A pharmacist controlled anticoagulation service was pioneered at a multi-physician household medicine clinic in December 2006. As a way to find out the individual and doctor satisfaction with the aid of a study was created to spell out the patients’ satisfaction with the warfarin instruction and direction they received from the pharmacist, also to characterize … Read more

A CONVERSATION WITH MICHAEL L. MILLENSON This former journalist is participating in one of the biggest stories of our time: Helping health plans and physicians locate that elusive point where doing the right thing and maximizing bottom lines intersect. Michael L. Millenson’s Demanding Medical Excellence: Doctors and Accountability in the Information Age (University of Chicago Press, 1997) … 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

Doctors have a saying: ‘Half of what we know is wrong.’ In which half is the conventional wisdom that competition is society’s best hope for improving quality and controlling costs? MANAGED CARE February 2007. ©MediMedia USA Doctors have a saying: ‘Half of what we know is wrong.’ In which half is the conventional wisdom that … Read more

Senior Vice President, Commercialization and Portfolio Management AstraZeneca Pharmaceuticals There is an expression often called “the curse,” attributed to the Chinese by most people, that goes, “May you live in interesting times.” And given the current state of affairs in managed care, to describe these times as merely interesting is to put it much too … Read more

Introduction Identifying the reasons for poor financial performance of health plans is important for startups and health plans expanding their markets and for state and federal regulators who aim to promote competitive markets, for health insurance. This is especially important during a time when 112 members of the House of Representatives have cosponsored HR 1384, … Read more

The 2016 election season: Democrats to play D while GOP devises a game plan   You can expect to hear about the ACA often during the presidential election next year. What is said about it will depend, of course, on the party. “I think health care has become a place holder for an ideological debate … Read more

Cancer specialists think that the U.S. Food and Drug Administration is too slow to approve new cancer-fighting medications and devices, and that such tardiness hinders physicians’ ability to fight the disease. A Competitive Enterprise Institute survey of 160 cancer specialists found that almost 8 of 10 oncologists think the FDA’s approval process has “hurt their … Read more

We’re in a quandary, says Paul R. Berger, MD, a consultant with William M. Mercer, pointing out that consumers do indeed mind having to pay more for choice. Technology has so often been pointed to as coming to the rescue of the health care system that you’d think that by now an expert such as … Read more

Full text of this article (PDF) ABSTRACT Purpose: HMG-CoA reductase inhibitors (“statins”) have become the drug class of choice for the treatment of hyperlipidemia. Six product brands encompassing 20 dosage strengths have been available during the past two years. The objective of this review is to describe dosing trends for the six statin brands and to … Read more

Whether a person is likely to develop diabetes, cancer, schizophrenia, or stroke will be reasonably well predicted, and tests can also determine whether a patient will respond to a given therapy. That’s the good part. At GHI in New York City, Chief Medical Officer Maria Lopes, MD, is asked to authorize payment for an investigational … Read more

Overall response rate was only 19% Patients with acute myelogenous leukemia (AML) whose disease had relapsed or was resistant to chemotherapy and those who were unable to tolerate chemotherapy have shown clinical responses to venetoclax (Venclexta, AbbVie/Genentech), with complete remissions in some, according to new phase 2 data published in Cancer Discovery. Venetoclax is a small-molecule … Read more

Affordable Care Act helps keep spending growth at modest level, report says Total health care spending growth is expected to average 5.8% annually over 2015–2025, according to a report published in Health Affairs and authored by the Centers for Medicare and Medicaid Services’ (CMS) Office of the Actuary (OACT). Projected national health spending growth remains lower than … Read more

The battle over legislation that would bind private insurance plans to consumer protection measures, while lifting their exemptions from the Employee Retirement Income Security Act, is starting to wear down its champion in the Senate. New York Republican Alfonse D’Amato, trying to force a vote on the Patient Access to Responsible Care Act before Congress … Read more

Learning these lessons from the Veterans Health Administration, the nation’s largest integrated system, leads to organizational success To have a meaningful discussion on improving health care delivery, one must first understand both how the individual components of health care systems function and how they interrelate. In my view, too much of health care today is … Read more

EDITOR’S MEMO John A. Marcille It happens over and over. Somebody has a clever idea for a system that will promote better care and/or lower cost. The health care system as a whole embraces the system, uses it for a while and then finds problems that were not envisioned, or were minimized. Global capitation encourages … Read more

Publication outlines implementation strategies in acute care According to the Centers for Disease Control and Prevention (CDC), drug-resistant bacteria cause two million illnesses and 23,000 deaths annually. The National Quality Forum, a nonprofit organization, has convened more than 25 experts and national stakeholders from the public and private sectors to develop Antibiotic Stewardship in Acute Care: … Read more

Affirmation of the efficacy of new and not-so-new cancer therapies was a running theme at the 2015 ASCO Annual Meeting. But a fiery talk by Memorial Sloan Kettering Cancer Center’s Leonard Saltz, MD, about the costs of many oncology therapies (see box below) has given greater momentum to the opinion that their affordability should be … Read more

The research included a lot more than 6,800 people in Iran elderly 50-75 – a few together with previous heart issues along with many others without. They Were given healthy life style information however, the 3,421 who obtained the polypill cut off their risk of cardiovascular disease by 3-4 %. Later Five decades, 202 men … Read more

Let’s say I have an hour to kill, and my alternatives are enjoying a cheese-laden pizza while reading, say, that wonderful David McCullough biography of Harry Truman or heading down the road to my health club for 60 sweaty minutes of huffing and puffing in the company of guys with telephone-pole arms who noticeably snort … Read more

Submitted by Frank Diamond on Wed, 2013-06-12 14:11 Forget about consumer Web sites that rate doctors, such as Vitals.com, Healthgrades.com, Ratemeds.com, and the famed Angieslist.com. Forget about recognized and respected outside auditors, such as the National Committee for Quality Assurance, the Joint Commission, and Press Ganey. Physician executives at hospitals, group practices, and hospital systems … Read more

Insurers and employers are busily compiling databases to control costs and improve care, but physicians are laying claim to the data As the significance of data from health claims becomes clear, the biggest private payers in America are building huge databases to mine the gold in that information. Many of America’s largest employers are pooling … Read more

Washington Watch The Senate debate over the Patients’ Bill of Rights made for great theater, but was the outcome ever in doubt? By the time Vermont Sen. Jim Jeffords defected from the Republican party, the handwriting was on the wall; not only had the Democrats seized the power to set the Senate calendar — they … Read more

The high court heard arguments in December, Originating from an Incident. The courtroom Monday reversed a June 2018 choice against the U.S. Court of Appeals to the Federal Circuit. The threat corridor app was designed to help insurance companies Because They Priced premiums at the very first years of this ACA market app, with no … Read more

Martin Sipkoff A new study finds that multiple sclerosis (MS) patients enrolled in a seven-month disease therapy management (DTM) program demonstrate increased adherence to injected medications and stay with their treatment regimens more readily than MS patients who do not participate in therapy management. The study, published in the February 2010 issue of the American … Read more

Doing Well by Doing Good Minnesota’s HealthPartners helps to introduce Uganda dairy farmers to prepaid health care. Care and delivery improve. Cover Story Physician Incentives: Fading Away Health plans use financial incentives less and less to control utilization and physician behavior. Public outcry over perceived wrongdoings, plus government and legal oversight, are why. The Doctor … Read more

Funding Up for Grabs in Medicare Advantage A new system set to start in 2012 will tie allocations to how well insurers hit quality benchmarks. There’s a curve, too. Frank Diamond Managing Editor The Patient Protection and Affordable Care Act uses an old approach to encourage insurers to improve the quality of Medicare Advantage plans: … Read more

Health plans need to take a closer look. HMOs and employers alike will feel increasing pressure to give in to the desires of consumers. Blaming any one group or industry for rising drug costs is not a useful exercise. Like the “energy crisis,” rising drug costs result from problems with the entire market, not with … Read more

Call it a result of the dragging economy: More Medicaid beneficiaries are joining Medicaid HMOs, which now cover nearly 64 percent of Medicaid managed care members. Of the 49.5 million Medicaid recipients nationally, 35.2 million (71.2 percent) were enrolled in some kind of Medicaid managed care plan in 2009.   Source: Public Payer Digest, 2010-2011

The California Department of Public Health requires that California hospitals article the recommendations they’d follow, due to overwhelming demands on health care resources, at the case they must initiate emergency care standards and allocate scarce resources among patients. Here is a description of this process our physicians could follow, which adheres to their state’s California … Read more

Despite what might be commonly believed, pharmacoeconomics is not a widely used tool for formulary development. Here’s a model to follow. Today’s pharmacy benefits management process often poses extraordinary moral, ethical, and financial dilemmas. Chief among them: How are finite resources fairly and appropriately used to cover infinite needs? Do costly life-saving prescription therapies offered … Read more

The family of a Texas man who died after drinking antifreeze during a bout with depression has sued NYLCare Health Plans in the first test of a Texas law allowing residents to sue their HMOs. According to a lawyer for the family, NYLCare’s behavioral health carveout contractor, Merit Behavioral Health, told a hospital to discharge … Read more

Even as health plans tout their ratings of the quality of their hospitals and other providers, it’s not surprising that hospitals, at least, are returning the favor. A survey released by Davies Public Affairs measured hospital executives’ perceptions of the nation’s largest health insurance companies. United Healthcare generated particularly intense responses among hospital executives. The … 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

Even though accountable care organizations have not lived up to their promise, some will ultimately succeed Richard Stefanacci, DO, MGH, MBA, AGSF, CMD Between now and 2014, much is about to change with regard to managed care. While those historically focused on managed care have found themselves primarily engaged with traditional managed care organizations such … Read more

Cost Differences Between Open and Minimally Invasive Surgery   Abstract Purpose: To analyze the cost difference between minimally invasive surgery (MIS) and open surgery from a commercial payer perspective for colectomy, ventral hernia repair, thoracic resection (resection of the lung), and hysterectomy. Design: A retrospective claims data analysis was conducted using the 2011 and 2012 Truven Health … Read more

The managed care backlash has claimed another casualty: Financial incentives in physician contracts as a means of controlling utilization. Is capitation far behind? Has risk become another one of those “four-letter words”? Utilization-management incentives and global capitation seem to be in retreat. Public distaste for perceived managed care abuses, more government oversight, class-action lawsuits against … Read more

Social determinants of health have been edging into the health care discussion for decades, but in the last few years payers and providers have been plowing millions into the once-marginal idea. And now SDOH has spawned a new group of specialized vendors selling software platforms that connect providers and patients with social service providers and … Read more

Other nations use ‘quality-adjusted life-years’ to measure the cost-effectiveness of drugs, but this tool has been anathema in the United States — so far Also available in PDF For doctors at Memorial Sloan-Kettering Cancer Center in late 2012, it was an easy call. The drug Zaltrap, new on the market (Bach 2012) for treatment of … Read more

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

As health increases, sufferers have been gaining much more control within the own treatment. Most have been compelled to become informed and associated in their health care, especially the divide among professionals and patients. It’s necessary for all these individuals to understand how neighborhood physicians may assist them do it, guaranteeing use of the perfect … Read more

David Brailer, MD, PhD, the nation’s health information chief, wants the industry, not the government, to devise a system that provides interoperability. John Carroll David Brailer’s mission to speed the rapid proliferation of securely accessible electronic health records in the United States faces a big challenge over the next few months as he prioritizes the … Read more

The per-visit cost of a house call is high, but used judiciously, this practice can lower overall medical costs — not to mention provide better care. During a physician house call, a patient complained of pain and swelling in her leg. Risa Lavizzo-Mourey, M.D., chief of geriatric medicine and director of the Institute on Aging … Read more

TOMORROW’S MEDICINE When traditional therapies fail in cancer treatment, turning off a chemical switch may offer hope to the hopeless. Thomas Morrow, MD Recent anticancer therapies have grabbed the headlines. In this month’s Tomorrow’s Medicine, I would like to focus on a new class of drug that offers an option where none existed in the … Read more

Why it is a big deal… It’s Amazon It started with books. And remember when people were dubious about Amazon ever making money? This is a company that has changed how Americans shop, and, as a result, large swathes of the American economy. The Washington Post and Whole Foods are now in its trophy case. Doubters of … Read more

Zika investigators now believe that microcephaly in newborns and Guillain–Barré syndrome in adults may be just the most obvious disorders caused by the mosquito-borne virus, according to a report from Reuters. Fueling that suspicion are recent discoveries of serious brain and spinal cord infections, including encephalitis, meningitis, and myelitis, in people with Zika virus infection. … Read more

Total HMO enrollment grew 6.1 percent, to 76.7 million, during the last six months of 1997, according to InterStudy, which tracks HMO trends…. Enrollment in PPOs is soaring. The American Association of Health Plans says PPOs have added 44 million members in the last five years, while HMOs have attracted 30 million…. How many doctors … Read more

The former senior VP for health policy at UnitedHealth Group joins a company that aims to shift power from HMOs to patients and physicians. Lee N. Newcomer, M.D., could well have ended up as a lawyer or a biologist. A draft number of 25 in the early 1970s prompted him to apply to various graduate … Read more

A Conversation with Brent C. James, MD Pay for performance is not enough. Fundamental changes in the fundamental relationship have to be taken into account. Brent C. James, MD, is chief quality officer and executive director of the Institute for Health Care Delivery Research at Intermountain Healthcare, an integrated health system in Salt Lake City. … Read more

Because curative interchange”by definition requires the interrelationship of both pharmacists and prescribers, no radical variations in [condition ] pharmacy practice acts need allowing it,” AACP explained. AACP concluded such structures are inherent in the idea of therapeutic interchange. AACP’s plank supports”that the notion of therapeutic interchange of numerous medication products by pharmacists under structures by … Read more

Research led by researchers at the University of California, Los Angeles, has unearthed that Zika-linked abnormalities which happen in human fetuses are somewhat more extensive–and even more acute –than previously thought, together with 46 percent of 125 pregnancies one of Zika-infected women leading to birth defects in teens or end fetal death. The findings, released … Read more

Familial hypercholesterolemia, is a underdiagnosed, undertreated, high‐risk illness which is correlated with a higher fat of cardiovascular morbidity and mortality. During this particular study, we utilize a population‐based strategy using digital health document established algorithms to spot FH. A-priori associated variables/confounders were useful for multivariate analyses with binary logistic regression and linear regression using propensity … Read more

COORDINATION OF CARE These physicians have been on the job for several years, and evidence is mounting that they are one of the HMO industry’s real success stories. Marlene Piturro Occasionally an important and successful idea about managing care comes along. Stakeholders, including health plans, hospitals, and physician groups test the idea’s viability, investing money … Read more

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

Effect of Drug Therapy on HEDIS Measurements of HbA1c Control In Diabetes Patients Nausea and Vomiting of Pregnancy: Cost Effective Pharmacologic Treatments Loss of Confidence in Diabetes Management Evaluation of a Continuous Glucose Monitoring System for Home-Use Conditions Health Plan Joins With Physical Therapy Facility to Manage Back and Neck Pain Capital Health Plan achieved … Read more

Anthony J. Kemper has been HIV-positive for 10 years. During that time, he has seen his condition transformed from a virtual death sentence to a manageable disorder. “I had some scary times in the early nineties when medications were not keeping up with my illness,” he reports. “Lately, though, I have been trying a triple-combo … Read more

At Long Last… Pay for Outcomes Starts to Replace Pay for Performance Think of P4O as P4P with its eyes on the prize. Unfortunately, even ordinary P4P is not yet widespread. Biologics Debate Heats Up Between FDA, NCCN Is the breast cancer drug Avastin the opening salvo that brings efficacy, toxicity, and costs together? Who … Read more

The company can be expected to be as tough in the PBM arena as in retail, but it has a few hurdles to overcome When Wal-Mart tackles a new market, it has enough brawn to bend prices for every player in the game. The retail leviathan’s low-price generic drug program — announced less than two … Read more

Clinical Brief: A Single Tablet to Help Manage Patients With Hypertension and Other Cardiovascular Risk Factors This Brief reviews a treatment option for hypertensive patients with other cardiovascular risk factors who need the blood pressure lowering of amlodipine and the cardiovascular benefits of atorvastatin. It also includes an analysis for MCOs by Steven R. Peskin, … Read more

Simplistic, for sure. But a movie pitting a man with modest income against the big bad managed care plan has drawn attention to the enormous cost of transplants and the difficulty of matching organs and recipients. Also available in PDF Managed care is known to have a poor image in the popular media, although it … Read more

When it comes to battling managed care fraud, the Blue Cross and Blue Shield Association takes the long view. The health insurer’s latest salvo against alleged medical crookedness was splashed across headlines around the country last month when news broke about the notorious rent-a-patient scam. Recap: Twelve BCBSA plans filed a $30 million civil suit … Read more

MANAGED CARE October 2010. ©MediMedia USA A head-to-head comparison of drug-coated stents suggests the old standby that used the drug sirolimus prevents more major cardiac events than a newer version, which is coated with zotarolimus. Coating stents with time-released drugs can help prevent infection or clogging, but it’s not clear whether there’s a clinical effect seen with … Read more

