Managed Healthcare Executive back issues from December 2007:
Understand choice, implications of law principles
Dec 01, 2007; ... Be mindful of the complex choice of law issues in individual and group insurance contracts in each state Choice of law issues arising from coverage disputes of both individual and group insurance policies many times determine which party will prevail on the merits of a particular case ....
Employer-based healthcare system under scrutiny
Dec 01, 2007; ... Business community questions cost, role in providing healthcare benefits to workers As the debate over healthcare reform accelerates, policy makers are weighing in with proposals to unlink coverage from the work place. In a major shift from the Clinton reform debate 14 years ago, ...
Part D plans boost fees for 2008
Dec 01, 2007; ... Rising premiums, narrower coverage may prompt seniors to switch WASHINGTON, D.C.-Change was in the wind as the Medicare Part D open enrollment period began last month. Most seniors who belong to stand-alone prescription drug plans (PDPs) face premium increases, particularly those ...
Emergency departments need industry support
Dec 01, 2007; ... Overcrowding is less about wasteful use of ED services and more about reduced availability Emergency departments (EDs) are a critical safety net for all Americans, and that net is becoming evermore threadbare. It's downright scary when you look closely at the reality of EDs ...
MAKING the CONNECTION
Dec 01, 2007; ... Commonwealth Connector's Jon Kingsdale works on making insurance attractive and affordable in Massachusetts Rich in American history, Boston's roots are also etched in revolution. Perhaps it's no coincidence that former historian Jon Kingsdale, PhD, finds himself overseeing one of the ...
Rethink care for Medicaid group with multiple chronic conditions
Dec 01, 2007; ... NATIONAL REPORTS-A national examination of disease prevalence among Medicaid beneficiaries underscores ways that managed care plans can rethink care management approaches for high-need, high-cost beneficiaries with multiple chronic conditions. Data from The Faces of Medicaid II, a recent ...
Mail-order pharmacy steps up patient services
Dec 01, 2007; ... PBMs train pharmacists to provide patients higher levels of care management when using mall services WHAT WORKS FOR retail pharmacy patients should work for mail-order recipients, namely, personalized drug counseling. When consumers pick up their prescriptions at a local pharmacy, they ...
Cost effectiveness can be part of benefit judgments
Dec 01, 2007; ... Cost-effectiveness comparisons come into play when clinical effectiveness is an even tradeoff HOW DO YOU PUT A PRICE TAG on health? If you're talking about a new, expensive treatment for your mother's cancer, the price seems irrelevant. For payers struggling with unmanageable cost ...
Increase in electronic remittance expected within two years
Dec 01, 2007; ... Electronic funds transfers now at 30% and slowly making progress for providers EMPLOYEES HAVE BEEN receiving paychecks via direct deposit for almost 40 years, according to the Electronic Payments Assn. In 2005, there were 4.4 billion direct deposits. According to a survey by ...
ELEVATING to ICD-10
Dec 01, 2007; ... Because of its greater specificity, ICD-10 could be one of the best things to happen to healthcare ALTHOUGH MOST ANALYSTS would be hard-pressed to equate the World Health Organization's latest version of the International Classification of Diseases and Related Health Problems (ICD) with ...
Medicare state enrollment
Dec 01, 2007; ... MEDICARE ADVANTAGE (MA) enrollment reflects die relative maturity of managed care markets generally, and the attractiveness of those markets from economic and demographic standpoints for these plans to operate in, experts say. "For instance, in just die last several years, Puerto Rico ...
CONSUMER RESILIENCE
Dec 01, 2007; ... Grace-Marie Turner advocates the free-market approach Grace-Marie Turner Founder and President Galen Institute MANY ORGANIZATIONS believe a free-market system is the best approach to healthcare, but the free market struggles against lagging public policy ....