http://managedhealthcareexecutive.modernmedicine.com/mhe Managed Healthcare Executive Online offers insight to healthcare
 providers, executive officers and management specialists to help them
 contain costs and improve the quality of health care. 2008-08-20T07:23:16Z http://managedhealthcareexecutive.modernmedicine.com/mhe/MHE+Online/Managed-Healthcare-Executive-To-Recognize-The-Indu/ArticleDouble/Article/detail/542442?ref=25 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. 2008-08-15T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articledouble/mhe/332008/542442null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Patient-care-navigators-push-cancer-care-to-the-ne/ArticleStandard/Article/detail/533835?ref=25 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. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533835null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Improve-care-with-provider-patient-electronic-comm/ArticleStandard/Article/detail/533834?ref=25 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. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533834null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Medicare%2FMedicaid+products/State-Report-Louisiana/ArticleStandard/Article/detail/533532?ref=25 The Louisiana House Health and Welfare Committee in June unanimously approved a bill that would shift some Medicaid uncompensated care money from New Orleans hospitals to other hospitals in the state. The measure would create a new formula for distributing Medicaid funds among seven hospitals in southern Louisiana. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533532null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Member+service/Actionable-information-draws-consumers/ArticleStandard/Article/detail/533529?ref=25 Consumers want information that's personalized and useful to their specific health problem, according to a recent healthcare consumer study from Deloitte. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533529null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Connectivity/Plans-get-their-feet-wet-with-virtual-physician-vi/ArticleStandard/Article/detail/533528?ref=25 E-visits appear to be on the present horizon, but reimbursements are still being worked out. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533528null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Medicare%2FMedicaid+products/Medicare-Advantage-plans-on-the-ropes/ArticleStandard/Article/detail/533520?ref=25 In enacting legislation to delay a reduction to Medicare physician fees, Capitol Hill Democrats demonstrated their intent to undermine the role of private insurers in providing care to seniors. Although all sides agreed to avoid a big cut in Medicare payments to doctors, Republicans fought efforts to fund the fees by reducing payments to Medicare Advantage plans. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533520null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Visionaries/Care-partners-Online-visits-present-new-opportunit/ArticleStandard/Article/detail/533524?ref=25 According to Deloitte's 2008 survey of healthcare consumers, two out of three consumers want to use their doctor's Web site to get information about health conditions or treatments; and 61% of consumers want tools that would provide personalized recommendations to improve their health. Roy Schoenberg, MD, CEO of American Well Systems, is well versed in healthcare consumers' growing interest in online tools. He invented the company's online health marketplace concept, which debuted in June. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533524null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Disease+Management/Sleepless-nights-cost-billions-in-care-and-product/ArticleStandard/Article/detail/533526?ref=25 The continual inability to fall asleep or stay asleep is keeping approximately one-third of the nation up at night. Individuals with insomnia incur $12 billion in direct medical costs and $2 billion in drug costs alone. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533526null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Medicare%2FMedicaid+products/Medicare-audits-CMS-imposes-corrective-action-plan/ArticleStandard/Article/detail/533525?ref=25 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. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533525null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Pharmacy+Best+Practices/Plans-vary-in-specialty-drug-benefit-models/ArticleStandard/Article/detail/533527?ref=25 A recent online survey from Serono Injectables Digest, which includes data from 83 health plans, looked at the challenges and strategies of managing specialty pharmacy, provider reimbursement and cost sharing. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533527null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Specialty+drugs/Leveraging-specialist-counsel-adds-insight-into-sp/ArticleStandard/Article/detail/533832?ref=25 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. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533832null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Congress-approves-Medicare-pay-patch/ArticleStandard/Article/detail/533530?ref=25 Washington, D.C. — Enough Republicans sided with Democrats last month to approve legislation canceling a scheduled 10.6% cut in Medicare fees for physicians. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533530null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/For+Your+Benefit/Collecting-payment-is-hard-work-for-small-practice/ArticleStandard/Article/detail/533523?ref=25 Personally, I'm concerned about the financial stability of the small physician practices that struggle to cover their costs. Small practices should consider options such as electronic fund transfers or an employment model to streamline financial activities. