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BLOG: Look beyond pharmacy claims to detect fraudAdvanced analytic solutions are being used to detect improper payments in pharmacy claims.
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CMS eyes bundled payment pilot for specialist physiciansThe initiative would expand Medicare’s present Bundled Payments for Care Improvement (BPCI) program
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Dysfunction at the FDA, NIH, Elsewhere | Predictions for 2025Predictions for this year from Perry Cohen, Pharm.D., CEO of the TPG Family of Companies and Managed Healthcare Executive editorial advisory board member.
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How Current Accreditation Approaches Impact Reduction of Hospital ReadmissionsHospitals are always looking for ways to reduce readmission rates. They may have an unusual ally in a quality control system originally developed in Europe for the manufacturing sector. Read more about it.
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Five Tech Predictions for Healthcare in 2018In the year ahead, we can expect to see an insurgence in technology solutions that address patient engagement, data, and security throughout the healthcare system.
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Three Essentials Providers Need for Risk-Based ContractsThese core elements make up a collaborative “provider enablement” strategy to break down resistance to value-based care.
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Take a three-pronged approach to defined contributionConsumer focus is an enterprisewide strategy
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Four Ways Health Plans can Guide Members to Wise ChoicesFor all health plans, increasing complexity requires rethinking the presentation of options to members. Choice design, stepped information reveal, high quality, and timely communication, are keys to providing members a helpful and trustworthy healthcare GPS.
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Four Ways to Leverage Artificial IntelligenceHere's how artificial intelligence improves the healthcare ecosystem.
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How to Develop a Targeted Care Management Approach for Addressing Social Determinants of HealthThis type of focused approach incorporates four key steps.
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Five Steps to Improve Healthcare Consumer ExperienceTo build trust, health insurers need to demonstrate their value to customers. That means offering a convenient, satisfying customer experience. Here’s how.
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News You Should Know: 3 Takeaways from Top Managed Care Articles JuneHave two minutes? Listen to this quick podcast for critical takeaways from three of our top articles.
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New Reimbursement May Level Playing Field for BiosimilarsThe new Bipartisan Budget Act of 2018 (to be in effect on January 2019) institute new reimbursement guidelines for biosimilars under the Medicare coverage gap discount program that remove disincentives for biosimilar uptake and level the playing field for the future market place.
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New Reimbursement May Level Playing Field for BiosimilarsThe new Bipartisan Budget Act of 2018 (to be in effect on January 2019) institute new reimbursement guidelines for biosimilars under the Medicare coverage gap discount program that remove disincentives for biosimilar uptake and level the playing field for the future market place.
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New Reimbursement May Level Playing Field for BiosimilarsThe new Bipartisan Budget Act of 2018 (to be in effect on January 2019) institute new reimbursement guidelines for biosimilars under the Medicare coverage gap discount program that remove disincentives for biosimilar uptake and level the playing field for the future market place.
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4 Ways You Can Keep PHI SecureWhat are the best ways for healthcare executives to keep protected health information secure? Here are some tips.
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Innovation Isn’t So Hard After AllWhat a movie can teach you about innovation in your organization.
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CMS to Cover Next-Gen Sequencing for Cancer: Implications for MCOsIn a decision reached through the joint FDA/CMS Parallel Review process, CMS has granted national Medicare coverage to next-generation sequencing tests approved or cleared by the FDA as companion diagnostics for cancer therapies. This is clearly a win for Medicare beneficiaries and some NGS test providers-but is it also good news for MCOs?
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CMS to Cover Next-Gen Sequencing for Cancer: Implications for MCOsIn a decision reached through the joint FDA/CMS Parallel Review process, CMS has granted national Medicare coverage to next-generation sequencing tests approved or cleared by the FDA as companion diagnostics for cancer therapies. This is clearly a win for Medicare beneficiaries and some NGS test providers-but is it also good news for MCOs?
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Closing Care Gaps: Chart Chasing Has Become ObsoleteFor far too long, chart chasing was the best method health plans had to improve HEDIS® measures and Medicare Star ratings. Now, there is a better way.
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Top 3 Problems with Healthcare Organizations’ Content StrategiesVirtually all healthcare leaders recognize the value of content creation, yet the use of a well-defined content strategy is rare. Here’s how to get yours.
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Top 3 Problems with Healthcare Organizations’ Content StrategiesVirtually all healthcare leaders recognize the value of content creation, yet the use of a well-defined content strategy is rare. Here’s how to get yours.
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A Look at the Two Sides of Bundled PaymentsWhy some health plans have mixed feelings on adopting bundled payments and what it can become.
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Top 3 Opportunities for Artificial Intelligence in HealthcareRapid advances in the availability of big data and in machine learning offer significant opportunities to improve the healthcare system.
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Three Areas That Benefit From Provider-Led Health PlansStarting or strengthening a provider-led health plan leads to true integration, resulting in quality care.
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How Healthcare Organizations are Rethinking Executive CompensationHow one public trust healthcare system overhauled its overall compensation program and successfully transformed its financial operations.
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Top 3 Capabilities Health Execs Need in Care Management TechnologyThe right technology will enable increased population health efficiencies while simultaneously reducing the resource burden associated with managing that effort. Here are three specific capabilities to look for.
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How Pharma Reference Pricing Can Contain Healthcare CostsReference pricing models are emerging as increasingly popular approaches for lowering drug costs.
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CMS Reevaluates Stark Law in Response to Value-Based Care InitiativesAn RFI presents an important opportunity for the healthcare industry to educate CMS on current experiences and challenges.
