payment Reform The Catalyst for Payment … Read more

Frank Diamond Steve Jobs famously staked his claim at the intersection of technology and creativity. Health insurers are looking for the intersection of technology and benefits knowledge, but are not quite sure how to get there. Do you hire information technicians and train them in the ways of health coverage, or do you hire (or … Read more

Cardiovascular disease, diabetes, and cancer benefit most from case management, according to the 2011 Benchmarks in Healthcare Case Management: Responsibilities, Results, & ROI. Case management involves the collaborative efforts to assess, plan, implement, coordinate, monitor, and evaluate the options and services required to meet a patient’s health and human service needs. The Commission for Case … Read more

By MargaretAnn Cross Contributing Editor A member signing on with a consumer-directed health plan may be attracted to the idea of taking on more responsibility for his own care, but what he’ll find once he has to have surgery, for example, is that many of the medical management mainstays of managed care are still in … Read more

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

WellPoint Health Networks is trying to attract an underinsured, price-sensitive market: the working poor. WellPoint hopes its new low-cost plans will lure small employers and uninsured people who earn under 200 percent of poverty. The product has a relatively rich catastrophic benefit and moderate limitations on routine care. It relies on high copayments to keep … Read more

“I was staggered by the outcomes. This truly assists us with bettering comprehend medical services in this country. This exploration highlights the way that crisis offices are basic to our country’s medical services conveyance framework.” said David Marcozzi, a partner educator in the UMSOM Branch of Crisis Medication, and co-head of the UMSOM Program in … Read more

HMOs are not rushing to follow the lead of the largest not-for-profit health plan because they fail to see how this makes them more competitive.   Kaiser Permanente’s recent mandate to post clinical treatment guidelines on its web site for enrollees later this year produced a ho-hum response from major health plans. Consumer groups hoped … Read more

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

The FDA has given the green light to expanded use of the Vidas Brahms PCT assay (bioMérieux Inc.) to help health care providers determine whether antibiotic treatment should be started or stopped in patients with lower respiratory tract (LRT) infections, such as community-acquired pneumonia, and stopped in patients with sepsis. This is the first test … Read more

Patients show 30% reduction in risk of death versus control Positive results have been reported from a phase 3, open-label, randomized study evaluating nivolumab (Opdivo, Bristol-Myers Squibb) in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck (SCCHN) after platinum therapy compared with the investigator’s choice of therapy (methotrexate, docetaxel, or cetuximab). … Read more

It’s been a year since the American Association of Health Plans said it would make compliance with its patient-centered policies a condition of membership. And never mind what you may read about those cold, heartless HMOs: Since that announcement, says Susan Pisano, vice president for communications, plans have embraced those policies full-bore. “The overwhelming response … Read more

With federal budgets tightening and the ranks of the elderly swelling, the managed care approach is expected to transform Medicare. What will this mean for HMOs and the physicians they contract with? For the elderly, the face of medical care is undergoing a drastic change. Medicare recipients are joining managed care organizations at a record … Read more

I once had a patient with HIV who refused to take his medication. His noncompliance was not because he lacked information about his illness or because he didn’t understand why it was important to take his medications. He knew full well that he would die without taking them. After doing a little digging, I learned … Read more

Mail order programs can provide savings, but HMOs need to ensure that they are actually receiving sufficient value. Consultants and pharmacy benefit managers often recommend designing and implementing a mail prescription service. There are a number of factors that need to be addressed to ensure an efficient and cost-effective program. Examining an existing mail prescription … Read more

At a glance Cesarean Section Appropriateness Collaborative Chicago, Ill. Participants: 5 employers, 5 hospitals, 3 health plans Number of covered lives: 1 million Goal: Safely to reduce the proportion of cesarean section births National average C-section rate: 21.2 percent Chicago area average C-section rate: 24 percent Program’s C-section goal: 15 percent Strategy: Educate physicians, nurses and expectant mothers about the benefits of … Read more

Improving physician behavior probably ranks somewhat lower on hospital priority lists these days than getting ready to avoid penalties for early readmissions, which are mandated by the Affordable Care Act. A study by IMA Consulting says that many hospitals are still not prepared to deal with this. The study cites the Centers for Medicare & … Read more