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533523null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Cover+Article/Delivering-information-AHRQ-drives-quality-in-cont/ArticleStandard/Article/detail/533522?ref=25 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. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533522/MHEAUGClancythumb_thumbnail.jpg http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533522/MHEAUGClancythumb_main.jpg http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533522null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Letter+of+the+Law/Congress-considers-sweeping-changes-to-False-Claim/ArticleStandard/Article/detail/533521?ref=25 The civil False Claims Act is the principal weapon in the government's arsenal to combat healthcare fraud. The Senate and the House are considering bills that would further expand the scope of liability under the Act and eliminate two of the key defenses to meritless lawsuits filed by qui tam plaintiffs. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533521null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Member+engagement/Health-plans-must-own-member-CDH-experience/ArticleStandard/Article/detail/533833?ref=25 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. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533833null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/SureScripts-RxHub-merger-provides-on-ramp-to-full-/ArticleStandard/Article/detail/533531?ref=25 National reports — The e-prescribing SureScripts and RxHub network merger reflects the national movement toward interconnected, standards-based technology infrastructures. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533531null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/HIPAA/Medical-blog-can-invade-patient-privacy/ArticleStandard/Article/detail/532555?ref=25 HIPAA rules expect the utmost in patient privacy, even online. 2008-07-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/312008/532555null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Efficiency/Consumer-label-presents-health-insurance-values/ArticleStandard/Article/detail/532553?ref=25 Consumers often don't understand their own benefit plans, but a collaboration of leaders is hoping to do something about that 2008-07-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/312008/532553null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Efficiency/Formerly-Uninsured-in-San-Francisco-Can-go-to-Priv/ArticleStandard/Article/detail/532552?ref=25 Efforts to help the uninsured receive care and sign up for existing coverage plans has progressed in San Francisco. 2008-07-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/312008/532552null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/State+Report/State-Report-Illinois/ArticleStandard/Article/detail/528035?ref=25 The administration of Illinois Governor Rod Blagojevich (D) has hidden its state budget problems by rolling over an average of $1.5 billion in Medicaid claims each year since 2005, according to a state audit released in May. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528035null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Maintain-competitive-cost-structure-in-uncertain-e/ArticleStandard/Article/detail/526687?ref=25 Regardless of an insurer's composition — public or private, large or small, geographically diverse or regionally focused — reducing non-labor general and administrative (G&A) expenses can contribute greatly to margin improvement. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/526687null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Managed+Care+Outlook/H-CAHPS-survey-reflects-patient-experiences/ArticleStandard/Article/detail/528030?ref=25 Starting March 28, data on patient experiences in the hospital was added to the federal government's Hospital Compare Web site. Patients' feedback was drawn from a 27-question survey developed by the Agency for Healthcare Research and Quality (AHRQ), and reflects the issues of greatest concern to patients. Data about patients' experiences in 2,500 hospitals has already been uploaded to the site; by the end of the year, information from most of the nation's hospitals will be available. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528030null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Ohio-mandate-calls-for-contract-transparency/ArticleStandard/Article/detail/528033?ref=25 National Reports — A new Ohio mandate standardizes the credentialing process and promotes more contracting transparency and fairness in the managed care process. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528033null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/CDC-urges-flu-vaccination-for-all-children/ArticleStandard/Article/detail/526686?ref=25 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. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/526686null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Hospitals+and+Providers/Grassroots-movement-grants-medical-home-access-to-/ArticleStandard/Article/detail/528026?ref=25 While legislators and healthcare stakeholders across the country wrangle over the problem of the nation's 46.5 million uninsured, a grassroots movement called Project Access is having an impact on the health of thousands of uninsured Americans. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528026null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Cover+Article/Purchasing-value-The-Pacific-Business-Group-on-Hea/ArticleStandard/Article/detail/528022?ref=25 When Peter Lee stepped down in January from his eight-year tenure as president and CEO of the Pacific Business Group on Health (PBGH), he chose to stay close to home, taking over the new role of executive director of national health policy for this non-profit organization of large employers and other major purchasers. Although Lee wears a new hat, he is confident that he has left the CEO position in the hands of a competent and experienced healthcare thought leader: David Lansky. The duo has easily blended its expertise—Lansky as the information technology whiz and Lee as the national healthcare policy guru and patient advocate. Both share a passion for data and measurement. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528022/mhe0708_Profile_thumbnail.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528022/mhe0708_Profile_main.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528022null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Letter+of+the+Law/States-decide-business-of-insurance/ArticleStandard/Article/detail/528021?ref=25 Capitation and other risk-sharing arrangements have been pursued by provider organizations for the past two decades. Yet the law on whether such arrangements result in the provider organization being in the business of insurance has not fully evolved in all states. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528021null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/For+Your+Benefit/Wacky-ad-campaign-reaches-the-right-people/ArticleStandard/Article/detail/528025?ref=25 Your advertising campaign has officially become old-school. That stock image of pleasant patients and attractive doctors? You aren't catching anyone's attention with that approach anymore. Meet HealthPartners' new mascot: Petey P. Cup. Yes, that's right, a urine specimen cup is a walking, dancing, huggable mascot that makes appearances at clinics, health fairs and events around the Twin Cities. Petey also has a syringe sidekick named Pokey. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528025null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Special+Report/Genetic-precision-New-fields-in-genetic-testing-le/ArticleStandard/Article/detail/528024?ref=25 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. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528024null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Desktop+Resource/Specialty-pharmacy-drives-drug-spend/ArticleStandard/Article/detail/528031?ref=25 Drug trend for 2007 was 2%, the lowest year-over-year trend since Medco began tracking it in 1999, according to the company. While the drug cost trend is small in terms of overall healthcare dollars spent, it was at one time rising at a rate more than double the rate of inflation, according to Lon Castle, MD, senior director, department of medical and analytical affairs at Medco. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528031null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Measure-includes-bonus-pay-to-encourage-more-e-pre/ArticleStandard/Article/detail/528034?ref=25 Washington, D.C. — Several Congressional leaders, the Bush administration and major players in the e-health community are promoting electronic prescribing systems as an achievable step toward broader health information interconnectivity. Legislation to postpone a cut in Medicare payments to physicians includes a provision that encourages electronic prescribing by physicians. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528034null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Medicare-opens-access-to-Part-D-data/ArticleStandard/Article/detail/528032?ref=25 Washington, D.C. — Government agencies and qualified researchers will be able to tap into Medicare Part D claims data to learn more about drug coverage and safety under a new policy issued by the Centers for Medicare and Medicaid Services (CMS). 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528032null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Visionaries/Information-aggregation-Safe-harbor-allows-compani/ArticleStandard/Article/detail/528023?ref=25 The need to not only provide greater value, but to document that value in a tangible way, is what led to the creation of the Center for Health Value Innovation in January 2007. The not-for-profit center represents industry stakeholders committed to sharing the evidence that value-based designs improve health status and reduce health cost inflation. Its members consist of large- and mid-sized employers, health plans, integrated delivery systems, self-funded unions, municipal and state governments, medical management firms, broker/consultants, pharmacy benefit management companies and vendor organizations. "Health plans are like other businesses, which means they often are segmented into different channels," says Cyndy Nayer, the center's president and executive director and one of the founders. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528023null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Health+Management/P4P-programs-aim-to-track-prevent-growing-MRSA-epi/ArticleStandard/Article/detail/528027?ref=25 Methicillin-resistant Staphylococcus aureus (MRSA), a type of bacterium that is resistant to certain antibiotics, has become a national epidemic, with increasing numbers of serious infections, hospitalizations and deaths. Hospital stays for these infections tripled from 2000 to 2005. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528027null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Maintain-confidentiality-with-ERISA-plans/ArticleStandard/Article/detail/526685?ref=25 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. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/526685null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Theres-a-paradox-of-recovery-auditing-for-ASO-prov/ArticleStandard/Article/detail/528036?ref=25 It's no secret that health insurance claim errors resulting in hundreds of millions of dollars in overpayments are common for large health plans. However, when the health plan is providing administrative services only (ASO) for self-funded plans, the incentive to recover overpayments decreases for a number of reasons. