Managed Care

Managed Care Medical Company
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The First and Last Resort
09/05/2019
The First and Last Resort

The First and Last Resort

People with behavioral health problems have stretched emergency departments to their limit as the number of inpatient psychiatric beds has decreased. For many patients, the ED is the first place they go. Even people under the care of a mental health professional wind up in EDs because they’re in c...

09/04/2019
Primary Care as a Platform for Value

Primary Care as a Platform for Value

Quantifying the worth of primary care and its delivery are essential for raising its profile. New data and payment incentives may push us closer.

09/03/2019
Making the Patient Voice Matter In Value Assessment

Making the Patient Voice Matter In Value Assessment

Conversations about the value of health care treatments have not traditionally included the patient perspective. In the past, value has been measured through cost-effectiveness analyses that weigh the clinical benefits of a treatment against its costs without a consideration of how those benefits al...

Slavitt on the ACA: It’s a Fixer-Upper, Not a Teardown
08/21/2019
Slavitt on the ACA: It’s a Fixer-Upper, Not a Teardown

Slavitt on the ACA: It’s a Fixer-Upper, Not a Teardown

The former head of CMS takes Congress to task. The ACA is not perfect (no law is) but could be improved, in his view, if only lawmakers would show more political courage.

08/02/2019
Some states find nuances in the letter of the ACA law

Some states find nuances in the letter of the ACA law

“That which does not kill us makes us stronger,” said Nietzsche. Goodness knows that the GOP and President Trump have been trying to kill the ACA, and/or replace it. There are battles on several fronts: legislative, judicial, political.

08/01/2019
Gives Some Pause About Checkpoint Inhibitors: Possible Link to Type 1 Diabetes

Gives Some Pause About Checkpoint Inhibitors: Possible Link to Type 1 Diabetes

A prospective study in the works will track 1,500 to 2,000 patients undergoing checkpoint inhibitor therapy at clinics and hospitals across the nation. Researchers will collect blood samples periodically, subjecting the samples to genomics and other technologies that they hope will suss out causativ...

07/31/2019
ACA Decreased Racial Disparities

ACA Decreased Racial Disparities

Racial disparity in the timely treatment of cancer effectively disappeared in states that expanded Medicaid under the ACA, according to the American Society of Clinical Oncology. Timely treatment was defined as starting first-line treatment within 30 days of a diagnosis for advanced or metastatic ca...

Top 10 Misconceptions About ACOs
07/29/2019
Top 10 Misconceptions About ACOs

Top 10 Misconceptions About ACOs

Even though misunderstandings abound, now is still a good time to take the plunge and become an ACO. New CMS rules have increased the chances of financial success.

Where housing can make a big difference: It’s in data analytics
07/22/2019
Where housing can make a big difference: It’s in data analytics

Where housing can make a big difference: It’s in data analytics

Presbyterian Healthcare Services in New Mexico has spent $50 million to centralize clinic, pharmacy, and SDOH in a single “data warehouse.” Now the not-for-profit health care system is marketing its data collecting and crunching expertise via a for-profit subsidiary.

07/18/2019
In New Jersey, a race to the bottom that saves a billion

In New Jersey, a race to the bottom that saves a billion

The state used a reverse auction whose rounds of bidding saved $1 billion on PBM services, according to the consultant who helped orchestrate the deal. Other states (maybe Maryland) and large purchasers may follow suit.

No winks. But Penn ‘nudges, nudges’ clinicians, patients to better decisions.
07/16/2019
No winks. But Penn ‘nudges, nudges’ clinicians, patients to better decisions.

No winks. But Penn ‘nudges, nudges’ clinicians, patients to better decisions.

The University of Pennsylvania has established the first “nudge unit” in a health care system to bring the lessons of behavioral economics to the practice of American health care. The goal is to steer clinicians and patients toward choices that will improve health—and save money.