Decellularized vascular grafts will be studied in dialysis patients with ESRD   May 23, 2016 AlloSource, a nonprofit cellular and tissue network, has announced the distribution of investigational bioengineered blood vessels for use in phase 3 clinical studies. The first shipment will be used in a trial investigating the potential of the blood vessels, manufactured … Read more

Group on Health sounds promising, but may not deliver the exact impact to self-insured companies its founders are still promising. The approach glosses over a crucial question: Exactly what makes”high-value”? This is of significance plays an essential part in learning the attention that patients eventually get. Formulary” it expects all buyers might utilize. This type … Read more

California Medical Association lobbyist Norm Plotkin will tell you that the language he managed to add to California Senate Bill 19 is necessary to protect physicians from stiff fines under the state’s new privacy law, and to keep them in the loop when patients are enrolled in disease management programs. But his last-minute amendment has … Read more

Society must realize that health care resources are limited and then must use them rationally. Fairly, too? Medical ethicists believe the United States needs to have a forthright public debate about how to spend limited health care resources wisely. We simply can’t pay for everything, so we must — as a country — decide what … 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. MargaretAnn Cross Contributing Editor Not … Read more

It costs about $19 to process a single health care claim, according to a survey by Milliman & Robertson, the actuarial firm. Now, an electronic system designed to whittle the cost and time involved in claims resolution may be around the corner. RealMed, an Indianapolis-based software developer and system integrator, plans to unveil a “smart … Read more

How lucky we are to be alive right now.” Those lyrics from Hamilton, when applied to innovation in health care, remind us how often life imitates art. One of health care’s most dramatic advances has been the progress of precision medicine, wherein medical treatment is tailored to the individual characteristics of each patient. Yet payers … Read more

MANAGED CARE December 2008. ©MediMedia USA News and Commentary The top 10 health plans were announced by U.S. News & World Report and the NCQA. The report identified the top commercial, Medicare, and Medicaid plans. Coming in at number 1 again this year among commercial plans was Harvard Pilgrim Health Care of Maine and Massachusetts, with Tufts … Read more

A highly respected expert on medical-decision making, Harold Sox, M.D., has been named editor of Annals of Internal Medicine. Sox, who will succeed the retiring Frank Davidoff, M.D., in July, was president of ACP-ASIM from 1998 to ’99, and chaired the Second U.S. Preventive Services task force. Genetic discoveries and public policy changes will make … Read more

Medical errors are estimated to function as third-highest trigger Of passing in the nation. Pros and patient safety advocates are attempting to improve this. However, at one of many gear that is contemplated that a cure isn’t yet working and it needs to, proposes that a report published Thursday. That is based on this Leap … Read more

Shares of Puma Bio-technology have Tripled since the onset of year to more than $ 9-5, whilst the la company has put to establish its introduction medication, Nerlynx to get HER2 positive breastcancer. Now analysts are forecasting premium prices for the newest medication they believe may drive stocks much greater. Investors stating he was tipped … Read more

Despite the fact that many of the incarcerated used opioids before being arrested, the criminal justice system has been wary of dispensing addiction-fighting medications. About one in five prison or jail inmates used heroin or opioids regularly before being locked up, Kaiser Health News reports. That places those institutions in a unique position to steer inmates toward … Read more

Numbers tell part of the story of the nation’s opioid crisis. The CDC says 91 Americans die daily from opioid overdoses, which have killed more than 300,000 since 2000—and the death rate is rising. But to John Machata, MD, of Wickford, R.I., some of the numbers have faces. He remembers the call he got not … Read more

Conversations about the value of health care treatments have not traditionally included the patient perspective. In the past, value has been measured through cost-effectiveness analyses that weigh the clinical benefits of a treatment against its costs without a consideration of how those benefits align with what patients want from a treatment. Value-assessment efforts often included … Read more

BY SCOTT WEINGARTEN, M.D., M.P.H., F.A.C.P. Research has shown that from 80 to 90 percent of health care costs are directly or indirectly determined by clinical decision-making. It is clear that however a health care organization tries to “re-engineer” or to apply total quality management or continuous quality improvement, it won’t achieve real control of … Read more

Centers for Medicare and Medicaid Services Administrator Thomas Scully has defended the Bush administration’s plan to allow states to opt out of mandatory Medicaid-coverage requirements. The CMS (formerly HCFA) chief, deflecting criticism that states might not use their savings to expand health coverage, says they will be required to plow the money into coverage for … Read more

