Every year, the poor quality of provider data costs healthcare payers an estimated $26 billion and sabotages their quest for efficient operations. Even the most highly automated plans remain vulnerable to the drain on resources caused by inaccurate provider data, rightly called "the Achilles' heel" of healthcare.
The aging baby-boomer population most likely is driving the health consumerism trend. Baby boomers now have more disposable income than any similar age group in the history of the United States. Now, as patients or care-providers for children and elderly patients, baby boomers are visiting physician offices armed with more information about medical conditions, but also are dissatisfied with the "interruption" to their lives caused by long waits in doctors' offices. They also are more interested in managing their own health and are investing heavily in health management aids including health club memberships, vitamins, herbal medicines, fad diets-virtually anything that will prolong or provide a healthier life.
Since the new San Francisco Health Access plan, approved in July, only covers preventive and catastrophic care, everyone who will receive coverage still needs to learn how to become an astute buyer, according to Chini Krishnan, founder and CEO of Healthia Inc., an integrated comparison-shopping portal for healthcare products and services, headquartered in Mountain View, Calif.
The top five HMO enrollment states also have high immigrant populations, says Cynthia Marcotte Stamer, a member of Glast, Phillips & Murray, PC, Dallas, Texas. "Among the top 20 HMO enrollment states, California, New York, Texas and Florida also are on the list of states qualifying for special Emergency Medical Treatment and Active Labor Act (EMTALA) Medicare reimbursements for undocumented aliens under MMA Section 1028."
The educational and professional qualifications of health coaches is relative to the type of health coaching that is being done, according to industry experts.
If you have not already added Medicare Advantage (MA) as part of your health plan's offerings, you are missing a key business opportunity. MA offers increased reimbursement, the chance to expand your product line, the ability to protect your senior business and a strategy for maintaining your membership base. It is worthwhile to recognize, though, that launching any new line of business always involves a certain amount of risk. The key to success is learning about and preparing for the opportunities and impacts of MA.
There's no doubt that HMO enrollment has been declining in recent years, experts say. Various factors explain this enrollment decline.
The issues have been framed brilliantly, debated enthusiastically and examined closely. While it might not resemble the California Gold Rush, employers that implement wellness programs can still find significant rewards.
Heart failure is a serious condition in which the heart doesn't pump enough blood throughout the body. It may be caused by several different diseases that damage or overwork the heart muscle; the leading causes include coronary artery disease, high blood pressure and diabetes.
Physicians insist that pay-for-performance programs should be voluntary and include risk-adjustments.
Not many CEOs would wish for a massive upheaval in their industries. Georganne Chapin, president and CEO of Hudson Health Plan (HHP), minces no words when she says the United States should transition to universal coverage, and HHP, a not-for-profit managed-care Medicaid plan that covers 60,000 members in New York state, should evolve to play a new role.
NATIONAL REPORTS-The San Francisco health access plan raises challenges for MCOs, say industry experts.
Gut instinct always used to tell me that America would never go for universal healthcare coverage. In the back of my mind, I kept picturing either a healthcare free-for-all with everyone and their uncle running to the doctor for every little paper cut, or just as bad, everyone and their uncle waiting in line for months to receive their ration of healthcare. You might have envisioned those alarming circumstances, too.
A salmeterol/fluticasone combination (SFC) surpassed a formoterol/budesonide combination (FBC) in reducing the rate of moderate-to-severe exacerbations in patients with persistent asthma, according to a study published by the journal Respiratory Medicine.
Potassium-sparing diuretics reduced the risk of Alzheimer's disease (AD) by >70% in patients aged >64 years while other antihypertensive (AH) medications, including all diuretics, beta blockers, and dihydropyridine calcium channel blockers, were linked with somewhat smaller decreases in Alzheimer's risk.
An observational case-control study of 1,384 adults presenting with coronary disease for the first time found that patients who presented with acute myocardial infarction (MI) received statins and beta blockers less often than patients who presented with stable exertional angina.
Bupropion extended-release tablets
Ambrisentan, a propanoic acid type-A selective endothelin receptor antagonist, improved exercise capacity and delayed clinical worsening in patients with pulmonary arterial hypertension (PAH) in phase 3 clinical trial results presented at the annual international conference of the American Thoracic Society in San Diego, Calif.
The anticonvulsant lacosamide is effective in relieving diabetic neuropathy and produces increased pain reduction with continued treatment for 22 months, according to phase 3 study results presented during the 25th Annual Scientific Meeting of APS in San Antonio, Texas. "This is a promising treatment that maintains a long-term effect," said Tibor Hidvegi, MD, Medical Department, Petz Hospital, Gyor, Hungary.
Morphine extended-release once daily significantly reduced pain among patients with chronic, moderate-to-severe low back pain compared with oxycodone controlled-release twice daily, according to results of a study presented at the 25th Annual Scientific Meeting of the American Pain Society (APS) in San Antonio, Texas. The once-daily opioid also demonstrated significant improvement in sleep scores, said Richard L. Rauck, MD, Carolinas Pain Institute, Winston-Salem, NC.
Valsartan is associated with a reduction in the levels of high-sensitivity C-reactive protein (hs-CRP), the inflammatory marker that is highly predictive of adverse cardiovascular outcomes, independent of its blood pressure-lowering effect, said Paul M. Ridker, MD, MPH, lead investigator of a trial presented at the 21st annual meeting of ASH.
The investigative agent aliskiren, the first orally active renin inhibitor, is an effective antihypertensive agent as monotherapy and in combination with hydrochlorothiazide, reported investigators at the 21st annual scientific meeting of ASH.
Phase 3 clinical trials demonstrated that the once-daily, highly selective beta blocker nebivolol lowers blood pressure in a dose-dependent manner and is well tolerated at all doses, according to presenters at the 21st annual scientific meeting of the American Society of Hypertension (ASH), in New York, NY.
FDA has announced further steps it plans to take to target the sales of counterfeit medications. The agency also rolled out a joint campaign with the Institute of Safe Medication Practices (ISMP) to discourage the use of confusing abbreviations that can potentially cause medication errors.
A double-blind, randomized, placebo-controlled study of the ketolide telithromycin administered orally over a 10-day period to 278 asthma patients demonstrated a reduction in asthma symptoms, but did not show a significant treatment effect on patients' morning peak expiratory flow.
Focused on a diverse number of areas in the study of gastrointestinal health, Digestive Disease Week (DDW) 2006 in Los Angeles, Calif, yielded important information about the pharmacologic treatment of certain GI cancers and Crohn's disease.
Abatacept (Orencia, Bristol-Myers Squibb) is the first T-lymphocyte co-stimulation modulator to be approved by FDA. The agent is indicated for use in patients with moderate-to-severe, active rheumatoid arthritis who have not had an adequate response to methotrexate, tumor necrosis factor (TNF) inhibitors, or other disease-modifying anti-rheumatic drugs (DMARDs).
A number of clinical approaches are utilized in managing insomnia. Indiplon (Pfizer) is a selective non-benzodiazepine sedative hypnotic under consideration by FDA for the treatment of insomnia. Like other agents in its class, indiplon binds selectively to the GABA-A receptors in the brain, promoting sleep.
Colestipol for oral suspension, 5 g/packet or scoopful (equiv to Colestid)
Approvable designations
