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Managed Care

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https://www.readbyqxmd.com/read/29068300/health-plans-can-t-ignore-the-customer-experience-any-longer
#1
Erik Swanson
With regulations limiting differentiation between products, health plans must rethink consumer experience to meet expectations of today's consumers, who seek convenience, quality, and speed from their health care organizations. Many plans understand they need to connect more effectively with their end customers, but technological, cultural, and other obstacles are in the way.
October 2017: Managed Care
https://www.readbyqxmd.com/read/29068299/the-health-insurance-conundrum-crossing-the-divide
#2
Zachary Hafner
Population health management is built on the notion that prevention, early intervention, and proactive management of chronic disease can reduce the incidence rates of costly episodes. But so far the economics are not penciling out. The cost of innovation is outstripping the financial return on investment.
October 2017: Managed Care
https://www.readbyqxmd.com/read/29068298/novartis-s-kymriah-harnessing-immune-system-comes-with-worry-about-reining-in-costs
#3
Thomas Morrow
FDA approval of the CAR T-cell therapy for leukemia could usher in an era of genetically engineered, individually tailored immunotherapies. But tap those brakes. Long-term results are in short supply-and there's that $475,000 price tag. Or is it a $750,000 price tag?
October 2017: Managed Care
https://www.readbyqxmd.com/read/29068297/diabetes-care-management-teams-did-not-reduce-utilization-when-compared-with-traditional-care-a-randomized-cluster-trial
#4
Patrick Kearns
Studies comparing team care of diabetes with traditional care should be redesigned, say researchers. "In order for redesign studies to support generalization of their findings, methodology should include a randomized, controlled study design with intention-to-treat analysis," the study states.
October 2017: Managed Care
https://www.readbyqxmd.com/read/29068296/time-to-lift-the-curtain-on-pbm-wheeling-and-dealing
#5
Robert Calandra
PBMs say their deals need to be kept private so they can drive a hard bargain with manufacturers. But employers, consumer groups, and legislators are calling for more PBM transparency. There's bipartisan support for legislation that would force more openness.
October 2017: Managed Care
https://www.readbyqxmd.com/read/29068295/congress-puts-shadow-pricing-of-ms-drugs-in-the-spotlight
#6
Ed Silverman
Lawmakers asked seven companies to explain not only "skyrocketing prices," but a practice known as shadow pricing in which a drugmaker increases the price of an existing medicine to match the price hike or higher price set for a new drug launched by another company.
October 2017: Managed Care
https://www.readbyqxmd.com/read/29068294/young-man-battles-for-his-life-against-rare-autoimmune-disease
#7
Robert Calandra
The author's nephew suffers from a rare form of familial hemophagocytic lymphohistiocytosis. His organs shut down and he's placed in a medically induced coma. Meanwhile, costs mount to $4.9 million, most of it paid by an employer-sponsored health plan.
October 2017: Managed Care
https://www.readbyqxmd.com/read/29068293/jailbreak-how-to-ease-the-life-sentence-of-inflammatory-bowel-disease
#8
Lola Butcher
Cutting-edge programs are sparing young people from many of the most dire IBD complications, which often occur when they are in school or starting careers and families. Most Crohn's patients are diagnosed in their teens and 20s; ulcerative colitis is typically diagnosed when a patient is between 30 and 40 years old.
October 2017: Managed Care
https://www.readbyqxmd.com/read/29068292/insurers-relax-rules-help-members-after-hurricanes-harvey-irma
#9
Jan Greene
Some health plans responded by making it easier to see an out-of-network doctor, get a new copy of an insurance card or replace prescriptions lost in the chaos. Insurers also set up telephone help lines and made it easier to get a referral to a specialist.
October 2017: Managed Care
https://www.readbyqxmd.com/read/29068291/theresa-blanco-often-manages-beyond-molina-s-benefits-package
#10
Frank Diamond
For instance, say something a patient needs is not covered by Medicaid or an ACA plan. Blanco helps members find what they need by working with Molina's Community Connectors (community health workers) who help connect members to local community and not-for-profit organizations.
