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Managed Care

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https://www.readbyqxmd.com/read/28895825/management-of-a-rare-disease-population-a-model-for-identifying-a-patient-population-with-tuberous-sclerosis-complex
#1
Michael P Johnson, Jonathan C Johnson, Nicole M Engel-Nitz, Qayyim Said, Judith Prestifilippo, Tanjala T Gipson, James Wheless
Tuberous sclerosis complex (TSC) is a rare genetic disorder affecting the brain and other vital organs with varying symptoms and severity among patients. This study developed and validated a risk model to identify patients with TSC using large databases of medical and pharmacy claims.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895824/value-based-care-will-flop-without-clinical-integration
#2
Chad Johnson
Value-based payment is gaining traction and proving to be a major factor in health care reform. But the success of those value-based models will depend on true clinical integration of providers-not just lip service to coordination.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895823/medical-travel-helps-unions-employers-improve-cost-and-quality-of-care
#3
Mark Stadler
Not all medical travel programs are created equal, so employers should shop with a discerning eye. Most programs use a "proprietary" method to evaluate and select high-quality providers for their networks. It is important to ask questions.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895822/navigating-the-changing-tides-of-health-care-5-areas-for-leaders-to-watch
#4
Zachary Hafner
Questions abound. Which trends will take hold-and which will fizzle? What will market conditions be like six, 12, or 18 months from now? Are there moves to make without compromising what you've worked so hard to achieve? Here's what to look for.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895821/acos-sit-like-gibraltar-in-rough-seas-of-change
#5
Robert Calandra
The ACO, a creature of the ACA that often gets confused with its progenitor, seems like it will survive-and maybe even thrive-in whatever healthscape emerges from the Republican anti-ACA push. But just what will happen to the various forms of the ACO that are now in place?
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895820/bob-kocher-believes-with-missionary-zeal-that-venture-capital-can-start-to-cure-what-ails-american-health-care
#6
Timothy Kelley
This upbeat doctor-policymaker-entrepreneur sees opportunity where others see a federal policy train wreck these days. For instance, he's pleased that both political parties seem to endorse a shift from fee-for-service to value-based care. However, continuing uncertainty about the individual market may chill new investment in that area for a while.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895819/paula-steiner-brings-her-blues-back-into-the-black
#7
Joseph Burns
The president and CEO of Chicago-based Health Care Service Corp. made tough decisions to raise premiums and narrow networks. But, at least for now, HCSC plans to stay in the ACA exchanges while other insurers are jumping ship.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895818/james-capretta-a-conservative-health-care-policy-expert-is-suddenly-a-hot-ticket
#8
Howard Wolinsky
The conservative voice of reason on American health care policy and a fellow at the American Enterprise Institute says that "It would be far preferable for the country to reach some stability around health policy that both parties bought into."
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895817/elizabeth-rosenthal-a-storyteller-who-hopes-her-telling-will-make-a-difference
#9
Timothy Kelley
As editor-in-chief of the increasingly influential Kaiser Health News, she hopes to push back against a health care system in which every sector seems rigged against the patient. She leads a staff of 25 editors and reporters that includes two deep-digging data whizzes.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895816/bernard-tyson-preaches-gospel-of-tech-and-change
#10
Timothy Kelley
Kaiser Permanente's CEO says that if he were redesigning Kaiser from the ground up, he would begin with a technology platform, not with hospitals, and that "telehealth is going to be our future." He sees a future in which consumers know their bodies at least as well as they know their cars.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895815/seema-verma-does-her-homework-pushes-for-beneficiaries-to-have-more-skin-in-the-game
#11
Timothy Kelley
The new head of CMS recently wrote the nation's governors urging that Medicaid recipients be required to pay premiums, be charged for ER visits, and be encouraged to get jobs or job training. This "skin in the game" approach appeals to conservatives, though critics say it can depress participation among the poor.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895814/scott-gottlieb-believes-a-nimbler-speedier-fda-can-spur-competition-lower-prices
#12
Joseph Burns
The new head of the FDA might as well be starring alongside Tom Cruise in the latest installment of Mission Impossible. Since being named commissioner in May, Gottlieb has said he wants the FDA to speed the approval process for generic drugs, introduce competition to drive down prices, and get the opioid crisis under control.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895813/mark-bertolini-wants-to-take-the-nasty-out-of-insurance
#13
Richard Mark Kirkner
The CEO and chairman of Aetna has a penchant for pulling headline-grabbing moves lately, including a high-profile departure from the industry's leading trade association, America's Health Insurance Plans, and an attempt to acquire another big-five insurer, Humana, then pulling out when the Justice Department opposed it.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895812/tom-price-the-aca-s-ardent-foe-pushes-for-repeal-and-replace-with-a-smile
#14
Howard Wolinsky
Price, 62, with pure white hair, rimless glasses, and an easy, slightly cherubic smile, comes across like a friendly, family doctor, not the ambitious, politically-minded orthopedic surgeon that he is. He calls the ACA "useless" because of the high deductibles.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895811/outcomes-based-pricing-program-puts-money-in-beneficiaries-pockets
#15
Ed Silverman
Harvard Pilgrim's program gives rebates to beneficiaries if Repatha doesn't help them avoid a heart attack or stroke. It's just the latest in a growing number of outcomes-based pricing agreements in which an insurer can get a discount from a drugmaker if a drug doesn't help patients as much as expected.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895810/10-notables-from-behind-the-scenes-of-the-health-care-reform-debate
#16
Richard Mark Kirkner
This is not meant to be "the 10 most important" people in health care policy. It's a sample from a larger group, and a different group of 10 might have been selected and would have been just as worthy-kind of like admission to a selective college.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28895839/ocrevus-s-role-in-ms-battle-may-signal-promising-trend
#17
Thomas Morrow
With a list price that is 25% less than a competing drug, better outcomes, and less frequent dosing, maybe Ocrevus will start a new trend: better outcomes, easier administration-and a lower price. That trifecta is great news for people managing the cost and quality of MS care.
July 2017: Managed Care
https://www.readbyqxmd.com/read/28895838/why-a-strong-consumer-centered-strategy-will-never-go-out-of-style
#18
Zachary Hafner
The awakening of the health care consumer is powerfully good news for the mission of providers and payers. In other industries, the same forces have led to innovation, cost reduction, and heightened value. We should expect health care to be no different.
July 2017: Managed Care
https://www.readbyqxmd.com/read/28895837/minnesota-a-health-care-island-scrambles-to-stay-afloat
#19
Peter Wehrwein
The Democratic governor and the Republican legislature have moved to shore up the individual market, but Minnesotans are leaving it in droves. About 167,000 residents bought individual coverage this year, compared with 270,000 in 2016. Premium hikes have been caused, in part, by the consolidation of providers.
July 2017: Managed Care
https://www.readbyqxmd.com/read/28895836/demographics-geography-make-for-an-uphill-battle
#20
Joseph Burns
Maine presents some daunting challenges when it comes to insurance coverage and health care costs because it's both the most rural state in the country and the one with the highest median age, two factors that drive up health spending.
July 2017: Managed Care
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