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528036null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Technology/Data-management-critical-to-meet-member-expectatio/ArticleStandard/Article/detail/528029?ref=25 ACCORDING TO THE RESULTS of Deloitte Consulting's 2008 Survey of Health Care Consumers, nearly 80% of consumers want their physicians to provide online access to medical records and test results. Thus, the cry has gone out for physicians, providers and purchasers to respond quickly. In the travel and banking industries, data moves freely between applications—and that's the current challenge for the healthcare industry. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528029null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Pharmacy+Benefit/Statins-fibrates-valuable-in-heart-disease-treatme/ArticleStandard/Article/detail/528028?ref=25 Statin medications lower cholesterol levels and have an anti-inflammatory effect. They should be used in combination with lifestyle changes to reduce heart disease risk. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528028null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Cost-cutting-must-occur-ahead-of-reforms/ArticleStandard/Article/detail/528020?ref=25 Although there is strong interest in providing universal coverage for Americans, there is a growing sense that any coverage mandate must follow other changes so insurance is made more affordable first. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528020null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Lack-of-access-can-be-life-changing/ArticleStandard/Article/detail/526639?ref=25 Access to coverage, especially for individuals and small groups, is a constant issue. So much so that many Americans are taking great steps to change their lifestyles in order to obtain it. Get married to gain access to insurance? Some are doing just that. 2008-06-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/262008/526639null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Two-votes-determine-Medicare-payment-rule/ArticleStandard/Article/detail/526637?ref=25 Two votes from Republican senators killed a House bill that would have averted statutory payment reductions for Medicare physicians, just before legislators left Capitol Hill for their Independence Day holiday. Medicare physicians now face 10.6% fee cuts, but there is an opportunity for retrospective increases after the recess. 2008-06-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/262008/526637null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Government-proposal-could-allow-e-Rx-of-controlled/ArticleStandard/Article/detail/526638?ref=25 U.S. drug regulators are said to be close to allowing doctors to e-prescribe addictive medications, including painkillers. According to Reuters, the Drug Enforcement Administration is expected to publish a proposal on e-prescribing controlled substances. 2008-06-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/262008/526638null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/More-employers-using-incentives/ArticleStandard/Article/detail/526641?ref=25 The number of major employers offering employee wellness programs with incentives grew over the past year, according to a study presented by Health2 Resources. The National Association of Manufacturers and The ERISA Industry Committee participated in the survey. 2008-06-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/262008/526641null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/NCQA-to-evaluate-wellness-programs/ArticleStandard/Article/detail/526640?ref=25 The National Committee for Quality Assurance’s (NCQA’s) proposed standards and measures for a new Wellness and Health Promotion (WHP) product evaluation have been released for public comment. 2008-06-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/262008/526640null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/MHE-E-news-July-images/ArticleStandard/Article/detail/526826?ref=25 2008-06-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/526826null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Special+Report/Where-Data-Stops-Employers-want-more-data-for-cost/ArticleStandard/Article/detail/522497?ref=25 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. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522497null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Desktop+Resource/Employers-manage-prescription-drug-costs/ArticleStandard/Article/detail/522502?ref=25 Employers are more than just concerned about the rising costs of prescription drugs—they're ready to stem the tide, according to industry experts. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522502null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Better-informed-members-are-more-satisfied/ArticleStandard/Article/detail/522504?ref=25 National Reports—Providing useful information is key to increasing satisfaction among health plan members, say industry experts. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522504null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Health+Management/Innovative-plan-designs-focus-on-consumer-engageme/ArticleStandard/Article/detail/522499?ref=25 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. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522499null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Visionaries/Physician-Proponent-Prescription-Solutions-Brian-S/ArticleStandard/Article/detail/522496?ref=25 The relationship between physicians and pharmacy benefit managers continues to change. A goal of Prescription Solutions' Brian Solow, MD, is to foster a collaborative approach to working with physicians, to ultimately deliver better care to patients. