Disease registries are gaining in popularity as electronic tools designed to give physicians clinical support to deliver appropriate care.

The continual inability to fall asleep or stay asleep is keeping approximately one-third of the nation up at night. Individuals with insomnia incur $12 billion in direct medical costs and $2 billion in drug costs alone.

Methicillin-resistant Staphylococcus aureus (MRSA), a type of bacterium that is resistant to certain antibiotics, has become a national epidemic, with increasing numbers of serious infections, hospitalizations and deaths. Hospital stays for these infections tripled from 2000 to 2005.

The convergence of rising healthcare costs, increased cost sharing and demand by consumers for more participation in healthcare decisions is producing a variety of innovative health insurance solutions.

The practice of shared decision making (SDM)—the collaboration between patients and caregivers to arrive at an informed, value-based healthcare decision when treatment options have features that patients value differently—is gaining recognition among health plans as a key function of a patient-centric model of care.

Although prevention has become a key element in traditional disease management programs—trying to prevent or mitigate a chronic disease before it exacerbates—that may not be sufficient when a patient has a late-stage or end-of-life condition. There is a new emphasis on caring for older adults with multiple comorbidities. Almost 80% of people 65 and older report having a chronic illness, according to the Robert Wood Johnson Foundation.

Disease management programs don't come cheap, but thanks to industry collaboration, purchasers are increasingly learning how to assess the business case for these programs.

As durable medical equipment (dme) becomes increasingly sophisticated, MCOs' challenges remain rooted in establishing medical necessity. To that end, most use strategies including prior authorization and coverage limits. Meanwhile, they must also satisfy changing state and national regulatory requirements.

IN THE WORLD OF professional sports, the competition isn't only on the gridiron, the court or the diamond. Just ask an MCO.