Healthcare organizations are intimately familiar with intense prosecutorial scrutiny resulting from the government's battle against fraud and corruption. There are prominent examples of focused federal fraud investigations, resulting in hefty settlements. Congress has now enlisted the healthcare industry in their campaign against fraud.
As more health plans turn to automated, speech-enabled calls to reach out to members with welcome programs, preventive health reminders, or with more sensitive information about a specific condition, they must use an appropriate approach. Done correctly, such phone programs can provide a cost-effective way to speak with members.
THE BEST STEP therapy programs first consider medical evidence regarding patient outcomes when identifying drug classes for inclusion, according to industry experts.
IN THE PAST TWO DECADES, the progress of pharmacy benefit management has brought about sophisticated strategies including formularies, utilization management and generic substitution. David B. Snow Jr., CEO of Medco Health Solutions, is bargaining that the next decade of pharmacy benefit management will bring enhanced patient therapy, personalized medicine and dramatic opportunities in the generic market-points all pharmacy benefit teams will have to ponder.
Today, healthcare payers and providers endlessly wrestle with three alligators-rising costs, inconsistent quality, and the uninsured. These alligators seem to grow larger and stronger with every passing year.
There is growing recognition that teenagers have healthcare needs that are distinct to their own age group-needs that pediatricians and primary care physicians are not always equipped to handle.
ALTHOUGH THE NUMBER of North Americans and Europeans seeking care abroad is relatively small-about 150,000 Americans traveled abroad for care in 2005-it's expected to grow as more patients learn about the option and as overseas hospitals, healthcare travel firms and insurers lay the groundwork to accommodate them.
DOUGLAS E. HENLEY, MD, BELIEVES that the U.S. healthcare system is so fragmented, so disjointed and so disorganized that he finds it hard to even refer to it as a system.
At present, most states have made HMOs subject to their insurance holding company acts. Insurance holding company acts are comprehensive bodies of law that govern the relationships and activities within insurance holding company structures. These laws indirectly regulate the activities of entities that are affiliated with insurance companies and HMOs, which would not otherwise be subject to regulation.
Despite a mounting clamor for reform from many health policy experts, Senate action to reduce payments to Medicare Advantage may be postponed this year. Influential senators oppose an across-the-board cut, which would reduce MA plan activity in rural and low-cost regions.
NATIONAL REPORTS-Corporate wellness programs are top-of-mind for the majority of large, and even many mid-size employers, according to industry experts.
WASHINGTON, D.C.-Legislation permitting federal government negotiation of Medicare drug discounts has stalled in the Senate, partly due to disputes over the measure's potential for savings. A coalition led by Sen. Debbie Stabenow (D-Mich.) claimed that government negotiation of Medicare drug prices would save patients and taxpayers $30 billion a year. That number assumes such a change would yield 40% drug price reductions to match rates obtained by the Department of Veterans Affairs health program.
NATIONAL REPORTS-Recent cancer society guidelines and a national study urging breast magnetic resonance imaging (MRI) scans for high-risk women could prove to be influential in the industry.
NATIONAL REPORTS-The proposed merger of Highmark Inc., of Pittsburgh, and Independence Blue Cross (IBC), of Philadelphia, combines two large health plans into a single organization that would become the dominant player in the Pennsylvania market. It also represents another step in the consolidation of the health plan marketplace, say industry experts.
Apparently somebody forgot to carry the one. The U.S. Census Bureau recently revised its 2005 data on the uninsured and now reports that the initial numbers were off by 1.8 million people. New totals show 44.8 million people were uninsured in 2005, not the 46.6 million previously reported.
A review of agents in late-stage development for the treatment of gastrointestinal disorders (April 2007).
Chronic kidney disease (CKD) affects 20 million Americans, and an additional 20 million are at increased risk for developing CKD. Anemia is a common complication in patients with CKD. Continuous erythropoiesis receptor activator (CERA) is a new erythropoiesis-stimulating agent (ESA) that is undergoing FDA review for the treatment of anemia in patients with CKD, including in those undergoing dialysis.
The need to reauthorize the Prescription Drug User Fee Act (PDUFA) before it expires September 30, 2007, has set the stage for congressional action on broader legislation to improve the handling of drug safety issues. Bills under consideration aim to expand FDA oversight by establishing new requirements for postmarket risk assessment, for posting active clinical trials and resulting study data, and for completing postmarket studies.
We propose using the results of pharmacodynamic Monte Carlo simulation studies as a surrogate marker for potential efficacy of antibiotic dosage regimens and applying these end points to the calculation of an incremental cost-effectiveness ratio (ICER).
One of the numerous factors shaping pharmacy and therapeutics (P&T) committees' operations and decisions is the push for electronic health information systems, including electronic prescribing (e-prescribing). E-prescribing is expected to help prescribers comply with plan formularies and formulary policies.
In patients with metastatic renal cell carcinoma, treatment with sunitinib yields longer progression-free survival rates and a better health-related quality of life than does the standard treatment, interferon alfa therapy, according to the results of a phase 3 trial published in the New England Journal of Medicine (NEJM). A total of 750 patients aged ≥18 years participated in this international, multicenter, randomized trial.
Maintaining treatment with imatinib as initial therapy in patients with chronic myeloid leukemia (CML) may yield positive outcomes, including increased overall survival to ≥5 years, according to a study published in the New England Journal of Medicine (NEJM). The follow-up study of the International Randomized Study of Interferon and ST1571 (IRIS), a multicenter, international, randomized, phase 3 trial, included patients aged 18 to 70 years diagnosed with Ph-positive CML in chronic phase within 6 months before the start of the study.
Healthcare professionals assembled at the 56th Annual Scientific Session of the American College of Cardiology (ACC) from March 24 to 27, 2007, in New Orleans, La, to exchange information and updates about new and continuing research in cardiovascular disease.
A discussion of new FDA-approved indications and formulations of drugs
A discussion of generic drugs recently approved by FDA
A discussion of drugs under consideration/review for FDA approval
Recombinant monoclonal antibody approved for reducing the signs and symptoms and inducing and maintaining clinical remission of moderately-to-severely active Crohn's disease
Recombinant monoclonal antibody approved for the treatment of paroxysmal nocturnal hemoglobinuria to reduce hemolysis
DIABETES, ASTHMA cardiovascular disorders, high-risk pregnancy and chronic obstructive pulmonary disease (COPD), will continue to account for anywhere between 55% and 70% of medical costs, according to industry experts. For these disease states, executives are taking a look at more creative DM programs, but they also are seeing emerging diseases on the horizon.
As healthcare costs continue to increase, information has become its own currency. Payers want to identify high utilizers of services; purchasers demand to know how their money is being spent; and providers seek information on patients' status. Even pharmaceutical companies want in, and consumers who are expected to pay for more of their healthcare want to know about the data available to them.
