News

For any savvy health insurer that expects to remain competitive in the increasingly challenging industry, health and wellness programs are no longer novel. Rather, the offerings of a health and wellness program have evolved into an imperative way to engage current and potential customers, as well as positively affect an organization's bottom line.

When disease management began, it just entailed a series of programs with a singular focus. Whether you had asthma, coronary artery disease, heart failure, diabetes or COPD, disease management programs managed only one chronic illness at a time.

One of the first visible payoffs of the Patient Protection and Affordable Care Act is the $250 rebate checks sent to thousands of seniors with high drug costs. Other strategies are built on questionable long-term outlooks.

Stronger opioids such as morphine, hydromorphone, oxymorphone, methadone, levorphanol, fentanyl and oxycodone are generally used for treatment of moderate to severe pain.

Nationwide, members are increasingly keeping their Medicaid coverage for a longer duration of time than has been typical in the past, and funding is thinner than ever.

A Kaiser Family Foundation survey reveals that 77% of enrollees with non-group coverage faced premium increases in the past year and "ever skimpier coverage."

Last year, prescription drug use among children rose almost four times faster than that of the overall population.

Accountable care organizations have become a hot commodity since the Patient Protection and Affordable Care Act opened the door for health plans to contract through an ACO for commercial enrollees. The momentum of ACOs will likely increase.

Employers are expressing frustration at lack of participation in wellness programs. This is in light of the fact that there was an increase in the number of such programs offered from 2008 to 2010.

Behavior modification is universally regarded as the best option to fight obesity, but plans can't do it alone.

Stakeholders seek uniformity of standards for several types of electronic health information transactions and specific operating rules, n one of which will be easy to implement.

There is great debate about the rigor of RCTs, which only demonstrate drug efficacy in comparison to a placebo and often test relatively homogenous populations.

The American Medical Association released its "Health Insurer Code of Conduct Principles," which defines 10 standards AMA believes will ensure consistent corporate practices.

Primary care providers are increasingly caring for and treating people living with HIV, according to a recent survey by HealthHIV.

Innovative payers are starting to look differently at how they build their pharmacy network, using a bottom-up approach to network design.

Some 70% of survey prescription drug users reported concerns about therapeutic substitutions without a physician's consent.

The regulations provide guidance to employers and sponsors regarding the definition of a grandfathered health plan, as well as the changes that may and may not be made.

The application of pharmacogenomics-the science of how genetic variations influence drug response-is new to the field of health benefit management, and its potential to improve care and reduce costs is significant.

The Money Follows the Person (MFP) demonstration, a federal initiative launched in 2005 and extended in 2010 as part of the Patient Protection and Affordable Care Act, provides funds to help states transition elderly people and people with disabilities from long-term care institutions to receive care in the community in the setting of their choice.

The future presents significant challenges and opportunities for Medicaid directors, who can leverage their purchasing power to influence improvements in health care quality, delivery and value.

Savings could reach more than $1 trillion over a period of 10 years if 25% of individuals participate in risk reduction and prevention programs.

The U.S. Department of Health and Human Services (HHS) has announced new federal investments in community-based practices led by nurse practitioners.

Recently, FDA Commissioner Margaret Hamburg, MD, addressed a press conference of global representatives from advocacy, industry, academia, and government who convened in Washington, DC, to launch a benchmark international consortium to fight tuberculosis (TB).

Using massively parallel gene sequencing technology, researchers were able to identify specific genetic mutations that appear to be predictive of response to a drug commonly administered for metastatic colorectal cancer.

Five-year data from a seminal study in patients with type 2 diabetes who are at especially high risk of heart disease show that intensive glucose control does slow the progression of microvascular disease, but mortality is increased and there is no benefit on macrovascular complications.

New data are changing the way gestational diabetes is diagnosed and treated.

The new standards using glycated hemoglobin for the diagnosis of diabetes issued in January 2010 have not come without controversy.

Agents in late-stage development for the treatment of female and male cancers.

New Molecular Entity: Denosumab (Prolia) was approved in June as a treatment for postmenopausal osteoporosis in women at high risk for fracture.

Forty-two cases of progressive multifocal leukoencephalopathy (PML) in patients receiving the humanized monoclonal antibody natalizumab have been documented since 2006 from MedWatch reports.