The Intention Behind this Expanded Access Method would be to let ancient accessibility To possibly favorable investigational remedies for those confronting a benign or serious illness for whom now readily accessible remedies have worked, and those that can’t take part in Period 3 medical trials. MAPS Creator and Executive Director, Rick Doblin, stated:”We Stopped FDA … Read more

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

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

Application to aid in increasing retention within an inpatient therapy program for those who have opioid use disorder. The reSET-O program is a pharmaceutical cognitive behavioral therapy meant to be utilized along with inpatient therapy under the maintenance of a medical care practitioner, together with treatment which features buprenorphine and anti aging direction. Contingency direction … Read more

The Simplicity of Choosing a oral Pill for erectile dysfunction has Improving ED therapy. It had been initially approved at the U.S. at 1998, and more than 30 million prescriptions are dispensed for Viagra in 120 nations. With era. A huge survey conducted at the USA determined roughly 1 / 2 of most men 40 … Read more

NCQA decided not to hold managed care companies that do not carve out behavioral health benefits to the same accreditation standards that managed behavioral health organizations face – at least, for now. NCQA’s managed behavioral health organization accreditation program began last year. Next year, NCQA would have extended those standards to plans that administer mental … Read more

“The central test for any new technology,” says this medical informaticist, “is whether you can get home earlier to do things you’d rather be doing.” Working as a teenager in a small-town drug store, Mark Frisse saw firsthand the difference that health care providers can make in people’s lives and found himself drawn to the … Read more

The National Committee for Quality Assurance has used HEDIS to encourage health plans to nudge physicians into screening diabetic patients annually for retinopathy. But the message hasn’t taken; only 41 percent of diabetics in any given health plan receive routine eye exams once a year, according to 1998 HEDIS data. Now, a study in the … Read more

Investors are plowing millions into telehealth startups. Millennials could be eager adopters. But these are early times and it may take years—and some regulatory changes—for profits to materialize. Doctors in the NICU at the Rocky Mountain Hospital for Children use telehealth to videoconference with doctors in rural and remote areas, helping with advice and sometimes … Read more

Although Medicare and most health plans are reworking how they pay for health care, it will take years to eliminate the old way In the 1958 movie The Blob, a gelatinous alien creature grows out of control, consuming everything and everyone in its path. The police force and townspeople are unable to stop it. In some … Read more

Bosom disease is the most widely recognized female malignant growth. Around the world, in excess of 1,000,000 ladies are analyzed each year. Anyway in spite of this increment, the death rate is declining. This is because of blend of elements including early finding and successful treatment. This composition which is introduced in two areas diagrams … Read more

Managed care contracts that pay you on a per-patient, per-month basis can be a good opportunity, but before signing you should evaluate the risk you’ll be taking on. Consider these five areas. Managed care contracts that pay you on a per-patient, per-month basis can be a good opportunity, but before signing you should evaluate the … Read more

Extensive Antibiotic resistance poses a significant threat to general health as for a lot of ailments antibiotic treatment is no more powerful. Hospitals are points of interest for a-rb disperse. We used a agent-based version to learn more about the effects of antibiotics to the transmission dynamics and also to look at the capacity of … Read more

One of the buzz terms often heard in discussions of improving the health care system is “patient engagement.” But what does it mean? The definition changes, says a new analysis in the Journal of Participatory Medicine. “Despite the widespread use of the term ‘patient engagement,’ our study showed significant variations in its conceptualization, testifying that … Read more

Memoranda of Understanding Between Medicaid MCOs and Public Health Departments Satisfaction and Patient Outcomes of a Telephone-Based Nurse Triage Service Inter-Rater Reliability Testing For Utilization Management Staff Covering Risk But Not Risky Behaviors: A Critical Review of the Arguments for Insurance Coverage for Smoking-Cessation Therapies A Comparison of Diabetes Patients’ Self-Reported Health Status With Hemoglobin … Read more

With the exception of specialty drugs, enrollees in Medicare Part D plans paid more for their commonly used drugs than beneficiaries in employer plans, according to a recent report, “Medicare Prescription Drug Plans in 2008 and Key Changes Since 2006: Summary of Findings.” Although there has been minimal change in coverage benefits among Part D … Read more

For decades, managed care plans have sought to stop paying fees for services. Now they’re trying bundled payments for episodes of care. Arkansas is on the leading edge of a movement to limit fee-for-service payment. Its weapon of choice is a modified version of bundled payment for episodes of care. Critics say bundled payment is … Read more

A significant number of office-based physician practices have yet to implement an electronic health record (EHR), according to Sage Healthcare Division, a developer of EHRs. But their implementation “continues to grow as an increasing number of physicians and staff gain a better understanding of the efficiency and cost-saving benefits,” according to a recent company survey. … Read more

The Joint Commission on Accreditation of Healthcare Organizations and the Commission on Accreditation of Rehabilitation Facilities have struck an agreement intended to eliminate duplicate surveys of freestanding medical rehabilitation hospitals and rehab units in acute care hospitals. Initially, JCAHO will recognize CARF accreditation of rehab hospitals seeking Joint Commission accreditation. After Aug. 1, recognition will … Read more

Although some health maintenance organizations have been forced to raise premiums to offset inadequate increases in the past two or three years, health costs for the nation’s largest employers will rise only about 3 percent for active employees this year, according to Towers Perrin, the benefits consulting firm. But these same employers said costs for … Read more

There’s been a lot of talk lately about the “safety net” for workers laid off due to the declining economy. However, the New York Times reports, the net may not be strong enough to ensure that those who lose their jobs and health benefits continue to get needed medication. COBRA was supposed to address this … Read more

A definitive diagnosis requires a full brain biopsy, but imaging compounds may help identify the deposition of amyloid plaque, which is associated with the disease Among the most dreaded outcomes of a long life, affecting 15 million people and costing over $200 billion annually in the United States, Alzheimer’s disease (AD) was first described in … Read more

Cardinal Health and McKesson see a future in an idea that has had difficulty taking root. Part D medication therapy management (MTM) has been on the road paved with good intentions. MTM services have the potential to do a lot of good by improving medication outcomes, preventing adverse events, and controlling costs. But for the … Read more

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 claims data (including both medical and pharmacy claims) to examine health care utilization and costs among CF patients with pulmonary infections over one year. … Read more

The Cancer Pill Not Taken Costs Insurers in Long Run As oral chemotherapy becomes more common, so does nonadherence. Cost is only one of the reasons. Frank Diamond Mental Health: Under ACA, Is It Better To Carve In or to Carve Out? The push to integrate health care services and financing may portend a move … Read more

Shop Talk Meet Ronald Brooks, M.D., network medical director at Aetna U.S. Healthcare. We follow him around for a day to see how he handles challenges — many that may seem familiar to you. Dazzling in Dallas Technology with the potential to improve care, not to mention save money and time, was displayed at a … 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

A lot hinges on this question: Do you feel comfortable getting a diagnosis or being treated for a condition by someone on a screen? Employers love telehealth and insurers love offering anything that their employers want to buy and that—debatably—can save money. One problem: Workers don’t share this enthusiasm, at least not yet. A survey … Read more

At a glance UNITED AUTO WORKERS Goal Balance health care needs of current members, new hires and retirees. Strategy Accept provision in contracts with Big Three car companies that require new hourly workers to join managed care plans for first two years of health coverage. Reject copayments and deductibles for current workers. Employers have tried … Read more

Maintaining tight glucose control is difficult to accomplish, but adding amylin to the mix may be the answer. Maintaining tight glucose control is difficult to accomplish, but adding amylin to the mix may be the answer. The discovery of insulin approximately 80 years ago heralded hope for millions of people who have struggled with this … Read more

Approximately 25 percent of VTE incidents occur in hospitalized patients on clinical care support. Even though VTE is more prevalent in surgical patients, patients hospitalized because of a serious medical condition have an eight fold greater risk of VTE within their class of stay. Many risk factors contribute to the growth of VTE in acutely … Read more

LEGISLATION AND REGULATION So How Much Would Medicare for All Really Cost? Good Question. RICHARD MARK KIRKNER The estimates range from $13.5 trillion to $47.6 trillion. The variables include the generosity of the benefit and forecasts for reining in health care expenditures. LEGISLATION AND REGULATION Residencies for Sale RICHARD MARK KIRKNER The closing of Hahnemann Hospital … Read more

BlueCross BlueShield of North Carolina’s vigorous patient-centered medical home may be an example to other plans and providers Frank Diamond Managing Editor The brave new world of provider-payer cooperation requires an approach that’s somewhat at odds with traditional managed care, says Don W. Bradley, MD, senior vice president for health care and chief medical officer … Read more

The researchers find that the costs of treating restless legs syndrome are fairly low, relative to the improved symptoms and associated health care outcomes, and are mainly attributable to prescription medication. Health plans are encouraged to expand coverage to reduce the associated suffering and costs. ABSTRACT Purpose: This study assessed the direct economic burden of restless … Read more

Amazon CEO Jeff Bezos, J.P. Morgan CEO Jamie Dimon along with Berkshire Hathaway CEO Warren Buffett past January declared they were booted up To handle rising healthcare expenses. They formed a non profit company and termed famous physician, speaker and author Dr. Atul Gawande as CEO in June. The partnership formed by among America’s strongest … Read more

Mark D. Abruzzo, J.D. There are approximately 2,600 ambulatory surgery centers in operation in the United States. A great number are entirely or partly physician-owned, but many others are owned, in whole or in part, by hospitals or health systems or by corporate chains. Given the present trends and incentives in the medical arena, we … Read more

Pastoral Service Renews Meaning of Faith in Medicine HIP of New York is the first HMO to provide spiritual assistance to its members. Can this approach help plans lower costs and improve outcomes? Michael D. Dalzell Getting Serious About Formularies Many physicians think narrowing the universe of available drugs from an estimated 8,000 to around … Read more

Self-employed physicians who practice with one or more other doctors tend to spend more time in patient-care activities than solo practitioners — and their compensation reflects that. A doctor in a typical two-physician practice, for instance, spends, on average, 12 percent more time in patient-care activities, and receives 23 percent more income from medical practice, … Read more

Adalimumab-adbm Cyltezo, by German family-owned pharma important Boehringer-Ingelheim, is well known for numerous signs for example treatment of adults who have moderate-to-severe rheumatoid arthritis symptoms. Here really is actually the 2nd FDA-approved biosimilar into US-licensed Humira, After Amgen’s Amjevita, that has been cleared for promotion at September 20-16. During March this year, Amgen additionally gained … Read more

A national leader in physician quality improvement believes providers should be judged on the services they provide MANAGED CARE April 2008. ©MediMedia USA A national leader in physician quality improvement believes providers should be judged on the services they provide Performance over pedigree is how Bruce Bagley, MD, the medical director for quality improvement, would like to … Read more

The law was supposed to give drugmakers freedom to share health care economic information about their products. Efforts to get clarity from the FDA are stepping up. Value-based purchasing in health care has reached the point of no return, no matter who wins the White House or if the ACA were to get scrapped. The … Read more

Colistin is your final broker utilized to fight germs which are resistant Into the most powerful antibiotics. Colistin has stayed the ideal tool offered to take care of multidrug resistant germs since bacteria weren’t measuring genes because of its immunity. This newest discovery demonstrates that colistin could be losing its efficacy in anti inflammatory therapy. … Read more

Only small premium rises next season, and a few are certain to get price reductions. That is the judgment in a private investigation of this besieged but resilient app, which sparks deep branches heading into this season’s mid term elections. And the exodus of insurance from this app has stopped, even reversed marginally, with an … 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

Market on the Green is a grocery store in a “food desert” in Toledo, Ohio. The store is a joint project of the ProMedica hospital system in Toledo and the Ebeid Institute. The list of ways, large and small, that health systems and payer organizations are trying to address patients’ social needs is long and … Read more

Two of the nation’s top accrediting bodies and the AMA are cooperating on a plan to coordinate performance measurements. The hope is that the effort will reduce overlap and the expense of data collection and reporting. The AMA, National Committee for Quality Assurance and Joint Commission on Accreditation of Healthcare Organizations have established the Performance … Read more

This page also available in PDF To paraphrase Mark Twain, rumors of the indemnity plan’s demise are greatly exaggerated–that is, if you ask hospital and health care network CEOs. Forty-eight percent of such executives surveyed by the consultant Arthur Andersen and Co. believe indemnity plans are here to stay. Mark D. Oshnock, head of Andersen’s … Read more

Helping to mend back strains and sprains for workers costs 30 percent more to achieve similar outcomes when directed by a chiropractor instead of a physician, according to a study by the Workers Compensation Research Institute. The reason is the higher number of visits to chiropractors per case. The study, “Patterns and Costs of Physical … Read more

Anew recommendation by the U.S. Preventive Services Task Force that primary care physicians screen all adult patients for depression shouldn’t be a big drain on time and resources, the USPSTF says. Although the task force does not recommend a screening vehicle, it suggests that the procedure can be completed inexpensively and with minimal use of … Read more

F. Randy Vogenberg, PhD, RPh: The growth of specialty pharmacy products and changing ownership patterns for medical practices can complicate delivery and administration of some patients’ treatments. More like this Beware of the Drug Shortage Domino Effect Who Will Pay for High-Cost Biologics? Costly biologics have plan sponsors looking at benefit designs What Changes are … Read more

Physicians are fairly happy with their incomes, but unhappy with the number of hours they have to work, as well as with the ancillary duties involved in practicing medicine, according to a survey by the Kaiser Family Foundation. The national poll of 2,608 doctors, conducted by mail between March 26 and Oct. 11, 2001, also … Read more

As Companies are Looking at methods to cut back expenses to continue to keep their doors remain profitable throughout this challenging market, they have been taking a look at the price of providing benefits. Medical health insurance, disability insurance, and sick days and retirement plans are a few of the benefits that companies are taking … Read more

How the Doughnut Hole Affects Prescription Fulfillment Decisions Involving Cardiovascular Medications For Medicare Part D Enrollees John W. Hales, MA, PhD ; Stephen George, PharmD, MS, RPh As Part D enrollees approach their coverage limits, their decisions are significantly affected through the doughnut hole period Identifying Characteristics of Patients With Low Urgency Emergency Department Visits In a … 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

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Spinraza is a breakthrough, no doubt. But it is another ultraexpensive drug, and the evidence so far points to a modest improvement in motor milestones.   Muscular dystrophy created a lot of news in 2016 with the controversial release of eteplirsen (Exondys 51), an antisense oligonucleotide indicated for a form of Duchenne muscular dystrophy. Exondys … Read more

A new IOM report urges widespread adoption of innovations. The committee’s chair and the California HealthCare Foundation’s CEO, Mark Smith is working to make that happen. A rural hospital may not know that it needs a telepharmacy service until a company makes a sales call and describes the innovation. The potential for better care and … Read more

Patients who visited their primary care physician once every one or two weeks to control their diabetes reached their clinical goals more often than those who visited less frequently, says a new study in the Archives of Internal Medicine. More frequent patient-physician interactions led to faster control of hemoglobin A1c levels and low density lipoprotein … Read more

Health plans weigh whether giving up control of the conversation with patients is worth all the possible benefits Do you tweet? Are you linked in? Have you been tagged, or viewed? These days, social media sites such as Twitter, LinkedIn, and Facebook are all the rage, with insurers like WellPoint and Humana slowly getting into … Read more

he man who advises President-elect Donald Trump about nominations to head HHS, FDA, and NIH has been called a visionary who understands how science can alter the future, and a “worrisome outlier” who’s impatience with the way medicine operates could endanger patients. Peter Thiel is a Silicon Valley billionaire who’s poured some of his vast wealth into … Read more

Data presented in the Medical Expenditure Panel Survey by the Agency for Healthcare Research and Quality indicate that about 13 percent of employees in companies with 10 or fewer employees had premiums of $7,200 or more a year for single-coverage plans in 2008. This group is more likely to have high premiums than employees at … Read more

HMO Liability Battleground Moving to Courts, Statehouse Two managed care lawyers say that the debate in Washington may not be as important as developments closer to home. COVER STORY After a decade of tumult, what’s next We asked eight influential participants in the health care system to explain what they consider to be the developments … Read more

This month we will narrow our look at the Stark II regulations, exploring their effect on income division. This arises in such contexts as how physicians are paid by their employers and contracting providers, and whether a medical group falls within the law’s “group practice” definition. Most frequently, the Stark law’s rules about revenue division … Read more

By the House of Representatives, also he will be the very first former president to be placed on trial at the Senate. Some tips about what to anticipate. The post of impeachment Cited Trump’s months-long fictitious claims of election fraud and also efforts to strongarm country officials to changing the outcomes of the Nov. 3 … Read more

In California, the Department of Corporations has refused Kaiser Permanente’s bid to drop coverage of Viagra. Kaiser, which argued that the expense unfairly forces all members to pay higher premiums, has made the same request in all states it operates; 12 have agreed. Six other plans in California have also asked for state approval to … Read more

Steps used in creating a system that markedly improved asthma outcomes and cut costs at Hartford Hospital are typical of what’s involved. Some argue that the extreme health problems in urban areas result from inability to deliver care. Others feel this inequality is inherent in the population’s attitude toward seeking appropriate services. The so-called urban … Read more