John Carroll From his vantage point at the National Conference of State Legislatures, Richard Cauchi counts 900 state laws that mold the way business is done by health plans coast to coast. It started about 10 years ago, as managed care emerged as a leader in the delivery of health care — and a lightning … Read more

MANAGED CARE December 2007. ©MediMedia USA Health insurance for all is essential, but not enough, says the Commonwealth Fund. In the report A High Performance Health System for the United States: An Ambitious Agenda for the Next President, it outlines strategies to contain costs and organize the health care delivery system…. An Ohio House bill may require … Read more

For all the potential of the Internet to erase old physician doubts about integrating information technology into everyday practice, scant few doctors have embraced it. A study by WebsurveyMD.com, a market-research organization, finds that physicians have little interest in Internet-based medical applications and are skeptical about the Internet’s potential benefits to health care delivery. When … 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

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – ../../../archives/0004/0004.compmon.gif 01-Apr-2000 12:00 46k 0004.compmon.html 09-Apr-2003 23:31 2k ../../../archives/0004/0004.compmon.pdf 01-Apr-2000 12:00 31k 0004.contents.html 09-Apr-2003 23:31 4k ../../../archives/0004/0004.cover.jpg 01-Apr-2000 12:00 10k 0004.daimler.html 09-Jun-2003 11:44 11k 0004.diamler.html 09-Jun-2003 11:44 12k 0004.editorsmemo.html 09-Apr-2003 23:31 3k 0004.ethics.html 09-Apr-2003 23:31 8k 0004.finger.html 09-Jun-2003 11:44 14k 0004.ipas.html 09-Jun-2003 11:44 24k 0004.legal.html … Read more

Blue Cross & Blue Shield of North Carolina addresses social factor as way to managed population health Frank Diamond Managing Editor Don Bradley, MD, the chief medical officer at Blue Cross & Blue Shield of North Carolina, says that health plan officials understand that they must venture into areas once the purview of public policy. … Read more

At a Questionnaire 8-K issued last Week, Spectrum Pharmaceuticals explained that it had”received a comprehensive Response Letter from the FDA into the New Drug Program for Qapzola.” The research noted that the firm satisfied together with the bureau on Nov. 1-5, And that centered on the negotiations, the corporation is evaluating a brand new smaller … Read more

A widely available but underused molecular genetic blood test has proved to be accurate over 98% of the time and costs less than $400 With the development of molecular diagnostics evolving at a rapid pace, it can be challenging for third-party payers to keep abreast of best practices in genetic testing and to develop smart … Read more

BY JOHN LA PUMA, M.D. Viagra is on every man’s lips, but not as much as we’d like. Managed care organizations have started to limit access. According to the Associated Press, Aetna offers no coverage. Kaiser Permanente is studying it. Prudential and United HealthCare cover some patients, depending on the plan. Cigna will pay for … Read more

The managed care industry says that the ramifications of the Supreme Court decision will be slight. But could that be just wishful thinking? When the Supreme Court recently came down solidly on the side of Kentucky’s “any willing provider” statute, industry leaders quickly shrugged off any major implications. “Today’s ruling by the U.S. Supreme Court … Read more

The Fifth Circuit Court of Appeals upheld three suits filed against HMOs under Texas’s right-to-sue law, based on assertions that the plans refused to cover medically necessary care. Two of the decisions reverse a federal court’s finding of ERISA pre-emption…. A URAC survey indicates that while 74 percent of health care organizations can link claims … 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

Large employers are increasingly setting up health clinics on-site or near workplaces to encourage workers to keep on top of basic and chronic health problems in hopes of keeping medical costs down. A 2018 Mercer survey found a third of employers with 5,000 or more employees had clinics, up from a quarter in 2012. Self-insured … Read more

We’ve made strides in increasing the transparency of pricing in the pharmacy supply chain, and now we need to change dispensing behavior Thomas Kaye, RPh, MBA Pay for performance in medicine is a topic of wide discussion among managed care executives for its supposed ability to contain costs, to improve health outcomes, and to raise … Read more

Or protracted utilization of general sedation and anesthetic medication throughout procedures or surgeries at kids younger than three decades or in elderly women throughout their 3rd trimester might impact the growth of children’s brains. In Line with animal research, recent studies suggest a Single, relatively brief experience of overall sedation and anesthetic medication in babies … Read more

