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.
Washington, D.C.-Medicare pays private fee-for-service (PFFS) plans 19% more than prevailing fee-for-service spending, according to the June 2007 report of the Medicare Payment Advisory Commission (MedPAC). At the same time, beneficiaries are complaining of misleading promotional tactics by these plans.
As payers have been increasingly impacted by rising drug costs, they have become more creative in plan design by introducing different copay tiers and member incentives to change drug purchasing behavior, say industry watchers.
While your pharmacy benefit program has no doubt been managing utilization for years with core strategies, it's important to review effectiveness often. Below are the proven strategies that payers should analyze frequently in the current market of increasing utilization.
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.
More than half of all state Medicaid programs incorporate a financial incentive encouraging providers to deliver better quality care, according to a study by the Commonwealth Fund. In addition, the study finds that 70% of existing Medicaid P4P programs operate in managed care or primary care management environments. Nine Medicaid programs are joining with other payers, employers and providers in statewide or regional P4P efforts, which is an indicator that the Medicaid plans are keeping pace with HMOs-half of which are offering P4P programs of their own.
If managed care executives can't get accurate information and honest opinions, they can't make the right decisions, according to Allan Baumgarten, author of annual state managed care reviews and an independent research consultant in policy, finance and local market strategies.
As far as Michael Howe is concerned, the healthcare community should no longer question whether retail clinics are here for the long haul. The way he sees it, the criticisms about quality and continuity remain theoretical and spoken by a vocal minority. But even more so, the millions of consumers who are driving demand for retail-clinic services seem to have answered the question already.
The practices of some California insurers have recently come under attack in lawsuits brought by private litigants and in administrative actions brought by state regulators. The practice involves the rescission of health insurance policies due to misrepresentations made in the policy application form.
Typically not a big fan of movies, I was surprised by how much I enjoyed my DVD rental of "Man of the Year." The basic premise of the movie has a quirky, independent-party candidate winning the popular vote in a presidential race.
Experts say that 5% of all claims are fraudulent or abusive. If the total spent on U.S. healthcare annually is approaching $2 trillion, that 5% would add up to nearly $100 billion a year in fraudulent or abusive claims. And the percentage may be higher, perhaps as high as 10% of claims.
Payers and employers can pay up to $350,000 per patient for just one year of treatment for high-cost conditions such as rheumatoid arthritis. Patients, too, share the burden, in some cases shouldering 50% of the bill in deductibles and co-pays.
A summary of case management adherence guidelines and online-based case management systems.
The investigational vasopressin receptor antagonist tolvaptan had no long-term impact on clinical events in patients hospitalized with acute decompensated heart failure (ADHF), but the agent did improve symptoms and volume status over the short term, according to results presented at the 56th annual ACC scientific session.
Succinobuccol, an investigational monosuccinic acid ester of probucol, was not associated with a reduction in a composite end point of major cardiovascular events in patients diagnosed with acute coronary syndrome (ACS), but use of the agent did result in improvements on certain secondary end points.
Initial combination therapy for early rheumatoid arthritis (RA) provides earlier clinical improvement and less progression of joint damage at 2 years compared with initial monotherapy, according to a randomized, controlled trial.
Results of a systematic review demonstrated that high doses of aspirin for >10 years may help reduce the incidence of colonic adenoma and colorectal cancer.
Men who use acetaminophen, nonsteroidal anti-inflammatory drugs(NSAIDs), or aspirin are at an increased risk of developing hypertension, compared with nonusers, according to a large, retrospective, case-controlled study.
FDA has approved a new formulation for zolpidem, a nonbenzodiazepine hypnotic, for short-term treatment of insomnia.
FDA has approved a new formulation for zolpidem, a nonbenzodiazepine hypnotic, for short-term treatment of insomnia.
The Prescription Drug User Fee Act (PDUFA) expires in September, therefore FDA may need to warn drug reviewers that their jobs may be eliminated if Congress does not honor the reauthorization deadline.
Insurers, payors, and health policy experts are seeking additional evidence that compares the safety, efficacy, and cost of medical products and procedures.
An oral thrombin receptor antagonist demonstrated no increase in major or minor bleeding when added to standard antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI), according to phase 2 trial results.
In a phase 3 trial, the investigational dihydropyridine calcium antagonist clevidipine demonstrated less pronounced perioperative blood pressure excursions compared with other intravenous antihypertensive agents in patients undergoing cardiac surgery.
Patients with pain related to fibromyalgia syndrome (FMS) can experience a 50% reduction in pain if they are treated with pregabalin, according to results presented at the AAN's 59th annual meeting.
New research presented at the AAN's 59th annual meeting regarding strategies for treatment of relapsing remitting multiple sclerosis.
A single dose of ibuprofen provides better pain relief than acetaminophen or codeine for children requiring emergency treatment for musculoskeletal trauma, results of a randomized, controlled trial demonstrate.
Statins may reduce risk of hospitalization for sepsis in patients with chronic kidney disease (CKD) who are receiving dialysis, according to a large cohort study.
When used to treat patients with ulcer bleeding, proton-pump inhibitors (PPIs) effectively reduce the risk of re-bleeding and the need for surgical intervention and repeated endoscopic treatment, according to a meta-analysis.
In a large, nested cohort study, use of inhaled corticosteroids at doses greater than 1,200 mcg/d was associated with a 61% reduction in the risk of developing lung cancer in patients with chronic obstructive pulmonary disease.