TV1001sr stimulates blood vessels with sodium nitrite Positive results have been reported from a phase 2 study of TV1001sr (TheraVasc, Inc.), an investigational sustained-release, nonaddictive, nonsedating pain medication, for the treatment of patients with pain associated with diabetic neuropathy. The treatment improved pain scores and the neuropathic pain symptom inventory. In a previous phase 2 … Read more

UnitedHealthcare’s VP for oncology says it will take time to come to grips with the cost of chemotherapy, but we have to start now It has been a little more than a year since UnitedHealthcare launched a pilot program to test a bundled payment model for oncologists, and the insurer and its five pilot sites … Read more

The requirement for hospital maintenance is badly known and underresearched. Entry rates climbed by 40 percent between 1988-9 and 1997-8, and just section of the is explained by fluctuations in people or morbidity. The rest of the growth is usually credited to brand new technology and also badly clarified exogenous variables such as fluctuations in … Read more

They are relatively cheap to develop, since clinical trials are small and “the lack of alternative treatments give orphan agents an advantage when up for regulatory review,” according to a report by Evaluate, a life science market intelligence company that provides forecasts on that sector. The company’s second annual EvaluatePharma Orphan Drug Report says that … Read more

The energetic growth of life has affected the health systems generating substantial adjustments and abusing health promotion being a crucial section of health brands. Healthcare is an area within an permanent development, the abundance of opportunities sparking imagination, excitement, and also certainly will exploit the pros within the area. As the doctrine and also advertising … Read more

A SPECIAL SECTION–CAPITATION: STATE OF THE ART The March of Capitation: Reversed or Just Delayed?  29 Confounding the predictions of many an expert, per-member, per-month prepayment of physicians is not sweeping the nation. The reality has turned out to be more complex than the prophecy. ‘Contact Capitation’ And Its Cousins  36 Between fee-for-service payment and pure capitation, … Read more

Treatment targets main constituents of neurofibrillary tangles The first patient has been vaccinated with an active tau vaccine, AADvac1 (Axon Neuroscience), in the phase 2 ADAMANT trial. AADvac1 was developed to be the first disease-modifying tau vaccine for patients with Alzheimer’s disease (AD) and other tauopathies. The ADAMANT trial is a 24-month, randomized, placebo-controlled, parallel-group, … Read more

A Deloitte & Touche study has added fuel to an argument the health insurance industry has advanced of late: When stacked against other issues, health care barely rates a yawn. The survey, conducted in conjunction with the International Society of Certified Employee Benefit Specialists, suggests that retirement planning is a far more pressing issue than … Read more

The CMO of Molina Healthcare of Utah grew up, let’s say, not rich. He says that and a varied background—including a stint in the Air Force—helps him deal with changing policies involving a challenging population. Molina finances the care, but the provider-patient encounter is where the deal is truly sealed, says Karl Brown, MD. “When … Read more

Treatment is equivalent to placebo at 12 weeks   Patients receiving the investigational anti-inflammatory drug losmapimod (GlaxoSmithKline) for 12 weeks after a heart attack did not show improvements in the trial’s primary endpoint, the rate of cardiovascular death, subsequent heart attack, or urgent coronary revascularization, which includes placement of a stent or coronary artery bypass … Read more

After years of skirmishing over mental health parity, the battle lines are drawn. Troops are armed with a cache of talking points and data — pro and con. And, after a brief summer truce, another big showdown looms on Capitol Hill. This is a drama with more players than Richard III. Parity supporters can count … Read more

The California Department of Corporations ordered six HMOs to restore coverage of prescription drugs that they trimmed from their formularies in the past several months. The state also prohibited the HMOs from making additional changes until it completes an investigation of whether formulary revisions were due to medical or financial reasons. At the heart of … Read more

Notwithstanding a black box warning from the FDA, ongoing research demonstrates the efficacy of treating adolescents and children with antidepressants Perhaps no issue in mental health treatment is more emotionally laden and controversial than whether adolescents and children should be treated with antidepressants. “It has been an issue which has led to debate and some … Read more

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

Association health plans provide a simple lesson on the wide political divide over the direction of health care reform. Jim Talent was mad. It was two years ago, and Talent — a member of the U.S. House of Representatives and a rising star in the Republican party — was trenchantly defending his new policy initiative … Read more

Anthem’s Geoffrey B. Crawford Wants To Fix Wellness Programs FRANK DIAMOND The 35-year-old is a rising star in one of the country’s largest health care plans. Included in his take: ACOs hold promise, and gene therapy could break the bank. Fee for Service Is Dead. Long Live Fee for Service? JAN GREENE The move toward … Read more

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 it … Read more

Insurers Give Substance Abuse New Identity: It’s a Disease After years of short shrift from payers and insurers, substance abuse services get renewed interest. Health Plans in particular are re-evaluating their approach. Martin Sipkoff Time To Decipher Legislation’s DNA Health plans have much at stake as Congress moves to lay down the do’s and don’ts … Read more

Development is well known in ovarian and breast cancer, its function in anti tumor immunity have been broadly studied. Treatments with anti-estrogen drugs which can considerably expand survival. “We all know about estrogen effects right to tumor cells, however the “Both nitric oxide have been expressed on many immune cells, thus we knew there was … Read more

While managed care has helped reduce the average length of stay in hospitals, it doesn’t seem to have affected hospital profit margins — at least until very recently. In fact, those margins rose between 1993 and 1997 as the average length of hospital stay dropped. Meanwhile, HMO profit margins dropped. SOURCE: KAISER FAMILY FOUNDATION ANALYSIS … Read more

Download PDF Prostate cancer is the second leading cause of cancer death in men in the United States. According to the American Cancer Society an estimated 240,890 new cases of prostate cancer will be diagnosed in 2011 and 33,270 men will die from the disease. Immunotherapy is a form of biologic treatment that uses a … Read more

According to a Milliman & Robertson study, 55 percent of all Medicare inpatient hospital days were potentially unnecessary in 1996. Basing its calculations on its own length-of-stay and admission guidelines, M&R concluded that the average LOS could have been reduced from 6.4 to 4.1 days, and that 43 percent of admissions were unneeded… An independent … Read more

Predicated on Avalere’s investigation, the decrease appears to be pushed by Varying patterns of inpatient healthcare, for example fewer hospital inpatient admissions and much more frequent monitoring remains, which lead to fewer sparks to SNFs. After hospitalizations for illness or injury, many individuals have been discharged to some post-acute maintenance centre, in which they could … Read more

Employers in revolt against fast-rising premiums could ask HMOs to pay more attention to time-loss management. NCQA’s interest may encourage this approach. Looking for a connection between what HMOs do and controlling indirect costs of ill health, such as absenteeism, has never been so heated a subject for discussion as, say, defined contribution. For one … Read more

Although retail clinics seem to be popping up everywhere, only a small fraction of American families have ever used them, according to a study conducted by the Center for Studying Health System Change. The number of retail clinics has grown rapidly in recent years, from about 60 in 18 states at the beginning of 2006 … Read more

ohn Marcille I’ d love to tell you that we planned it this way, but it just happened. Many of the articles this issue deal with managing pharmaceuticals, with several focusing on specialty pharmacy. I pull a comparison from the shelf, one about publishing a newspaper before a presidential election: One topic overrides all others. … Read more

Talking honestly about problems can help organizations, so long as those in charge take a compassionate approach Conflict in organizations is pervasive; the challenge for health care leaders is to handle it constructively. It is often useful to externalize conflict in order to resolve it. The metaphor of a “moose on the table” can be … Read more

Almost 90 percent of Americans know that antibiotics can treat bacterial infections, but a third also believe that they can fight viral infections as well, according to a poll done by the Pew Charitable Trusts for the Centers for Disease Control and Prevention. This type of information is followed closely by public health policy experts … Read more

MANAGED CARE June 2000. ©2000 MediMedia USA Don’t try to tell this GTE official that HMOs and doctors have done all they can to improve health care. He sees much amiss with the system. Jim Astuto has been a regional manager in the GTE Healthcare Management Group since 1991. He came to GTE through its merger that … Read more

Conflicting state and national policies add to the confusion   As the number of states allowing medical marijuana grows—the total has reached 25 plus the District of Columbia—some are working to address physicians’ knowledge gap with training programs, according to a report from Kaiser Health News (KHN). States are beginning to require doctors to take continuing medical … Read more

Most regret the decision to change systems, survey finds The implementation of electronic health record (EHR) systems has put a dent in the bottom line of several major health care organizations, according to a report in Becker’s Hospital Review. The organizations include the University of Texas MD Anderson Cancer Center and Partners HealthCare, the predominant … Read more

On the Last Twenty Five Decades, Healthcare spending growth in General Has surpassed gross domestic product development, and complete healthcare costs now account for at least 17 percentage of GDP. A mix of factors–including tech, inefficiency, people health status, and insurance plan rates–have been the significant contributors to cost increase. Greater healthcare costs have translated … Read more

The Medical Group Management Association surveyed 960 member practices to gauge compensation trends. Gross charges — which are the charges, at undiscounted rates, of all services provided (or productivity) — for all primary care physician categories increased slightly (0.4 percent) in 2000 compared with the 11.6 percent increase in 1999. This is the first time … Read more

The technology’s been around, but early participants often were burned. New Internet-based products threaten to turn nonbelievers into yesterday’s news. By John Carroll Contributing Editor When Dan Griffin, M.D., finished his medical training two years ago, he began a new course in another type of science: computer technology. For more than two months, working 40 … Read more

Arizona, Virginia, and West Virginia are leading the pack. Bills have been introduced in several states that would effectively ban copay accumulators. Pharmaceutical industry observers have been riveted by recent reform proposals introduced by the Trump administration to regulate drug rebates—the backend price concessions that drug manufacturers pay to plan sponsors and PBMs to influence … Read more

Health insurers are getting behind a bill that would ditch a federal requirement that annual increases in Medicare+ Choice payments fall below spending increases for fee-for-service beneficiaries. Rep. Mike Bilirakis, a Florida Republican, introduced the bill as plans stampeded out of Medicare. HMOs with 300,000 members said they will quit Medicare next year because of … Read more

With apologies to James Taylor, I was recently introduced to a UNC-Chapel Hill professor of psychology, Dr. Edwin Fisher, from my alma mater and the university where the famous singer/ songwriter’s father was dean of the School of Medicine. The work that Dr. Fisher is doing under the aegis of the American Academy of Family Physicians … Read more

Of an investigational ready-to-use rescue pencil for that treatment of acute hypoglycemia in patients with diabetes. The pencil is really a liquid-stable glucagon Auto Injector, developed with The entire findings of these trials won’t be published until after this calendar year, no matter how the business said that the trials have been a triumph, with … Read more

The The main end point was change in monthly migraine days (MMD) from evaluation to 912 weeks, using secondary end points of responder speed of lowering of MMDs by 50 percent or greater, change in additional migraine drugs usage, and developments in handicap and function. The trial comprised a double treatment period of 1-2 weeks … Read more

Women bear the brunt of the system’s dysfunction, and their trust will be hard to earn back.   It’s long been recognized that women interact with the health care system more than men—as patients, as caregivers, as coordinators of care for their loved ones, as the managers of medical bills. Given their regular exposure to … Read more

The Pioneer ACO Model program has gotten some bad press. A significant number (13 of 32) have dropped out of the program, and under half (13 of 32 in 2012 and 11 of 23 in 2013) have earned the shared savings payments that are supposed to animate the program, so providers work to lower spending … Read more

Health supplements are extremely popular. Approximately 11-4 million Americans — about half of the elderly people — simply take a minumum of one nutritional supplement, running a collective tab of over $28 billion this season alone. It’s simple to find out why supplements are all those significant sellers. The people has a legitimate wish to … Read more

But critics of the Center for Medicare and Medicaid Innovation see too much power and money accruing to the ACA-created skunkworks.   It seems that under HHS Secretary Alex Azar, the Center for Medicare and Medicaid Innovation—that ACA-enabled office given almost carte-blanche authority to experiment with new payment and care models—may be getting its groove … Read more

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

Findings of this retrospective database study further emphasize the importance of effectively managing the side effects of opioid pain therapy and achieving optimum clinical and economic outcomes, thus improving the quality of care Shrividya Iyer, PhD Associate director of global health outcomes assessment at Wyeth Research Keith L. Davis, MA Senior director of health economics … Read more

MARCH 12, 2018 Regeneron, Sanofi offer price reductions Alirocumab injection (Praluent, Regeneron Pharmaceuticals/Sanofi) reduced the risk of major cardiac events by 15% among patients who had suffered heart attacks and other coronary events in the ODYSSEY OUTCOMES trial. The two companies immediately announced that they were willing to offer price breaks on the costly medication. … Read more

What distinguishes the better-performing medical group practice from all the others? The Medical Group Management Association wanted to know, and now it does — at least, it has the numbers. You can’t quantify inspiration, dedication, skill, and attitude, but you can look at many of the outward characteristics of physicians and practices. MGMA put this … Read more

The United States spends more—close to double—on health care per capita than other rich countries. By many measures, we’re not getting a good return on those trillions of dollars. In health care, the United States is the world’s biggest spender—by far. In 2016, this country spent $10,348 per capita on health care, almost double the … Read more

CMS puts positive spin on first-year results for Pioneer ACOs So last week it was all doom and gloom about Pioneer ACOs. The buzz in health care wonkdom was all about 9 of the 32 organizations defecting from a program supposedly designed for the best and brightest of American health care organizations — with maybe … Read more

As the preceding article by Butler and Keller suggests, even a little communication training can help physicians work more effectively with patients. A study funded by Kaiser Foundation Health Plan and Permanente Medical Group quantifies this perception. Between 1990 and 1995, 1,384 clinicians — 1,055 of them physicians — attended one-day workshops designed to improve … Read more

A more sophisticated version of a longtime data-gathering tool — the request for information — helps companies gain a clearer picture of health plans’ quality-improvement efforts. HealthPlus of Michigan’s enrollment of General Motors’s salaried workers and retirees in Flint and Saginaw, Mich., has jumped by 4,000 — a 30 percent increase — over the last … Read more

A peripheral attraction amid the thrills of this year’s election was Maine voters’ rejection of a bill legalizing physician-assisted suicide. Oregon remains the only state where this is sanctioned. Proposals for “physician assistance in dying” will surely come before other legislatures over the next few years, however. Up to now, these have tended to follow … Read more

Feature Why Medication Adherence Matters To Patients, Payers, Providers A CMS demonstration program will determine whether Medicare Advantage health plans improve their quality scores by responding to bonuses that correspond with a five-point rating scale Medication nonadherence costs billions. It costs almost $300 billion in avoidable medical spending — billions that payers can ill afford. … Read more

Patients will obtain more buying power and use it wisely, with the help of dedicated professionals. “The history of medicine has been written as an epic of progress, but it is also a tale of social and economic conflict over the emergence of new hierarchies of power and authority, new markets, and new conditions of … Read more

Paying hospitals extra money does not appear to improve the way they treat heart attack patients, or how well those patients do. But giving hospitals the information that they need to improve heart attack care does help. Researchers at the Duke University Clinical Research Institute found no evidence that financial incentives were associated with improved … Read more

“We’re going to see the rapid demise of the onesy-twosy private practice primary care doctor,” says says David B. Nash, MD, MBA, the founding dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia. For one thing, there are not enough of them. Watch the full interview with Dr. Nash or read the … Read more

It depends partly on whether the population is rural or urban and whether utilization can be controlled After more than a year of rancorous debate, the discord over a dizzying slate of ideas for reforming the country’s health care system was finally reduced to a few swift legislative thrusts. The final defining features of reform … Read more

Use of financial incentives in HMOs’ contracts with physicians may be losing favor, but it’s not about to be declared outright illegal any time soon. The U.S. Supreme Court ruled unanimously that patients maynot sue a health plan just because it offers physicians incentives intended to limit health care services. Cynthia Herdrich of Bloomington, Ill., … Read more

Twenty-four states may gamble that providing a prescription drug program to low-income elderly who do not qualify for Medicaid could save them money in the long run. Under the Bush administration’s Pharmacy Plus program, states may apply to the federal government for waivers to extend Medicaid coverage for prescription drugs to Medicare enrollees with incomes … Read more

Swine flu had us all pretty worried a year ago, but preventive measures seem to have done their job Tony Berberabe Associate Editor Back in August 2009, President Obama’s Council of Advisors on Science and Technology (PCAST) developed a plausible scenario based on the 2009 H1N1 influenza strain and its appearance in the spring, its … Read more

Sorafenib raised the available treatment choices for patients with extrahepatic disperse and vascular disease and increased survival in patients with advanced HCCnonetheless, various short comings like low response levels and relatively significant toxicity prompted joint campaigns directed at developing new molecular targeted agents to supply greater treatment plans and second-line agents for patients with illness … Read more

Some insurers are taking these health care professionals from the front lines and putting them into leadership positions Frank Diamond Managing Editor MANAGED CARE August 2011. ©MediMedia USA Some insurers are taking these health care professionals from the front lines and putting them into leadership positions Frank Diamond Managing Editor Forget good or bad intentions: It’s demographics … Read more

