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Managed Care

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https://www.readbyqxmd.com/read/30216160/pharma-apms-can-the-industry-learn-to-play-well-with-others
#1
Maggie Alston, Bruce Pyenson
The alternative payment model (APM) is a nontraditional financial arrangement that rewards health care providers who deliver cost-effective, high-quality care. Now we are facing the possibility that pharmaceutical manufacturers and insurers will embrace APMs as a payment mechanism in some situations.
September 2018: Managed Care
https://www.readbyqxmd.com/read/30216159/how-a-waste-free-formulary-misses-what-s-most-important-to-employers
#2
Jennifer Bright, Mark Linthicum
The "waste-free formulary" under development by the Pacific Business Group on Health sounds promising, but ultimately may not deliver the impact to self-insured employers its creators are promising. The approach glosses over a critical question: What constitutes "high-value"? The definition of value plays a central role in determining the care that patients ultimately receive.
September 2018: Managed Care
https://www.readbyqxmd.com/read/30216158/care-variation-reduction-going-nowhere-used-strategically-a-heip-might-help
#3
Laurie Golemi Norman
HEIP stands for hospital efficiency improvement program. It is a legal contract outlining specific initiatives where physician-driven variance can be improved across specialties and departments. For organizations with a good strategy to reduce care variation, a HEIP can provide the jolt of incentive that generates real improvement.
September 2018: Managed Care
https://www.readbyqxmd.com/read/30216157/the-opaque-fight-against-price-transparency
#4
Fran├žois de Brantes
For those who doubt the importance of transparency in price and quality to free the market, you just have to look behind the public curtain and observe the fierceness with which the opponents of transparency are trying to keep consumers in the dark.
September 2018: Managed Care
https://www.readbyqxmd.com/read/30216156/nurse-practitioners-to-docs-lawmakers-give-us-our-independence
#5
Jan Greene
And that means full scope of practice as primary care providers. Medical societies hate the idea and think that nurse practitioners need to be tethered securely to a physician office in order to ensure top-notch care. Nurse practitioners counter that they can help shore up primary care.
September 2018: Managed Care
https://www.readbyqxmd.com/read/30216155/have-a-date-with-surgery-proms-help-patients-decide
#6
Lola Butcher
Patient-reported outcomes measures (PROMs) use a patient's response to questions to measure health status. If they're going to catch on payers will need to incentivize use. So far, that's not happening. But clinicians who use PROMs for clinical decision making might be providing a valuable service.
September 2018: Managed Care
https://www.readbyqxmd.com/read/30216154/hey-big-spender-why-does-your-quality-lag-so-far-behind-other-countries
#7
Joseph Burns
The United States is the world's biggest spender on health care by far. And what do we get for it? Not as much as we should. Our quality shortcomings are not for lack of knowledge: Stakeholders know what to do to close these gaps. So why aren't they doing it?
September 2018: Managed Care
https://www.readbyqxmd.com/read/30216153/health-care-quality-it-s-motherhood-and-apple-pie-until-you-start-to-measure-it
#8
Lola Butcher
The pay-for-value movement could justify rewarding-and punishing-doctors based on quality scores. PROBLEM: Hardly anyone likes the current ways quality is measured, especially physicians. Few believe that Medicare's Merit-based Incentive Payment System (MIPS) will clear things up. In fact, it might cause more confusion.
September 2018: Managed Care
https://www.readbyqxmd.com/read/30216152/backlash-against-copay-accumulators
#9
Ed Silverman
With accumulators, the value of any copay assistance cards or coupons does not count toward out-of-pocket medicine costs that are applied toward deductibles. It's a cost-shifting tool that's facing pushback from patients, providers, and others saying that accumulators will hurt public health.
September 2018: Managed Care
https://www.readbyqxmd.com/read/30216151/dupixent-a-new-entrant-in-the-asthma-lists
#10
Thomas Reinke
Sanofi and Regeneron's Dupixent (dupilumab)-which is already approved for atopic dermatitis-has an FDA action date of October 20 for its asthma indication. It will join Nucala, (mepolizumab), Cinqair (reslizumab), and Fasenra (benralizumab) as a monoclonal antibody approved as a treatment for the type 2 inflammation phenotype in severe asthma.
September 2018: Managed Care
https://www.readbyqxmd.com/read/30216150/with-cms-demanding-more-accountability-in-the-mssp-will-it-be-acos-overboard
#11
Michael D Dalzell
For 169 ACOs, time is up to take on downside risk. This group-30% of all of those in the Medicare Shared Savings Program (MSSP)-are Track 1, upside risk-only ACOs and are nearing the end of their contracts with CMS.
