Managed Healthcare Executive - Managed care trends and analysis - benefit strategies for Medicare/Medicaid and commerical populations

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Healthcare industry continues quest for connectivity
The healthcare industry is calling for greater connectivity, or interoperability standards to increase adoption, safety and implementation.

International financial standards have implications for U.S. health insurer
Major changes are under way in global accounting standards, and all U.S. insurance companies will be affected.

Improve care with provider-patient electronic communications
Employers and health plans are pursuing technologies such as secure email, personal health records (PHR) and home monitoring in hopes of improving compliance with treatment plans and care management programs.

Leveraging specialist counsel adds insight into specialty drugs
Specialty pharmacy as a managed benefit has arrived at the same place pharmacy benefit management was several years ago (offering open formularies, flat co-pays, etc.). Yet little is being done to address specialty pharmacy as a managed benefit.

Patient care navigators push cancer care to the next level
An important concept surfacing of late is that of patient care navigators, whose goal it is to decrease the number of cancer deaths caused by healthcare treatment disparities.

Health plans must own member CDH experience
The evolution of consumer-driven healthcare (CDH) has increased the demand for value-added services from health plans. The ability to offer these new services is a prerequisite for those hoping to succeed in the CDH market.

Special Reports

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.