http://managedhealthcareexecutive.modernmedicine.com/mhe Managed Healthcare Executive Online offers insight to healthcare
 providers, executive officers and management specialists to help them
 contain costs and improve the quality of health care. 2008-07-06T02:18:57Z http://managedhealthcareexecutive.modernmedicine.com/mhe/MHE-E-news-July-images/ArticleStandard/Article/detail/526826?ref=25 2008-06-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/526826null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/NCQA-to-evaluate-wellness-programs/ArticleStandard/Article/detail/526640?ref=25 The National Committee for Quality Assurance’s (NCQA’s) proposed standards and measures for a new Wellness and Health Promotion (WHP) product evaluation have been released for public comment. 2008-06-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/262008/526640null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/More-employers-using-incentives/ArticleStandard/Article/detail/526641?ref=25 The number of major employers offering employee wellness programs with incentives grew over the past year, according to a study presented by Health2 Resources. The National Association of Manufacturers and The ERISA Industry Committee participated in the survey. 2008-06-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/262008/526641null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Two-votes-determine-Medicare-payment-rule/ArticleStandard/Article/detail/526637?ref=25 Two votes from Republican senators killed a House bill that would have averted statutory payment reductions for Medicare physicians, just before legislators left Capitol Hill for their Independence Day holiday. Medicare physicians now face 10.6% fee cuts, but there is an opportunity for retrospective increases after the recess. 2008-06-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/262008/526637null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Lack-of-access-can-be-life-changing/ArticleStandard/Article/detail/526639?ref=25 Access to coverage, especially for individuals and small groups, is a constant issue. So much so that many Americans are taking great steps to change their lifestyles in order to obtain it. Get married to gain access to insurance? Some are doing just that. 2008-06-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/262008/526639null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Government-proposal-could-allow-e-Rx-of-controlled/ArticleStandard/Article/detail/526638?ref=25 U.S. drug regulators are said to be close to allowing doctors to e-prescribe addictive medications, including painkillers. According to Reuters, the Drug Enforcement Administration is expected to publish a proposal on e-prescribing controlled substances. 2008-06-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/262008/526638null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Managed+Care+Outlook/Many-still-wrong-in-their-DM-savings-calculations/ArticleStandard/Article/detail/522501?ref=25 How is it that well-informed people can look at the same data and come up with dramatically different conclusions and action implications? It turns on whether the analysis is done by biostatisticians looking at utilization data in an academically rigorous way, or by actuaries and benefits consultants looking at overall financial trends in a pre-post manner. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522501null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Letter+of+the+Law/Understand-Public-Information-Act-to-protect-recor/ArticleStandard/Article/detail/522494?ref=25 When companies interact with governmental bodies, issues related to the Public Information Act frequently arise. It is imperative for those companies to understand the Public Information Act as well as the internal procedures that may be developed to handle open records issues. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522494null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Hospitals+%26+Providers/Intensivists-bring-experience-to-critical-care-med/ArticleStandard/Article/detail/522498?ref=25 The intensive care unit (ICU) is, in many ways, the most significant section of a hospital, because it is where life-threatening issues occur almost daily. The ICU is the one area where most hospitals don't employ specialists—board-certified intensivists with expertise and training in critical care medicine. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522498null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Health+Management/Innovative-plan-designs-focus-on-consumer-engageme/ArticleStandard/Article/detail/522499?ref=25 The convergence of rising healthcare costs, increased cost sharing and demand by consumers for more participation in healthcare decisions is producing a variety of innovative health insurance solutions. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522499null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Visionaries/Physician-Proponent-Prescription-Solutions-Brian-S/ArticleStandard/Article/detail/522496?ref=25 The relationship between physicians and pharmacy benefit managers continues to change. A goal of Prescription Solutions' Brian Solow, MD, is to foster a collaborative approach to working with physicians, to ultimately deliver better care to patients. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522496null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Technology/Complex-decision-making-requires-better-collaborat/ArticleStandard/Article/detail/522500?ref=25 The use of technology to automate simple tasks has been widely adopted. E-mails broadcast information in a fraction of the time it would take a manual process. More complex tasks, however, require a human driver, and those tasks are in higher demand today. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522500null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Dashboards-boost-patient-services-in-call-centers/ArticleStandard/Article/detail/522811?ref=25 Contact centers must prove their value to the organization and the patient. Kaiser Permanente has seen success with its dashboard approach. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522811null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/State+Report/State-Report-Minnesota/ArticleStandard/Article/detail/522492?ref=25 Minnesota Ranked first in the nation in overall state healthcare quality, according to a recent report by the Agency for Healthcare Research and Quality. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522492null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Health-reforms-set-comparative-research-goals/ArticleStandard/Article/detail/522493?ref=25 As the 2008 presidential campaign moves into its final stages, there is much enthusiasm within both parties for developing objective information on the effectiveness of medical treatments and therapies in real-world settings. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522493null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Consider-increasing-emphasis-on-healthcare-program/ArticleStandard/Article/detail/521794?ref=25 The majority of program development or improvement plans fail to meet their projected performance. What can a healthcare executive leadership team do to change this outcome for their organization? 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/232008/521794null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Strategies-for-ICD-10-take-proactive-approach/ArticleStandard/Article/detail/521793?ref=25 Most healthcare players agree that ICD-10 implementation will be expensive and resource-intensive. Yet opportunities abound to enable proactive organizations to become industry leaders with the new system. