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Medical home model invests in primary careMCOs must evaluate outcomes of pilot programs before concluding that cost savings will follow quality trends
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Contraceptive coverage laws remain contentiousThe contraceptive mandate stoked the legal fire of religious groups.
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Young Adult Black Patients With Acute Myeloid Leukemia Patients Have Higher Death RateThe younger Black patients with acute myeloid leukemia (AML) had “alarmingly high” early death rates within the first 30 days of study enrollment, indicating possible delays in diagnosis and care, according to research results reported in the journal Blood Advances.
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MA star-rating policy must be improvedMedicare Advantage's star rating program includes overly ambitious benchmarks.
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Plans, NGA examine infant mortalityJapan and the UK outrank the United States in infant mortality measures
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Helping People Help Themselves: Driving Participation In Health Improvement ProgramsPrograms designed to improve health and lower health care costs only work if people use them. In an effort to increase participation, Health Management Corporation (HMC), a wholly owned subsidiary of WellPoint, Inc., researched what drives health plan members to enroll and engage in programs to improve their health.
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Best Practices in On-Site Wellness Series: Guidelines for Choosing a Health Screening and Flu Shot VendorToday, more companies are implementing wellness programs in order to improve the health and productivity of their employees, while at the same time reducing overall health care expenses. However, it is easy to think of health screenings as a commodity instead of what they truly are ? health care.
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Disease Management: a Look Back & AheadDisease management (DM) in the US can trace its roots back to the mid-1980s with the early work of California health plans and has come a long way since then. However, it wasn't until the mid 1990s that disease management became part of mainstream thinking, after several private for-profit companies introduced outsourced disease-management programs to large commercial health insurance providers. The "process/evolution" of DM in the United States has been and continues to be the major difference between disease management in the US and the UK...and other countries.
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The Missing Link in Healthcare Reform Why Healthy Living & Prevention Aren't Part of the Plan...But Need To BeAt this moment in history, we have a real opportunity to re-invent and revolutionize our entire healthcare system. However, current proposals are nothing more than a band-aid, missing the chance for true healthcare system reform. The proposed "fix" does very little to keep healthcare sustainable 10, 20 or 30 years from now.
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Intense family programs address motivation to reduce risk associated with weightOne case of a mother and child shows promise in family-oriented weight management and risk reduction
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Online management comes of age for chronic conditionsOnline virtual lifestyle management must include evidence based programs that are flexible and integrated
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Real-time data drives ACO effectivenessReal-time data sharing plays big role in effective, high-quality care.
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A prescription for specialty pharmaceuticals: Transparency and collaboration for improving drug and diagnosis coding on medical claimsSince the completion of the Human Genome Project, the explosive growth in molecular diagnostics and specialty pharmaceuticals is outpacing the growth seen in any prior era, raising serious concerns about clinical quality and cost. According to an industry survey conducted earlier this year by the Pharmaceutical Research and Manufacturers of America (PhRMA), more than 900 medicines and vaccines have been identified in various stages of development. To keep pace, the strategies that were adequate for the “empty pipeline” scenarios of a few years ago-to code each agent, communicate clinical evidence and clinical guideline developments, and update reimbursement methodologies-must now be enhanced.
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Include stroke prevention for members with AfibProgram for Afib patients could provide template of improved outcomes.
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Information evolves for better decisionsCollaborative healthcare communities gather clinical and claims data to apply to real-world settings
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Patient feedback programs lower healthcare costsIf these programs are executed correctly, they can educate patients about their medications, provide physicians with information about the effectiveness of drugs and facilitate communication
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ICD-10 preparation must begin nowThe United Kingdom implemented ICD-10 as far back as 1995, making the United States one of the last major global economies to begin the implementation process.
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Manage schizophrenia with individualized careSlow-release depot antipsychotics help manage schizophrenia.
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APA now the main control over new PPACA rulesHealth reform provisions must be deemed lawful by the Administrative Procedure Act.
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Comparative effectiveness needs reimbursement reformStraying from the popular opinion of the industry, a handful of medical device manufactures have aligned with Obama's proposed investment in comparative effectiveness research.
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APA now the main control over new PPACA rulesHealth reform provisions must be deemed lawful by the Administrative Procedure Act.
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Social media transforming healthcare interactionsSocial media is moving beyond the solely social sphere to influence engagement and outcomes.
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Provider organizations must prepare for reformProactive organizations will begin a painful transition to emerge as larger, fuller enterprises with concentrated authority designed around very different roles and responsibilities than what they have today
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Your PBM's MAC list impacts your bottom lineIf MAC lists were not in place, prices for drugs would vary dramatically. Discounts for generic drugs would also decrease significantly.
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Your PBM's MAC list impacts your bottom lineIf MAC lists were not in place, prices for drugs would vary dramatically. Discounts for generic drugs would also decrease significantly.
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How to Meet the Challenge of Evolving Senior Healthcare NeedsCreating a health ecosystem for our modern-day customer-seniors with evolving healthcare needs and challenges
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Opinion: 5 Ways MCOs Can Address COVID-19 TransmissionPrincipals of DeltaSigma, LLC , Don Hall, M.P.H., and Sherry Rohlfing provide Managed Healthcare Executive an opinion piece on how managed care organizations can address COVID-19 transmission.
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Medication reconciliation drives readmission reduction strategyExperts are paying closer attention to medication reconciliation as a means to curb cost, but providers are finding the implementation isn't always easy.
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Kaiser: Diabetes, Antivirals, and Psychotherapeutics Rank Highest for Drug SpendingWhere plans and patients are spending the most money on medications.
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Payers Should Take Action on Rising NSCLC CostsA new report outlines the sharp cost increase associated with a NSCLC drug’s move from second-line to first-line treatment, and suggests payers work with manufacturers to address treatment pricing.
