Hospitals & Providers

Health plans should consider turning to their members to ask for quality feedback.

Four key developments to watch for

Q&A with Charles Kennedy, MD

Drug prices show staggering markup

Avoidable costs amount to more than $1 trillion

The medical community is using checklists to voluntarily cut costs

URAC recognizes best practices

Focus on exchanges gives plans an opening to repair their image among consumers.

Fear and dosing schedules are barriers

Tools help patients and physicians

Florida Blue creates single-specialty ACOs

Critical care patients have higher HAI rates

Approach could save hundreds of thousands of visits annually

Be mindful of data breaches with cloud-based systems

Physician behavior unaffected by malpractice risk.

Even under innovative payment models, RBRVS is here to stay

Consider shifting to condition episodes and linking member benefits

Managing diabetes and preventing microvascular and macrovascular complications requires a more holistic approach that goes beyond glucose, and includes careful management of other risk factors.

New utilization management opportunities will increasingly include cardiology and diagnosis of sleep disorders.

A small but costly percentage of patients have a variety of reasons for frequent ED visits.

Medical home providers gain tailored prescription data

Remote monitoring helps plans keep tabs on member progress

Stakeholders weigh the pros and cons of convenient care clinics found in drug stores and grocery outlets

A key initiative for Seaside Health Plan is California Children’s Services demo

Payers must look at waste and abuse