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How to be member-centricAs the industry moves toward a retail environment, the importance of becoming member-centric can't be understated.
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Courts will have their say as legal concerns lingerLower courts will decide on the lingering concerns of uncertain PPACA provisions.
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EMR updateSmaller companies might offer innovation with a lower price tag, but they might not be able to achieve proper certification for incentives
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Be wary when providing privileged documentsCongressional authority is not the same as the authority given to a court of law
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Gender-specific clinical trials needed to address CVD in womenCardiovascular disease (CVD) is underrecognized and undertreated in women, despite its prevalence
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Be wary when providing privileged documentsCongressional authority is not the same as the authority given to a court of law
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How to target high-risk populations with behavioral healthHere are four of the top benefits of incorporating behavioral health management into care management plans for members with chronic conditions.
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Making sense of a complex marketUnfortunately, many providers can't squeeze much more money out of cost reductions.
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Medicaid populations can benefit from DM interventionsAs the spiraling cost of healthcare continues to strain federal and state budgets, state Medicaid agencies are looking for powerful, workable solutions to the crisis.
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Four New Ways to Approach Opioid Use DisordersA new study has eye-opening findings on the use of buprenorphine induction in an opioid-dependent population with commercial benefit coverage.
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Bundled payments expected to reward providersCMS will begin demonstration projects to further test the promise of P4P by bundling payments for certain services as single case-rates
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When paperwork doesn't workThere is a growing records management crisis in the world of healthcare. Hospitals are awash with paperwork, as legal, payer and regulatory requirements steadily generate an increasing number of documents per patient visit. Unfortunately, most healthcare information technology (HIT) systems are wholly inadequate to meet these growing documentation requirements.
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The immeasurable value of EMRs for improved patient careAmong large physician practices and acute care facilities, physicians and healthcare executives widely recognize the value of electronic medical records (EMRs). However, physicians at small or individual practices are just beginning to use the technology, noting high implementation costs as a deterrent.
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Hospital redesign can offer patients the best clinical careStep into any newly designed hospital today and you just might do a double take. Lobbies, corridors and patient rooms look more like those in hotels these days, catering to patients and families with restaurant-like pagers, plush family seating that converts into beds and a menu of dining options that allows patients to order what they want and when.
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Abelacimab Shows Promise in Reducing Bleeding Risks for High-Risk Patients | ACC 2025In an interview with Managed Healthcare Executive, Christian T. Ruff, M.D., M.P.H., director of general cardiology at Brigham and Women's Hospital and associate professor at Harvard Medical School, addressed the uncertainty of the bleeding risks of abelacimab compared to rivaroxaban and highlighted abelacimab’s safety profile.
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Data helps clinicians choose options in the patient's best interestHosptial program aligns high-cost clinical areas and financial strategies to realize benefits of the latest innovations
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Data helps clinicians choose options in the patient's best interestHosptial program aligns high-cost clinical areas and financial strategies to realize benefits of the latest innovations
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Data helps clinicians choose options in the patient's best interestHosptial program aligns high-cost clinical areas and financial strategies to realize benefits of the latest innovations
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Physician collaboration is key to successful disease managementThere are inherent challenges and opportunities for DM
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Prenatal ultrasound gathering momentum in disease managementFor more than three decades, clinicians have routinely conducted prenatal ultrasound screenings to detect congenital anomalies, multiple-gestation pregnancies, fetal growth disorders, placental abnormalities and errors in the estimation of gestational age. When managed care was born, executives realized the importance of providing benefit coverage for this test because they recognized prenatal ultrasound is one of the earliest tools in the disease management arsenal to promote fetal, neonatal, and maternal health. In an era where medical costs are surging, and in response, healthcare premiums of employers and their workers have climbed twice as fast as wages and inflation in 2006, the evidence-based benefits of prenatal ultrasound is gaining momentum and medical community recognition as a disease management tool.
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Administrative tasks simplified: Electronic transmission saves time, moneyThere is no doubt about it-transmitting claims and other healthcare information electronically saves time and money.
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False Claims Act looms for healthcare regulationThe False Claims Act (FCA), 31 U.S.C. 3729, et seq., is about to become the worst-kept secret of the healthcare industry. One of the nation's oldest statutes, the FCA has allowed the government to recover more than $3.1 billion in the first nine months of 2006, including an eye-popping $900 million dollar settlement with Tenet Healthcare-the largest FCA recovery ever. And, as if these staggering numbers were not enough to garner attention, as of January 1, 2006, entities that receive $5 million or more per year in Medicaid payments will be required to inform their employees about the FCA. Because employees are the most likely whistleblowers in an FCA lawsuit, the FCA's prominence in the healthcare industry should increase over the next few years.
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False Claims Act looms for healthcare regulationThe False Claims Act (FCA), 31 U.S.C. 3729, et seq., is about to become the worst-kept secret of the healthcare industry. One of the nation's oldest statutes, the FCA has allowed the government to recover more than $3.1 billion in the first nine months of 2006, including an eye-popping $900 million dollar settlement with Tenet Healthcare-the largest FCA recovery ever. And, as if these staggering numbers were not enough to garner attention, as of January 1, 2006, entities that receive $5 million or more per year in Medicaid payments will be required to inform their employees about the FCA. Because employees are the most likely whistleblowers in an FCA lawsuit, the FCA's prominence in the healthcare industry should increase over the next few years.
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EHRs not sufficient for data liquidityAn EHR is one technology within the health IT portfolio, which also includes e-prescribing, clinical decision support, messaging and alerting, telehealth, consumer health information portals and other technologies
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Small data creates backbone for medical homesMedical home providers gain tailored prescription data
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On Finance: Will managed care physicians see an advantage with the new Medicare Advantage?With the additional funding, there's a brighter future for MCOs
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Health plans can stay ahead of market curve with CRMDeveloping preferred relationships with members leads to increased market share for payers
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Insomnia symptoms can indicate underlying medical conditionsSymptoms of insomnia can be treated with several different drugs, but be aware of side effects.
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MCOs saddled with legal struggles when forming physician networksConflicting interests cause disputes over fairness, contracts and liability with MCOs stuck in the middle