Genetic advances could spawn incredible improvements in health care. Given public demand, they also pose what may be unmanageable issues of resource use. By Michael D. Dalzell Managing Editor At the dawn of the 21st century, we stand on the cusp of the fourth great age of healing: genetic medicine. There are striking similarities between … Read more

MANAGED CARE January 2010. ©MediMedia USA John Marcille The dominant health care news for months has been the reform legislation in Washington, and we cannot ignore it. But while we’ve done our share of reporting on this process, we know that there is plenty going on in the managed care industry itself that also deserves attention. Take … Read more

Because specialty drug expenditures will grow, P&T committees may become more involved with drugs provided under the medical benefit Sarah Collins, MBA Specialty pharmaceuticals have contributed substantially to the rise in the nation’s drug bill over the last several years. Given their presence in the FDA pipeline, they are expected to continue to do so. … Read more

GlaxoSmithKline Plc said on Saturday its own asthma medication, Nucala, that is approved in the USA and Europe, revealed a similar security profile at a longterm study in comparison to previous research studies. GSK Said Nucala, that will be administered once every 4 weeks by regeneration, claimed its risk/benefit profile within an elongated 52-week period … Read more

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. How the … Read more

Physicians are a tough audience for clinician executives at health insurance plans. We’ve been reporting on the doctor-plan tension for a long time, and have excitedly — but always warily — noted any sign of rapprochement. (For instance here, way back in 1998: Truce!) One of the things that obstructed such cooperation was physicians’ feeling that … Read more

Approximately 25 percent of physician organizations pay their doctors on a purely fee-for-service basis, 25 percent pay them on a purely prospective (capitation or some method completely unrelated to productivity) basis, and 50 percent pay the physicians by using blends of retrospective and prospective payment methods, according to a study by researchers in the School … 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

Tennessee Gov. Don Sundquist wants a $400 million tax increase, much of which would keep TennCare, the state’s managed Medicaid program, from “imploding” — as put by its director, Brian Lapps. An actuarial study found that TennCare, which covers nearly a fourth of the state’s residents, is $289 million underfunded. Lapps says TennCare needs to … Read more

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

For years, it’s been a matter of educated conjecture that some Medicare HMO enrollees skip from health plan to health plan to take advantage of pharmacy benefits: Once an enrollee exhausts the benefit in one plan, he jumps to another and begins with a clean slate. Now, a study in the Journal of the American … Read more

Fourth quarter and full-year 20 20 financial outcomes. The business continues its efforts to lead a as it handles the maximum tumultuous disaster in aviation heritage. United has increased over $26 billion in bandwidth and made crucial advancements in cutting core cash burn off to make sure the organization’s survival. On the previous 3 quarters, … Read more

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – 0004.risk.html 09-Jun-2003 11:44 12k 0004.qna_inlander.html 09-Jun-2003 11:44 17k 0004.outcomes.html 09-Jun-2003 11:44 15k 0004.ipas.html 09-Jun-2003 11:44 24k 0004.finger.html 09-Jun-2003 11:44 14k 0004.diamler.html 09-Jun-2003 11:44 12k 0004.daimler.html 09-Jun-2003 11:44 11k 0004.compmon.html 09-Apr-2003 23:31 2k 0004.contents.html 09-Apr-2003 23:31 4k 0004.editorsmemo.html 09-Apr-2003 23:31 3k 0004.ethics.html 09-Apr-2003 23:31 8k 0004.news_amap.html … Read more

It took a while for a managed care company to combine a consumer-directed plan with a traditional HMO. Health Net of California, taking advantage of the strengths of California’s managed care market, is launching a hybrid product called OptimizerHMO that “provides tools to help [members] make better health care decisions and incentives for demonstrating healthy … Read more

More than half of shortages involved life-saving drugs Emergency departments (EDs) are health care’s front line — in the U.S., nearly 45 out of 100 people visit an ED in any given year. But there is an issue brewing behind the scenes in emergency medical facilities, one that can’t be fixed by a simple stitch … Read more

A longtime advocate is still betting on a single payer system because, she says, the new reform law won’t come near to doing what’s needed All of the talk about health care reform has been a little like debating whether to “give a cancer patient Tylenol or aspirin when the person needs a surgeon,” says … Read more

