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Managed Care

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https://www.readbyqxmd.com/read/28121599/health-information-technology-dos-and-don-ts-for-today-and-tomorrow
#1
Jaan Sidorov, Akash Randhar
The challenges include not overburdening physicians and fitting into an increasingly complex, multilayered informatics ecosystem. Innovative health care entities that neglect health care's reliance on evidence-based medicine and go to market without the benefit of any peer review do so at their own peril.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121598/is-step-therapy-a-move-in-the-wrong-direction
#2
Joseph Burns
If insurers insist that doctors use older, lower-cost drugs first, the burden is on the health plan to respond to doctors' request for different medications quickly, nimbly, and appropriately. But quick and nimble do not often describe insurers' step-therapy efforts.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121597/zinplava-tackles-toxins-of-hard-to-treat-c-difficile
#3
Thomas Morrow
Merck has recently received FDA approval for bezlotoxumab (Zinplava), as a treatment to reduce recurrence of C. diffcile in patients 18 years of age or older who are receiving antibiotic treatment for the infection and for whom there is a high risk of recurrence.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121596/real-world-evidence-and-the-unsticking-of-health-care-data
#4
Ramita Tandon
Ideally, real-world evidence would be continually looped back into the drug development process. There is a deep reservoir of information about side effects, adherence, and differences in efficacy among subpopulations embedded in the various sources of real-world evidence. Extracting it will take hard work.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121595/integrated-plans-fertile-for-real-world-evidence
#5
Frank Diamond
But most insurers are taking a wait-and-see attitude even though in some clinical areas, such as diabetes, real-world evidence (RWE) has been a true game-changer. Payers have a pessimistic view that RWE can help them. It doesn't help that respected voices in health care agree.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121594/observational-studies-fill-a-void-left-by-rcts
#6
Thomas Reinke
There is momentum building to use observational studies to investigate the safety and efficacy of medications in new ways. Drug companies are using them to establish the value of medicines in negotiating prices, rebates, and formulary placement with payers.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121593/variant-post-acute-care-needs-measuring-to-be-managed
#7
Carter Paine
Areas of the country with high concentrations of long-term acute care hospitals or inpatient rehabilitation facilities often have much higher utilization rates, even if a skilled nursing facility or home health provider could provide care comparable in quality and at a much lower price.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121592/accurate-encounter-data-a-must-for-medicaid-mco-quality-measurement
#8
Jason Duhon
CMS depends on encounter data submitted by state Medicaid programs to maintain the massive Medicaid Statistical Information System (MSIS), a database of claims, encounter data, and beneficiary eligibility information. Poor encounter data can hinder quality measurement in multiple ways.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121591/use-measures-metrics-to-tell-your-story-before-someone-else-tells-it-for-you
#9
Zachary Hafner
For both providers and payers, the time, effort, and resources dedicated to collecting and reporting data is exorbitant. While most reporting requirements are well intentioned, the proliferation is not adding value and-in some circumstances-does more harm than good.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121590/hedis-is-the-hassle-that-became-a-habit
#10
Joseph Burns
After 25 years, the Healthcare Effectiveness Data and Information Set (HEDIS) is still criticized for focusing on process and taking up doctors' time. But it has been incorporated into physicians' workflow and may yet be instrumental in bringing about value-based care.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121589/the-missing-ingredient-in-quality-measurement
#11
Thomas Reinke
The measures most often used today to assess care quality are process measures. Actual outcomes, of course, are harder to measure than whether a certain action has been taken-checking the feet of a patient with diabetes, for example. But many experts don't think process measures get at the heart of quality.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121588/cms-rating-of-hospitals-gets-1-5-stars
#12
REVIEW
Richard Mark Kirkner
The problem, say hospitals and some analysts, is that rating hospital quality is not so straightforward. How a hospital delivers care is multifactorial and complex, they argue, so trying to cram that into a single score is misleading and can end up like rating a restaurant on its parking.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121587/an-old-fashioned-notion-stand-behind-your-wares
#13
Michael D Dalzell
Experience from the field suggests that measuring the outcomes that underpin risk-based contracts is not always as simple as it sounds. There are many practical challenges to value-based contracts: administrative overhead, the intricacies of data collection and validation, and understanding how or why the data are relevant to the agreement.
January 2017: Managed Care
https://www.readbyqxmd.com/read/28121564/the-view-from-the-intermountain-top
#14
(no author information available yet)
The new president and CEO of Intermountain looks ahead to the Utah system becoming a referral center and says last year's net operating margin can be chalked up to an implementation of an electronic medical record system.
December 2016: Managed Care
https://www.readbyqxmd.com/read/28121563/healing-becomes-a-fishy-business
#15
Thomas Morrow
Fish skin skews the contest between healing and the biodegradation of healing molecules toward the healing side. Fish skin is very high in omega-3 fatty acids, compounds that promote healing. And cod evokes virtually no inflammatory or immune response in humans.
December 2016: Managed Care
https://www.readbyqxmd.com/read/28121562/joint-venture-health-plans-may-give-acos-a-run-for-their-money
#16
Thomas Reinke
Joint venture plans are starting to demonstrate their ability to implement clinical management and financial management reforms. A JV health plan replaces the offloading of financial risk by health plans to ill-equipped providers with an executive-level cost management committee stated jointly by the hospital and payer.
December 2016: Managed Care
https://www.readbyqxmd.com/read/28121561/better-outcomes-for-less-cost-will-follow-engaged-patients
#17
Chuck Hayes
Nearly half (45%) of American adults have a chronic health condition and a quarter have more than one chronic illness. Patients readily admit they do a better job of taking care of themselves when they receive reminders and motivational messages from their health care providers.
December 2016: Managed Care
https://www.readbyqxmd.com/read/28121560/beating-the-zero-sum-game-together
#18
Zachary Hafner
If you're still bickering over rate hikes and contract minutiae, then you're out of step with the new health care economy. In progressive markets, savvy payers and providers that work together rather than constantly bumping heads are pulling ahead at the expense of slow movers and status quo players.
December 2016: Managed Care
https://www.readbyqxmd.com/read/28121559/health-care-an-easy-target-needs-to-get-its-guard-up
#19
Susan Ladika
Health care ranked ninth in terms of its cybersecurity in a recent report by SecurityScorecard, a company that provides risk monitoring and security ratings. The health care industry is widely infected with malware and has come under repeated ransomware attacks.
December 2016: Managed Care
https://www.readbyqxmd.com/read/28121558/smart-technology-prepares-to-ace-the-popularity-test
#20
Jan Greene
Getting older people to bring a new technology into their homes has been more difficult than expected. Nevertheless, the tech industry continues to work on new options, and there are some intriguing possibilities on the horizon for 2017 and beyond.
December 2016: Managed Care
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