The Ongoing Evolution of Endpoints in Oncology Download supplement Since the U.S. Food and Drug Administration’s 1992 adoption of accelerated drug approval regulation, manufacturers often have turned to surrogate endpoints to speed the market arrival of new agents with the potential to save or extend lives. Despite its “gold standard” status, overall survival is increasingly … Read more

Whether they are $2 or $10 or nothing, HMO copayment amounts aren’t just picked out of thin air. Because so much–from utilization rates to physician revenue–is at stake, setting copayments is a complicated process. Co*pay*ment n (1975): a cost-sharing arrangement in which a covered person pays a specified charge for a specified service, such as an … Read more

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“We’re eager to partner with Dr. Gottlieb to both safeguard and foster the healthiness of the American public,” said Secretary Tom Price, HHS, subsequent to a news. “Dr. Gottlieb brings significant experience to the FDA. His heritage will probably be important to keeping the FDA while the golden standard to safe treatments while progressing new, … Read more

Madeleine A. Estabrook In a highly regulated industry such as health care, it is just a matter of time before every component of the industry comes under scrutiny and review. Pharmacy benefit managers are taking center stage now. Currently, PBMs are either of great interest or of great concern to employers, pharmaceutical manufacturers, investors, legislatures, … Read more

CONTRIBUTING VOICES Not a Third World Experience The title is part of a quotation from Henry Chao, a CMS official who is involved with building and launching the health care exchanges. The federal government is running or co-managing 33 exchanges. They are expected to be functional by October 1 to enroll patients for coverage starting … Read more

Express Scripts has agreed to purchase a rival pharmacy benefit manager, Diversified Pharmaceutical Services, for $700 million. When the transaction is completed, Express Scripts will double its membership to 46 million, solidifying its position as the third-largest PBM. SmithKline Beecham’s sale of Diversified marks the second time in three months that a pharmaceutical maker has … Read more

It’s an idea that just won’t die: Having government pay the medical bills guarantees universal coverage. Is that laughter we hear? When President Clinton’s health plan crashed in 1994, many of the ideas that had been brought to the fore during the debate were lost in the wreckage. Some — such as quality monitoring — … Read more

It isn’t nearly as comprehensive and trustworthy as the ideal electronic health record, but what’s called the personal health record has its place Tom Reinke MANAGED CARE January 2007. ©MediMedia USA It isn’t nearly as comprehensive and trustworthy as the ideal electronic health record, but what’s called the personal health record has its place Tom Reinke While … Read more

The Health Care Financing Administration has taken steps to make Medicare+Choice more attractive to health plans in low-paying rural counties, while encouraging them to enroll or keep sicker patients. HCFA will boost the payment floor by nearly 6 percent in 2000, while instituting a blending formula that pushes health plan capitation rates in many low-to-moderate-payment … Read more

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, And Why It Has to Change Are We on the Way to a Real ‘Learning Health Care … Read more

New findings from the Center for Studying Health System Change’s 2003 Community Tracking Study Household Survey indicate that an increasing number of Americans face the serious consequences of medical debt. Almost two thirds of all families with medical bill problems reported difficulty paying for other necessities — rent or mortgage, transportation, food — as a … Read more

In reference to the article in the May 2003 issue of Managed Care entitled “A Health Care Management Company’s Experience with Palivizumab,” the assertions made by William Silverman, MD, in that article deserve comment. The article indicates that Horizon/Mercy denied palivizumab immunoprophylaxis for 152 infants who qualified for such prophylaxis according to the American Academy of Pediatrics … Read more

These tools, often adopted by other industries, can help insurers improve health care delivery Preetinder S. Gill Also available in PDF Preetinder S. Gill A healthy workforce is critical to the success of an organization or a society. Properly managing the delivery of health care is thus an important function of modern health care systems. … Read more

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

As we were going to press, legislators were weighing whether to extend the subsidy contained in the American Recovery and Reinvestment Act of 2009 (the stimulus) that allowed thousands of unemployed workers to maintain COBRA coverage. Some stories in this issue of MANAGED CARE deal with utilization, whether overtly, as does our cover story on page … Read more

A medical director’s casual ruminations suggest that HMOs watch primary care doctors not out of malice, but with a true desire to help. Managed care organizations measure physician performance against many criteria, most of which fall under the categories of customer service, medical outcomes and cost. Where do we get the data to take these … 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

Patients who were considered inoperable have a new option that involves placement of a bioprosthetic heart valve Thomas Morrow, MD Most people don’t think much about their heart valves — structures that control the direction of blood flow by allowing pressure differentials to exist within the blood vessels. These valves open and close roughly 4 … Read more

Patients who switched to a high-deductible health plan (HDHP) cut their emergency department use by 10 percent, compared to a control group comprising members with traditional coverage, according to a study from Harvard Medical School and Harvard Pilgrim Health Care. There was a slight decline in first-time emergency visits for members in high-deductible plans, but … Read more

The trial reached its primary endpoint by fulfilling the statistical Criteria for non-inferiority of complete survival with lenvatinib in comparison to sorafenib, the existing quality of maintenance for systemic treatment in this setting. Eisai intends to show the outcomes of the study in an impending Medi cal meeting and explore these records with regulatory authorities … Read more

Health plans see value in rewarding physicians for participating in their specialty boards’ maintenance-of-certification programs   A board-certified cardiologist or internist or pediatrician used to be like the Pope: The physician passed a test just once, early on, and carried the “board-certified” designation for life, no requalification or retesting required. Board-certified physicians who are held … Read more

The unlikely partnership between the two could portend the beginnings of an industry trend Martin Sipkoff It puts one in mind of what Katherine Hepburn said about Fred Astaire and Ginger Rogers: “She gives him sex appeal, he gives her class.” It’s an odd union, between two kids from opposite sides of the track: Medco, … Read more

The U.S. official who was President Donald Trump’s pick for drug autocrat pulled out on Tuesday after a report he initiated a bill that hurt the public authority’s capacity to take action against narcotic producers flooding the market with the habit-forming painkillers. Trump had fixed Agent Tom Marino, a conservative from Pennsylvania, to lead 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

Beware of the Drug Shortage Domino Effect Drug shortages might cause more drug substitutions which, in turn, could increase the chances of adverse events and the legal ramifications that go with them, says F. Randy Vogenberg, RPh, PhD, principal of the Institute for Integrated Healthcare and a member of Managed Care magazine’s Editorial Advisory Board. … Read more

Drug Pricing Regulation Pushed From Many Sides The public wants it. Presidential candidates are talking about it. Will Congress make it happen?   When Turing Pharmaceuticals raised the price of its toxoplasmosis drug, Daraprim, from $13.50 to $750 a pill, it captured the attention of policymakers in Washington that drug pricing was out of control. … Read more

T. Emmet Thornton One of the purposes of the Health Insurance Portability and Privacy Act of 1996 is to increase consumers’ control over their health care information. The regulations that guide HIPAA implementation, which become effective on April 14, 2003, contain minimum national standards for medical information privacy. State laws that provide greater privacy rights … Read more

Printer-friendly version A great deal of money is at stake, to the tune of $1.7 trillion in 2030, according to the Pharmaceutical Care Management Association Designed for limited patient populations, specialty pharmaceuticals target people with comparatively rare, chronic, and severe medical conditions, such as rheumatoid arthritis, hemophilia, cancer, and multiple sclerosis — all of which … Read more

Color charts Also available in PDF Much has been made of market-share gains made by PPOs at the expense of HMOs — even in this publication (for example, last month’s cover story, “PPOs: A Better Brand of Health Care?“). But while PPOs seem to be “what everyone wants” — as put by one of the people … Read more

The opening murmurs in negotiations between health plans and large employers have been heard. Insurers are expected to seek an average 13.7 percent hike in premiums in 2005, according to a survey of 160 large employers by Hewitt Associates. Again, that’s an average, not a consensus. Different insurers will ask for different increases. For instance, … Read more

Will the electronic revolution overthrow managed care? Not necessarily, but it may help define a new role for MCOs not far in the future. Consultant and author Peter Boland is an E-commerce expert, and has been a close observer of the managed care landscape for more than 20 years. He is president of Boland Healthcare, … Read more

John Marcille Supply meeting demand isn’t always good. We watched for years as young doctors displayed less and less interest in primary care. They’re only human, after all. An income difference between primary care physicians and specialists that can be measured in hundreds of thousands of dollars is difficult to ignore. That’s why the point … Read more

“Nasal polyps May Lead to lack of odor and Frequently patients need Operation to remove the polyps,” explained Sally Seymour, M.D.,” Director of the Department of Pulmonary, Allergy and Rheumatology Products at the FDA’s Center for Drug Research and Evaluation. “Dupixent has a significant treatment alternative for patients whose sinus polyps aren’t satisfactorily controlled by … Read more

PBMs Pumping Brakes on Autoimmune Drug Expenditures A few years ago, the costs associated with treating autoimmune diseases were a fringe concern—small potatoes next to cancer or diabetes drugs. Now some evidence suggests that the prevalence of diseases caused by errant immune systems may be inching up. The may must be emphasized because solid prevalence statistics for autoimmune diseases … Read more

COVER STORY HIV: A Fragile Population Enters Managed Care The ACA is moving people with HIV into Medicaid and commercial health plans. Disruption of care can be bad news for people with HIV and for payers. Michael D. Dalzell Senior Contributing Editor By the time the Illinois Medicaid expansion takes effect January 1, new enrollees … Read more

The age of the “Super Blues” may be dawning, thanks to the consolidation of Blue Cross and Blue Shield health plans. That’s the opinion of some experts after Anthem’s $4 billion purchase of Trigon Health Care. There are 43 Blues plans today, far fewer than what existed in earlier years. Mike Taylor, a principal with … Read more

The major mobile communications companies are among the players that hope to cash in as technology meets growing needs Medical device manufacturers in the United States — the largest medical device market in the world — expect to see a 7% or more increase in sales in the coming years. In 2013, the medical device … Read more

Health plan clinical administrators can take much better advantage of the low prices of pharmaceuticals that become untethered to a brand name The coming fiscal cliff continues to dominate Americans’ attention. But sitting in your health plan’s offices and trying to achieve lower health plan costs, it’s the patent cliff — not the fiscal cliff … Read more

A Conversation With J. Lyle Bootman, Ph.D. In his inaugural address as 1999 president of the American Pharmaceutical Association, J. Lyle Bootman, Ph.D., noted that many issues facing pharmacists at the turn of this millennium were present in the year 1000. Four major issues, as recorded in The History of Pharmacy, were the “development of … Read more

In April, American physicians—and many others who work in health care—celebrated when President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) that repealed the Sustainable Growth Rate payment method used by the CMS. In 2016, they will start to find out if the law that they don’t know is better than one that … Read more

We are going to find out what happens to this government’s Component B suggestion. Congress Is unlikely to consider bold actions, partially because drug makers have a powerful impact on both parties. For over 30 Decades, the FDA has encouraged patients’ accessibility to Investigational medical services and products for treatment, out participation in a clinical … Read more

Getting More for Our Health Care Dollar The United States spends considerable money on health care. Unfortunately, the clinical return on investment has been coming up short for years, according to Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally, an oft-cited Commonwealth Fund study. Among the 11 nations studied in this report — Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, … Read more

COVER STORY Medical Directors Explain Hows and Whys of Burnout These high-achievers wrestle with competing interests as they operate both in the medical and business worlds Frank Diamond HPV Vaccine Goes Underused Only about 35 percent of girls get the full three doses of the vaccine for the human papillomavirus, which causes most cervical cancers … Read more

Mark D. Abruzzo, J.D. There’s a new type of insurance policy out there. You may have heard about it. Many national, state, and local medical societies sponsor it. If you’re a physician or physician group, you may even have one. It insures against violations of Medicare and Medicaid fraud and abuse. Most such policies are … Read more

The relationship between managed care and physician financial incentives to reduce care has declined over time, a study in the American Journal of Managed Care suggests. In 2000–2001, both capitated and nonlaminated managed care significantly increased physician incentives to reduce care, but that changed by 2004–2005. Capitated managed care, rather than noncapitated managed care, had … Read more

Could small not-for-profit health insurers overtake the nation’s largest publicly traded in terms of market share? Yes, it’s possible within five years, says Wendell Potter, a former insurance company public relations professional who is now an author and industry watchdog. The Affordable Care Act has fostered competition among health insurers, and this competition is causing … Read more

This former Reagan administration official is working to change how health information is processed. However, that’s only part of the solution. Jeanne Scott is on a mission of atonement. Back in the early Reagan years, she served as senior counsel in the Health Care Financing Administration’s Office of the General Counsel. Later, she came to … Read more

Encouraged by employers, health plans ponder expensive options in covering a generation of obese Americans The news on weight in America is almost all bad. Pick up any popular consumer magazine, flip on any morning news show, or surf health-related Web pages, and chances are you’ll find at least a few reports sounding the alarm … Read more

The study met its main objective of displaying non-inferior Individuals who received the ZVL vaccine five or more decades ahead of being calmed with Shingrix revealed an identical immune reaction to people without any previous exposure into the ZVL disease. Additionally, Shingrix has been well-tolerated in study groups when evaluated upto at least one month … Read more

For the second time in a little over a year, a “for sale” sign hangs on PCS Health Systems, the country’s largest pharmacy benefit manager. Rite Aid, the pharmacy chain that bought PCS from Eli Lilly in late 1998, faces a cash-flow crunch, and is willing to listen to offers for it. Analysts say Rite … 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 … Read more

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 such as a BMI of less than 30 or who meet … Read more

Medicaid expansion looks safe for now, but nothing else is certain Health plans are pleased that, at least for now, the major gains in enrollment under Medicaid that the ACA facilitated will be left intact. Other than that, though, the uncertainty about the future leaves them unsettled after the latest attempt by the GOP to … Read more

Optimizing the Use of 17P In Pregnant Managed Medicaid Members Mary V. Mason, MD, MBA ; Kara M. House, MBA ; Janice Linehan, PA-C, MHP ; Carol A. Speers, RN ; Lisa M. Joseph, RN, MBA Evolution of TennCare Yields Valuable Lessons Cyril F. Chang, PhD The old TennCare program had many flaws and detractors. Its near collapse led to a more realistic … Read more

While 99 percent of insured workers have coverage for prescription drugs, how that coverage is distributed differs by plan type. Overall, 78 percent of workers are enrolled in plans with three, four, or more tiers for prescription drugs. That number hasn’t changed from last year, according to the most recent Kaiser Family Foundation report, Employer … Read more

Cardio vascular outcomes for those who have familial hypercholesterolaemia might be made better together with medical and diagnosis direction. But, 90 percent of those who have familial hypercholesterolaemia stay undiagnosed in america. We planned to quicken premature identification and timely intervention for at least just 1 ·3 million Favorable people who have familial hypercholesterolaemia at … Read more

Efficacy sustained for up to two years Encouraging data from the MS-SPI trial were presented on April 21 at the annual meeting of the American Academy of Neurology. The study tested the efficacy of MD1003, a pharmaceutical-grade biotin, administered at a dosage of 300 mg/day in patients with “not active” progressive multiple sclerosis (MS), for … Read more

Nearly 4 out of 5 hospitalized children receive medications that have been tested and approved only in adults, according to a study in the Archives of Pediatric and Adolescent Medicine. Pediatric Health Information Systems Research Group performed the study in 31 tertiary hospitals. The adult-approved drugs most prescribed for children were central or autonomic nervous … Read more

Full text in PDF On May 7, 2010, at the Early Stage Breast Cancer Advisory Board meeting, held in Philadelphia, an expert panel of oncologists, physicians, pharmacy directors, and managed care payers discussed the current management of early-stage breast cancer and reached unanimous agreement on the necessity for closer collaboration among oncologists, provider networks, and … Read more

The Office of the Actuary in the Centers for Medicare & Medicaid Services annually produces projections of health care spending. The latest projections begin after 2007 and go through 2018. From 2008 through 2018, health spending growth is expected to outpace growth in the overall economy by 2.1 percentage points per year. By 2018, national … Read more

LOOKING FORWARD For other articles in the series, see listing at end The two main players in the managed care industry have their work cut out for them for the next several years. While HMOs retrench, physicians need to become more constructive participants. The biggest wild card facing the industry in the next few years … Read more

The Sachs Group, an Illinois consulting firm, surveyed more than 100,000 members in 140 health plans before listing six health plans on its fourth annual “HMO Honor Roll.” While the number of plans making the cut was down from last year’s 14, this year’s criteria differed slightly. Plans that scored well in member loyalty and … Read more

Installation: Install Node View Count Go to admin/config/content/nodeviewcount. Select node types and user roles for which to count node view.  

