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SCOTUS Ruling on False Claims Act has big implicationsThe industry is awaiting the Supreme Court’s ruling on Universal Health Services v. Escobar. This case concerns the viability of the “implied certification” theory of legal falsity under the False Claims Act.
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The risks and rewards of medical loss ratio come to managed careExecutives of Medicare managed plans can benefit from knowing the challenges of the Medical Loss Ratio, a key cost control tool that went into effect last year.
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The risks and rewards of medical loss ratio come to managed careExecutives of Medicare managed plans can benefit from knowing the challenges of the Medical Loss Ratio, a key cost control tool that went into effect last year.
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Three Emerging Leader Qualities That Guarantee SuccessThere is no one way a leader may develop, but there are three qualities that effective leaders possess.
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The risks and rewards of medical loss ratio come to managed careExecutives of Medicare managed plans can benefit from knowing the challenges of the Medical Loss Ratio, a key cost control tool that went into effect last year.
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Opinion: Top 2 takeaways from UBS Global Healthcare ConferenceThe conference raised important points about unregulated growth opportunities and new pharmacy arena players.
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The countdown to King v. BurwellAny day now, the Supreme Court will decide the highly anticipated King v. Burwell, which will determine the viability of a central mechanism of the Affordable Care Act.
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Top ways to tap value from specialty drugs for chronic careThe next stage of chronic care management and value-based insurance design for the continuing onslaught of high-priced specialty drugs, including PCSK9 inhibitors.
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Hospital Health IT Budgets, Staff Changes: What Execs Should KnowA recent survey reveals how hospital technology budgets are changing. Find out if your organization is making similar changes.
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Stabilize dual eligible payAn ongoing challenge particular to plans serving duals is a gap between the plans’ reimbursement rates and the health status of the populations they serve.
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Four trends changing the health insurance marketSeveral changes, from new payment models to the "Cadillac Tax," are impacting the health insurance market.
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Four reasons MCOs should outsource administrative tasksBy working with service providers that are employing robotics and advanced analytics, organizations can leverage automation and innovation to address key challenges.
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How health policies are impacting diabetes diagnosesIn this blog, the vice president of medical affairs for Quest Diagnostics discusses how Medicaid expansion has impacted diabetes diagnoses.
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CMS okays new payments for chronic care managementThe Centers for Medicare and Medicaid Services recently instituted a billing code that finally reimburses providers separately for non-face-to-face services.
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Five ways hospitals can cut equipment maintenance costsStreamlining equipment maintenance and repair processes presents an enormous opportunity for healthcare facilities to reduce expenses associated with outside technicians.
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How precision medicine improves chronic disease managementIf we can accurately understand each patient’s risk for disease, we can create more nuanced preventive care plans and better invest our resources.
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Five ways hospitals are helping patients find health coverageTo survive, hospital executives must find new and creative ways to help uninsured and low-income patients secure health insurance.
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Four ways managed care executives can advance interoperabilityManaged healthcare executives can set the table for future economic expansion of interoperability capabilities by following a few simple, straightforward tips.
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How to Ramp Up Physician Engagement at Your Health SystemSuccessful health systems share their tips.
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Opinion: The Future of Pharmacy Care Services, Post-PandemicSenior Vice President and Chief Pharmacy Officer for Optum Rx and member of the Managed Healthcare Executive® Editorial Advisory Board, David Calabrese, provides his commentary on the future of pharmacy care services after the coronavirus pandemic.
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CMS okays new payments for chronic care managementThe Centers for Medicare and Medicaid Services recently instituted a billing code that finally reimburses providers separately for non-face-to-face services.
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Four ways to engage physicians in health IT initiativesCreating buy-in among hospital physicians when embarking on a new technology initiative can be difficult. Here are some tips.
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Five ways your physicians should use mobile devicesMobile devices are becoming a very real part of the healthcare journey. Are your physicians making the most of their capabilities?
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Overcoming a key barrier to highly satisfied patientsHere are four ways to help your organization overcome key hurdles to effective patient communication.
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How retail medicine lost its wayIf most patients are not going to exceed their deductible in a given year, they are now “consumers” and are looking for differentiators that offer fixed fee care.
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How retail medicine lost its wayIf most patients are not going to exceed their deductible in a given year, they are now “consumers” and are looking for differentiators that offer fixed fee care.
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Eight changes that foretell the modernization of healthcareWe are on the verge of healthcare modernization that will transform the healthcare experience.
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Liable for a data breach?Taking reasonable preventative care is a must as healthcare breaches grow in number.
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What healthcare executives should know about ICD-10Experts say the benefits of ICD-10 will far outweigh the risks. Here's why.