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522496null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Use-customer-service-to-reap-bottom-line-benefits-/ArticleStandard/Article/detail/521795?ref=25 Today's hospitals now compete with something far more engaging and intoxicating than the hospital down the street — consumer expectations. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/232008/521795null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Cover+Article/Package-pricing-Geisingers-new-model-holds-the-pro/ArticleStandard/Article/detail/522495?ref=25 Geisinger Health System and Geisinger Health Plan have attracted attention from key industry players ever since introducing a bundled-pricing program called ProvenCare in 2006. Richard Gilfillan, MD, president and CEO of Geisinger Health Plan, played a critical role in the launch of the new payment structure. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522495/Gilfillan_thumbnail.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522495null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Dashboards-boost-patient-services-in-call-centers/ArticleStandard/Article/detail/522811?ref=25 Contact centers must prove their value to the organization and the patient. Kaiser Permanente has seen success with its dashboard approach. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522811null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Hospitals+%26+Providers/Intensivists-bring-experience-to-critical-care-med/ArticleStandard/Article/detail/522498?ref=25 The intensive care unit (ICU) is, in many ways, the most significant section of a hospital, because it is where life-threatening issues occur almost daily. The ICU is the one area where most hospitals don't employ specialists—board-certified intensivists with expertise and training in critical care medicine. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522498null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Managed+Care+Outlook/Many-still-wrong-in-their-DM-savings-calculations/ArticleStandard/Article/detail/522501?ref=25 How is it that well-informed people can look at the same data and come up with dramatically different conclusions and action implications? It turns on whether the analysis is done by biostatisticians looking at utilization data in an academically rigorous way, or by actuaries and benefits consultants looking at overall financial trends in a pre-post manner. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522501null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/For+Your+Benefit/Irish-healthcare-system-offers-access-at-72-GDP/ArticleStandard/Article/detail/522491?ref=25 I had the honor of joining 40 executive delegates for a week to observe the Irish healthcare system. While spending in the Irish healthcare system is just 7.2% of GDP, the public hospitals are filled to the gills. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522491null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Health-reforms-set-comparative-research-goals/ArticleStandard/Article/detail/522493?ref=25 As the 2008 presidential campaign moves into its final stages, there is much enthusiasm within both parties for developing objective information on the effectiveness of medical treatments and therapies in real-world settings. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522493null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/State+Report/State-Report-Minnesota/ArticleStandard/Article/detail/522492?ref=25 Minnesota Ranked first in the nation in overall state healthcare quality, according to a recent report by the Agency for Healthcare Research and Quality. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522492null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Technology/Complex-decision-making-requires-better-collaborat/ArticleStandard/Article/detail/522500?ref=25 The use of technology to automate simple tasks has been widely adopted. E-mails broadcast information in a fraction of the time it would take a manual process. More complex tasks, however, require a human driver, and those tasks are in higher demand today. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522500null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Consider-increasing-emphasis-on-healthcare-program/ArticleStandard/Article/detail/521794?ref=25 The majority of program development or improvement plans fail to meet their projected performance. What can a healthcare executive leadership team do to change this outcome for their organization? 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/232008/521794null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Feds-limit-deceptive-MA-marketing-tactics/ArticleStandard/Article/detail/522503?ref=25 Washington, D.C. — The Bush administration has proposed additional curbs on certain sales practices by insurers likely to confuse and deceive seniors enrolling in Medicare Advantage and prescription drug plans. Insurers applauded the marketing policy, partly in hopes of heading off legislation that would give states a larger role in policing Medicare marketing activities. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522503null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Win-Win-Dental-benefit-consulting-adds-value-for-i/ArticleStandard/Article/detail/522812?ref=25 Dental benefit consultants are important allies for insurers as the dental profession transitions to an evidence-based dentistry (EBD) perspective. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522812null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Strategies-for-ICD-10-take-proactive-approach/ArticleStandard/Article/detail/521793?ref=25 Most healthcare players agree that ICD-10 implementation will be expensive and resource-intensive. Yet opportunities abound to enable proactive organizations to become industry leaders with the new system. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/232008/521793null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Letter+of+the+Law/Understand-Public-Information-Act-to-protect-recor/ArticleStandard/Article/detail/522494?ref=25 When companies interact with governmental bodies, issues related to the Public Information Act frequently arise. It is imperative for those companies to understand the Public Information Act as well as the internal procedures that may be developed to handle open records issues. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522494null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Kaiser-completes-national-EMR-rollout/ArticleStandard/Article/detail/519725?ref=25 Oakland, Calif.—Nearly 9 million Kaiser Permanente members in nine states are now on the books with the plan’s HealthConnect electronic medical record system, which completed a four-year rollout recently. Installation cost $4 billion, including $1 billion for maintenance. 2008-05-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/222008/519725null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Agreement-on-biosimilars-emerges/ArticleStandard/Article/detail/519718?ref=25 Washington, D.C.—There’s a lot of talk in Washington about the importance of enacting legislation to establish a pathway for FDA to approve “similar” or “follow-on” versions of biotech drugs. Biopharmaceutical companies have been pushing for compromise legislation this year, that is aligned with health insurers, pharmacy benefit managers, and public and private payers, who envision big savings. 2008-05-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/222008/519718null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Cleveland-Clinic-to-test-PHR-security-with-Google/ArticleStandard/Article/detail/519727?ref=25 Cleveland—Cleveland Clinic has its own electronic personal health record system for patient viewing, and now it plans to pilot information-exchange capabilities with GoogleHealth, an online PHR platform. 2008-05-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/222008/519727null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/June-E-news-Art/ArticleStandard/Article/detail/519759?ref=25 2008-05-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/222008/519759null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Retailers-expand-4-drug-programs/ArticleStandard/Article/detail/519724?ref=25 National News—Wal-Mart will offer generic medications for $10 for a 90-day supply, which previously cost $4 for a 30-day supply, offering more over-the-counter medications at $4. About 350 generics are covered. At the same time, Target’s prescription drug program now includes an expanded assortment of $4 prescription drugs, 90-day supply of these medications for $10 and OTC medications for $4 or less. 2008-05-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/222008/519724null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Corporationrsquos-age-factors-into-health-benefits/ArticleStandard/Article/detail/519728?ref=25 National News—Small businesses are less likely to offer employee health benefits, especially if they’re the new kid on the block, according to a recent report from the Kaiser Family Foundation. Analysis finds that among firms with nine employees or fewer, those in business for 20 years or more are more likely to offer benefits. 2008-05-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/222008/519728null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Desktop+Resource/Enrollment-process-offers-key-opportunities/ArticleStandard/Article/detail/515155?ref=25 The enrollment process offers opportunities to engage employees, but the tools themselves are not enough, according to one industry expert. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515155null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Cover+Article/Welcome-Back-Network-Health-Plan-tracking-number-o/ArticleStandard/Article/detail/515156?ref=25 Higher-than-expected enrollment has challenged the budget and the administration of public health coverage in Massachusetts ever since its universal health plan took effect in April 2006. Christina Severin, executive director of Network Health in Medford, Mass., a private plan that covers subsidized Commonwealth Care members as well as MassHealth Medicaid members, believes programs will continue to struggle until one particular problem is solved: enrollment churning. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515156/severin.web2_thumbnail.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515156/severin.web2_main.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515156null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Pharmacy+Benefit/Plan-PBM-programs-help-identify-prescription-drug-/ArticleStandard/Article/detail/515154?ref=25 How much attention is being paid to abuse of prescription drugs? One group, pharmacy benefit managers, are beginning to take a closer look by creating programs to identify members who may be abusing prescription drugs. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515154null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/How-to-survive-healthcares-war-for-talent-Four-pat/ArticleStandard/Article/detail/514479?ref=25 Attracting the right candidate and landing that talented employee for your organization are challenges. As the labor market continues to tighten, healthcare employers need to focus on long-term recruitment and retention strategies. