Recently added articles from Managed Healthcare Executive:
Broker compensation rules keep MAOs on their toes
Jan 01, 2009; ... New laws respond to reports of brokers churning enrollees through plans to gain more compensation The last six months have been a rollercoaster ride for Medicare Advantage Organizations and Part D sponsors (collectively, MAOs) who have been attempting to interpret and comply with the ...
Insurers address healthcare costs
Jan 01, 2009; ... PwC report shows only 3% of premiums are dedicated to capital investment and profit WASHINGTON, D.C. - The steady rise in the cost of healthcare services and insurance premiums continues to alarm providers, payers and policy makers, particularly those seeking to craft reform legislation ....
New Day
Jan 01, 2009; ... Managed care can take advantage of opportunities in the Obama era Incoming Congressional leaders and the President-elect have launched a major campaign to overhaul the nation's healthcare system, and insurers, employers and providers are reaching out to grab their piece of the ...
Dual eligibles best served with coordinated benefit design
Jan 01, 2009; ... Flexibility needed in FFS and capitated environments in order to weave in care coordination, disease management CAUGHT BETWEEN A ROCK AND A hard place. If the cliché wasn't coined to describe the plight of individuals who are for both Medicare and Medicaid, it should been. While dual ...
Young health IT professionals expect more flexibility
Jan 01, 2009; ... Recruit your next generation of IT workers from a larger pool while transitioning your experienced staff to retirement AS A GENERATION OF IT workers prepares to retire, health plans are maneuvering to replace the vast amount of experience and knowledge that is leaving with them. The ...
Cost, quality, access not mutually exclusive
Jan 01, 2009; ... THERE IS GROWING DEMAND for health reform among the American public and the health industry itself, with great pressure to reduce costs, expand coverage and improve quality of care. But, there are differences in priorities, explains Michael Thompson, principal, PricewaterhouseCoopers ...
Hawaii
Jan 01, 2009; ... COMMONWEALTH FUND STATE PERFORMANCE RANKING (2007): 1 SEVEN MONTHS after launching Keiki Care, Hawaii ended the universal healthcare program for children. The state stopped funding the program effective Nov. 1, 2008. Its private partner, Hawaii Medical Service Assn. (HMSA), paid to cover ...
Non-traditional care sources offer opportunity
Jan 01, 2009; ... Medical tourism and other trends create new models for a more efficient delivery system More than 750,000 Americans sought less-expensive medical treatments in other countries, a number projected to grow to 6 million by 2010. This is potentially costing the U.S. healthcare system ...
5 New Realities of Disease Management
Jan 01, 2009; ... Challenge your expectations of disease management Over the past decade, MCOs have turned to disease management to improve outcomes for patients as well as to gain financial returns. Now experienced industry observers are asking whether disease management is experiencing backlash or if it ...
Part D tiers shuffle more costs on patients for cancer treatment
Jan 01, 2009; ... WASHINGTON, D.C. - Medicare prescription drug plans (PDPs) are covering most popular drugs on their formularies, including costly biotech therapies and anticancer treatments. Beneficiaries have to pay more out-of-pocket, however, for high-cost drugs. PDPs are shifting more costs to ...
Federal incentives up e-prescribing's attraction
Jan 01, 2009; ... Incentives might not encourage the hesitant to adopt e-prescribing, but penalties could push them along THE PASSAGE OF THE MEDICARE Improvements for Patients and Physicians Act of 2008 begins a five-year program, which combines a 2% incentive payment with a mandate to transmit orders for ...
Post-marketing surveillance brings added drug safety
Jan 01, 2009; ... Initial clinical trials can't reveal all risks, but better data collection and FDA involvement can help THREE INITIATIVES HAVE converged to place the spotlight on drug safety: the Sentinel Initiative, which is a long-term effort to create a national electronic system for monitoring ...
New age of healthcare calls for equality
Dec 01, 2008; ... Women have made exciting inroads toward equality but expect similar voices from minority groups This nation is becoming more diverse at a faster rate than ever. Racial equality and cultural sensitivity - while always an issue - seem to be reaching a new point of activation similar to ...
Congress maps route for health reform
Dec 01, 2008; ... Leading legislators weigh prospects for broad reform versus incremental change WASHINGTON, D.C. - Policy makers on Capitol Hill are staking out positions for the anticipated debate on overhauling the nation's healthcare system. A number of powerful legislators involved in ...
SECRETARY TOM DASCHLE
Dec 01, 2008; ... PRESIDENT-ELECT BARACK OBAMA MOVED QUICKLY in selecting former Seriate Majority Leader Tom Daschle as secretary of Health and Human Services. Daschle has been a close advisor to Obama and now will be the administration's point person on moving health reform legislation through Congress. Reform ...
Employers asking for care abroad to reduce healthcare costs
Dec 01, 2008; ... NATIONAL REPORTS - Fueled by employer clients seeking access to foreign providers as a means of reducing their claim expenditures, domestic insurers have been evaluating programs and benefits whereby its customers can elect to seek certain services overseas. "There has been a growing ...
Healthcare reform campaign faces big hurdles
Dec 01, 2008; ... To expand health coverage during this economic crisis, Obama will first seek out ways to cut costs President-elect Barack Obama stated loudly and clearly during the election campaign that all Americans have a right to affordable healthcare. Now he faces significant challenges in boosting ...
Financial turmoil means greater scrutiny of insurers
Dec 01, 2008; ... There will be renewed interest in solvency regulation for entities that hold significant funds from the general public In the midst of the current U.S. financial turmoil, there are many uncertainties with respect to the future of our nation's financial institutions. A significant upgrade ...
Puerto Rico's Plan
Dec 01, 2008; ... Encouraged by recent milestones, Triple-S eyes the U.S. market As more U.S. health insurers edge into the global market seeking growth, one Blue Shield plan is looking to compete in the United States against its familiar American cousins. Triple-S Management Corp., based in San Juan, ...
Bundled Payment
Dec 01, 2008; ... Global-rate pilots expected to reward providers who do the right thing In the mid-1990s, Medicare tested a bundled-payment reimbursement arrangement for cardiac bypass surgery at four hospitals and was able to document savings. Provider pushback hampered further efforts, and the bundled ...