Mark Kestner


Look to HROs to Sustain Healthcare Innovation

Despite advances in medical science and technology, our healthcare system doesn’t always translate knowledge into practice. All too often, this leaves healthcare providers questioning the key business decisions that impact patient care. What caregivers need is a model for applying new technology safely and appropriately. Thankfully, such a model exists: the High Reliability Organization (HRO) model.

Lauren Ruef


Behind the Curtain: Automating Payments in the Healthcare Industry

The COVID-19 pandemic is transforming the way the healthcare industry hands payments.

Ron Singh


The Top Six Qualities of an Effective Coordination of Benefits Solution

There is no lack of available COB solutions on the market, and the trouble is often identifying which option is the best fit for your organization. For optimal results, look for the following six elements in a COB solution to have the most success.

Skylar Jeremias


Biosimilars, Once Dubious, Looking Like a Surer Thing | 2023 Asembia Specialty Pharmacy Summit

But payers may be putting undue emphasis on interchangeability, said a panelist at session on biosimilars at the 2023 Asembia Specialty Pharmacy Summit.

Lucy Lamboley


How Rural Hospitals Are Benefiting from Remote Patient Monitoring

Patients who live in rural areas incur a variety of costs attributed to physically getting into the office to meet with their doctor when the need arises. When those patients require more frequent visits for chronic disease management, the cost of transportation, missed work, out-of-pocket copays, and any number of other costs can become a substantial barrier to care.

Ketan Patel, MD


4 Ways Natural Language Processing Will Help Payers Manage the Clinical and Financial Challenges of Long COVID

As of early this year, as many as 23 million Americans may have developed long COVID, in which symptoms persist four or more weeks after first being infected with the virus. The condition is likely to have additional long-term effects that are not yet clear. However, the U.S. has begun to obtain a glimpse of long COVID’s far-reaching impact on those who suffer from it - and the picture is rather disturbing.



Addressing the Mental Health Needs of Seniors with a Value-Based Care Team Approach

Caring for seniors means attending to both their physical and emotional health. Unfortunately, the mental health of older patients is rarely evaluated and treated. Multiple barriers to care exist, including availability and access to mental health practitioners, as well as the stigma associated with psychological conditions that may prevent patients from seeking help.

Heath Sampson


Building Relationships to Improve Access to Healthcare, Improve Health Equity

Connecting the healthcare system and patients in a positive, empathetic, respectful way may help lessen the fatigue many groups have with the healthcare system at-large and individual healthcare providers, while improving health equity.

Amy Amick


Medicare Advantage Star Ratings: The New Patient Experience Imperative for Health Plans

CMS is putting more weight on patient experience measures in its Medicare Advantage and Part D Star ratings. What health plans can do now to improve their ratings.

Dr. Sharon K. Jhawar


The Medicare Part D Senior Savings Model is Working. So Let’s Expand It.

The prevalence of a single, prominent, chronic condition among Medicare beneficiaries is staggering: fully one-third of all Medicare beneficiaries have diabetes. As a result, 3.3 million Medicare beneficiaries take insulin.

Sara Ratner


The Secret Weapon to Combat Healthcare’s Digital Divide: Health Plans

While there was a noticeable surge in telehealth usage during the global pandemic, broadband coverage has only increased by about 10%.

Amy Heymans


Keys to Effective Remote Patient Monitoring in the COVID-19 Pandemic

Health organizations that had RPM solutions in place pre-pandemic have been more successful at scaling up than organizations that were starting from scratch during the pandemic.

Belinda Griffin


Why COVID-19 Has Put Records Management in the Spotlight for Healthcare Insurers

Although the importance of comprehensive records management programs is not a new phenomenon, over the last few months events surrounding COVID-19 have brought records management into increased focus.

Patricia Kirkpatrick


Managed Care – a Path to the Future

Though value-based care is a critically important topic today, the question of—and obsession with—healthcare value goes back more than half a century.

Gregory M. Weiss, MD


What's New in Hypertrophic Cardiomyopathy, With Gregory Weiss, MD

Hypertrophic cardiomyopathy or HCM is one of the most common genetic or congenital cardiac diseases. Affecting as many as 1 in 500 people, HCM is characterized by large increases in cardiac mass, in particular, left ventricular mass. Such enlargement predisposes seemingly healthy sufferers to sudden death at young ages.

Danielle Russella


The Future of Primary Care is Here. Are You Ready?

With the COVID-19 pandemic almost in our rear-view mirror, we stand on the horizon of a profound change in healthcare: The evolution of primary care from a static provider relationship to a virtual care team in your pocket.

Richard Watson, M.D.


Improving Interfacility Transfers: Better Processes Impact Outcomes

Improving interfacility patient movement is an art and a science: to be well-executed, it requires clinical judgment and aggregated data.

Kate Driscoll


Addressing Ransomware in Healthcare

There have been an alarming increase of ransomware attacks on healthcare systems in 2021—with more than 65 reported ransomware attacks on healthcare organizations in the third quarter alone and two-thirds of organization reporting that they had been targeted by ransomware strikes—a trend that is likely to continue in 2022.

Lakiea Wright, MD MAT MPH


Managing Allergies and Asthma: What Primary Care Physicians Need to Know

With more than 50 million Americans suffering from allergies each year, it’s critical for primary care physicians to play a pivotal role in appropriately managing asthma and allergic diseases.

Rose McNulty


NCCN Update in Urothelial Bladder Cancer Highlights Checkpoint Inhibitors, Maintenance Therapy

The advent of checkpoint inhibitors has altered the treatment landscape in urothelial bladder cancer, said Arlene O. Siefker-Radtke, MD, during last week’s NCCN Conference.

Marsha Flores-Harris


The Lesser Known COVID-19 Supply Chain Issue: DME Shortages for At-Risk Patients

How health plans and providers can work together for better outcomes via a data-driven approach that streamlines the prescribing and procurement process.

Rosanna Sutherby, Pharm.D.


Risk Factors for Chronic Opioid Use Includes a History of Chronic Opioid Use in Veterans With MS

Chronic prescription opioid use is common among a sizable minority of veterans with MS, according to a recent study.

Debra Patt, MD, PhD, MBA


Value-Based Decision-Making in Metastatic Breast Cancer

In this Managed Healthcare Executive® KCast, Ian Krop, M.D., Ph.D., oncologist and associate professor of medicine at Dana-Farber Cancer Institute in Boston, and Debra Patt, M.D., Ph.D., MBA, executive vice president at Texas Oncology in Austin, provide key insights into the value-based care model for patients with HER2-positive metastatic breast cancer (mBC). This article summarizes the highlights of the discussion.

Kerry Jessani


Telemedicine and Reimbursements: Preparing for Virtual Care in a Post-Pandemic World

Centralized technology that connects payers, providers and patients are needed to optimize telemedicine reimbursement, argues J.P. Morgan's Kerry Jessani.

Walt Meffert


Out of Service: How a Missed Ride Can Impact Health Outcomes

Using predictive analytics to address social determinants of Health and transportation barriers.

Tom Mottlau


How Technology Can Revolutionize Outcomes-Based Care

Hospital room TVs have become interactive portals to a better patient experience.

Calum Yacoubian, M.D.


Interoperability Is Happening — Why Natural Language Processing Is Such an Essential Part of It

Some 80% of the clinical data is in an unstructured or semi-structured form within the notes sections of electronic health records. Natural language processing can "read” those notes and extract information without fatigue.

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