Special Report - Managed Healthcare Executive

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Special Report
  • New image: Payers hope prior authorization will reduce growing imaging costs


    The cost of imaging procedures tops $100 billion a year and is expected to double in the next four years. MCOs hope managed care strategies will contain the increases.

    Medicare audits: CMS imposes corrective action plans on sponsor faults


    Beginning on October 1, 2007, the Centers for Medicare and Medicaid Services (CMS) began posting Corrective Action Plans (CAP) on the public area of its Web site. The goal was to post all review findings for audited conducted on Medicare Advantage and Part D plans for a specific time period that resulted in a CAP.

    Genetic precision: New fields in genetic testing lend support to clinical effectiveness


    Genetic testing is used to predict or diagnose a disease for an individual. It also makes possible the use of pharmacogenetics—the study of genetic variation that translates to differing response to drugs—to align drug treatment for maximum effectiveness. The emerging field of pharmacogenetics has opened up a new world of personalized treatment and evidence-based medicine.

    Where Data Stops: Employers want more data for cost planning, but where is line drawn?


    The U.S. healthcare system continues to struggle with costs. As costs have climbed, data needs among employers are changing swiftly. Some employers are asking their health plan providers for deeper, more telling employee health information, only to find that they aren't able to obtain it because of HIPAA and similar laws.

    Early Retirees: Consumer-driven options the plans of choice for young retirees


    As employers continue to cut back on health insurance for retirees (and might even stop offering it to new employees), early retirees are stuck in an expensive conundrum. More and more this group of retirees is turning to consumer-driven solutions.

    Core Competencies: With many options, outsourcing enables plans to evolve


    Few words have become as vilified as "outsourcing." For some Americans, it might bring to mind low-paid and poorly trained workers working at an overseas call center. As competition and cost pressures worsen and the talk of recession continues, outsourcing is becoming an increasingly attractive option for healthcare payers. When done correctly, it can be both efficient and cost-effective. Despite popular belief, outsourced work doesn't have to go overseas; in some cases, the work can go across the city, or even across the street.

    Emergency situation: Working harder unlikely to solve crisis in emergency room overcrowding


    George Clooney's challenges make for good TV. While the former star of "ER" struggles with fictional patients, much of the drama in today's emergency department (ED) centers around the problems of overcrowding, increased utilization and increased wait times.

    The art of medicine: Applying evidence-based medicine drives improvements, creates partnerships


    The healthcare industry has yet to use evidence-based medicine (EBM) to its fullest potential, despite studies suggesting the need for it. Wide variation in medical practice and resulting clinical outcomes is indicative of the not-yet completed journey toward implementing evidence-based medicine.

    Candidates 2008: Presidential hopefuls' proposed healthcare plans



    Healthcare reform is on the lips of every 2008 Presidential hopeful. Take a look beyond the lip service and examine the platforms of Democratic and Republican front-runners.

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