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Managed Care

Saurabh Nagar, Jeetvan Patel, Richard H Stanford
PURPOSE: To characterize subjects with chronic obstructive pulmonary disease (COPD) newly initiated on long-acting muscarinic antagonists (LAMA) or dual LAMA/long-acting ╬▓2-adrenergic agonist (LABA) therapy. DESIGN: This pilot/preliminary analysis was a retrospective crosssectional study of subjects with COPD from the Optum Impact National Managed Care Benchmark Database. METHODOLOGY: Subjects with at least one LAMA prescription in the index period (July 2008-June 2009) were included and stratified by treatment...
May 2018: Managed Care
Jeremy Schafer
The breast cancer mortality rate in 2012 declined 49% compared with the expected baseline, and 63% of that reduction was from treatment drugs. You'd think that patients would take their cancer medicines no matter what. But when cost sharing reached between $100 and $500, the abandonment rate soared to 32%.
May 2018: Managed Care
Peter Boland
On the one hand, the PCMH is an admirable effort to gather in one place all the disparate and disorganized clinical and social supports the patient needs. At the same time, though, medical homes employ provider-defined business models and conventional performance measures, belying the patient-centered in the name.
May 2018: Managed Care
Fran├žois de Brantes
It's no mystery why this country has both the highest per capita health care costs and the lowest overall percentage of people with coverage. The two are connected, but as if on a teeter-tooter: As one goes up, the other goes down.
May 2018: Managed Care
Susan Ladika
Sometimes patients are angry. Sometimes it is a symptom of their illness. Either way, nurses are on the front lines of health care and bear the brunt of the physical and verbal abuse from patients; gender may be a factor. In California, hospitals and other health care providers are now required to keep a log of violent incidents and develop violence prevention plans. Federal legislation has been introduced.
May 2018: Managed Care
Zachary Hafner
At last count, the pharmaceutical industry's new product pipeline included more than 7,000 products in late-stage development, roughly half of which are deemed "specialty." The reality is, our health care system is poorly equipped to address this issue head-on.
May 2018: Managed Care
Charlotte Huff
The deadliness of liver cancer is undisputed, but a growing body of data shows that too often, patients, and particularly those who are uninsured or nonwhite, miss out on earlier diagnosis and potentially life-saving surgery.
May 2018: Managed Care
Sarah Kwon
Although outcome-based pricing has proven to be more popular, experts and industry insiders say indication-specific pricing should be getting more attention, especially in oncology. But will administrative costs offset any benefit? And legal and regulatory obstacles could get in the way.
May 2018: Managed Care
Eric Bender
The drugs often are more effective and have fewer side effects. The science-often just amazing. Medically, cancer treatment has never been in a better place. But are high prices making it unaffordable? Payers, providers, policymakers, and drugmakers themselves are wrestling with the issue. Meanwhile, many patients are being priced out of treatments that could save their lives.
May 2018: Managed Care
Ed Silverman
On the one hand, ICER determined that the cost would exceed conventional chemo for B cell acute lymphoblastic leukemia by almost $330,000. On the other hand, its analysis showed that Kymriah would provide youngsters with about eight extra years of life beyond what conventional treatment would typically provide. Who's going to say "no?"
May 2018: Managed Care
Michael D Dalzell
The architects of Medical Episode Spending Allowance (MESA) benefits are radically reframing coverage as allowances for episodes of care and have a plan for engaging members in making better choices. MESA could catch on quickly, particularly with plan sponsors who have seen consumer-directed plan designs work against them.
May 2018: Managed Care
Thomas Reinke
Immunotherapy is advancing at break-neck speed. But a plain, come-down-to-earth fact sometimes gets lost in the excitement about checkpoint inhibitors and the flurry of approvals: The majority of patients do not respond to these agents, and many of those who do respond eventually relapse.
May 2018: Managed Care
Richard Mark Kirkner
A federal bill would expand access to experimental treatments to seriously ill patients, but critics say the right to try would take away FDA oversight and create a "Wild West." Proponents counter that the FDA's current process can be onerous for people with just a few months to live. Meanwhile, most states' right-to-try laws have gone unused.
May 2018: Managed Care
Richard Mark Kirkner
Consultants predicted it would be a major business. Large employers and insurers were experimenting with it. But medical tourism has not lived up to the heady expectations. The ACA and moderation of increases in health care costs cooled off interest. Besides, who really wants to go to an unfamiliar place for health care?
April 2018: Managed Care
Thomas Morrow
Diabetes is the scourge of our times, but we have been chasing the wrong culprits. A simple, $40 test of insulin resistance could put us on the right track.
April 2018: Managed Care
Charles Cini
These eight questions show that the use of an LBM or a PAP should be just one of the potential results of your laboratory benefit management program, not the program itself. You shouldn't have to pay for services you already provide yourselves or add a middleman that's not necessary.
April 2018: Managed Care
Zachary Hafner
It's a must because there is a cost to keeping the underserved that way whether that means funding integrated primary care to help people live healthier lives or footing the bill when people get care in the emergency department.
April 2018: Managed Care
Thomas Reinke
The randomized controlled trial reigns supreme, but the FDA is working on ways to incorporate real-world evidence into its approval processes.
April 2018: Managed Care
Frank Diamond
The CMO of Molina Healthcare of Utah grew up, let's say, not rich. He says that and a varied background-including a stint in the Air Force-helps him deal with changing policies involving a challenging population.
April 2018: Managed Care
Robert Calandra
CMS is granting waivers that impose work and other new requirements on some Medicaid beneficiaries. Medicaid managed care plans are wary of the added administrative complexity-and possibly a change in the Medicaid population's risk profile.
April 2018: Managed Care
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