You’ll spend 12 hours traveling and upward of $2,000 in tuition charges, room and board, then work twice as hard for a week when you get back. It’s 7 a.m. You’ve brought your own alarm clock, used the hotel’s wake-up service, or successfully figured out how to program the bedside alarm. You flew in last … Read more

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

Oncologists Plead For Fairer Drug Payments Once accused of milking the system, oncologists are now complaining that they are losing money on some drugs that they administer John Carroll Contributing Editor There are some cancer victims George Kovach, MD, can’t treat anymore. It has nothing to do with how sick they are. Medicare’s reimbursement formula … Read more

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

Critics complain that some HMOs withhold data, but NCQA President Margaret O’Kane responds that HMOs are exemplary in measuring and reporting quality. A recent JAMA article, critical of efforts to evaluate and report on the nation’s HMOs, attracted a good deal of attention in the trade press, including this publication (“Has the Time Come for … Read more

Quentin Young, M.D., is careful to point out that he doesn’t oppose markets or organized health care systems. But Young, national coordinator for Physicians for a National Health Program, thinks that combining the two to create a market-based health system has been a disaster. He points to turmoil among for-profit health care companies and increased … Read more

Let’s talk about arrogance — managed care arrogance. I frequently remind physicians that a successful managed care contract establishes a relationship where both parties give and receive. Physicians frequently disagree when I tell them that virtually all managed care contracts can be improved substantially by attention to detail and an interest in fairness. But some … Read more

Biodegradable cylinder can hold up to 100 different drugs A microdevice implanted into a tumor could release up to 100 individual cancer therapeutics or combinations and, upon retrieval from the tumor, could identify the best treatment option for that tumor, according to findings presented at the annual meeting of the American Association for Cancer Research, … Read more

Eighty-one percent of Americans believe that to get universal coverage, employers should either provide health insurance to their workers or contribute to the cost of their coverage, according to a survey by the Commonwealth Fund. In addition, health insurance costs should be shared by individuals, employers, and the government, according to 67 percent of Democrats, … Read more

Abstract Purpose: A minimally invasive endoscopic treatment that utilizes radiofrequency energy (RFE) has received increased attention as an appropriate middle-ground approach in the treatment of refractory gastroesophageal reflux disease (GERD) and as an alternative to complicated and invasive surgical procedures. The objective of this study was to develop a longitudinal budget impact analysis from the payer … Read more

Alzheimer’s disease has proven to be a daunting foe. A cure remains elusive as treatments have come up short, perhaps because most have been based on a faulty hypothesis. The medicines on hand might temporarily ease symptoms—if the patient is lucky. But that’s about it. File under frustrating. In fact, you could hear the frustration in … Read more

Plan sponsors are wasting $4.9 billion annually as a result of inadequate management of specialty medications in the medical benefit, according to our estimates using MarketScan data. Most of these costs could be avoided by applying the utilization- and trend-management programs that are traditionally found in the pharmacy benefit to the medical benefit, according to … Read more

Do you think you have too many employees? Some physicians let doubts on that question fester, sending signals to the staff that can be ruinous to morale. Here are some ways to face the issue squarely. Jeffrey J. Denning Contributing Editor There are good statistics on the subject of physician office staffing. The Medical Group … Read more

“What we’ve got here is a failure to communicate,” says Strother Martin as the captain in Cool Hand Luke. He’s talking about the prisoner Luke, played by Paul Newman — but he could just as well be explaining why it’s so hard for physicians to get their claims paid. According to the National Conference of … Read more

The roots of modern managed care go back to prepaid health plans of the 19th century, but many of the concepts we use today were embraced in ancient times. The Babylonians had a system with many parallels to the present one. AT THE DAWN OF CIVILIZATION, about 4,000 years ago, nomadic Semite tribes developed a … Read more

An employers’ coalition and health quality company have jointly created the New York State Health Accountability Foundation, a not-for-profit consortium of health purchasers. The New York Business Group on Health and IPRO launched the foundation with $250,000 in seed money from the New York Legislature. IPRO is a health care quality consultancy that has its … Read more

Is the breast cancer drug Avastin the opening salvo that brings efficacy, toxicity, and costs together? Who will blink first — health plans, providers, regulators, or patients? About three years ago, Medicare made a key change in how it covers cancer drugs for off-label uses. It expanded the number of compendia that doctors could turn … Read more

He spent a week at a hospital also was recovering in his house in London since. Growing a flight of stairs leaves him breathless. Piot, that was raised in Belgium, was certainly one among those discoverers of this Ebola virus at 1976 and spent his career fighting infectious diseases. However, his private confrontation with all … Read more

Burgeoning legions of managed care detractors would love to see this practice spread, but it would take some high-maintenance gardening. It’s perhaps ironic that Minnesota, where the wind roars off Lake Superior with all the force of a full-body slam, has provided the habitat to let a “plant” like direct contracting grow. This is where, … Read more

Beware of the Drug Shortage Domino Effect F. Randy Vogenberg RPh PhD Drug shortages might cause more drug substitutions which, in turn, could increase the chances of adverse events and the legal ramifications that go with them, says F. Randy Vogenberg, RPh, PhD, principal of the Institute for Integrated Healthcare and a member of Managed … Read more

Strategy in a position to prevent pain over the neural tissues, in what might possibly be a significant development of a direct and long-lasting treatment such as pain. One In five Australians suffer from chronic pain which amount is forecast to develop, driven by the greater endurance, increasing incidence of cancer and diabetes, together with … Read more

Name Last modified Size Description Parent Directory 01-Mar-2005 11:31 – 0005.compmon.html 09-Apr-2003 23:33 2k 0005.news_headlines…> 09-Apr-2003 23:33 2k 0005.news_arizona.html 09-Apr-2003 23:33 2k 0005.news_fudge.html 09-Apr-2003 23:33 2k 0005.news_prescrip.html 09-Apr-2003 23:33 2k 0005.outlook.html 09-Apr-2003 23:33 2k 0005.news_texas.html 09-Apr-2003 23:33 3k 0005.news_latest.html 09-Apr-2003 23:33 3k 0005.contents.html 09-Apr-2003 23:33 3k 0005.washington.html 09-Apr-2003 23:32 8k 0005.states.html 09-Apr-2003 23:32 8k 0005.conf.html … Read more

Up to 70% of people with prediabetes eventually go on to develop type 2 diabetes. But dietary changes and increased physical activity can slow or even prevent progression to full-fledged diabetes. Although the number of U.S. adults diagnosed with diabetes has decreased in recent years, about 1.4 million new cases of diabetes were diagnosed in … 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

If employers make decisions based on URAC’s and NCQA’s rating of traditional managed care plans, shouldn’t they want similar ratings of CDHPs? MargaretAnn Cross Contributing Editor When health plan accreditation organizations began taking note of emerging consumer-directed health plans in early 2003, the evolving insurance products were difficult to define. Today, as two major accrediting … Read more

Some pretty amazing stuff was on display in Dallas. Where were those most-sought-after potential buyers — physicians? Barry Martin spent much of 1999 buried in his basement office in Halifax, Canada, feverishly working on the prototype for his home-monitoring telemedicine device. With a tiny camera and a speaker, Martin’s new gadget transforms your home television … Read more

More than 30 decades ago, Congress overwhelmingly passed a milestone medical bill targeted toward inspiring pharmaceutical companies to create new medication for those whose infrequent diseases were discounted. By the drug makers’ calculations, the niches for such diseases have beenn’t large enough to make use of. More than 200 organizations have attracted nearly 4 5 … Read more

Cosmetic medication products, for example stem cell items along with exosome services and products. There’s a whole lot of misleading advice online about those services and products, including announcements about the requirements they are sometimes used to take care of. FDA is worried that lots of patients seeking remedies and remedies could be fooled by … Read more

In 1997, 15.3 million Medicaid beneficiaries were enrolled in managed care, more than five times as many as in 1991. Except for Alaska and Wyoming, all states have undertaken Medicaid managed care programs, and 12 now have more than 75 percent of their Medicaid beneficiaries enrolled in managed care. But so far, only one state … Read more

Our recent cover story shows how some health plan executives favor clinical decision support systems over utilization management to better control costs and improve doctor performance. CDS, they argue, seems to work better in a changing world in which the financial risk of delivering care shifts from insurers to the kinds of entities in which physicians play … Read more

The government joins health plans, providers, employers, and pharmaceutical companies in seeking to establish DM’s value Maureen Glabman MANAGED CARE August 2005. ©MediMedia USA The industry is evolving, with a nice boost from Uncle Sam The government joins health plans, providers, employers, and pharmaceutical companies in seeking to establish DM’s value Maureen Glabman Disease management’s legitimacy got … Read more

Congress this month will take up a bipartisan managed care reform bill, perhaps the first this year to truly worry the insurance lobby. The bill, sponsored by Georgia Republican Charles Norwood and Michigan Democrat John Dingell, has 65 cosponsors, and is supported by the AMA. It was introduced in the House after the GOP leadership … 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

Over The past couple of decades, I have undergone several big difficulties with medical billing. It has made me fast know just how to dispute your healthcare billand get errors fixed, and cut back your payment. I had been Wrongly charged for the incorrect procedure – the one which cost nearly 10x more compared to … Read more

Three conditions — hepatitis C, diabetes, and cancer — show how budgets can be busted (and patients harmed) if providers and payers don’t astutely manage the use of costly new drugs Every profession has its maxim for survival. For academics, it’s “Publish or perish.” For lawyers, it’s “Bill or move on.” What should the maxim … Read more

Pharmacy benefit managers are under fire from many corners. What will the push for transparency mean for the industry? David Halbert arrived in New York with a good story to tell: Business was great. And he had the perfect audience to tell it to. Assembled in the opulent St. Regis Hotel on Fifth Avenue was … Read more

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

PPMs: Are They Beauties… Or Are They Beasts? PRO: Paul Keckley, PhyCor CON: Jeff Denning, practice consultant “So, let’s see if I understand this,” the doctor says to the representative of the physician practice management company. “In exchange for my assets, you’ll improve my information systems, manage my office operations, keep up with the byzantine … Read more

Almost 3 of every 4 employees in Fortune 1000 companies say they think buying their own health insurance using an employer’s defined contribution is a good way to select health coverage. KPMG Peat Marwick, the consulting and accounting firm, surveyed more than 14,000 workers, as well as 103 senior executives. More than half of the … Read more

The top five generic drugs released over the past three years reduced pharmacy spending for Caremark by 4.8 percent in 2004, compared with what it would have spent on the branded drugs. This reduction is largely based on the timing of the release of generic products to the market. As more highly prescribed drugs lose … Read more

Buyers of health care are looking at risk adjustment to discourage parsimonious care. They’re also hoping to transfer power and responsibility to workers. Historically, businesses that provide health coverage have acted independently, doing their best to balance the pressure points: network size, quality of benefits, and price. This go-it-alone approach may allow a single employer … Read more

It’s been suggested that, in order to battle obesity, HMOs should use their collective information and knowledge to change their members’ behavior. Are they ethically or morally responsible for doing anything? That’s one question. Here’s another: Assuming, for the moment, that they are ethically and morally responsible for acting, should they be held legally accountable … Read more

A new report sheds some light on the prevalence of high deductible health plans (HDHPs). People who purchase their health insurance directly are more likely to be enrolled in an HDHP than those with employment-based coverage. Source: CDC/NCHS, National Health Interview Survey

We focus this month on health care’s hidden costs … and also on oncology. There’s a connection because there’s always something new, and usually costly, in oncology. On April 4, the FDA said that Pfizer’s Ibrance (palbociclib) can be used to treat breast cancer in men. Each year in the United States, about 237,000 cases … Read more

MANAGED CARE July 1998. ©1998 Stezzi Communications Have hospitals adopted managed care’s regimen of efficiency as standard operating practice? A new Milliman & Robertson survey suggests that when it comes to hospitalization, medical/surgical lengths of stay are not heavily influenced by what it says on a patient’s insurance card. In 11 states where M&R studied discharge data, … Read more

We need to reduce unwarranted geographical variations in care Elliott Fisher’s e-mail box is full these days, the result of communications with congressional staffers working on health care reform. Fisher and his team at the Dartmouth Atlas Project are intent on making sure the bills going through Congress help create an environment in which integrated … Read more

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

COVER STORY PPOs: A Better Brand of Managed Care? For the first time, HMOs are losing market share to PPOs. But costs and accountability will challenge PPOs’ staying power. Diverse Populations Offer Plans Chance To Do Good — and Well Health plans can do well by doing good, if they know how to create programs that … Read more

Standardizing health plan administrative processes and eliminating duplication of effort would go a long way toward strengthening the doctor-insurer relationship. Medical Group Management Association (MGMA) What do physicians want from health plans? Beyond the obvious — a fair rate of compensation for their services — what physicians want most from health plans is consistency, simplicity, … Read more

Advances through new technologies can be an integral catalyst of change within the fiscal industry which has resulted in immeasurable efficacy profits, though these changes may be accompanied by doubt and uncertainty. The insurance industry is no exception for such advancements, together with chances of new procedures of service supply in addition to greater chances … Read more

Health Plans and Medicare Step Up To Eliminate Costly Variation Now that we know there is so much unwarranted deviation in care, payers are promoting comparative effectiveness research and other efforts to help providers embrace the evidence Joseph Burns A Conversation With Lee N. Newcomer, MD, MHA: Payments With Purpose UnitedHealthcare’s VP for oncology says … Read more

Decreasing Medical Costs: How Insurers Are Taking the Easy Way Out Submitted by Archelle Georgiou MD on Tue, 2012-08-14 21:07 In May 1999, Abigail Sulerzyski was born deaf and blind with cerebral palsy and multiple other medical complications. While Victoria, her mother, was learning how to cope with the needs of a severely disabled child, … Read more

Talking honestly about problems can help organizations, so long as those in charge take a compassionate approach Arthur Lazarus, MD, MBA Conflict in organizations is pervasive; the challenge for health care leaders is to handle it constructively. It is often useful to externalize conflict in order to resolve it. The metaphor of a “moose on … Read more

Providing free handheld or even desktop computers is a small step toward minimizing medication errors. Will docs finally abandon pen and pad? Tony Berberabe Associate Editor Physicians react to change in a many ways. Some are “early adopters,” some are “late adopters,” and some are “non adopters,” clinging stubbornly to the way they have always … Read more

In this column we follow new developments in systems and technology for health care. Despite the downturn in technology stocks, the stream of new technology and dot-com products for health care has not diminished. As each new product is announced, users are told how it will save them time, save money, save staff, enhance quality, … Read more

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

A summary of ECRI Institute’s Health Technology Forecast Report Editor’s Note: 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 bi-monthly summaries of either an ECRI Institute Emerging Technology Evidence Report or a Health Technology Forecast profile. ECRI … Read more

In their relationships with vendors, employers all too often don’t set expectations for levels of service, adequacy of reports, or how performance will be measured. They are often left with the performance deemed appropriate by the vendor, which may not satisfy them or meet the needs of their employees. Warren Buffet once noted, “Price is … Read more

Competition benefits consumers, the theory goes. Policy makers who seek to alter market forces in health care should keep this corollary of capitalism in mind, says the Center for Studying Health System Change, a Washington-based think tank. Put another way, the group says, if too few consumers have a choice of health plans, then insurers … Read more

Just because Medicare is hobbled in what it can do with comparative effectiveness research, doesn’t mean that MCOs cannot use the information for both quality improvement and cost control Comparative effectiveness research, now that it has significant funding, can make a real difference to health insurers. But is the money going for truly useful projects? … Read more

We want to hear from medical directors about how they approach one of the most vexing and chronic problems in health care Do you, Mr. Medical Director, have a definitive solution to the growing problem of overutilization in emergency rooms? If you do, then we’d like to hear from you via email (see the box … Read more

Wellness Programs: No Longer Just an Add-On In the face of stiff competition from a growing category of dedicated wellness companies, major health plans are launching sophisticated, ambitious programs to slake employers’ thirst for these products You Will Live Healthily! Employers want to do everything within the law to make workers change their lifestyles, and … Read more

Agency notes cases of intracranial hemorrhage, cardiac failure, and cardiac arrest Previously, CTI BioPharma Corp. described a partial clinical hold issued on February 4 by the FDA regarding clinical studies being conducted under an investigational new drug (IND) application for the myelofibrosis treatment pacritinib. Now CTI BioPharma reports that studies of pacritinib have been placed … Read more

If patient involvement is to be a driver of cost containment and improved outcomes, we’ll need to think more about what that really means A Plausible Encounter Scene: A physician’s office, spring 2006. Receptionist: That’ll be $25 for your co-pay. Patient: [Handing over the money.] Could I please have a copy of the summary sheet … Read more

Thanks to a Business Roundtable-sponsored group calling for better outcomes at hospitals, health plans’ lobbying efforts may pay off. Contributing Editor In late 1994, the health columnist for the Boston Globe, Betsy Lehman, died as a result of an overdose of the chemotherapeutic agent she was receiving for breast cancer at the renowned Dana-Farber Cancer … Read more

Currently, Canada is planning to follow along in The footsteps of this popular US effort Choosing Wisely. Choosing Wisely Canada is made to help patients and physicians take part in conversa- tions about unnecessary evaluations, procedures and treatments, also encourages doctor efforts to aid patients create smart and productive decisions to guarantee highquality maintenance. The … Read more

Download supplement Respiratory syncytial virus (RSV) bronchiolitis is a common and easily transmitted disease that affects infants, particularly premature infants, and young children, and is the leading cause of hospitalization among infants <1 year of age in the United States. RSV immunoprophylaxis tailored to local conditions can help ensure infant protection and avoid hospitalization. This … Read more

