The tools may have changed -- from cookie jars and ledger books to electronic spreadsheets -- but keeping a family household budget is nothing new. As healthcare costs rise and traditional cost-sharing disappears, consumers need to wear the hat of a healthcare financial planner.
Practically every service-oriented business in America today talks about how in tune they are with their customers. Terms like "caring" and "compassion" often are tossed about in their advertising collateral. For Summa Health System, an organized delivery system situated in the heart of Northeast Ohio, and its health plan, SummaCare Inc., these aren't just clever lines crafted by a copywriter.
When health insurers buy an existing book of business, they often effect the acquisition through an asset purchase transaction known as assumption reinsurance. There are many accounting and financial issues to consider in pursuing such a transaction.
WASHINGTON, D.C. -- The main Bush administration proposal for dealing with the high cost of healthcare and rising number of uninsured is to create a new commission. In his State of the Union address in January, President Bush called for a new bipartisan panel to propose changes that will equip Medicare, Medicaid and Social Security to deal with the millions of baby boomers headed for retirement.
The Medicare Prescription Drug Plan, which began January 1, 2006, makes the federal government the largest purchaser of pharmaceuticals in the United States, and probably in the world. It is projected that the Centers for Medicare and Medicaid Services (CMS) will spend more than $1 trillion on medications over the next decade, a volume that will influence the pharmaceutical market more broadly and generate new initiatives to encourage utilization of more cost-effective treatments.
Although experience tells us that formulary conversion programs are commonplace, they are discussed fairly infrequently in the literature. A recent MEDLINE search did not identify any conversion programs similar to a human growth hormone (HGH) program implemented at HIP Health Plan of New York (HIP-NY).
In an attempt to improve patient outcomes and control costs, a guide to empiric antimicrobial therapy, including a urinary tract infection (UTI) algorithm, was distributed to hospital physicians at an academic medical center. A retrospective study was conducted to assess the impact of the guide on physician prescribing of empiric antimicrobial therapy for UTIs. Prior to the implementation of the guide, 45% (n=55) of patients with UTIs were treated consistently with the algorithm. Although not statistically significant, consistency increased to 51% (n=45) after implementation of the guide. The initial publication of a guide to empiric antimicrobial therapy did not significantly influence physician prescribing patterns regarding UTIs. Educational sessions at the time of implementation along with reinforcement of the guidelines may further impact prescribing habits and influence algorithm compliance.
Approvable designations, Fast-track designations
FDA approved ranolazine extended-release tablets (Ranexa, CV Therapeutics) on January 31, 2006, for the treatment of chronic angina. A more thorough review of the agent will appear in the FDA Drug Approvals section of Formulary's March issue.
New inhalable insulin formulation approved
Kinase inhibitor approved for GIST and advanced renal cell carcinoma
A review of agents in late-stage development for the treatment of ophthalmic disorders (January 2006)
Leadership cements the foundation for increasing the efficient and effective delivery of treatment plans in project management and performance improvement programs at Sparrow Hospital in Lansing, Mich.
Health advocacy has emerged as an important facilitator to help employers and consumers better navigate healthcare and insurance.
As the industry's largest managed care organizations continue to acquire smaller, consumer-directed health plans, it is evident that providers are making their move into the CDHP arena.
Early assessments of the growing consumer-directed healthcare trend point to the model's potential, but with cautious optimism. Mary O. McWilliams, president of Regence BlueShield in Seattle, believes a little less caution and a lot more action on the part of health plans will give consumer-directed healthcare (CDHC) just the kick it needs.
In 2005, Medicaid surpassed Medicare as the largest government healthcare expenditure, and it is the fastest growing population of covered lives, say industry experts.
The New York Times reports that patients in New York City often have trouble securing a reimbursement for a $75 visit to the nutritionist, who counsels them on controlling their diabetes.
In many existing IT systems, gathering and analyzing data simply takes too many steps.
Employers and other purchasers of health insurance continue to face rising costs for employee health benefits. The overall cost of providing such benefits has reached such a high level that employers are now often requiring their employees to share part of this burden.
New technologies have lifecycles that include a curve of initial resistance as well as an eventual plateau of acceptance. There are some who rush out and buy the latest gadget the minute it's available, and others—myself included—who wait to see how the new product or service pans out. Some of us cling to our old ways and our comfortable devices because we're used to them or because they're so much less expensive. At some point in time, however, we resisters just have to give in.
Patients who have switched statins should receive special care as they are substantially less likely to be compliant and remain on the treatment long enough to obtain its full benefits, researchers reported in the American Journal of Managed Care.
A review of agents in late-stage development for the treatment of multiple sclerosis (January 2006).
Objective: Pharmacy-managed medication assistance programs (MAP) have the potential to recoup losses incurred by the pharmacy department, but whether this offsets the personnel cost of the program has not been well-established. The purpose of this study was to conduct a cost-benefit analysis of the pharmacy-managed MAP at an urban teaching clinic at Hartford Hospital in Hartford, Conn.
Methylphenidate transdermal patch (Daytrana, Shire/Noven) to treat attention-deficit/hyperactivity disorder (ADHD)
The number-one health policy issue for the new year is to find ways to keep healthcare costs under control. An aging population and more costly medical technology could increase current spending trends. These developments could have an impact on efforts to reduce the number of uninsured people in the United States and could prompt initiatives to make consumers more aware of treatment costs and options.
Sitaxsentan, a highly selective endothelin-A (ET-A) receptor antagonist undergoing FDA review as an alternative to bosentan for pulmonary arterial hypertension (PAH) treatment, demonstrated improved efficacy over bosentan in a recent study.
Because several molecular pathways are relevant in the pathogenesis and progression of pulmonary arterial hypertension (PAH), combinations of therapies are being explored to better manage the disease.
The presence of antibodies to heparin is an independent risk factor for potentially serious complications following cardiac surgery, even in patients who do not develop heparin-induced thrombocytopenia (HIT), said David Kress, MD, at the 71st international scientific assembly of the American College of Chest Physicians in Montreal, Quebec, Canada.