Bob Carlson Issues like HMO solvency, physician antitrust waivers, and external review come and go, but you’ll find scope-of-practice bills in state legislatures year after year. State laws determine what optometrists, naturopaths, psychologists, and other allied health practitioners can do. Despite vigorous opposition from state medical associations, scope-of-practice bills succeed in changing those laws every … Read more

University Hospitals Case Medical Center in Cleveland, Ohio, is the first site in the world to use a new technology for patients with hypertension. Led by Sahil Parikh, MD, the team performed the first procedure on a subject in the international RADIANCE-HTN trial, which is evaluating the effect of the ReCor Paradise renal denervation system … Read more

Interest in consumer-directed health plans lost steam last year, with the number of employers offering such plans declining for the first time since 2007, according to United Benefits Advisors, a benefit survey organization. The 2012 UBA Health Plan Survey calls this a critical trend that its employer customers should consider “when making health plan purchasing … Read more

Subscription Options for Managed Care

A CONVERSATION WITH RICHARD STEFANACCI, DO This expert who hopes to help everybody adjust nevertheless expects big headaches come Jan. 1, 2006. However, e-prescribing could make the drug plan work. Once Medicare’s new prescription drug benefit and revamped approach to managed care kick in next January, expect a bumpy transition for millions of beneficiaries and … Read more

The percentage of heart failure–related deaths that occur in a hospital has been decreasing steadily — from 42.6% in 2000 to 30% in 2014, according to CDC researchers. The percentage of deaths attributed to heart failure in nursing homes or long-term care (LTC) facilities decreased from 30.1% in 2000 to 26.7% in 2014. Rates of … Read more

A major assessment of Americans’ health is mixed. What role has managed care played in the nation reaching — or not reaching — key health goals? We’ve only fully met about 15 percent of the objectives set out in the Healthy People 2000 program, which Washington developed in 1979 as a blueprint for federal and … Read more

Loopholes in federal and state laws that curb physician referral to diagnostic imaging providers in which they have a financial stake (self-referral) are allowing physicians to stretch how they are paid and for what. Jean M. Mitchell, PhD, a professor of public policy at Georgetown University, gathered information on all providers (physicians, hospitals, independent diagnostic … 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

Prescription costs are expected to increase at a lower rate than medical costs during the next 12 months. This will be the first time in four years that the general pharmacy cost will be lower than medical costs. So says a survey of 70 health care insurers conducted by Aon Consulting, a provider of risk … Read more

An investigational long-acting formulation of the opioid painkiller oxycodone (Troxyca ER, Pfizer) can be manipulated despite its potential to deter abuse, according to a preliminary review by FDA staff. Pfizer is seeking approval of Troxyca ER for the management of chronic pain that may require daily, around-the-clock opioid treatment and for which alternative treatment options … Read more

Banning Indoor Smoking Helps Kids With Asthma You’ve Got a Friend Electronic Health Records Bolster Diabetes Outcomes Case Studies That Flunk Every Plausibility Test Known to Mankind Population management claims: The Seven Rules of Plausibility provide means to test the claims of population management vendors. With case studies and commentary. Reports of the Death of … Read more

Despite several advances in postresuscitation care on the last ten years, population-based mortality rates of patients hospitalized with cardiac arrest from the USA have been studied within this period of time. The intention of this analysis was to establish that the yearly in-hospital mortality rates of patients having cardiac arrest by 2001 to 2009. Employing … Read more

Fifty-seven percent of employers with 500 or more workers are providing wellness programs to their workers. This is up from 49 percent in 2006. The number of smaller employers that offer programs has remained steady the last two years at 16 percent, according to MetLife’s Employee Benefits Trends Study… Hawaii has dropped the only state … Read more

Manufacturer Endo Pharmaceuticals is “evaluating the options” The FDA has requested that Endo Pharmaceuticals remove its opioid pain medication, reformulated Opana ER (oxymorphone hydrochloride), from the market. The agency is seeking removal based on its concern that the benefits of the drug may no longer outweigh its risks. This is the first time the agency … Read more

CONTRIBUTING VOICES Shingles is Hell! Three days of a severe headache that would not respond to the ibuprofen, naproxen, or acetaminophen. “I never get headaches” is what I said multiple times to my wife and to colleagues. The morning of day three, a rash started to appear on my forehead, in the left eyebrow, in … Read more

