Private fee-for-service (PFFS) plans are the fastest growing, and most controversial, aspect of the Medicare Advantage (MA) program. They account for approximately 18% of total enrollment, and according to MedPAC, they are receiving payments that average 19% more than payments to traditional Medicare.
Leaders of Medicare Advantage (MA) organizations are concerned about maintaining the profitability of their MA products. To be successful, organizations should develop internal profitability best practices.
Healthcare reform has surfaced as a national topic. Intel co-founder Andy Grove outlined some noteworthy ideas on healthcare reform during a national speaking tour, and California Governor Arnold Schwarzenegger recently proposed a plan to cover the citizens of his state. Getting a head start on the 2008 Presidential race, Mitt Rommey is weighing in with proposals based on his experience as former Governor of Massachusetts. While all these ideas are coming from different sources, they all share a few basic themes: healthcare should be easy to find, to buy, and to understand.
Preventable medication errors are resulting in $3.5 billion in drug-injury related healthcare costs. To address this crisis, the IoM recommends that the entire system move to electronic prescribing (e-prescribing) by 2010.
NATIONAL REPORTS-An opportunity for drug companies to voluntarily provide detailed evidence of their products' cost effectiveness to existing alternatives is showing progress-but is still far from successful, according to industry experts.
WASHINGTON, D.C.-Instead of going back to academia, former FDA Commissioner and Medicare Administrator Mark McClellan, MD, is setting up his own shop to tackle health reform and drug safety more actively. Dr. McClellan will head the Engelberg Center for Health Care Reform at the Brookings Institution, starting with $20 million in funding from Alfred Engelberg and Leonard Schaeffer.
SACRAMENTO-California's six largest preferred provider organizations (PPOs) have agreed to initiate quality-of-care measures to create a Health Insurance Report Card for the state, the first in the nation for PPOs.
PPOS are seeing a continued resurgence in some areas, and in others, are not able to compete effectively with HMOs, industry experts say.
Probably never before in the history of managed care have health plans tolerated a bigger gap between actual and potential reimbursement than in Hierarchical Condition Coding (HCC) for Medicare Advantage (MA).
If we are treating healthcare as a commodity, then why not determine its real value? That might be more easily said than done, but as more and more consumers demand transparency in healthcare, payers, providers and pharmacy benefits managers (PBMs) are sharing information on the cost of treatments, screenings and drugs.
IN THE WORLD OF professional sports, the competition isn't only on the gridiron, the court or the diamond. Just ask an MCO.
Medicare Advantage (MA) plans are increasingly under financial scrutiny. Some fear they might suffer the same fate as Medicare + Choice in the late 1990s when MCOs pulled the plug on plans because of low payments.
Pat Ford-Roegner, MSW, RN, FAAN, CEO of the American Academy of Nursing (AAN), seems a natural fit for her latest appointment as a member of the new Washington, D.C.-based Partnership to Fight Chronic Disease (PFCD) Advisory Board. The board, led by Richard H. Carmona, MD, MPH, FACS, former U.S. Surgeon General, is comprised of 40 high-profile CEOs and presidents from the public and private sector.
John Hopkins, president and CEO of Rocky Mountain Health Plans, has a 20-year history with the organization and has witnessed the ongoing changes in the nation's healthcare delivery system from Rocky Mountain's headquarters in Grand Junction, Colo. Few CEOs can claim such a tenure with a single plan, but Hopkins has never been anxious to leave an organization that remains solid despite healthcare's constant transformation.
The need to reauthorize the State Children's Health Insurance Program (SCHIP) by September 30, has evolved into a broader debate about the role of government in providing healthcare to Americans. The Bush administration wants to maintain a limited program for low-income children, while Democrats envision more open-ended coverage for more children and families.
Coffee shops, restaurants and grocery stores have started getting serious about employees washing their hands to prevent the spread of germs. If the guy who steams my cafe latte remembers to scrub his hands for 30 seconds before getting behind the coffee counter, then why aren't more healthcare providers remembering to do it?
Agents in late-stage development for the treatment of acute pain and migraine/headache (August 2007)
Data from 2 identical double-blind phase 3 studies demonstrated that patients with migraine who were assigned to sumatriptan plus naproxen were more likely to be pain-free at 2 hours and more likely to experience relief from both traditional and nontraditional migraine symptoms compared with those assigned to placebo.
Nebivolol, an investigational (NDA submitted) vasodilating beta-blocker, demonstrated a neutral effect on blood glucose levels in two 12-week clinical studies of patients with hypertension.
Investigators have demonstrated that patients with type 2 diabetes who use inhaled insulin as part of their basalbolus insulin regimen experience a small decline in pulmonary function.
An open-label extension study of exenatide demonstrated sustained blood glucose control and weight loss in patients with type 2 diabetes.
A quick-release formulation of bromocriptine reduces the incidence of diabetic cardiovascular complications in patients with type 2 diabetes and improves glycemic control in those patients who did not achieve HbA1c <7.5% with metformin plus a sulfonylurea.
As Congress continues to work towards the reauthorization of the Prescription Drug User Fee Act (PDUFA), drug safety is once again at center stage after reports of serious cardiovascular problems associated with GlaxoSmithKline's diabetes drug rosiglitazone (Avandia).
Statins and fibrates reduce the risk of peripheral neuropathy in patients with type 2 diabetes independent of the agents' effects on lipids, according to results presented at the 67th annual scientific sessions of the American Diabetes Association.
The use of pioglitazone in patients with renal dysfunction, type 2 diabetes, and macrovascular disease can reduce the risk of death, nonfatal myocardial infarction (MI), and stroke according to results presented at the 67th annual scientific sessions of the American Diabetes Association.
Rosiglitazone did not demonstrate an increased risk of hospitalizations and death from cardiovascular causes (the composite end point) in an interim analysis of a prospective study.
A pooled analysis involving 1,748 patients in 4 randomized trials contradicts the results of recent trials that have demonstrated that the risks for death and myocardial infarction (MI) are potentially higher in patients receiving drug-eluting stents (particularlysirolimus-eluting stents) compared with patients receiving bare-metal stents.
In a small, retrospective, case-control study, it was demonstrated that aspirin (ASA) improved 7-day survival in patients with cancer who developed acute coronary syndrome (ACS), with or without thrombocytopenia.
The results of the Standard and New Antiepileptic Drugs (SANAD) trial, an unblinded, randomized, controlled, 2-arm study comparing the efficacy of various epilepsy drugs showed that for treatment of patients with partial seizures, lamotrigine demonstrated superior efficacy.
A greater percentage of patients at high risk for cardiovascular disease are likely to reach target low-density lipoprotein cholesterol (LDL-C) levels with initial treatment with rosuvastatin than with atorvastatin or simvastatin, according to the results of the Satisfying Optimal LDL-C ATP III Goals with Rosuvastatin (SOLAR) trial.