Extended-release capsules, such as oral use, C-II to the administration of pain severe enough to take daily, aroundtheclock long-term opioid treatment and also for that alternative therapy plans are inadequate. TROXYCA ER has properties which can be anticipated to decrease abuse when smashed and managed by both the oral and intranasal routes. Yet, misuse of … Read more

As recommended treatment grows more aggressive, health plans should better manage both infusion and injectable medications There’s a lesson for health plans in the way treatment of rheumatoid arthritis (RA) is changing. “The trend today is to try to attain complete remission,” says Patience White, MD, a practicing rheumatologist and vice president at the Arthritis … Read more

Remember the 1960s bumper sticker slogan, “People, not profits”? Though they haven’t printed up any bumper stickers yet, a group of influential Massachusetts physicians is organizing a campaign againstprofit-driven health care that might have as its slogan “patients, not profits.” Calling themselves the Ad Hoc Committee to Defend Health Care, the physicians are not anti-managed … Read more

It’s a problem, all right. Patients aren’t just complaining any more. As forgotten players in what all too often seems to be a tug of war in many directions, patients — the ultimate consumers of health care, are making their presence felt. A few years ago they might simply have groused about being denied a … Read more

Name Last modified Size Description Parent Directory 30-Sep-2000 10:40 – 9808.outlook.gif 06-Jul-1999 09:05 53k 9808.compmon.gif 06-Jul-1999 09:03 51k ../../../archiveMC/9808/9808.compmon.pdf 06-Jul-1999 09:03 45k ../../../archiveMC/9808/9808.outlook.pdf 06-Jul-1999 09:05 44k ../../../archiveMC/9808/9808.news_docreport.gif 06-Jul-1999 09:04 37k 9808.truce.shtml 29-May-2000 11:53 24k 9808.negotiate.shtml 29-May-2000 11:52 24k 9808.school.shtml 29-May-2000 11:53 21k ../../../archiveMC/9808/9808.news_riskchart.gif 06-Jul-1999 09:04 18k 9808.qna_berenson.shtml 29-May-2000 11:53 17k 9808.truce_gatechart..> 06-Jul-1999 09:06 16k 9808.downturn.shtml … Read more

It’s widely believed that primary care physicians who work in practices owned by large hospital or other health care systems are paid more and produce less than their peers at large physician-owned group practices. But a Towers Perrin study of physician compensation and productivity turns that theory on its ear. The consulting firm drew a … Read more

Far from final words on obesity were splashed across headlines last month when the Centers for Disease Control and Prevention announced that the condition is responsible for 112,000 deaths annually in the United States. That’s considerably fewer than contained in a March 2004 CDC report, now discredited, that put the number of yearly deaths from … Read more

Insurers should like contraceptives. They prevent expensive unintended pregnancies. But the rollout of ACA-mandated coverage has been bumpy. It’s been almost four years since the ACA’s contraceptive coverage requirements kicked in, and women have benefited from broader coverage and lower out-of-pocket costs for birth control. But that doesn’t mean this provision of health care reform … Read more

Medical Director: A Typical Day Requires Both Strength and Tact Ruling on queries from phone banks, working to end hospital errors, meeting with disgruntled physicians: Does any of this sound familiar? Internet on Center Stage At Technology Conference Some pretty amazing stuff was on display in Dallas. Where were those most-sought-after potential buyers — physicians? … Read more

The most commonly accepted procedure for detecting Alzheimer’s disease before symptoms appear will be always to have a PET scan of their brain, to look for that the amyloid protein deposits which are a bit of this disorder. Boffins from Washington University School of Medicine at St. Louis attempted to create an even more efficient … Read more

The answer depends on whom you ask. A search of news archives turns up two reported experiments with reimbursement of physicians for e-mail communication with patients. In these cases, the most paid for a cybervisit is $25. But in a Deloitte & Touche survey, doctors thought that, on average, $57 would be a more desirable … Read more

Despite some slowing in the trend, employers can still expect to face the fifth straight year of double-digit increases for employee health care benefits. Towers Perrin surveyed 200 businesses with an average workforce of 7,200 to find that a 12-percent increase in costs is expected in 2004. It’s little consolation that the figure is smaller … Read more

The National Business Group on Health introduces the Purchaser’s Guide to Clinical Preventive Services The drumbeat for putting new emphasis on preventive health care grew considerably louder in late November when the National Business Group on Health, comprising some of America’s most influential employers, published a guide for employers that may influence health benefit designs … Read more

Steven Andes, PhD, CPA Research Assistant and Professor at the University of Illinois at Chicago, Director of Physician Information and Research, American Osteopathic Association, Chicago, Ill. Lawrence M. Metzger, PhD, CPA Professor of Accounting, Loyola University Chicago, Chicago, Ill. John Kralewski, PhD Wallace Professor of Health Research and Policy, School of Public Health, University of … Read more

A third of Americans ages 50 to 70 — about 23 million people — have never been screened for colorectal cancer, according to the Centers for Disease Control and Prevention. This is despite the consensus that screening saves lives. The U.S. Preventive Services Task Force recommends screening with colonoscopy every 10 years, or sigmoidoscopy every … Read more

POPULAR CONTENT TODAY’S POPULAR CONTENT Type Title Author Story AWP Leaves, AAC Arrives; Can It Really Do the Job? webadmin Story 5 Threats To Value-Based Insurance Design webadmin Story Paying More Than You Should For Outpatient Procedures? webadmin Story Mergers, Acquisitions Afoot In Disease Management Industry webadmin Story Plans Confront Specialty Pharmacy’s Escalating Costs in … Read more

Translational research comprises over fundamental lab research findings to community and clinical settings so as to’interpret’ the findings to training. But, several problems negate the progress of translational scientific tests have improved in developing countries, such as limited financing, insufficient research investigation and comprehension, lack of government image or consortium, along with insufficient communication among … Read more

Making hospitals pick up the tab for patients who are readmitted because of infections contracted in those facilities on a previous visit doesn’t seem to improve outcomes, says a study of a policy implemented by the Centers for Medicare & Medicaid Services several years ago. “Effect of Nonpayment for Preventable Infections in U.S. Hospitals,” published … Read more

This former Reagan administration official is working to change how health information is processed. However, that’s only part of the solution. Jeanne Scott is on a mission of atonement. Back in the early Reagan years, she served as senior counsel in the Health Care Financing Administration’s Office of the General Counsel. Later, she came to … Read more

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

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – 0003.news_employers…> 09-Apr-2003 23:29 1k 0003.news_ncqappo.html 09-Apr-2003 23:29 1k 0003.news_threetier…> 09-Apr-2003 23:29 2k 0003.news_headlines…> 09-Apr-2003 23:29 2k 0003.news_americans…> 09-Apr-2003 23:29 2k 0003.outlook.html 09-Apr-2003 23:29 2k 0003.news_jama.html 09-Apr-2003 23:29 2k 0003.news_aetna.html 09-Apr-2003 23:29 2k 0003.compmon.html 09-Apr-2003 23:29 3k 0003.editorsmemo.html 09-Apr-2003 23:29 3k 0003.contents.html 09-Apr-2003 23:29 4k 0003.legal.html … Read more

Katherine T. Adams In light of the tremendous implications for overuse, misunderstanding, and abuse of a person’s genetic and disease-risk data, regulators have a lot to think about The FDA is weighing the appropriate regulatory approach to next-generation sequencing (NGS), in which a single test potentially can be employed to identify a person’s millions of … 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 … Read more

The Catalyst for Payment Reform finds that only 10 percent of care is paid through new methods, but its executive director says shared goals and incremental change will make a difference With UnitedHealth Group’s recent study finding that the United States could save between $200 and $600 billion in the next 10 years by reforming … 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 and … 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

These re-engineered versions of the primary care practice have been discussed since 1967. Has their time come at last? America’s health care crisis is like a Russian Matryoshka doll — open it, and you find its slightly smaller twin. Just below the cost and coverage concerns there is an equally grave and in some ways … Read more

If a patient is in an HMO, chances are that both patient and health plan are in a big city. Metropolitan areas with a population of one million or more hold 37 million out of the total national HMO enrollment of 53.9 million, a leading health care publisher reports. Another 12.9 million are covered by … Read more

There was a smattering of good news about American primary care physicians (PCPs) in the United States in a survey published in Health Affairs that looked at PCPs in 10 countries. What grabbed the headlines last month (as well it should) was that only 1 in 4 PCPs here were prepared to care for patients … Read more

View a photo of a typical city street in the 1950s and notice that most men wear hats. Times change and now, according to a study by the Altimeter Group and Definitive Insights that was done for Aetna, a typical street scene these days will show many pedestrians talking into, or fiddling with, a mobile … Read more

At issue is how much large provider systems can charge for services after they’ve acquired physician practices Over the past few years hospitals around the country have been steadily snapping up physician practices to help bolster their business. The trend has drawn the scrutiny of Medicare’s Congressional watchdogs at MedPAC, who say that the consolidation … Read more

Now that we know there is so much unwarranted deviation in care, payers are promoting comparative effectiveness research and other efforts to help providers embrace the evidence Barry Patel, PharmD, is on a mission to improve the delivery of health care, one physician at a time. His company, Total Therapeutic Management, hires physicians, pharmacists, nurses, … Read more

PacifiCare says it isn’t necessarily for sale, but won’t rule one out, either, as it examines “value-increasing strategies.” PacifiCare’s soul-searching, prompted by a 43-percent decline in its stock price this year, officially began on a November day when it shook up management and formed an executive committee to sift the company’s options. PacifiCare President Jeffrey … Read more

This action also restricts the accountability of people who engage in Professional-review activities and specifically defines this kind of activity. The court failed to determine if the plaintiff might have lasted her challenges into the action, but noticed that if she’d have a reason for actions, it might have neglected due to the reasons below: … Read more

To compare medical care costs and their components inpatients who have chronic illnesses. Quasi-experimental retrospective database analysis of an incorporated state-Medicaid data set. Six chronic diseases and 28 two-disease mixes were assessed at 284,060 patients. Dependent variables have been overall cost along with the percentage costs (hospital, doctor, home health insurance and health care equipment, … Read more

A Conversation with Jeffrey Kang, MD, MPH Health insurers and plan administrators will have to emphasize quality and cost management, says Cigna’s chief medical officer Jeffrey L. Kang, MD, MPH, is the chief medical officer for Cigna. He is responsible for clinical strategy and policy, coverage policy, quality measurement and improvement, value-based purchasing, and design … Read more

Immunotherapy targets CD30 proteins Five-year survival data published online in Blood, the journal of the American Society of Hematology, suggest that the targeted therapy brentuximab vedotin (Adcetris, Seattle Genetics) may have cured some Hodgkin’s lymphoma patients whose disease had persisted despite previous therapies. A multinational phase 2 trial examined brentuximab in patients with Hodgkin’s lymphoma who … Read more

A Managed Care magazine analysis of Quality Compass 98 — the National Committee for Quality Assurance’s annual compilation of HEDIS data — has blown the dust off of some controversial generalizations about the health plan industry. Our study of Quality Compass data indicates that on the whole, not-for-profit health plans tend to outperform for-profit plans … Read more

By John La Puma, M.D. While health care becomes something that haves have and have-nots can’t get, there remains a disconnect between those who arrange and finance care and those who deliver and practice it. Relationships — whether business, personal, or professional — need not have trust. But most medical relationships do. That this cornerstone … Read more

The stimulus bill’s $27 billion for health information technology will go to providers, but health plans will experience other financial and operational benefits. When Congress passed the stimulus last year, it included in the law a multibillion-dollar subsidy that legislators hoped would promote a high-tech revolution in health care. The law stipulated what kind of … Read more

How To Run Managed Care — If You Want To Destroy It How Managed Care Affects the Malpractice Liability Problem 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. Chuck Appleby An … Read more

The Nuka Way Submitted by Steven Peskin MD on Wed, 2012-03-28 20:29 One of the four 2011 Malcolm Baldridge National Quality Award winners in health care is Southcentral Foundation, a nonprofit organization established in 1982 to serve Alaska Natives who live in and around Anchorage. The Southcentral Foundation (SCF) describes itself as a Nuka system … Read more

Statins and fibrates represent both big categories of lipid-lowering representatives. Statins are commonly useful for its treating absolute hypercholesterolaemia whereas fibrates are utilized for its treating hypertriglyceridemia. These two medication have been also applied for its procedure of combined dyslipidemia. A few fibrates effectively lessen serum ldlcholesterol. Statins hinder hmg coa reductase and reduce cell … Read more

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – 0004.outlook.gif 01-Apr-2000 12:00 59k ../../../archives/0004/0004.compmon.gif 01-Apr-2000 12:00 46k ../../../archives/0004/0004.outlook.pdf 01-Apr-2000 12:00 38k ../../../archives/0004/0004.compmon.pdf 01-Apr-2000 12:00 31k 0004.ipas.html 09-Jun-2003 11:44 24k 0004.qna_inlander.html 09-Jun-2003 11:44 17k ../../../archives/0004/0004.news_fallout.gif 01-Apr-2000 12:00 15k 0004.outcomes.html 09-Jun-2003 11:44 15k 0004.finger.html 09-Jun-2003 11:44 14k 0004.risk.html 09-Jun-2003 11:44 12k 0004.diamler.html 09-Jun-2003 11:44 12k 0004.daimler.html … Read more

Psychogenesis and Health Reform 2.0 Recently a Minnesota school was evacuated after 10 students got sick during choir practice. A carbon monoxide leak was the presumed cause, given the similarity of student’s symptoms and the rapid spread of complaints. Thirty students in all were taken to the hospital and the school was closed for the … Read more

Name Last modified Size Description Parent Directory 30-Dec-2000 15:10 – 9808.compmon.gif 06-Jul-1999 09:03 51k ../../../archiveMC/9808/9808.compmon.pdf 06-Jul-1999 09:03 45k 9808.compmon.shtml 01-Jan-2001 22:05 1k 9808.contents.shtml 01-Jan-2001 22:05 5k 9808.downturn.shtml 01-Jan-2001 22:05 15k 9808.editorsmemo.shtml 01-Jan-2001 22:05 3k 9808.ethics.shtml 01-Jan-2001 22:05 8k 9808.legal.shtml 01-Jan-2001 22:04 7k 9808.negotiate.shtml 01-Jan-2001 22:05 24k 9808.news_andnow.shtml 01-Jan-2001 22:04 2k ../../../archiveMC/9808/9808.news_docreport.gif 06-Jul-1999 09:04 37k 9808.news_drugmakers..> … Read more

Name Last modified Size Description Parent Directory 11-Jan-2005 13:10 – 0003.qna_jessee.html 09-Jun-2003 11:44 19k 0003.pbmeval.html 09-Jun-2003 11:44 11k 0003.obesity.html 09-Jun-2003 11:44 24k 0003.dmpharma.html 09-Jun-2003 11:44 15k 0003.compmon.html 09-Apr-2003 23:29 3k 0003.contents.html 09-Apr-2003 23:29 4k 0003.editorsmemo.html 09-Apr-2003 23:29 3k 0003.legal.html 09-Apr-2003 23:29 6k 0003.news_americans…> 09-Apr-2003 23:29 2k 0003.news_aetna.html 09-Apr-2003 23:29 2k 0003.news_employers…> 09-Apr-2003 23:29 1k 0003.news_jama.html … Read more

A pilot program that used a patient-centered medical home model has improved primary care and cut costs after two years, according to Group Health Cooperative, the not-for-profit Seattle-based health system. After its finding, Group Health expanded its medical home model to all 26 of its medical centers. A comparison of the medical home prototype to … Read more

In Disney’s charming “Beauty and the Beast,” Maurice — the girl’s father — is an eccentric inventor. (Wouldn’t you, for once, just love to see a movie show a non-eccentric inventor? After all, some — Jefferson and Franklin, for instance — were practical enough to invent a nation without getting hanged in the process.) Maurice’s … Read more

The hope is that sending a doctor, nurse practitioner, or pharmacist to a frail old person’s home will keep the patient out of the hospital A new pilot program being kicked off at the Centers for Medicare & Medicaid Services may help make house calls a thing of the future for managed care groups. The … Read more

Announced in March 20-19 , Some invest or analysts contested that the merger awarded that the significant overlap between each plan’s registration and give attention to political programs. Works outin a few nations, the combined entity might have monopolistic trends. Provided that they conform to all those particular requests, then you might have yourselves a … Read more

It has not been easy to launch the massive HealthConnect system, but officials at the health plan say it has been rewarding Talk to Louise Lang, MD, the executive vice president for clinical systems and quality at Kaiser Permanente, about how the health plan managed to install what it calls the biggest electronic medical record … Read more

Officials at the Centers for Medicare & Medicaid Services don’t like the idea, but Congress makes the rules (unless the president vetoes them) Next year’s Medicare Part D offerings contain the seeds of significant future change. No doubt unhappily for consumers, more than three fourths of the plans carry premium increases. Unhappily for health plans, … Read more

Full text in PDF ABSTRACT: Nausea and vomiting of pregnancy (NVP) can range from morning sickness to moderate NVP to hyperemesis gravidarum (HG). If it is left unmanaged, health plans may pay for expensive unproven outpatient therapies that are not necessary for treatment of simple morning sickness or moderate NVP. Meanwhile, patients with serious hyperemesis … Read more