MANAGED CARE April 2010. ©MediMedia USA With 2010 well under way, Medicare beneficiaries participating in Part D plans face increasing drug prices for which they will have to pay 100 percent of total drug costs after their spending exceeds the initial coverage limit, according to a new report from the Kaiser Family Foundation. It should be noted, … Read more

These arrangements too often become a hindrance instead of a help. Simple precautions today can help prevent major headaches later on. It seems as though every week, another managed care organization announces that its financial targets cannot be met, or even that it is heading into insolvency. In contrast to fee-for-service health care, the managed … Read more

MANAGED CARE March 2010. ©MediMedia USA Will insurers provide coverage for a new device that takes much of the guesswork out of screening for this deadly skin cancer? Thomas Morrow, MD Nearly 70,000 Americans will be diagnosed with an invasive melanoma, very difficult to treat, this year. In the past 30 years, the incidence of invasive melanoma … Read more

Move comes amid national drug-pricing controversy   Last week, Pfizer increased the list prices of its medications in the United States by an average of 8.8%, according to an article in STAT News. This is the second time this year that the company has boosted prices for its prescription drugs. On January 1, Pfizer’s prices rose an … Read more

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

Physical therapy could help many people avoid expensive and unnecessary back surgery. F​irst the good news: For employers and other health care payers, the medical cost trend this year will be, as it has been for the past several years, relatively stable. But now for that other, less desirable variety of news: The medical cost trend … Read more

One of the possible issues is ‘biosimilars,’ agents that would fill the role that generics play in traditional pharmacy coverage John Carroll Last year, Kaiser Permanente could count 50 patients in its northern California division whose cumulative drug costs hit $10 million. Sharon Levine, MD, the associate executive director of the Permanente Medical Group, doesn’t … Read more

I went last night to my first meeting of an exclusive club. It’s a club whose literature offers newcomers an ironic greeting. It tells them: “We’re sorry you’re here.” I went more out of curiosity than immediate need, for I’d paid my dues a long time ago. The club is Survivors of Suicide, and I … Read more

Health Reform and the Use of Financial Incentives in Wellness Programs The Affordable Care Act codified the worksite wellness exemption to the federal medical underwriting provisions in the group health plan market. This means companies are allowed to use an “outcomes-based” incentive model that provides financial rewards for those who satisfy a prescribed health standard … Read more

Employee Health programs have become a staple in Most companies as a Method to draw great talent, keep them productive and happy, and reduce employee turnover. In Reality, 80 percent of employees in firms with strong health and Health apps in the office feel participated and looked after with their own companies. The Trick to … Read more

Advanced therapy management may lead to physician acceptance of additional medications infused at home Home infusion has been around for over 30 years, but it is a service that has never really taken off. Effective infusion drugs have been developed for acute conditions, but home infusion has been relegated to less glamorous uses such as … Read more

This could be actually the very first FDA-approved CGM strategy to incorporate an entirely conductive sensor to find sugar, which is exploited for approximately ninety days. “The FDA is dedicated to progressing publication Items that leverage This endorsement of an even seamless electronic system which gives patients the potential to effortlessly manage a chronic illness … Read more

Also available in PDF ABSTRACT PURPOSE: The unsupplemented Medicare Part D prescription drug benefit does not provide coverage for stand-alone prescription drug plan (PDP) beneficiaries within the coverage gap (often called a doughnut hole) in Medicare Part D. DESIGN: We evaluated whether the doughnut hole was a factor in altering prescription fulfillment decisions regarding cardiovascular … Read more

There was little difference between the options in terms of the frequency and cost of return visits. Patients receiving one-stage reconstructions returned slightly less often for breast-related services during the first 18 months after reconstruction, but the difference was not statistically significant. Abstract Objective: Growing acceptance of nipple-sparing mastectomy and rising rates of prophylactic mastectomy … Read more

Medical Savings Accounts: Movement Toward Individual Health Benefit Accounts Robert A. Connor, Ph.D., M.H.A. Who Is at Risk for Influenza? Using Criteria Other Than Age Jenae M. Plourde Ernst, M.P.H. Pneumococcal Conjugate Vaccine for Young Children Sharon Selman ; Diane Hayes ; Lawrence A. Perin ; Winifred S. Hayes Prospective Value-Based Assessment Of New Health Care Technologies and Practices Christopher S. … Read more