October 2017: Managed Care
https://www.readbyqxmd.com/read/29068290/otezla-warts-and-all-racks-up-sales-and-eyes-blockbuster-status
#11
Thomas Reinke
Otezla-the generic name is apremilast-also exploited a new mechanism of action as the first inhibitor of phosphodiesterase 4 (PDE4) that results in increased expression of both anti-inflammatory proteins and reduced expression of their pro-inflammatory counterparts.
October 2017: Managed Care
https://www.readbyqxmd.com/read/29068289/medical-malpractice-reform-a-fix-for-a-problem-long-out-of-fashion
#12
Richard Mark Kirkner
State tort reforms have all but relegated the malpractice crisis to the history books. But there's good news for those of you into all things retro: The House of Representatives just voted to fix the malpractice crisis by a 222-197 margin.
October 2017: Managed Care
https://www.readbyqxmd.com/read/29068312/the-role-of-proteomic-testing-in-improving-prognosis-and-care-planning-quality-measures-for-lung-cancer
#13
Ray D Page, A Christine Argento, David B Nash, Alexandria Skoufalos, Eric S Schaefer
PURPOSE: The Oncology Care Model (OCM) is a payment model from the Centers for Medicare and Medicaid Services designed to reduce costs and improve quality in cancer care. Key components of quality for the OCM originate from the 13-component cancer care plan. We surveyed the literature to understand the value of prognosis in OCM-directed planning for non-small-cell lung cancer (NSCLC) care and to investigate how the results of a prognostic, proteomic biomarker test, the VeriStrat test, can help OCM-participating providers meet the specific quality measures...
September 2017: Managed Care
https://www.readbyqxmd.com/read/29068311/three-components-missing-in-many-population-management-strategies
#14
Jack Plotkin
Many PHM strategies fall short because they fail to address three critical components that relate to patient-centeredness: patient-centered education, patient-centered social indicators, and patient-centered technology. Each of these three components is absolutely essential for population health strategies to work.
September 2017: Managed Care
https://www.readbyqxmd.com/read/29068310/health-plans-start-to-focus-more-on-social-needs-of-beneficiaries
#15
Gerard A Vitti
Health plans have known for years that there are many non-health factors that play a role in a person's health and well being. Now a coterie of health plans is starting to tackle factors that were seen as being completely outside the purview of anyone in the health care system, let alone a health plan.
September 2017: Managed Care
https://www.readbyqxmd.com/read/29068309/physician-compensation-let-form-follow-function
#16
Zachary Hafner
In true accountable, outcomes-driven models, there is an implicit expectation that physicians, payers, and other caregivers will be working together in new and collaborative ways. This introduces entire new layers of time and effort as new processes must be forged and evaluated, supported by investments in training, technology, and staff.
September 2017: Managed Care
https://www.readbyqxmd.com/read/29068308/wilson-cook-s-flourish-device-uses-magnets-to-fix-pediatric-esophageal-atresia
#17
Thomas Morrow
EA, although uncommon, is a complex and dangerous newborn birth defect with, until now, only chest surgical approaches. The Flourish Pediatric Esophageal Atresia Device is a remarkable alternative to traditional chest surgical procedures. No procedure or device is free of adverse events, but the results with this are so far impressive.
September 2017: Managed Care
https://www.readbyqxmd.com/read/29068307/and-the-oscar-health-goes-to-cleveland-clinic
#18
Susan Ladika
Oscar Health, a small insurer with big ambitions, has been enlisted to assist the storied Cleveland Clinic launch its own health plan. Each member of the plan will be matched with a care team made up of primary care provider, physician assistants, and other health care professionals.
September 2017: Managed Care
https://www.readbyqxmd.com/read/29068306/direct-primary-care-is-about-to-take-off-or-maybe-not
#19
Charlotte Huff
Direct primary care (DPC) occupies only a small niche in the health care payment system. But proponents say that federal legislation that would allow people to pay the monthly fee with health savings account dollars would help DCP take off.
September 2017: Managed Care
https://www.readbyqxmd.com/read/29068305/fee-for-service-is-dead-long-live-fee-for-service
#20
Jan Greene
The move to a value-based payment system was supposed to end perverse incentives that pay doctors more for delivering often unnecessary services. But things are changing slowly and the market is still 95% fee for service. There's talk of reworking the Medicare fee schedule so docs are paid more for the things that work, and less for those that don't.
September 2017: Managed Care
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