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Opinion: A Biden win, a Republican Senate and a slim Democratic majority in the House: That’s a recipe for compromise.With the 2020 election season nearly behind us, conventional wisdom is that we will have divided government: a Democratic president, a Republican Senate and a razor-thin Democratic majority in the U.S. House of Representatives. That combination is a recipe for compromise on President-elect Joe Biden’s healthcare priorities; namely, the federal response to the COVID-19 pandemic and adjustments to the ACA.
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Why Timing Matters When It Comes to PBM ContractingPlan sponsors should begin evaluation of PBM performance at least a year before the contract expires, say lawyers with expertise in PBM contracting.
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Important Takeaways Regarding the Utilization of RuxolitinibPanelists discuss how ruxolitinib offers significant advantages in atopic dermatitis management through its targeted JAK inhibition mechanism, demonstrating rapid and sustained improvement in itch and lesions, effectiveness across various disease severities and body regions, favorable safety profile compared to systemic alternatives, and potential for reduced healthcare resource utilization over extended treatment periods.
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To Proactively Address SDOH, the ‘Top of Funnel’ is CriticalWe can identify and engage the right people. But to make a real difference in any community, a managed care organization, government agency or healthcare system needs to have a robust list/dataset of its population so the tools, processes and individuals that come after can do the work to identify and engage members with the highest needs.
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What’s Next in Healthcare Mergers & AcquisitionsLast year was a record setting year in worldwide merger and acquisition activity across multiple industries, and healthcare was a big part of that.
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Don’t Overlook the Importance of Annual Dilated Retinal ExamsThe annual dilated retinal exam, a unique tool which uses drops to dilate the pupil, is not just about eye health. It offers a comprehensive view of a member's overall well-being, potentially identifying serious health issues at an early stage.
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Addressing Ransomware in HealthcareThere 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.
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Future Direction of Intravenous and Subcutaneous BiologicsDr. Seminerio predicts how the future landscape will change for intravenous and subcutaneous biologics.
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Reproductive Privacy Rights: Changes Coming for Healthcare OrganizationsThe Office of Civil Rights published a proposed rule that could have healthcare organizations evaluating their practices surrounding, and interactions with, reproductive healthcare information.
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DOJ Issues Important Updates to Evaluation of Corporate Compliance GuidanceA strong, up-to-date compliance program should be part of a healthcare company's risk management strategy.
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Empowering the Next Generation of Nurse LeadersHealthcare organizations must encourage anyone in need to explore the mental health and wellness resources available at their institution.
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CMS’ RADV Strategy Will Reverberate Throughout Health Plan OperationsTo prepare for CMS’ new risk adjustment data validation (RADV) strategy, Medicare Advantage plans must take a coordinated, organization-wide approach.
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Optimizing Multidisciplinary Care in VitiligoAn expert discusses how patients with vitiligo are often initially misdiagnosed by primary care providers as having fungal infections before being referred to dermatologists, with care coordination typically involving endocrinologists for thyroid management and psychologists for mental health support.
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As the COVID-19 Pandemic Drives Record Telehealth Use, What’s Your Long-Term Plan?Preparing for a future that includes telehealth means considering revenue streams, ROI, facility planning and other factors.
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Addressing Ransomware in HealthcareThere 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.
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Optimizing the Management of TRDDrs Steven Levine, Patricia Ares-Romero, Samuel Nordberg, Martin Rosenzweig, and Carrie Jardine share insight on the future treatment landscape for TRD.
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Zeposia, Vumerity Tie on Efficacy but Zeposia Has Superior Safety ProfileFindings presented at the 2023 Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) were the first to compare the two drugs for relapsing-remitting multiple sclerosis.
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How AI Can Help Payers Streamline Prior Authorizations to Save Time, Improve Member CareMany prior authorizations requests still come in by fax. Natural language processing and artificial intelligence can extract and use information from faxes.
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The Urgent Case for Proactive Behavioral HealthcareThe healthcare system is facing an onslaught of patients with new and worsening conditions due the COVID-19 pandemic, but it is nowhere near ready to accommodate them.
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How Payers Can Weather the COVID-19 Storm – and Its AftermathCOVID-19 has revealed the power and value of data analytics as claims have gyrated in unprecedented ways.
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5 Tips for Health Plans to Improve Race and Ethnicity DataEquity is a central part of healthcare quality, but health plans often lack information on individual members’ race and ethnicity, making assessing and improving health outcomes challenging.
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Key Takeaways Following MAJIC-PVGabriela Hobbs, MD, and Timothy Mok, PharmD, BCPS, BCOP, close the discussion with key takeaways for payers to consider related to ruxolitinib and insights on future research.
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Remove the COBRA Creditable Coverage Penalty in Medicare and Help SeniorsCOBRA coverage is not currently considered creditable coverage, so some seniors face Part B penalties. That needs to change.
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An Urgent Call to Reduce and Reuse Hospital Supplies for Stronger Financial, Environmental and Clinical SustainabilityNow is the time to take serious action to reform wasteful hospital practices and strengthen the healthcare supply chain. The high cost of American healthcare has topped headlines for years.
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Overcoming Barriers to Narcolepsy Treatment and Looking to the FutureAn expert discusses considerations for tailoring narcolepsy treatment plans for patients with complex comorbidities or lifestyle needs, the role of insurance policies, prior authorizations, and specialty pharmacies in treatment access, emerging strategies to improve care in underserved populations, and the role of hypocretin in narcolepsy.
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Developing Winning Supplemental Benefits PackagesFacing a variety of financial pressures, health plans need to take a measured approach to identify supplemental benefit strategies that facilitate their success.
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AI Hype and Engagement Fatigue | Predictions for 2025A forecast for this year by Luis E. Taveras, Ph.D., senior vice president and chief information officer of Lehigh Valley Health Network.
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Why 2021 Patient Experience Will be Tied to Telehealth SuccessHow consumers feel about their virtual care encounters will influence everything from CAHPS surveys to compensation beyond the pandemic.
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The Oncology Care Model Provides a Framework for the New Enhancing Oncology ModelThe new model starts in July 2023. Practices will be required to take on two-sided risk right from the start.