At a glance Savannah Business Group on Health Savannah, Ga. Covered Lives: 34,000 Membership: 22 employers Strategy: Preferred-provider arrangements for hospital, medical and ancillary services. Affiliation with an alliance of coalitions to gain access to national contracts. The destination of General William T. Sherman’s march to the sea in 1864 was the coastal city of Savannah, Ga. After … Read more

So far in 2006, if the benchmark measure is inflation, then physician salaries are above that line, and work RVUs (relative value units) are below that indicator. RVUs are used by CMS and other payers to determine the payment rate for physician services. According to the Medical Group Compensation & Financial Survey, groups report an … Read more

Business health isn’t a brand new idea. Johnson & Johnson’s Live for-life application , frequently called the model for corporate worksite health programs, has been launched in 1979 and has been viewed as revolutionary; offering their workers onsite accessibility to behavior modification equipment and teaching them on topics like stress management, nutrition. Ever since that … Read more

Color chart Also available in PDF A dramatic increase in pharmaceutical expenses contributed to HMOs’ less-than-stellar financial performances during the last two years. Sharp cost hikes for some of the most widely prescribed classes of drugs, coupled with new uses of medicines to treat chronic illnesses, are spurring this trend.Antidepressants move up to second in … Read more

Some of the nation’s best health plans are coming up with creative ways to encourage women to get mammograms. The importance of breast cancer screening received renewed attention in November after Elizabeth Edwards was diagnosed with the disease and acknowledged that she had not had a mammogram in four years. Edwards, the wife of last … Read more

Become a frequent topic of conversation. Almost 30 percent of men and women looking for mental health providers report cost being a significant deterrent. Vittorio Maio, PharmD, by Jefferson College of Population Health lately published a post talking the Influence of this Affordable Care Act’s Medicaid growth. Both talk the way that it gave lots … Read more

Louisiana Health Care Alliance Goal: Lower health care costs for small and large employers in Louisiana Number of employers represented: 100 Number of employees involved: 250,000 Amount, based on experience of other states, that the purchasing coop hopes to save employers: 10—20% Although its bayous are filled with deceptively drowsy ‘gators, Louisiana is also home to a number of … Read more

LEGAL FR0NT The Senate version would leave previous state and federal rulings against HMOs intact. Medical directors ignoring external-review boards can be sued. The recent passage in the Senate of the Patients’ Bill of Rights means patients are closer than ever before to being able to sue health plans and their employees. This bill amends … Read more

Formulary managers need to make head-to-head comparisons of dabigatran and other anticoagulants used to treat atrial fibrillation Thomas Reinke Sometimes it can be hard for a new medication to become established when its competition is a drug with an illustrious history. Warfarin, the stalwart clot fighter, began life as rat poison, causing fatal bleeding. Its … Read more

BY NEIL CAESAR, J.D. Suppose you decide to contract for “designated health services,” such as diagnostic imaging, physical or occupational therapy, prescription drugs or hospital services, that are prohibited under the Stark law. Suppose further that the financial arrangement does not satisfy any of the Stark law’s exceptions. Is there any way you nonetheless may … Read more

Medicare’s pay-for-performance (P4P) program, the Physician Quality Reporting Initiative (PQRI), is falling short on bonus payments, according to a study in the Journal of the American College of Radiology. Not only that, but “There’s very little transparency in the process,” says lead author Richard Duszak Jr., MD, a radiologist at Mid-South Imaging & Therapeutics in … Read more

This year, the impending national election in November will play a significant role in dampening the groundswell of voter desire for some sort of legislative health care reform. And while consumers’ frustration at rising drug costs continues to grow, few politicians are likely to risk a platform that includes major cost reductions in health care. … Read more

Two studies suggest that this design may not be a long-term method for controlling costs The debate over consumer-directed health care (CDHC) — the next great hope or mostly hype — got a little louder recently when two organizations checked in on the early adopters of CDHC and came away frowning. A report by the … Read more

Managed care has the potential not just to achieve savings, but to improve health care outcomes dramatically. But does it create extra malpractice complications along the way? The experts have different views. You might call the Austin Regional Clinic in Austin, Texas, an anomaly, an exception to the conventional wisdom about managed care. The clinic, … Read more

But, PBMs are confronting growing examination for an alleged lack of transparency in neglecting to ensure asserts, together with testimony from drugstore spouses who’ve undergone hardships from PBM clinics. The Other Day, Gilead Sciences advised Bloomberg News which All these drugs, such as for instance Sovaldi (sofosbuvir), are exceptionally pricey, and also the pharmaceutical industry … Read more

