As durable medical equipment (dme) becomes increasingly sophisticated, MCOs' challenges remain rooted in establishing medical necessity. To that end, most use strategies including prior authorization and coverage limits. Meanwhile, they must also satisfy changing state and national regulatory requirements.
Washington, D.C—Employer-sponsored health-insurance plan premiums increased only 6% in 2007, less than the last four years. However, insurance costs are rising much faster than inflation and wages, according to a leading survey of employer health benefits. Premiums now average more than $12,000 for family coverage (almost $4,500 for individuals), pricing many workers out of the market.
Pat Ford-Roegner, MSW, RN, FAAN, CEO of the American Academy of Nursing (AAN), seems a natural fit for her latest appointment as a member of the new Washington, D.C.-based Partnership to Fight Chronic Disease (PFCD) Advisory Board. The board, led by Richard H. Carmona, MD, MPH, FACS, former U.S. Surgeon General, is comprised of 40 high-profile CEOs and presidents from the public and private sector.
Coffee shops, restaurants and grocery stores have started getting serious about employees washing their hands to prevent the spread of germs. If the guy who steams my cafe latte remembers to scrub his hands for 30 seconds before getting behind the coffee counter, then why aren't more healthcare providers remembering to do it?
The need to reauthorize the State Children's Health Insurance Program (SCHIP) by September 30, has evolved into a broader debate about the role of government in providing healthcare to Americans. The Bush administration wants to maintain a limited program for low-income children, while Democrats envision more open-ended coverage for more children and families.
The economics and the politics behind the major healthcare problems affecting men, such as cardiovascular disease, cancer, obesity and depression, aren't receiving the attention they deserve. It has been the rule that women make health decisions for themselves and also for their male partners and their children. In contrast, most men have a more casual attitude toward their care: "if it ain't broke, don't fix it."
Newly diagnosed patients with chronic conditions wait an average of 105 days until someone reaches out to them with disease management support. Precious time is lost, affecting their health, attitude and openness to change.
NATIONAL REPORTS—For chronically ill patients, increased cost sharing can be associated with lower rates of drug treatment, less adherence among existing users and more frequent d iscontinuation of therapy, according to research published in a recent issue of the Journal of the American Medical Assn.
Grace seems an unlikely acronym for a study of acute coronary events, but given the findings of the Global Registry of Acute Coronary Events published in the Journal of the American Medical Association, the name may be apropos.
Ann Arbor, Mich.— In the past, plans provided electronic explanation of benefits to consumers, which reflected a major customer service innovation. Today, innovations involve enabling consumers to connect their physicians and other care providers with a comprehensive information repository enriched by the data managed by the plan—including medical and drug claims, lab results, and health risk information, industry experts say.