Business Strategy

In the wake of the upcoming presidential election, experts say both candidates cater to the public by assuring that everything will change, but neither candidate has offered up meaningful dialogue about the most needed change of all - reducing costs.

Independent, nonprofit Blue plans are becoming extinct

Health plan executives are encouraged by the decline, noting that public and private stakeholders have had a hand in devising ways to improve the widespread problem of Americans lacking coverage

The ads were aired in a multimillion-dollar national advertising campaign run through the Democratic and Republican national conventions

Grassroots campaigns seek to solve several healthcare issues ahead of the candidates' political promises for 2009

Consumers are demanding fundamental changes in the U.S. healthcare system to gain more timely access and better coordination of healthcare, according to a survey.

Healthcare leaders must begin forecasting where Americans will draw the line on their generosity when it comes to the healthy subsidizing the sick, the insured subsidizing the uninsured, and the wealthier subsidizing the less wealthy.

Strategic Flexibility concept includes a portfolio of options to handle likely scenarios for the unpredictable times

Professionals with problematic and tarnished credentials pose serious risk to healthcare consumers and create financial exposure – in the form of CMS fines -- for the institutions that unknowingly employ them. This black cloud now extends to health plans.

Health and productivity management (HPM), disease management (DM), and wellness programs continue to gain traction in the corporate marketplace. As employers and vendors address gaps, these programs will become fundamental in employer efforts to contain health benefit costs, better manage benefit use, and achieve transparency across employee data.

An increasing number of studies are linking oral health to general health. While not establishing a direct cause-and-effect, the reports show that early prevention and treatment of gum disease could improve outcomes for pregnancy, heart disease and diabetes.

If you had $40 million to spend each year on a philanthropic mission in healthcare, what would your mission be? Helping the uninsured? Bankrolling demonstration projects? To deliver the greatest impact within the $2 trillion U.S. healthcare system, you would have to be choosy about your commitments.

Across the country, state and local lawmakers are discussing various mechanisms to provide healthcare coverage to uninsured residents, and some states have recently enacted such legislation. Some of these laws include the requirement to make employers fund at least part of the states' health insurance programs.

In response to continued complaints from Medicare beneficiaries about unscrupulous sales reps and misleading plan information, members of Congress and state insurance regulators are urging better oversight of Medicare Advantage and Part D plans. The Centers for Medicare and Medicaid Services (CMS) says it is beefing up policies and enforcing rules with more vigor.

Washington, D.C.-The campaign to combat rising healthcare costs is now targeting industry methods for calculating "reasonable and customary" rates for coverage of out-of-network medical expenses. New York Attorney General Andrew Cuomo filed lawsuits last month against UnitedHealth Group and several subsidiaries for allegedly using "rigged data" and fraudulent methods to manipulate reimbursement rates.

Washington, D.C.-National healthcare spending rose 6.7% in 2006 to $2.1 trillion, just slightly faster than the previous year but still fairly stable. Overall, outlays for healthcare reflected a continued slowdown from the double-digit growth rates of the 1990s. Payments for most major health services-hospitals, physicians, nursing homes, home health services-experienced slower growth than 2005.

The state of the overall economy along with industry-specific challenges, such as uncertain reimbursement fees, presents a challenge to even the most experienced healthcare executive who must set a firm budget and stabilize costs.

Since the passage of the Sarbanes-Oxley Act in 2002, corporate executives have spent substantial time and money addressing potential security risks and regulatory compliance requirements.

Sometimes in our technology-driven environment, we get into a fixed routine of the current standard of care for our patients. What would we see or hear if we saw our practice or facility through the eyes and ears of our patients?

More than 650 hospitals have pledged to adopt the Leapfrog Group's policy on "never events"-rare medical errors that should never happen to a patient.

When Newt Gingrich recently suggested that in the future, consumer healthcare is going to look more like Travelocity and that consumers are going to go where the best care is and shop for the best price for drugs and services, Jonathan Edelheit, president of the Medical Tourism Assn., couldn't have agreed more.

Medicare Advantage plans escaped threatened payment cuts last year, but the issue is at the top of the health policy legislative agenda for the coming months. Legislation enacted in late December postponed a scheduled reduction in Medicare payments to physicians-but only for six months. Congress paid for that short delay plus an extension of the State Children's Health Insurance Program (SCHIP) without cutting MA rates or raising taxes.

Washington, D.C.-Pressure to uncover potential adverse events before a new drug reaches patients seems to be taking a toll on drug development and marketing. The Food and Drug Administration (FDA) approved only 19 innovative new drugs in 2007, according to preliminary analyses. That's way down from the peak of 53 new drugs in 1996, but in line with a steady decline in new drug approvals since 2002.

Insurers and health plans have seen business grow in recent years, benefiting from changes in Medicare and efforts to expand health coverage. With health policy in the center of the 2008 U.S. political debate, healthcare costs, benefits and access will be in the spotlight, along with a host of issues for managed care executives to deal with.

Healthcare will never be an industry where one size fits all, but through reducing adminstrative complexity, resources can be redirected and put to better use.

Medicare advantage enrollment reflects the relative maturity of managed care markets generally, and the attractiveness of those markets from economic and demographic standpoints for these plans to operate in, experts say.

As the debate over healthcare reform accelerates, policy makers are weighing in with proposals to unlink coverage from the work place.

A national examination of disease prevalence among Medicaid beneficiaries underscores ways that managed care plans can rethink care management approaches for high-need, high-cost beneficiaries with multiple chronic conditions.

For payers struggling with unmanageable cost increases in the business of delivering care, however, price cannot be overlooked. Insurers don't necessarily deny coverage of a treatment just because it's expensive, but they would be remiss if they didn't take cost into consideration, as well as safety and effectiveness.

Perhaps it's no coincidence that former historian Jon Kingsdale, PhD, finds himself overseeing one of the most progressive healthcare initiatives in the country, the Massachusetts Commonwealth Health Insurance Connector Authority. The Connector facilitates the purchase of health insurance for individuals and small businesses across New England.