Tomorrow’s Medicine How small is small? The latest digital camera takes images of a patient’s ‘inner space.’ Thomas Morrow, MD The 1966 movie “Fantastic Voyage” took us on a trip through the human body. Today, a device called the PillCam is capturing the essence of that travel. The PillCam, a small digital camera about the … Read more

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

MANAGED CARE October 2011. ©MediMedia USA Many currently marketed antidepressants will be falling off the patent cliff soon. Nonetheless, the antidepressant market is set for steady expansion, according to Datamonitor, a drug information company. The company compiled data from seven major markets for this drug category and found total sales to be $10.9 billion in 2010. By … Read more

Cardiovascular disease (CVD) is primarily a disease of old age. But it’s certainly capable of cutting down people in the prime of life, something that worries the World Health Organization (WHO) and U.S. health officials. The WHO wants to see a 25% reduction in premature mortality (death between ages 30 and 70) caused by CVD … Read more

Repeal and Replace, Part Deux A return to the dark days of unaccountable care? One thing lost in the din about repealing the Affordable Care Act is that the ACA gave value-based health care the biggest shove forward it’s ever gotten. The health care reform law set standards for the development of quality measures and, … Read more

Epidemic proportions internationally. Worldwide, the incidence of chronic, non communicable diseases is rising in an alarming speed. Approximately 18 million people die annually from cardiovascular disorder, for that hypertension and diabetes are major predisposing factors. As stated by a quote of International Diabetes Federation relative incidence of Diabetes throughout 2007 is 8.0 percent and more … Read more

John M. Eisenberg, MD, MBA, the director of the federal Agency for Healthcare Research and Quality, died March 10, of a brain tumor. He was 55. Eisenberg was named AHRQ’s director in 1997 (when the agency was still known as the Agency for Health Care Policy and Research), becoming the point man for the federal … Read more

Send editorial inquiries and questions to: Peter Wehrwein, Editor (link is external) To respond to an article for possible inclusion in the “Letters to the Editor” column, write to: Editors (link is external) Advertising inquiries, including media kit requests: Maureen Dwyer Liberti, Publisher (link is external) Production, including advertising deadlines and materials Dawn Flook (link … Read more

By Peter Wehrwein Two years ago, Medicaid managed care looked mighty tempting to Jeff D. Emerson, the CEO of NYLCare Health Plans of the Mid-Atlantic. Other plans seemed to be doing OK enrolling Medicaid beneficiaries as members. And there was a tantalizing number of covered lives at stake–over a million in his company’s prime stomping … Read more

NCQA has clarified how many plans publicly reported HEDIS data in 1998: 247 managed care organizations, representing 410 products, shared HEDIS data in Quality Compass ’99…. More than 6 in 10 physicians responding to a Kaiser Family Foundation survey see health plans deny prescription-drug coverage routinely; 37 percent of those say the most recent event … Read more

Advanced therapy management may lead to physician acceptance of additional medications infused at home   Home infusion has been around for over 30 years, but it is a service that has never really taken off. Effective infusion drugs have been developed for acute conditions, but home infusion has been relegated to less glamorous uses such … Read more

MANAGED CARE OUTLOOK On the whole, large employers are more satisfied with their pharmacy benefit managers than are HMOs, but a study released by the Pharmacy Benefit Management Institute suggests that both groups find their PBMs lacking in some aspects of utilization management and service. Room for improvement Employers and HMOs share common concerns about … Read more

Tom Price takes aim at federal mandates In testimony before House appropriators, Health and Human Services (HHS) Secretary Tom Price has stated that the Trump administration is still determined to dismantle parts of the Patient Protection and Affordable Care Act (PPACA) even if Republicans lack the votes to rewrite it, according to an article in … Read more

Ateev Mehrotra, MD, MPH, is an associate professor of Medical care policy and medicine at Harvard Medical School and Also a hospitalist in Beth Israel Deaconess Medical Center. Much of Dr. Mehrotra’s research is dedicated to delivery creations like retail practices, e-visits, and telemedicine, for example their effects on quality, costs, and accessibility to medical … Read more

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. Labor Unions For Physicians: An Idea Whose Time Is Coming? To most people, the idea of class struggle conjures up anything but the image of downtrodden physicians. And … Read more