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/514479null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Efficiency/Recognize-value-of-certified-case-managers-in-mana/ArticleStandard/Article/detail/514478?ref=25 Case managers provide services at critical junctures, whether facilitating discharge from acute care to a sub-acute facility or coordinating home healthcare services for an individual to prevent hospital readmissions. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/514478null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/For+Your+Benefit/Expert-protection-laws-to-follow-federal-parity-la/ArticleStandard/Article/detail/515147?ref=25 Long debates in Congress over mental health parity laws position the most human of health needs up against stretched budgets and market disagreements on treatment value. At the moment, arguments center on insurers' coverage obligations, but few are addressing another debate that is certain to follow. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515147null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Demand-grows-for-transparent-quality-measures/ArticleStandard/Article/detail/515150?ref=25 The health-quality measurement bandwagon is picking up steam these days as both public and private payers struggle to deal with rising costs and the need to ensure quality care. Medicare has greatly enhanced its "Hospital Compare" Web site by posting the results of a patient survey on satisfaction with care during hospital stays. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515150null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Visionaries/Merger-activity-Jon-Cohen-MD-addresses-state-of-ho/ArticleStandard/Article/detail/515157?ref=25 When Jon R. Cohen, MD, was recently appointed managing director of health industries advisory services for PricewaterhouseCoopers LLP, he says it was "complex solution solving" that drew him to the firm. Here, he discusses trends on hospital mergers, profitability and hospitals, and his thoughts on the 2008 presidential hopefuls. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515157null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Report-card-standards-developed/ArticleStandard/Article/detail/515148?ref=25 Washington, D.C. — Health insurers and medical groups have agreed to work together to develop national standards for rating physician performance. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515148null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Letter+of+the+Law/Captive-insurance-arrangements-more-common/ArticleStandard/Article/detail/515151?ref=25 Many healthcare entities have explored certain alternative risk transfer arrangements as a means for insuring, or perhaps self-insuring, various exposures. The use of captive insurance arrangements has been a common approach, and thus, "protected cell companies" have become popular vehicles. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515151null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Special+Report/Early-Retirees-Consumer-driven-options-the-plans-o/ArticleStandard/Article/detail/515152?ref=25 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. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515152null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/CDHP-savings-modest-enrollment-low/ArticleStandard/Article/detail/515267?ref=25 Recent Milliman analysis of employer programs that offer employees a choice of consumer-directed health plans or non-CDHPs, shows that when offered as a new choice, CDHPs deliver a modest 1.5% in savings beyond non-CDHPs based on typical risk- and benefit-adjustment factors. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515267null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Medicare-Medicaid-and-SCHIP-Extension-Act-of-2007-/ArticleStandard/Article/detail/514477?ref=25 On Dec. 29, 2007, President George W. Bush signed the multi-faceted Medicare, Medicaid, and SCHIP Extension Act of 2007. Section 111 of the bill, titled, Medicare Secondary Payor (MSP), mandated that effective Jan. 1, 2009, all Group Health Plans (GHP) or any related entity (i.e. insurer or third party administrator) serving on behalf of the GHP will be responsible for identifying and submitting "situations where the group health plan is or has been a primary plan to the program," according to Medicare. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/514477null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/State+Report/State-Report-Vermont/ArticleStandard/Article/detail/515149?ref=25 In May 2006, Vermont became one of a handful of states to pass comprehensive health reform legislation intended to increase access to affordable healthcare while reducing cost through quality improvement measures. The plan requires employers to provide or help finance coverage for their workers. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515149null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Hospitals+and+Providers/Management-systems-keep-hospitals-from-meeting-goa/ArticleStandard/Article/detail/515153?ref=25 A few hospital systems already are improving work process by implementing Lean and Six-Sigma management principles. Implementing Lean Sigma (a complementary combination of Lean and Six-Sigma) in a hospital setting is not about fixing problem employees who fail to improve their work. It's about fixing the broken systems and processes that hinder medical professionals from doing what they do best. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515153null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/FDA-would-regulate-tobacco-under-new-legislation/ArticleStandard/Article/detail/513370?ref=25 Congress is looking to give the Food and Drug Administration the controversial and complex job of controlling tobacco marketing and advertising. FDA would not be able to ban cigarettes or require zero nicotine products, under legislation recently approved by a key House committee. But it would gain authority to approve cigarette labeling, limit certain promotional claims and curb marketing to minors. The measure provides legal authority for a regulatory approach devised more than 10 years ago under former FDA Commissioner David Kessler, but subsequently struck down by the courts. 