Just because Medicare is hobbled in what it can do with comparative effectiveness research, doesn’t mean that MCOs cannot use the information for both quality improvement and cost control Comparative effectiveness research, now that it has significant funding, can make a real difference to health insurers. But is the money going for truly useful projects? … Read more

The diagnostic procedure has medical promise, but a lack of utilization guidelines raises questions about resource use and keeps payers away. The diagnostic procedure has medical promise, but a lack of utilization guidelines raises questions about resource use and keeps payers away. HealthScreen America has carved out a niche. With 150-plus diagnostic centers nationwide, the … Read more

Fetal mesencephalic tissue provides dopaminergic cells Scientists in Europe are researching an experimental treatment approach that grafts dopamine cells into the brains of patients with Parkinson’s disease, according to news from the Community Research and Development Information Service (CORDIS). The TRANSEURO research project is studying patients with early-onset disease to determine their tolerance to transplanted … Read more

Contractor has challenges to overcome in turning a dead parrot into a phoenix. The GOP’s assault on big government finally claimed a notable takedown when the government-sponsored website that provides context on a multitude of clinical care guidelines went as dark as an off-Broadway flop. To paraphrase John Cleese in Monty Python’s legendary “Dead Parrot” … Read more

Commercial and public payers concerned by prolonged hospital stays will be considering this μ-opioid antagonist 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 functions are resuming, … Read more

Harvard Pilgrim Health Care learned the hard way what Oxford Health Plan and others had already found out: HMOs need good information flow. By Bob Carlson Contributing Editor The ink was hardly dry on Massachusetts’s new HMO insolvency law when its first case reared. An unexpected $60 million in additional 1999 losses, discovered early last … Read more

With big companies steadily reducing coverage for retirees, plans need to devise products for this needy population. John Carroll Contributing Editor In early March, managers at the giant auto supplier Delphi knew they were knee-deep in fiscal hot water. Their chief financial officer had just resigned after an audit pointed to accounting errors, and the … Read more

Pay increases for chief medical officers have been pretty consistent from year to year, says Tom Pavlik, managing principal of Sullivan, Cotter & Associates, a consulting company that specializes in compensation. “The 9.9 percent increase [in total cash compensation] between 2004 and 2005 is relatively consistent with many organizations, which are implementing leverage models that … Read more

Pay-for-performance (P4P) programs promise a fair shake for provider and plan, but a former chairman of the NCQA sees many design flaws to overcome. Alice G. Gosfield, JD Pay for Performance (P4P) programs are springing up all over the country in direct response to the failure of existing payment methodologies to produce optimal quality levels. … Read more

Some times individuals who have cancer bother about, joke , or be aggravated by the things they portray as emotional cloudiness or affects they may notice prior to, during, and after cancer therapy. This cloudiness or psychological modification is often known as chemo brain. The phrase”cognitive” identifies just how that your brain works that will … Read more

Color charts A California Medical Association study suggests that not-for-profit health plans in the state generally spend more money on medical expenses than their for-profit counterparts do. Not-for-profits broke even, on average, during fiscal 1996 – 97, while for-profits pocketed small gains. Among California health insurers and managed care companies with 50,000 or more enrollees, … Read more

The majority of physicians surveyed about health care financing by the Indiana University School of Medicine were in favor of government legislation to establish national health insurance. Fifty-nine percent of the 2,200 physicians were in favor, while only 32 percent opposed it. . . . Barriers still remain among hospitals, physicians, and health plans when it comes to … Read more

Only the Other Day, CVS and Also Aetna announced the Final Of these megamerger, however, a federal judge is currently efficiently saying maybe not so fast. Leon said Monday the 2 needs to continue to keep their organizations different until they could input a last decision on the circumstance. “I can not remember anything such … Read more

The head of the Pacific Business Group on Health says the coming trend in care will be patients making informed decisions before they get sick. The head of the Pacific Business Group on Health says the coming trend in care will be patients making informed decisions before they get sick. In 2000, Peter Lee, then … Read more

PLAY HARDBALL WITH SOFTWARE The amount of fraud in the health care system is staggering, but computer analysis can help reduce the level. Here is one company’s strategy. Fraud in health care can assume diverse forms. According to the National Health Care Anti-Fraud Association, the most common is billing for health care services that were … Read more

It’s fast becoming the new yardstick for covering emergency care, but nobody yet has a handle on how much it adds to HMO costs. With all the partisan political wrangling in Washington over the Patients Bill of Rights, it’s easy to forget that one of its provisions, the prudent-layperson standard for emergency care, has already … Read more

The American College of Emergency Physicians has proposed a payment model that would have ED physicians tracking patients for 30 days after discharge. CMS is mulling it over. Emergency physicians are in an awkward spot when it comes to the value-based payment revolution. The emergency department is a potent symbol of old-fashioned, fee-for-service medicine—it’s expensive … Read more

Economic Analysis of Oral and Topical Therapies For Onychomycosis of the Toenails and Fingernails Julian Casciano ; Karine Amaya, PhD ; John Doyle, MPH ; Steve Arikian, MD ; Neil Shear, MD The Quandary of Compounding for MCOs: Administrative Costs, Risks, and Waste Thomas Kaye, RPh, MBA Assuring the safety and efficacy of pharmaceuticals is important to any managed care organization. Compounding in … Read more

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

A medication produced from fish oil slice on the pace of cardiovascular complications, including heart attacks and strokes, by 25 percent, an outcome which may likely alter the fortunes of its own maker, Amarin Pharmaceuticals, also up end years of believing about cardio vascular illness. “What??!!! Excellent! Wow!” “That is wonderful! This fantastic news for … Read more

Here’s a list, by no means exhaustive, of think tanks that have developed conservative and libertarian policies and principles in health care: AMERICAN ENTERPRISE INSTITUTE FOR PUBLIC POLICY RESEARCH. Advances ideas rooted in free enterprise, American strength, and global leadership. Ranks third on ProPublica’s list of think tanks with appointees to the Trump administration, with 14 in … Read more

How electronic health records, in their many manifestations, will transform health care should be evident within a couple of years. Will the potential be realized? Martin Sipkoff Contributing Editor Seventeen years ago, David W. Bates of Brigham & Women’s Hospital in Boston and Lucian Leape, MD, of the Harvard School of Public Health, with others, … Read more

By Carolyn Buppert, C.R.N.P., J.D. The forms discussed in this article can be downloaded below With health plans measuring ability to serve patients, avoidance of unnecessary costs and actions to keep people healthy, physicians may feel they are back in school, report cards and all. Plans are evaluating how physicians perform on a variety of measures–patient … Read more

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

This method of matching drugs to patient starts with RA but may eventually be used for many other conditions In 1800, Augustin Jacob Landre Beauvails, a doctor at the famed Salpetriere Hospital in Paris, described what is now known as rheumatoid arthritis (RA). But he did not name it. That was left to Alfred Bring … Read more

The savings to consumers and employers are apparent, but are health plans left holding the bag in mail-order pharmacy? Martin Sipkoff Arecent study sponsored by the Pharmaceutical Care Management Association, the trade organization for pharmacy benefit management companies, concludes that the potential savings to the health care industry from the use of mail service pharmacy … Read more

Chicago, IL 09/08/2014 More like this HealthIMPACT West HealthIMPACT Southeast Star Ratings Leadership Summit 2014 Customer Analytics & Engagement in Health Insurance Hospitals, Health Plans and Employers Unite to Reduce Cesarean Deliveries

John A. Marcille Perhaps it’s just coincidence. The National Committee for Quality Assurance issues its State of Health Care Quality report the same month that a study is published in the Journal of the American Medical Association that dismisses the idea of grading health plans. Talk about irony. As noted in our News and Commentary department, … Read more

Name Last modified Size Description Parent Directory 26-Jul-2000 21:05 – ../../../../archiveMC/9711/9711.addyears_large.gif 17-May-2000 12:17 17k ../../../../archiveMC/9711/9711.addyears_small.gif 17-May-2000 12:17 11k 9711.amap.shtml 17-May-2000 12:17 8k 9711.capitation_part..> 17-May-2000 12:17 19k 9711.capitation_part..> 17-May-2000 12:18 17k 9711.capitation_part..> 17-May-2000 12:18 8k 9711.compass.map.gif 17-May-2000 12:18 15k 9711.compass.nationa..> 17-May-2000 12:18 15k ../../../../archiveMC/9711/9711.compass.pdf 17-May-2000 12:19 155k 9711.compass.regions..> 17-May-2000 12:19 28k 9711.compass.reportc..> 17-May-2000 12:19 30k 9711.compass.shtml … Read more

An Easy and Profitable Way to Turbocharge Disease Management? When an employer group shifts from one health plan to another, why not allow them to take their claims data to the next health plan? That way, the new plan would gain immediate knowledge of the specific disease burden faced by its new members and be … Read more

By engaging patients and forming strategic alliances, plans can gain immediate cost and clinical benefits — despite conventional wisdom to the contrary. Trying to change the direction of the health care system is like steering a supertanker. It takes miles for a supertanker to make a small change in direction. And now the government says … Read more

Hospital costs for bone marrow transplants shot up 85 percent (from $694 million to $1.3 billion) between 2004 and 2007, according to the Agency for Healthcare Research and Quality (AHRQ). Ten procedures experienced rapid cost increases between 2004 and 2007. About 75 percent of the rise was attributed to increases in the number of patients … Read more

New Hampshire Insurance Commissioner Charles Blossom estimates that his office will receive more than 9,000 consumer complaints against managed care companies this year, a 44-percent increase from 1997. Though Blossom says the state has resolved about 70 percent of complaints against HMOs accused of failing to provide promised coverage or of violating state regulations, Gov. … Read more

Why pay through the nose for tomorrow’s high-tech cures when you can buy an inexpensive ounce of prevention today? As director of the University of Michigan Health Management Research Center, Dee W. Edington, PhD, has been measuring the effects of corporate attempts to help employees live healthier lives for three decades. He’s been called the … Read more

Reports of the death of the Agency for Health Care Policy and Research, to borrow from Mark Twain, appear to be exaggerated. After flirting with extinction, AHCPR may well be making a full recovery, thanks to newfound bipartisan support in Congress. Under pending legislation, AHCPR, once the target of elimination by the Republican leadership, would … Read more

Although they’re an old form of managed care, the best continuing care retirement communities (CCRCs) strive to be life maintenance organizations. During the latter part of her long life, my maternal grandmother bounced around a bit. When she enjoyed good health, she lived quite successfully by herself for many years — having been divorced long … Read more

Hill Physicians Medical Group, one of the largest IPAs in the country, has learned to deliver what managed care plans want Hill Physicians Medical Group is a success story that operates on several levels. Here is an IPA who really seems to “get” managed care. Here are doctors who practice with an appreciation that they’re … Read more

Value-based methods to coordinating healthcare delivery are frequently touted as critical for improving the outcomes of patients worldwide and controlling health care expenses. Value-based medical care’s principal tenant is that respect for patients have to be the overarching principle at the company and direction of all medical care delivery techniques. Value means the outcomes that … Read more

A unique health plan-provider partnership focuses on giving practical knowledge to those to whom the CEOs report Frank Diamond MANAGED CARE January 2010. ©MediMedia USA A unique health plan-provider partnership focuses on giving practical knowledge to those to whom the CEOs report Frank Diamond The Wall Street Journal and the business pages of other major newspapers will … Read more

Critics of Medicare Advantage (MA) who have long voiced concern that the program lends itself too easily to cherry-picking have new ammunition. Many beneficiaries who leave MA plans for traditional Medicare turn out to have significant health problems that they possibly believe might be better addressed in the fee-for-service (FFS) program, according to a study … Read more

Multiple cost cutting strategies zero in on every aspect of physician remuneration Thomas Reinke After toying with different ways of controlling rising expenditures for imaging services, such as stressing appropriateness criteria, Medicare is tackling the problem head on by whacking payment rates for services provided in physicians’ offices and in freestanding facilities. In 2009, it … Read more

First randomized study to evaluate EGFR T790M medication The phase 3 AURA3 trial has met its primary endpoint, demonstrating superior progression-free survival (PFS) with osimertinib (Tagrisso, AstraZeneca) compared with standard platinum-based doublet chemotherapy as second-line treatment in patients with EGFR T790M mutation-positive, locally advanced or metastatic non–small-cell lung cancer (NSCLC) whose disease had progressed after … Read more

Name Last modified Size Description Parent Directory 28-Aug-2000 11:10 – 9808.compmon.gif 06-Jul-1999 09:03 51k ../../../../archiveMC/9808/9808.compmon.pdf 06-Jul-1999 09:03 45k 9808.compmon.shtml 29-May-2000 11:52 2k 9808.contents.shtml 29-May-2000 11:52 5k 9808.downturn.shtml 29-May-2000 11:52 15k 9808.editorsmemo.shtml 29-May-2000 11:52 3k 9808.ethics.shtml 29-May-2000 11:52 8k 9808.legal.shtml 29-May-2000 11:52 8k 9808.negotiate.shtml 29-May-2000 11:52 24k 9808.news_andnow.shtml 29-May-2000 11:52 2k ../../../../archiveMC/9808/9808.news_docreport.gif 06-Jul-1999 09:04 37k 9808.news_drugmakers..> … Read more

An Institute of Medicine report sheds some light on race and medicine that all sectors of the health care system must pay attention to. The report — “In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce” — points out that the health care workforce does not mirror the rest of society’s move … Read more

avituximab PS is a anionic membrane phospholipid, invisibly confined to the inner tissue booklet; various pathophysiologic procedures induce the exposure of PS to the outside tissue booklet. Bavituximab, once jump, begins server effect or pursuits, such as antibody dependent cellular cytotoxicity, inducing boat devastation along with enhancing antitumor resistance. A Phase II randomized, placebo-controlled identification … Read more

The big packages of the 1990s are long gone. Mergers mean stiffer competition for fewer positions. There are a few good reasons compensation for managed care executives hasn’t increased very much recently — mergers, mergers and, well, mergers. Faced with ongoing consolidation in the health care industry, the average remuneration for chief executive officers rose … Read more

When is a cancer not a cancer? When it can be described as a “subclinical disease,” according to a study in JAMA Otolaryngology — Head and Neck Surgery (http://tinyurl.com/thyroid-study (link is external)). That’s just one of the solutions researchers offer to what they call an epidemic in thyroid cancer diagnosis. They suggest “relabeling incidentally identified … Read more

Employers and health plans are starting to see the advantage of what has been termed evidence-based benefit design Martin Sipkoff Slowly but surely, the idea that improved quality of care means lower care costs is permeating our health system. “Resistance to that idea is not like it once was,” says Brent James, MD, executive director … Read more

In what appears to be a wrenching decision, Kaiser Permanente is gearing up to begin offering health savings accounts, something that some point out contradicts the health plan’s oft-stated philosophy that physicians, and not members’ financial needs, will direct medical care. HSAs were approved as part of the Medicare reform legislation passed by Congress about … Read more

MANAGED CARE February 2003. ©MediMedia USA Although prescription drug spending was only 14 percent of total Medicaid spending in 2002, that’s the place where states are looking to save money to shore up growing deficits in their budgets. “I think it’s fair to say almost all 50 states will consider some aspect of this issue,” Richard Cauchi, … Read more

MANAGED CARE July 2009. ©MediMedia USA Want to Change Patients’ Behavior? Look to the Internet Patients are responding to online programs that help them improve or maintain their health and become better consumers By Thomas Reinke Health insurers face ever-changing expectations from their primary customers — employers — and one challenge that has been tough … Read more

There are few issues that unite the political polarities these day, but there seems to be consensus emerging about this: We dump too many people in prison, including dumping them on a former coal ash landfill, a situation sparking controversy in a corner of Pennsylvania. Liberals might see overpopulated prisons as resulting from, say, police … Read more

The work group meets regularly to handle critical concerns in esophageal cancer prevention and treatment at UCLA Health. Stop by our site about quality improvement efforts to learn about more regarding this work group. We’re quitting pancreatic cancer in its tracks by teaching our clients, staff and providers about the value of prevention and screening. … Read more

I remember when, back in the early 1990s, the physician community went ballistic over the threat, and in some cases the actuality, of payment by capitation. It was bad — bad for the docs, perhaps, but very, very bad for patients. And docs were just looking out for their patients. Capitation, as we all know, … Read more

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

Hospital executives seem to be sending contradictory messages regarding patient safety in a survey by American International Group (AIG), the huge insurance company. Every staff member in the hospital is responsible for patient safety, according to 98% of hospital C-suite executives. But then 52% say that nurses “own it.” The survey report adds, “Interestingly, these … Read more

A health plan saved $28.5 million by separating the service physicians perform in administering medical injectable drugs (MIDs) from the cost of the drugs themselves. Highmark, a licensee of the Blue Cross & Blue Shield Association, paid for the drugs and the doctors’ time and skill through the medical benefit. Historically, the plan used a … Read more

