
Advanced analytic solutions are being used to detect improper payments in pharmacy claims.

Advanced analytic solutions are being used to detect improper payments in pharmacy claims.

You will never be able to measure wellness and you actually don't want to

Once-daily dosing of the investigational drug tiotropium helped to improve lung function over 24 hours in individuals with severe asthma, according to data presented at the 2013 American College of Chest Physicians annual meeting (CHEST 2013) in Chicago.

Patients with prostate cancer who use statins may have a lower risk of death from their disease, according to a study published online ahead of print in the Journal of Clinical Oncology.

Some fixes have been created for insurers selling through healthcare.gov but not many

Cynthia Ambres of KPMG discusses the future of payment reform.


Healthcare giant Johnson & Johnson has agreed to pay more than $2.2 billion to settle charges it fraudulently promoted drugs and used kickbacks to spur sales, the U.S. Justice Department announced Monday.

FDA has approved a new boxed warning for the anti-seizure drug ezogabine (Potiga) because of the potential risk of vision loss, retinal abnormalities, as well as skin, nail, mucous membrane, and sclera discoloration. The agency recommends that ezogabine use be limited to individuals who have not responded to alternative therapies for seizure control, and when the benefits of treatment are greater than the risks.

Citing the risk of life-threatening blood clots and severe narrowing of blood vessels, FDA has asked Ariad Pharmaceuticals to suspend marketing and sales of ponatinib (Iclusig).

Up-and-coming generation has an “occupy healthcare” attitude and could advocate for Medicare for all by 2020.

Now is the time to dedicate resources in the inpatient and outpatient world to optimize antimicrobial stewardship.

Future upgrades will include cost information, provider directories and tons of scale

Even under innovative payment models, RBRVS is here to stay

Consider shifting to condition episodes and linking member benefits

Managing diabetes and preventing microvascular and macrovascular complications requires a more holistic approach that goes beyond glucose, and includes careful management of other risk factors.

New utilization management opportunities will increasingly include cardiology and diagnosis of sleep disorders.

Redesign your industry interactions

Engage your entire network in quality and cost-containment goals

Test patient response with initial 14 day fill

PBGH program gives employees no-cost joint replacement and free travel to top hospitals

Industry metrics must move beyond HEDIS measures

A small but costly percentage of patients have a variety of reasons for frequent ED visits.

State exchange products lean toward limited networks

Agreements must be judged by antitrust’s rule of reason to determine true consequences.

Medical home providers gain tailored prescription data

Allopurinol, considered the standard of care for gout, may be inadequate to lower uric acid levels in patients with gout, according to new safety and efficacy data from a large study presented at the American College of Rheumatology (ACR) 2013 annual meeting recently in San Diego, Calif.

Fluticasone furoate and vilanterol inhalation powder (Breo Ellipta, GlaxoSmithKline and Theravance) once-daily for chronic obstructive pulmonary disease (COPD), is now available to pharmacies throughout the United States.

GlaxoSmithKline and Community Care North Carolina team up to put medication data to good use “What we found with small data is there are still a lot of barriers to being able to apply data,” says John Easter, senior director in the public policy department at GSK. “Providers may not have right data set or may be using legacy systems that can’t integrate with each other. What this group was able to do is create these models in a lightweight way so they only needed a small amount of data to predict the correct outcomes.”

MHE | 2014 Managed Healthcare Executive Editorial Calendar