The convergence of rising healthcare costs, increased cost sharing and demand by consumers for more participation in healthcare decisions is producing a variety of innovative health insurance solutions.

The practice of shared decision making (SDM)—the collaboration between patients and caregivers to arrive at an informed, value-based healthcare decision when treatment options have features that patients value differently—is gaining recognition among health plans as a key function of a patient-centric model of care.

Although prevention has become a key element in traditional disease management programs—trying to prevent or mitigate a chronic disease before it exacerbates—that may not be sufficient when a patient has a late-stage or end-of-life condition. There is a new emphasis on caring for older adults with multiple comorbidities. Almost 80% of people 65 and older report having a chronic illness, according to the Robert Wood Johnson Foundation.

Disease management programs don't come cheap, but thanks to industry collaboration, purchasers are increasingly learning how to assess the business case for these programs.

As durable medical equipment (dme) becomes increasingly sophisticated, MCOs' challenges remain rooted in establishing medical necessity. To that end, most use strategies including prior authorization and coverage limits. Meanwhile, they must also satisfy changing state and national regulatory requirements.

IN THE WORLD OF professional sports, the competition isn't only on the gridiron, the court or the diamond. Just ask an MCO.

The economics and the politics behind the major healthcare problems affecting men, such as cardiovascular disease, cancer, obesity and depression, aren't receiving the attention they deserve. It has been the rule that women make health decisions for themselves and also for their male partners and their children. In contrast, most men have a more casual attitude toward their care: "if it ain't broke, don't fix it."

Grace seems an unlikely acronym for a study of acute coronary events, but given the findings of the Global Registry of Acute Coronary Events published in the Journal of the American Medical Association, the name may be apropos.

Worldwide, 388 million people will die from chronic diseases in the next 10 years. Chronic diseases account for about 75% of all healthcare costs. Clearly, disease management and prevention is sorely needed, but it's been a struggle to change the behaviors of large groups of people. A number of programs are finding success using non-traditional methods.