September 2018: Managed Care
https://www.readbyqxmd.com/read/30216149/guideline-clearinghouse-is-dead-long-live-the-guideline-clearinghouse
#12
Richard Mark Kirkner
The National Guidelines Clearinghouse might be making a comeback. It's been contracted out to the ECRI Institute, a not-for-profit organization that conducts medical safety research. ECRI plans to have a version of the clearinghouse website up and running anytime soon, with plans for a full relaunch in 2019.
September 2018: Managed Care
https://www.readbyqxmd.com/read/30142074/apply-integrated-care-to-our-opioid-crisis
#13
Eric Lederhaus, Rebecca Sanders Fung
Integrated care models can foster the kind of collaboration that's needed to treat complex, multifaceted problems like chronic pain. They are among our best hopes for an alternative to the overuse of prescription painkillers that has caused so much suffering and early death.
August 2018: Managed Care
https://www.readbyqxmd.com/read/30142073/how-smart-use-of-data-can-help-to-manage-complex-medicaid-patients
#14
Candace Saldarini, Monica E Oss
Care managers can quickly assess clinical complexity and monitor members climbing the cost and risk curve if they are armed with up-to-date information about a member's medical and behavioral diagnoses, prescription medications, physician office visits, emergency room visits, and hospitalizations.
August 2018: Managed Care
https://www.readbyqxmd.com/read/30142072/in-cardiac-imaging-things-are-looking-up-for-cta
#15
Thomas Reinke
But the adoption of new technology is rarely smooth; learning curves create jagged edges. The gee-whiz factor of technology can easily get ahead of true utility and effectiveness. And, of course, there's the expense. Hospitals and other providers need to be ready to plow millions in new machines.
August 2018: Managed Care
https://www.readbyqxmd.com/read/30142071/employer-groups-pushing-for-improving-maternal-health
#16
Joseph Burns
Given the startling statistic that the rate of women dying of pregnancy-and childbirth-related complications in the United States is increasing, it seems logical that the U.S. health system would focus on improving outcomes in this area of care. But not all health plans address this disparity in health care delivery.
August 2018: Managed Care
https://www.readbyqxmd.com/read/30142070/sessions-leaves-the-aca-undefended
#17
Richard Mark Kirkner
In a last-minute filing, the attorney general elected not to defend the health care law. The legal arguments in Texas v. Azar hinge on severability and legislative intent. While Texas seeks an injunction to block enforcement of the ACA beyond January 1 next year, the Justice Department is seeking a declaratory judgment.
August 2018: Managed Care
https://www.readbyqxmd.com/read/30142069/rates-for-hedis-screening-for-diabetic-nephropathy-quality-measure-may-be-overstated
#18
Trudy Millard Krause, Cecilia Ganduglia-Cazaban, Kevin W Finkel
The Healthcare Effectiveness Data and Information Set (HEDIS) is used by health plans to measure and report on quality and performance. This study evaluated the appropriateness of the prescription drug compliance step for the Medical Attention for Nephropathy quality measure for patients with diabetes. Data from national commercial claims for 28,348,363 persons were reviewed. The study applied the standard HEDIS specifications for compliance in medical attention for nephropathy for diabetic patients. Evaluation of the third and final process (evidence of angiotensin-converting enzyme [ACE] inhibitors or angiotensin II receptor blockers [ARBs]) found that the addition of this step contributed 14% to 16% of the numerator, bringing the final rate to the >80% range...
August 2018: Managed Care
https://www.readbyqxmd.com/read/30142068/a-telehealth-hookup-hospitals-and-retailers
#19
Susan Ladika
At telehealth walk-in centers, patients get care at the touch of a screen. They were able to choose from a long list of board-certified physicians for their virtual visit. Medical devices such as thermometers and blood pressure cuffs are also on hand.
August 2018: Managed Care
https://www.readbyqxmd.com/read/30142067/the-dialysis-less-traveled-by
#20
Charlotte Huff
Many diabetes patients can use peritoneal dialysis, which allows them to self-administer dialysis at home. But researchers and kidney specialists say there are many obstacles in the way: a lack of doctors and nurses with training in how to instruct patients, the sunk costs of existing dialysis clinics, and the reluctance of patients and their families.
August 2018: Managed Care
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