07/11/2019
New knees, new hips–to go

New knees, new hips–to go

Bundled payment is pushing providers to look for ways to control the cost of joint replacements. Is joint replacement going to become outpatient surgery?

Game of drones
07/10/2019
Game of drones

Game of drones

Stringent FAA safety regulations don’t necessarily mean that medical drones won’t fly as an everyday tool—but it will be a lift.

07/09/2019
How blockchain has strange bedfellows singing kumbaya

How blockchain has strange bedfellows singing kumbaya

Competitors are coming together to see if they can leverage blockchain’s magic to solve big problems. Provider directories are among the first use cases.

AI for all that ails American health care. But how smart is that?
07/08/2019
AI for all that ails American health care. But how smart is that?

AI for all that ails American health care. But how smart is that?

The evidence base is wobbly, but artificial intelligence is coming on strong and the hype for it is even stronger. Screening for diabetic retinopathy is an early application. Lingering questions include whether the use of AI will contribute to health care inequities rather than solve them.

Anthem’s push to have physicians take on two-sided risk lands at South Bend Clinic
07/03/2019
Anthem’s push to have physicians take on two-sided risk lands at South Bend Clinic

Anthem’s push to have physicians take on two-sided risk lands at South Bend Clinic

Under Anthem’s recently launched Cooperative Care program in South Bend Clinic in Indiana, the ACO’s 150 providers will take on two-sided risk. Cooperative Care also focuses on data sharing and quality measurement as part of a targeted program to bypass prior authorization for select services in...

SGLT2 Inhibitors, No Diabetes Required?
07/02/2019
SGLT2 Inhibitors, No Diabetes Required?

SGLT2 Inhibitors, No Diabetes Required?

Jardiance, Invokana, and other SGLT2 inhibitors may be used to treat and prevent heart failure and kidney disease in people without diabetes.

High Administrative Costs and Low Enrollment Led To the Demise of Startup Insurer Crystal Run
07/01/2019
High Administrative Costs and Low Enrollment Led To the Demise of Startup Insurer Crystal Run

High Administrative Costs and Low Enrollment Led To the Demise of Startup Insurer Crystal Run

Crystal Run will close its health plan at the end of this year. Its losses in the small-group market were driven, in part, by risk adjustment. But another major factor was excessive administrative costs, which were three times as high as the administrative costs at established health plans.

ED visits: After the ACA, the uninsured–Medicaid seesaw
06/27/2019
ED visits: After the ACA, the uninsured–Medicaid seesaw

ED visits: After the ACA, the uninsured–Medicaid seesaw

The proportion of emergency department visits by Americans without insurance decreased from 14% to 8% from 2013 to 2016, while visits by those with Medicaid coverage increased from 26% to 34%. Meanwhile, hospital discharge of patients without insurance was steady at about 6% from 2006 to 2013, then....

Antibiotics Help Birth Outcomes
06/26/2019
Antibiotics Help Birth Outcomes

Antibiotics Help Birth Outcomes

Oxford University researchers found that prescribing antibiotics as a preventive measure could save about 5,000 mothers who gave medically assisted births from getting infection in the United States. Women receiving antibiotic prophylaxis had a 56% reduction in the risk of confirmed systemic infecti...

A Mismatch Made in America
06/25/2019
A Mismatch Made in America

A Mismatch Made in America

When patients and their medical records are out of whack, it causes harm and wastes money. American attitudes about privacy—and the multitude of competing provider organizations—makes the patient matching problem hard to fix.

As Health Care Landscape Shifts, Stakeholders Need To Shift as Well
06/24/2019
As Health Care Landscape Shifts, Stakeholders Need To Shift as Well

As Health Care Landscape Shifts, Stakeholders Need To Shift as Well

Change is happening on multiple fronts and at a faster pace than ever before. Stakeholders that ignore or minimize it will do so at their peril. To be clear, addressing organizational change or purpose internally, as well as external positioning today, is the more likely path to success.

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19067

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