Printer-friendly version Insurers are being handed some treatment responsibility for this complex disorder, but some say that it is an educational, not medical, task Advocacy organizations are making headway in state legislatures to expand mandated private health insurance coverage for autism services. In July, Louisiana and Pennsylvania passed legislation that guarantees specific services for children … Read more

Call it the nature of the fragmented U.S. health care system — U.S. physicians spend nearly four times as much money interacting with insurers and health plans than their counterparts north of the border, according to a survey from the Commonwealth Fund published in Health Affairs. Those administrative costs amount to $82,975 per physician per … Read more

Change comes at all speeds, but for the sake of this discussion, let us consider two: slow and fast. Our cover story concerns incremental change. Contributing Editor MargaretAnn Cross focuses on three national pay-for-performance programs that are innovative and substantial. They are efforts by the Centers for Medicare & Medicaid Services, the Integrated Healthcare Association, and Bridges … Read more

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

Type Title Author Story Benefits of Ticagrelor Debated As Antiplatelet Class Approaches Generic Market webadmin Story Lax Coding by Physicians Hurts Medicare Advantage Plans webadmin Story Treatment Persistence & Health Care Costs of Adult MDD Patients Treated With Escitalopram Vs. Citalopram in a Medicaid Population webadmin Story Liability Concern Balances Medical Tourism’s Cost Appeal webadmin … Read more

Changes in Antibiotic Recommendations for Children The public comment period on the 2019 Draft Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease has been extended until Sept. 9. Although the guidelines are not final yet, they were developed after a great deal of discussion and literature review by experts from the Infectious Diseases Society of … Read more

Autumn at the National Committee for Quality Assurance means the annual release of its State of Managed Care Quality report, which highlights HEDIS data for commercial health plans. This year’s incarnation, however, adds data qualifying the performance of physicians and of Medicare and Medicaid plans. The renamed State of Health Care Quality report is, at best, a toe in … Read more

That might change as experts continue to point out that hospitals—even more than insurers or drug companies—are the main reason costs are soaring. There was a no-show at the Democratic debates this week: The issue that hospitals are the main contributor to rising health care costs. As Axios reports this morning, even though Democratic candidates … Read more

Submitted by Robert Royce on Thu, 2013-04-04 15:09 Those seeking some clarity regarding the future of health care policy in the UK will be forgiven for being baffled by recent events. First up was an abortive attempt by the government to introduce a requirement for National Health Service commissioners (known as clinical commissioning groups –see … Read more

The Major executive In a Waltham-based drug-maker said he’s leaving the door open to chase dispute settlement with all the Food and Drug Administration on the agency’s refusal last month because of its own medication targeting the infrequent disorder, acromegaly. Chiasma obtained a complete-response letter by the FDA on April 15 later it’d openly been … Read more

When American Healthways posted a collaborative methodology on its Web site, not everyone in the industry applauded. One year ago, Victor Villagra had good reason to believe the disease management industry was on the threshold of embracing a standard method for evaluating just how well DM programs work. Villagra, the former president of the Disease … Read more

The National Business Group on Health’s CEO looks for employers and insurers to collaborate to improve patient safety and cut costs Helen DarlingWhen the National Business Group on Health announced recently that health care premiums will increase an average of 7.2 percent next year, Helen Darling, the organization’s president and CEO, emphasized that such costs … Read more

American scientists analyzing the Zika virus also have cautioned that it might possibly be ten years before a vaccine is currently publicly offered. The herpes virus is connected to shrunken intelligence in unborn kids, resulting in acute brain damage or death. It’s spread into more than 20 states, and it has caused anxiety in Brazil … Read more

MANAGED CARE October 2007. ©MediMedia USA The Prestige Cervical Disc system can replace a single disc from C3 to C7 and gives people with cervical disc disease another viable treatment option Thomas Morrow, MD In July, the FDA approved the marketing of the Prestige Cervical Disc made by Medtronic Sofamor Danek of Memphis. This is the first … Read more

A core health care improvement principle, adapted from systems theory, is that our health care system is perfectly designed to deliver the results we get. The corollary is that improving results requires changing the system. But system change isn’t everyone’s cup of tea. Implementing team care in an office practice, patient-safety initiatives in integrated delivery … Read more

Yes, it failed to uproot the volume and intensity incentives of fee-for-service medicine. But P4P deserves credit for getting the world ready for today’s value-based payment. When Doug Moeller, MD, a medical director at McKesson Health Solutions who specializes in coding compliance, assessed just what role pay for performance plays these days, he had to … Read more

A look at hospital inpatient formularies and drug use for pneumonia reveals a dramatic shift in therapy over the last five years. This information is based on a panel of representative hospitals reporting their formulary and drug usage data by diagnosis on an ongoing basis to MediMedia USA. This ongoing study (the Hospital Diagnosis and … Read more

The PBM industry stands at the intersection of two recent blockbuster announcements. Mergers, acquisitions, and other activities have resulted in a growing number of health plans owning a PBM capability similar to Anthem’s in-house PBM IngenioRx. And the Trump administration proposed a rule to eliminate rebates from pharmaceutical companies to PBMs. While every stakeholder in the … Read more

An investigational anti–interleukin-6 receptor (IL-6R) “nanobody,” vobarilizumab (Ablynx/AbbVie), has successfully completed a 12-week phase 2b monotherapy study in patients with moderate-to-severe rheumatoid arthritis (RA) who were intolerant of methotrexate or for whom continued methotrexate treatment was inappropriate. The study’s objective was to explore the efficacy and safety of various dose regimens for vobarilizumab monotherapy to … Read more

Meanwhile, Because his Amendment has been contemplated, Cruz was nearly cried down through a Fourth of July address by protesters angry with his healthcare attempts, The Cruz change would let insurance Providers to market any type of coverages that they wanted-as long since they additionally Sold a minumum of one policy which complies with all … Read more

In a effort that will be watched by health plans and physician associations nationwide, Premera Blue Cross of Washington puts doctors into tiers according to how well they help control costs. Physicians considered most efficient are placed in the lower-cost tier. The Washington State Medical Association’s reaction is that tiering doesn’t make sense without outcomes … Read more

The shift in mass – to healthcare (VBC) is gaining traction throughout the US medical care business, tough health programs to modify their conventional, payer-focused part in the eco system. To understand VBC’s increase and its consequences to health plans, Deloitte interviewed senior executives in more than several regional plans at late 2014 and ancient … Read more

Discussing Together with Senior and Junior Health students Throughout symposiums in The college of Minnesota,” George Isham, MD, chief wellness club and also plan clinical manager at HealthPartners, shares his adventures also discusses how lots of wellness care issues, for example what form of medical doctors the college pupils will wind up. Since an overall … Read more

An important federal law encourages development of drugs for populations so small that the market would otherwise ignore them. Should they not then be covered? An important federal law encourages development of drugs for populations so small that the market would otherwise ignore them. Should they not then be covered? The Orphan Drug Act (ODA) … Read more

Urged on by employers, the Big 3 are going beyond traditional pharmacy benefit management, stressing consumer interactions and disease outcomes and threatening the existence of captive PBMs While the 14–15 percent annual increases in drug expenditures of the early 2000s have settled down to around 5 percent, there are unsettling forces at work within the … Read more

Manufacturing and governmental restrictions, leading to limited clinical studies to specify the efficacy and safety of using cannabis to cure diseases. Preliminary evidence shows that cannabis can decrease nausea and throwing up throughout Chemo Therapy , improve appetite in people with HIV/AIDS, and cut back chronic pain along with muscle cramps . Shortterm use raises … Read more

Even today, studies show, only half of treatments are truly based on evidence. Here’s an organization looking to better that share, and it may behoove health plans to help. Does Joe V. Selby, MD, MPH, have the toughest job in health care? The evidence is fairly compelling. As executive director of the Patient-Centered Outcomes Research … Read more

Giving a lower dose of clot-busting drugs to ischemic stroke patients reduced serious brain bleeding by two-thirds but led to a slight rise in ongoing disability, according to results of a study presented at the Second European Stroke Organization Conference 2016 in Barcelona, Spain. The ENCHANTED study, led by Professor Craig Anderson of the George … Read more

Also available in PDF Managed care companies have long endured complaints about preauthorization, utilization review, and provider-panel credentialing. Provider complaints have resulted in individual and class-action suits typically seeking large monetary awards and changes in managed care business operations. Even when MCOs prevail, they spend vast amounts of time and money defending themselves. The U.S. … Read more

The Institute of Medicine’s 2013 analysis of Medicare spending up-ended a frequent premise about the largest drivers of regional variant: it wasn’t hospital usage that accounted for the biggest the gaps in spending across regions, however exactly what happened after patients arose out of physicians and began using psychiatric facilities and home healthcare. The report … Read more

TOMORROW’S MEDICINE By reducing restenosis, these devices will save managed care money. Thomas Morrow, MD Technophiles would be hard pressed to come up with better names than Cypher, Cypher Stallion, Achieve, Taxus, Express and Maverick. But it is unlikely that most managed care executives would guess that these names represent an industry that, up until … Read more

Year:  2011  |  2010  |  2009  |  2008  |  2007  |  2006  |  2005  |  2004  |  2003  |  2002  | 2004 January Health Plan 2009 Huge Challenges Cannot Be Avoided Cooperation Gets to Heart of the Matter Transparency Called Key To Uniting Cost Control, Quality Improvement Reinsurers Offer Services To Keep Client Costs Down Consumer-Directed Health Care Won’t Fly No End in Sight to … Read more

Michael Levin-Epstein Washington Initiatives Managed care reform — a.k.a. the patient bill of rights — is definitely a priority for Democrats, but is it at the top of their health care agenda? Look for the Senate Labor and Human Resources Committee to give at least equal weight to legislation to protect the confidentiality of medical … Read more

Most hospitals and physicians have been paid exactly the exact same whatever quality of the care they supply. That produces no monetary benefits and, sometimes, produces disincentives such as caliber. Increasing quantities of apps relate payment to performance. To review studies analyzing the consequence of explicit financial incentives to get improved performance on measures of … Read more

Philadelphia’s Jefferson Health System has threatened to drop Independence Blue Cross June 1 unless a new contract can be hammered out. Few expect that to happen — Jefferson makes up 20 percent of IBC’s business, while the insurer means a quarter of Jefferson’s revenue. But both sides sent letters to patients and members to frame … Read more

FDA uses the term”Remember” If a manufacturer Requires a correction or Removal activity to tackle a challenge with a health care apparatus that violates FDA lawenforcement. Re-calls occur each time a health apparatus is defective, as it might be a possibility to health, or even if it really is both defective and also a risk … Read more

Q&A A Conversation With David A. Fleming, MD: Medical Practices Struggle With Change New regulations, EMRs, maintenance of certification, and concern about cost are burdens for physicians, but things will improve, says this year’s president of the American College of Physicians John Marcille Imagine that your physician believes that your hip pain could be helped … Read more

Workers’ compensation is attracting managed care companies because they can, more effectively than individual providers, concentrate on what’s really important to employers — getting injured workers back on the job. Jean Lawrence Contributing Editor The average injured employee is a 34-year-old male blue-collar worker with a musculoskeletal injury such as a wrenched back or shoulder. … Read more

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It’s only 1997, but managed care companies have already begun to fear 2000. That’s because their big computers, which faithfully serve them by keeping track of virtually everything from appointment scheduling and clinical data to payroll and risk contracting, pose a serious threat to their masters. It is known as the “Year 2000 Problem” or … 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

Researchers at Harvard Medical School wanted to determine the effect of changes in drug benefit design on pharmaceutical use and spending. They observed prescription drug spending by plan and member and also formulary compliance, including use of generic medications and mail-order fulfillment. Eligible enrollees were younger than 64, had prescription drug coverage provided by the … 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

According to a recent poll of 150 corporate executives, health care plans have a lot in common with corn, VCRs and computers: They’re all commodities. Not too much distinguishes these products except price.Wirthlin Worldwide of McLean, Va., asked executives from the nation’s leading service and manufacturing companies, “How strongly do you agree that health care … Read more

The federal government plans to give Medicaid disease management a lift by matching the money states pay to run such programs. “Disease management is an exciting opportunity to significantly improve the care delivered to Medicaid beneficiaries with chronic conditions,” said Dennis G. Smith, acting administrator of the Centers for Medicare & Medicaid Services when the … Read more

It is ironic and instructive that HMO stock prices are climbing in the expectation that the industry can return to profitability and give investors what they want. Common sense says that the best way to give owners what they want is for the industry to give its customers what they want, or to look at … Read more

By Michael D. Dalzell Senior Editor Let’s make it clear at the outset. This isn’t another lecture about clinical practice guidelines. It’s not another article pondering the ever-perplexing question, “Why do so many physicians — who are grounded in science — often rely on outdated ways of treating certain common illnesses, rather than follow protocols … Read more

Kentucky Gov. Paul Patton and a predecessor are squabbling over a decision to overhaul the health insurance plan that covers about 24,000 state workers. Patton is replacing Kentucky Kare, which allowed state workers to go to any physician, with a managed care plan built around networks of physicians and hospitals. In a letter faxed to … Read more

A drug-induced Disorder is That the Unintentional effect of a Medication, which Contributes to mortality or morbidity with symptoms adequate to prompt an individual to request medical care and/or require hospitalization. This publication, a contemporary classic, assesses these unintentional results and makes a knowledgebase of possibly planetary drugs that have to be viewed in drug … Read more

Back in the ’40s, patients recovering from cataract surgery were fitted with monofocal lens implants and forced to wear Coke-bottle glasses Thomas Morrow, MD Few of us who have reached the half century mark can forget the sight of our grandparents wearing their Coke-bottle eyeglasses after having surgery to remove a cataract. Those extremely thick … Read more

In the first half of 2010, five of the largest for-profit managed care companies — WellPoint, UnitedHealth, Aetna, Humana, and Cigna — reported high profits, according to a KPMG report. The net income of these companies collectively increased 20.2 percent in the first half of 2010 to $6.05 billion, compared with the same period in … Read more

Insurers have maintained strong earnings in recent years — much to the delight of stockholders — because of relatively stable expenses, improved case management, and new technology. However, a report by A.M. Best Company, a global credit rating organization, suggests that insurers will need to navigate a challenging financial landscape in 2008. According to “Health … Read more

Mavyret Now Approved for Adults and Children Over 12 The FDA approval of glecaprevir/pibrentasvir (Mavyret, AbbVie, Inc.) represents another treatment option for children and adolescents with hepatitis C virus (HCV) infection. It is the first approval of a therapy for all HCV genotypes, without cirrhosis or with compensated cirrhosis. Glecaprevir/pibrentasvir, previously approved in 2017 for … Read more

Patient-reported outcome measures (PROMs) have a long history in orthopedic research. Wider use of PROMs will depend on payers. Thom Walsh was a young physical therapist specializing in spinal disorders in the mid-’90s, when he first heard about patient-reported outcome measures (PROMs). He typed up some questions about pain levels and functional status and started … Read more

By John La Puma, M.D. The American Medical Association has voted to form a: Wednesday morning golf league Drive-through morning checkup service National doctors union Frequent-patient program — Chicago Tribune, 6/27/99 This is the public’s attitude regarding physicians and unions. For anyone who doesn’t believe it, think about basketball and the public’s tolerance for star … Read more

HIPAA’s timetable has been known for years, but many organizations that the law covers are dawdling pitifully in preparing for compliance. John Carroll ACCOUNTABILITY For the past five years, the Health Insurance Portability and Accountability Act has been chugging its way steadily through the corridors of power in Washington. Shepherded by two administrations against a … Read more

Rates of chicken pox drop dramatically when patients receive two doses of the varicella vaccine, according to a study in the journal JAMA Pediatrics. Researchers looked at two locations: Antelope Valley, Calif., and West Philadelphia to see what happened when the two-dose regimen was introduced in 2006. Antelope Valley saw a 76% decline in varicella … Read more

Back in 2005, the National Committee for Quality Assurance called on PPO plans to report HEDIS data, which are clinical measures of quality, with 80 plans — ranging from national carriers to smaller insurers — answering the call. This year, 83 commercial and 58 Medicare PPOs, covering more than 21 million Americans, reported audited HEDIS … Read more

Medicaid Wellness Programs Face Challenges One of the paradoxes of human nature is that people who have little money are often the most generous. My old Uncle Joe (dead for over 30 years) had half his stomach blown away in the Battle of the Bulge and suffered the rest of his life from what we … Read more

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

Neil Caesar, J.D. For physicians in multispecialty groups or in groups with multiple locations, the Stark II regulations offer some guidance on how income should be distributed. Even so, ambiguities exist. For instance, Stark requires that group practice overhead and income be distributed according to methods “previously determined.” Those methods must be in place before … Read more

In an effort to make the best use of specialty drugs, everybody gets into the act at Independence Blue Cross Thomas Reinke While specialty pharmacy may be the most costly element in case management programs for complex conditions like multiple sclerosis, it may not be the most important. Managing comorbidities and the effect of functional … Read more

LEGISLATION & REGULATION ACA’s MLR Rule Tough on Brokers The need for health plans to cut administrative costs is hammering insurance brokers. Is this another instance of the law of unintended consequences? John Carroll A few months ago, the Government Accounting Office polled a group of insurers around the country about the effect that the … Read more