Julie Miller

Charles Kennedy, MD, plays a vital role in WellPoint's innovative health record that contains clinical benchmarks

UnitedHealth's Dr. Reed Tuckson believes managing the health of large populations and individuals calls for the best in every stakeholder

Eight Ohio health plans are participating in a pilot to streamline administration with hopes that national efforts could come next

Every pre-existing condition is subject health insurers' anti-fraud mechanism, but that doesn't help them make many friends

Emerging markets provide some potential for new members while retaining current members requires improved service offerings

The Senate Finance Committee is hammering out a bipartisan bill while other leaders will drive ultimate implementation

Dean Health Plan and its PBM business seek sure footing for today's changing times in healthcare

While co-ops do provide good care and the right incentives, they still face market pressures that have historically destroyed them

Health coverage is typically gender-balanced, but in some states, women are paying higher premiums that simply cannot be justified actuarially, according women's groups and some Congressional leaders.

Triple-S hopes to leverage its local market success in Puerto Rico to gain new business within the United States' growing Hispanic population

Physicians' first-hand experience has no substitute, and Dr. William Cromie has maintained CDPHP's vision of including physicians in the governance of this health plan. Often, the plan and the physicians are faced with tough choices and collective compromises.

HIPAA prohibits group plans from charging higher premiums to individuals due to health status, medical history, genetic information, claims experience, receipt of care or evidence of disability. The Department of Labor's Employee Benefits Security Administration recently issued guidelines that closed off a loophole that might have allowed employers to charge less healthy workers higher deductibles.

With healthcare quality being so difficult to quantify, flawed ratings are unavoidable. Health plans, patients and governments, however, are desperate for some sort of yardstick by which to judge providers.

Millions of people's lives have been influenced by the work of Mollie Orshansky, even though very few people know who she is. Dozens of health-related programs throughout history have benefitted from Mollie's contributions, including programs through HHS, charitable agencies, private companies and managed care. In 1963, it was Mollie-an accomplished mathematical genius and daughter of a poor immigrant family-who developed the U.S. government's official measure of poverty and the guidelines for what we call the Federal Poverty Level (FPL) today.

When you're the most populous state in the union, any extraordinary policies you sketch out could likely become a national catalyst for change. California has begun working on its state initiative for comprehensive healthcare reform, not simply for lack of a national proposal, but also because the health of its 36.1 million residents is at stake.

As the managed care industry continues to consolidate, not-for-profit and provider-sponsored plans haven't lost their niche in the marketplace. They compete on demonstrated quality and the added value of community accessibility, which would, on the surface, seem to be exactly what politicians and healthcare advocates are begging for.

Everyone is jumping into the pool-the state-purchasing pool that is. States are beginning to dive into healthcare overhaul with almost artistic creativity, coming up with state-specific, collectively funded plans to fix the leaks in coverage.

Obesity is the new smoking. While states are increasingly outlawing public smoking, no one is ready to initiate similar measures targeted at people who are obese. It's just not polite.

When you're in the innovation business, you take some risks and temper your expectations. When one of your innovations produces $100 million in annual savings, you know you're doing something right.

Like the wide-eyed toddlers who will stare in awe at their stack of holiday gifts this year, healthcare consumers certainly have a few surprises to get excited about as 2006 comes to a close.

Every organization is accountable to its stakeholders, and Caremark, the Nashville-based pharmacy benefit manager, is no exception. Caremark, however, is also accountable to its customers for clinical execution, so performance metrics are both wide and deep.

Heartfelt sympathies to any of you who at this moment are holding a fistful of soggy tissues and cough drops as you read.

Would you pay $19,900 to add another year to your life? If only it were that simple. The New England Journal of Medicine (NEJM) recently published a study that concluded between 1960 and 2000, we paid an average of $19,900 in medical costs per year of life gained during that time. In 1960, a newborn's life expectancy was 69.9 years, and in 2000, it was 76.87 years, according to the study.

A unique social HMO for Medicare eligibles, SCAN goes beyond medical benefits and is able to offer its members access to community-based services such as transportation, housecleaning and home-delivered meals-dessert included.

Months before my grandmother moved into a nursing home, she called me over to her house to help in the kitchen.

Plans are making some progress, but providers still rely on paper, phone calls and out-dated technology

Massachusetts goes after generic makers for overcharging the state

Members and brokers want real-time plan quotes

By bringing scientific evidence forward and applying it to specific cases in healthcare, independent review organizations (IROs) are helping to shape standards of care for plans nationwide.

Not too big and not too small, disease subcategories reduce the administrative burdens of DM