News

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.

The link between gum disease and systemic disease is becoming more top-of-mind with health plan and dental providers alike.

The use of rosiglitazone to treat type 2 diabetes in older patients has been associated with an increased risk of cardiovascular events.

In 2 studies, lenalidomide plus dexamethasone has been demonstrated to be an effective therapy for relapsed and/or refractory multiple myeloma.

Report by FDA's Science Board cites a need for updates to the agency's information infrastructure and research programs to avoid significant problems.

First-time generic approval: Granisetron injection

A summary of drugs and indications recently approved by FDA: Cialis, Evicel, Voluven, Thyrogen, Diovan, Cymbalta, Triesence, Vyvanse, Glumetza, Sular

Ceftobiprole is the first anti-MRSA cephalosporin antibiotic to be sumbitted to FDA for approval. If approved, the drug will likely be considered a second-line antibiotic for the treatment of cSSSIs.

This article provides information about pharmacologic and nonpharmacologic treatments that are used to help people stop smoking, including the use of varenicline.

FDA-related information through February 2008 on Fluvoxamine extended-release capsules, dalbavancin, bazedoxifene, HPV vaccine (Cervarix), valrubicin, motexafin gadolinium, COL-003, CDX-110, sugammadex, mecaserim rinfabate, A-001, beclomethasone, clobazam, fludarabine tablets, JZP-8, and AST-120

FDA-related information through February 2008 on Fluvoxamine extended-release capsules, dalbavancin, bazedoxifene, HPV vaccine (Cervarix), valrubicin, motexafin gadolinium, COL-003, CDX-110, sugammadex, mecaserim rinfabate, A-001, beclomethasone, clobazam, fludarabine tablets, JZP-8, and AST-120

Studies show that patients with behavioral health conditions are less apt to be compliant with medications than other patients, but many of their reasons for non-compliance are equally applicable to all drugs.

Studies show that patients with behavioral health conditions are less apt to be compliant with medications than other patients, but many of their reasons for non-compliance are equally applicable to all drugs.

Although prevention has become a key element in traditional disease management programs-trying to prevent or mitigate a chronic disease before it exacerbates-that may not be sufficient when a patient has a late-stage or end-of-life condition. There is a new emphasis on caring for older adults with multiple comorbidities. Almost 80% of people 65 and older report having a chronic illness, according to the Robert Wood Johnson Foundation.

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.

HIPAA prohibits group plans from charging higher premiums to individuals due to health status, medical history, genetic information, claims experience, receipt of care or evidence of disability. The Department of Labor's Employee Benefits Security Administration recently issued guidelines that closed off a loophole that might have allowed employers to charge less healthy workers higher deductibles.

One of the most important therapeutic classes according is going to be cancer and transplant. "In fact, its contribution to spending increases over the next three years is definitely underestimated here since our projections are based on pharmacy claims data and a large portion of the spending for cancer treatments is paid through the medical benefit," says Lon Castle, MD, senior director, department of medical and analytical affairs at Medco.

Realizing economic benefits of eHealth information sharing, forward thinking payers began working years ago to sponsor multi-payer web communications platforms that allow providers to communicate with many sponsors from one access point.

The need for healthcare workers is quickly outpacing an ever-shrinking candidate pool. As one response to the labor crisis, healthcare organizations need an effective way to communicate the full value of the benefits they provide to employees.

A never event (also known as a serious reportable adverse event) is an error in medical care that is clearly identifiable, preventable and serious in its consequences for patients, according to the National Quality Forum (NQF).

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.

One of the most important therapeutic classes according is going to be cancer and transplant. "In fact, its contribution to spending increases over the next three years is definitely underestimated here since our projections are based on pharmacy claims data and a large portion of the spending for cancer treatments is paid through the medical benefit," says Lon Castle, MD, senior director, department of medical and analytical affairs at Medco.

When wildfires tore through San Diego last year, approximately 1 million people were displaced. At San Diego-based American Specialty Health, the management team knew that, beyond personal challenges, there was the potential impact of a long-term shut down on more than 12 million insured.

For managed care executives, the first step in lowering costs for specialty drugs is to look at the total specialty spend by combining information from the pharmacy and medical benefits, one expert says.

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?

In chronic obstructive pulmonary disease (COPD), airways in the lung are partially obstructed. It's often a mixture of two diseases, chronic bronchitis and emphysema. The condition is marked by a progressive decline in lung function.

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.

The healthcare industry has yet to use evidence-based medicine (EBM) to its fullest potential, despite studies suggesting the need for it. Wide variation in medical practice and resulting clinical outcomes is indicative of the not-yet completed journey toward implementing evidence-based medicine.

Physicians' first-hand experience has no substitute, and Dr. William Cromie has maintained CDPHP's vision of including physicians in the governance of this health plan. Often, the plan and the physicians are faced with tough choices and collective compromises.