2008-04-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/182008/513370null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Blue-Cross-of-California-now-known-as-Anthem-Blue-/ArticleStandard/Article/detail/513363?ref=25 Blue Cross of California, one of the state’s largest health plans, has changed its name to Anthem Blue Cross, the San Francisco Business Times reports. Anthem Blue Cross has 8.4 million members in California. 2008-04-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/182008/513363null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/May-Enews-art/ArticleStandard/Article/detail/513399?ref=25 2008-04-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/182008/513399null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/WellPoint-acquires-Resolution-Health/ArticleStandard/Article/detail/513359?ref=25 WellPoint Inc.’s acquisition of Resolution Health Inc., a data analytics-driven personal healthcare guidance company, is yet another reflection of the interest in consumer-driven tools such as EHRs, PHRs, and health-related search engines, among others. 2008-04-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/182008/513359null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Obesity-weighs-heavily-on-employers/ArticleStandard/Article/detail/513367?ref=25 The rate of obesity in the United States has doubled in the last 30 years, and is weighing down companies’ bottom lines, according to a new report from the Conference Board, a business membership and research organization in New York. 2008-04-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/182008/513367null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Medicare-Advantage-rates-holding-steady/ArticleStandard/Article/detail/513353?ref=25 Medicare Advantage plans will see payment rates increase by 3.6% in 2009, slightly higher than last year’s rise of 3.5%, but not as much as the 3.7% boost previously predicted. This slight drop from earlier estimates is a result of lower-than-expected plan expenditures for 2007, according to analysis by the Centers for Medicare and Medicaid Services (CMS). 2008-04-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/182008/513353null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Drug+Safety/Creating-drug-monographs-and-drug-class-reviews-in/ArticleStandard/Article/detail/512496?ref=25 P&T committees can create evidence-based formularies with a variety of tools and proven methods of evaluation 2008-04-25T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/172008/512496null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/bpastatementpdf/ArticleStandard/Article/detail/511375?ref=25 bpa_statement.pdf for Request a Media Kit, Rate Card, or BPA Statement form 2008-04-21T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/172008/511375null PDF http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/New-Jersey-considers-coverage-mandate/ArticleStandard/Article/detail/506572?ref=25 If a new proposal is adopted, New Jersey would be the fourth state to enact mandatory coverage. About 1.4 million residents currently are uninsured. 2008-04-03T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/142008/506572null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Medicare-eyes-reporting-of-industry-physician-rela/ArticleStandard/Article/detail/506570?ref=25 The Medicare Payment Advisory Commission (MedPAC) has been examining the feasibility of requiring hospitals and medical product manufacturers to report financial relationships with physicians on a national basis. 2008-04-03T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/142008/506570null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Insurersrsquo-marketing-promises-draw-support-skep/ArticleStandard/Article/detail/506566?ref=25 Medicare Advantage plans are supporting efforts to halt inappropriate marketing tactics, partly to head off more stringent federal and state oversight designed to stop abusive practices. Last month, America’s Health Insurance Plans (AHIP) adopted a proposal urging enactment of new rules to prohibit certain marketing practices that violate Medicare policy. 2008-04-03T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/142008/506566null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Texas-employers-gain-more-access-to-health-records/ArticleStandard/Article/detail/506560?ref=25 Federal law allows insurers to pass along disidentified health information to employer plan sponsors, however, a law that went into effect in Texas in January now forces insurers to pass the information along. 2008-04-03T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/142008/506560null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Cover+Article/Beware-of-barriers-to-care-Pitney-Bowes-increases-/ArticleStandard/Article/detail/507966?ref=25 Employers are finding themselves between a rock and hard place when it comes to health benefits. If they reduce or eliminate benefits, they lose quality workers as well as productivity. If they maintain or increase benefits, they're almost certain to spend beyond their budgets year after year. In trying to strike a happy medium, more employers are now remodeling their health benefit plans dramatically, hoping to see better results. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/507966/0408_1_thumbnail.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/507966/0408_1_main.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/507966null XML