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COVER ARTICLE
Delivering information: AHRQ drives quality in context
To improve the quality, safety, efficiency and effectiveness of the healthcare system, the U.S. Agency for Healthcare Research and Quality (AHRQ) is tasked with a mission to gather research and disseminate valuable findings to those who can translate information into practice. Carolyn Clancy, MD, an internist with decades of experience in fact finding and analysis, directs the agency.
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Leveraging specialist counsel adds insight into specialty drugs
Specialty pharmacy as a managed benefit has arrived at the same place pharmacy benefit management was several years ago (offering open formularies, flat co-pays, etc.). Yet little is being done to address specialty pharmacy as a managed benefit.
Improve care with provider-patient electronic communications
Employers and health plans are pursuing technologies such as secure email, personal health records (PHR) and home monitoring in hopes of improving compliance with treatment plans and care management programs.
Patient care navigators push cancer care to the next level
An important concept surfacing of late is that of patient care navigators, whose goal it is to decrease the number of cancer deaths caused by healthcare treatment disparities.
Health plans must own member CDH experience
The evolution of consumer-driven healthcare (CDH) has increased the demand for value-added services from health plans. The ability to offer these new services is a prerequisite for those hoping to succeed in the CDH market.
CDC urges flu vaccination for all children
The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted to expand the recommended ages for annual influenza vaccination to include all children from 6 months through 18 years of age.
Maintain confidentiality with ERISA plans
The purpose of the attorney-client privilege is to encourage frank communications between attorneys and clients, which promotes dissemination of sound legal advice. Regarding the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), some courts have found that an ERISA plan fiduciary may not assert the attorney-client privilege against plan participants regarding matters of plan administration.
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Special Reports
Medicare audits: CMS imposes corrective action plans on sponsor faults
Beginning on October 1, 2007, the Centers for Medicare and Medicaid Services (CMS) began posting Corrective Action Plans (CAP) on the public area of its Web site. The goal was to post all review findings for audited conducted on Medicare Advantage and Part D plans for a specific time period that resulted in a CAP.
Genetic precision: New fields in genetic testing lend support to clinical effectiveness
Genetic testing is used to predict or diagnose a disease for an individual. It also makes possible the use of pharmacogenetics—the study of genetic variation that translates to differing response to drugs—to align drug treatment for maximum effectiveness. The emerging field of pharmacogenetics has opened up a new world of personalized treatment and evidence-based medicine.
Where Data Stops: Employers want more data for cost planning, but where is line drawn?
The U.S. healthcare system continues to struggle with costs. As costs have climbed, data needs among employers are changing swiftly. Some employers are asking their health plan providers for deeper, more telling employee health information, only to find that they aren't able to obtain it because of HIPAA and similar laws.
Early Retirees: Consumer-driven options the plans of choice for young retirees
As employers continue to cut back on health insurance for retirees (and might even stop offering it to new employees), early retirees are stuck in an expensive conundrum. More and more this group of retirees is turning to consumer-driven solutions.
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Leaders in Disease Management
Managed Healthcare Executive To Recognize The Industry's Leaders In Disease Management
Leaders in Disease Management were evaluated by their commitment to the disease management discipline, their program results, their innovation and their thought leadership. Watch for the Special Issue of Managed Healthcare Executive, available beginning September 7, 2008!
  • George Bennett, Health Dialog Services Corp.
  • Paul Bluestein, ConnectiCare
  • John Castiglia, Premera Blue Cross
  • Terry Crowson, HealthPartners
  • Dee Edington, University of Michigan Health Management Research Center
  • Jay Feldstein, AmeriHealth Mercy Family of Cos.
  • Judith Frampton, Harvard Pilgrim Health Care
  • Ron Geraty, Alere Medical Inc.
  • Bob Ihrie, Lowe's Cos., Inc.
  • Joan Kennedy, Wellpoint
  • Barry Lachman, Parkland Community Health Plan
  • Ben Leedle, Healthways
  • Harlan Levine, Towers Perrin
  • Dijuana Lewis, Comprehensive Health Solutions Business Unit of Wellpoint
  • Ariel Linden, Linden Consulting Group
  • Pam Menard, Independent Health
  • Tracey Moorehead, DMAA: The Care Continuum Alliance
  • David Nash, Jefferson Medical College
  • Gordon Norman, Alere Medical Inc.
  • Michael Norris, Great-West Healthcare
  • Harold Picken, BCBS Rhode Island
  • David Plocher, Blue Cross Minnesota
  • Jim Prochaska, Cancer Prevention Research Center
  • Michael Quilty, Matrix Medical Network
  • Emad Rizk, McKesson Health Solutions
  • Richard Safeer, CareFirst BlueCross BlueShield
  • Chris Selecky, Lifemasters
  • Kara Trott, Quantum Health Inc.
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