Specialty pharmaceuticals require payers' attention
March 1st 2006Advanced specialty pharmaceuticals are increasingly used to treat a wide range of conditions. They require close clinical monitoring. With a relatively short shelf life and limited stability, they call for special handling and timely distribution.
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Effective medicines now available to combat osteoporosis
March 1st 2006In the United States today, 10 million people have osteoporosis (bone density that's about 25% less than a healthy young adult). In addition, 34 million more people have low levels of bone mass, placing them at increased risk. Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, approximately 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 other fractures. About 68% of those affected by osteoporosis are women.
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Payers at forefront of adopting electronic patient health records
March 1st 2006As the U.S. healthcare industry continues its evolution from paper toward electronic medical record-keeping, a trend is emerging: The payers are leading the way, but the consumer ultimately will benefit from -- and actively participate in -- the shift toward industrywide computer-based medical-record databases.
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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.
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Servant leaders: Summa's Thomas Strauss and Martin Hauser
March 1st 2006Practically 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.
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Assumption reinsurance: getting the bad along with the good
March 1st 2006When 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.
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Bush scales back healthcare initiatives
March 1st 2006WASHINGTON, 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.
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Medicare encourages more drug effectiveness information
February 1st 2006The 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.
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A growth hormone conversion program and patient outcomes at a not-for-profit HMO
February 1st 2006Although 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).
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Influence of a UTI empiric treatment pathway on physician prescribing in an academic medical center
February 1st 2006In 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.
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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.
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HMO regulations aim to protect, but can burden buyers
February 1st 2006Employers 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.
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Achieving technology goals appears within reach
February 1st 2006New 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.
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Retrospective analysis demontrates that switching statins hinders treatment compliance, persistence
January 1st 2006Patients 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.
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