Practice Management

Early in his career, Lyman Dennis, chief information officer (CIO), Partnership HealthPlan of California (PHC), was project manager of a grant from the National Institutes of Health to develop a system that planned diets.

National Reports— In the days after Hurricane Katrina, the Department of Health and Human Services (HHS) demonstrated the value of electronic health records (EHRs) by developing an online database that includes prescription information for the previous 90 days prior to the day Katrina hit for more than 800,000 individuals located in 150 ZIP codes affected by the hurricane.

The 2006 introduction of Part D under the Medicare Modernization Act will definitely affect medications targeting osteoporosis, the majority of which are prescribed to those 65 or older.

In his state of the union address in April 2004, President George W. Bush called for most Americans to have interoperable electronic health records (EHRs) within 10 years. More than a year after that ambitious pronouncement, business leaders, IT executives, healthcare professionals and average consumers are still debating exactly how that will happen.

In Some Parts of the United States, health plans have observed a growing trend of hospital-based provider groups, such as radiologists, pathologists, anesthesiologists, and emergency room physicians refusing to contract with health benefit plans. When a health plan enrollee seeks services from an in-network hospital in order to obtain lower out-of-pocket costs (for a PPO product) or full benefits (for an HMO product), the enrollee can be hit with a large, unexpected bill from the provider.

Competition Is heating up among insurers, pharmacy benefit managers (PBMs) and health plans as they ready major marketing campaigns to attract and enroll thousands of seniors in Part D Medicare prescription drug plans (PDPs). Insurers are offering hundreds of stand-alone and Medicare Advantage prescription drug plans (MA-PDs) in every region of the country, many promoting lower costs as a way to build market share.

There also needs to be sufficient access and guidance so the beneficiary can make informed and knowledgeable choices.

National Reports — The industry probably can look forward to further consolidation, as managed health insurers position themselves to better serve Medicare participants in the prescription drug benefit program scheduled to begin in January, and move to compete against other giant players in the industry, according to industry experts.

Obstetricians and surgeons are among those attracted to reform states.

Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services (CMS), plans to produce extensive information on how drugs and prescribing decisions affect health outcomes and costs by linking reimbursement data from Medicare prescription drug plans (PDPs) and Medicare Advantage (MA) plans with existing Medicare hospitalization and physician care databanks.

Several for ces are causing changes in healthcare payer IT investment priorities.

In the evolving process of electronically linking all aspects of the healthcare industry so that important data can be shared quickly, efficiently and effectively, another step is being taken, one that holds promise for those who take the time to understand the potential value as well as how to overcome some inherent challenges.

Members of Congress began to roll out bi-partisan legislation.

Practice takes back control of administrative functions

Computerized provider order entry reaches ambulatory care setting.

Realistic reimbursement calculations are crucial to any stragetic plan, but how do you arrive at a reasonable answer?

About three years ago I asked a large group of health plan executives if they knew how much they spend annually for ?specialty pharmacy? products. Few could respond, and virtually none had launched any efforts to control the then unknown rapid increase in these costs.Today, this is not the case.

One physician practice gains advantages through an EMR implementation

CONFUSION ABOUNDS as healthcare payers attempt to make decisions about technology acquisitions for care management. It is not surprising, given the enthusiasm for "new technology" that Gartner analysts hear questions from clients like, "Should my organization invest in an e-prescribing solution, an e-visit solution or a personal health record?" and the list of technologies goes on.

EARLY IN 2004 we identified six major savings drivers that should be addressed while developing a comprehensive management program for injectable products.

President George W. Bush began his second term by launching a high-profile campaign to limit skyrocketing medical malpractice insurance premiums for physicians and hospitals.

At a minimum, healthcare organizations must show an ongoing effort to assess their level of compliance. And for many, compliance is uncharted territory where processes, costs and solutions are unknown.

From a compliance standpoint, one medical center wanted to make sure that none of its personal health information (PHI) was leaving the network.

For those healthcare providers and payers who still believe large claims clearinghouses are the only way to reduce administrative costs, it may be time to think again.

The New Prescription Drug Benefit UnderThe Medicare Modernization Act