WASHINGTON, D.C. -- Some pharmaceutical companies are dropping Patient Assistance Programs (PAPs) for seniors who enroll in the Medicare drug benefit program. They fear they'll be hit with fraud charges by the Office of the Inspector General (OIG) at HHS if they provide free or low-cost drugs to Medicare beneficiaries enrolled in prescription drug plans.
News that Blue Cross and Blue Shield affiliates have begun funding the formation of Regional Health Information Networks (RHIOs) should serve as a wake-up call for all managed care organizations (MCOs).
WASHINGTON, D.C. -- The main Bush administration proposal for dealing with the high cost of healthcare and rising number of uninsured is to create a new commission. In his State of the Union address in January, President Bush called for a new bipartisan panel to propose changes that will equip Medicare, Medicaid and Social Security to deal with the millions of baby boomers headed for retirement.
In 2005, Medicaid surpassed Medicare as the largest government healthcare expenditure, and it is the fastest growing population of covered lives, say industry experts.
When cultures enter Renaissance periods, new learning and ideas create transition. Heightened interest in the workings of pharmacy benefit management and subsequent changes in business philosophy represent a Renaissance for managed care. All key stakeholders will feel the ripples of change: payers, physicians, pharmacists, patients and pharmaceutical companies.
The New York Times reports that patients in New York City often have trouble securing a reimbursement for a $75 visit to the nutritionist, who counsels them on controlling their diabetes.
Government, Employers, medical associations, payers, and many others are part of a nationwide momentum toward making electronic health records (EHRs) a reality. President Bush has cited the necessity to create EHRs, leading politicians of both parties have issued joint statements, and some states have accelerated activities. A number of initiatives by the Department of Health and Human Services (HHS), standards development organizations, and other groups are moving several issues ahead.
The rise of the healthcare consumer, pay for performance and the focus on care management and prevention will not just be blips on managed care executives' radar screens this year. They will not only need to address these issues, but build a framework around them for long-term sustainability, according to PricewaterhouseCoopers.
Establishing and managing a RHIO is a little like promoting world peace.
EMRs can add to a practice's bottom line