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/232008/521793null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Cover+Article/Package-pricing-Geisingers-new-model-holds-the-pro/ArticleStandard/Article/detail/522495?ref=25 Geisinger Health System and Geisinger Health Plan have attracted attention from key industry players ever since introducing a bundled-pricing program called ProvenCare in 2006. Richard Gilfillan, MD, president and CEO of Geisinger Health Plan, played a critical role in the launch of the new payment structure. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522495/Gilfillan_thumbnail.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522495null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Feds-limit-deceptive-MA-marketing-tactics/ArticleStandard/Article/detail/522503?ref=25 Washington, D.C. — The Bush administration has proposed additional curbs on certain sales practices by insurers likely to confuse and deceive seniors enrolling in Medicare Advantage and prescription drug plans. Insurers applauded the marketing policy, partly in hopes of heading off legislation that would give states a larger role in policing Medicare marketing activities. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522503null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Win-Win-Dental-benefit-consulting-adds-value-for-i/ArticleStandard/Article/detail/522812?ref=25 Dental benefit consultants are important allies for insurers as the dental profession transitions to an evidence-based dentistry (EBD) perspective. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522812null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/For+Your+Benefit/Irish-healthcare-system-offers-access-at-72-GDP/ArticleStandard/Article/detail/522491?ref=25 I had the honor of joining 40 executive delegates for a week to observe the Irish healthcare system. While spending in the Irish healthcare system is just 7.2% of GDP, the public hospitals are filled to the gills. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522491null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Use-customer-service-to-reap-bottom-line-benefits-/ArticleStandard/Article/detail/521795?ref=25 Today's hospitals now compete with something far more engaging and intoxicating than the hospital down the street — consumer expectations. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/232008/521795null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Special+Report/Where-Data-Stops-Employers-want-more-data-for-cost/ArticleStandard/Article/detail/522497?ref=25 The U.S. healthcare system continues to struggle with costs. As costs have climbed, data needs among employers are changing swiftly. Some employers are asking their health plan providers for deeper, more telling employee health information, only to find that they aren't able to obtain it because of HIPAA and similar laws. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522497null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Desktop+Resource/Employers-manage-prescription-drug-costs/ArticleStandard/Article/detail/522502?ref=25 Employers are more than just concerned about the rising costs of prescription drugs—they're ready to stem the tide, according to industry experts. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522502null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Better-informed-members-are-more-satisfied/ArticleStandard/Article/detail/522504?ref=25 National Reports—Providing useful information is key to increasing satisfaction among health plan members, say industry experts. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522504null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Corporationrsquos-age-factors-into-health-benefits/ArticleStandard/Article/detail/519728?ref=25 National News—Small businesses are less likely to offer employee health benefits, especially if they’re the new kid on the block, according to a recent report from the Kaiser Family Foundation. Analysis finds that among firms with nine employees or fewer, those in business for 20 years or more are more likely to offer benefits. 2008-05-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/222008/519728null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Kaiser-completes-national-EMR-rollout/ArticleStandard/Article/detail/519725?ref=25 Oakland, Calif.—Nearly 9 million Kaiser Permanente members in nine states are now on the books with the plan’s HealthConnect electronic medical record system, which completed a four-year rollout recently. Installation cost $4 billion, including $1 billion for maintenance. 2008-05-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/222008/519725null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Cleveland-Clinic-to-test-PHR-security-with-Google/ArticleStandard/Article/detail/519727?ref=25 Cleveland—Cleveland Clinic has its own electronic personal health record system for patient viewing, and now it plans to pilot information-exchange capabilities with GoogleHealth, an online PHR platform. 2008-05-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/222008/519727null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/June-E-news-Art/ArticleStandard/Article/detail/519759?ref=25 2008-05-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/222008/519759null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Agreement-on-biosimilars-emerges/ArticleStandard/Article/detail/519718?ref=25 Washington, D.C.—There’s a lot of talk in Washington about the importance of enacting legislation to establish a pathway for FDA to approve “similar” or “follow-on” versions of biotech drugs. Biopharmaceutical companies have been pushing for compromise legislation this year, that is aligned with health insurers, pharmacy benefit managers, and public and private payers, who envision big savings. 2008-05-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/222008/519718null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Retailers-expand-4-drug-programs/ArticleStandard/Article/detail/519724?ref=25 National News—Wal-Mart will offer generic medications for $10 for a 90-day supply, which previously cost $4 for a 30-day supply, offering more over-the-counter medications at $4. About 350 generics are covered. At the same time, Target’s prescription drug program now includes an expanded assortment of $4 prescription drugs, 90-day supply of these medications for $10 and OTC medications for $4 or less. 2008-05-29T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/222008/519724null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/How-to-survive-healthcares-war-for-talent-Four-pat/ArticleStandard/Article/detail/514479?ref=25 Attracting the right candidate and landing that talented employee for your organization are challenges. As the labor market continues to tighten, healthcare employers need to focus on long-term recruitment and retention strategies. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/514479null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/CDHP-savings-modest-enrollment-low/ArticleStandard/Article/detail/515267?ref=25 Recent Milliman analysis of employer programs that offer employees a choice of consumer-directed health plans or non-CDHPs, shows that when offered as a new choice, CDHPs deliver a modest 1.5% in savings beyond non-CDHPs based on typical risk- and benefit-adjustment factors. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515267null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Hospitals+and+Providers/Management-systems-keep-hospitals-from-meeting-goa/ArticleStandard/Article/detail/515153?ref=25 A few hospital systems already are improving work process by implementing Lean and Six-Sigma management principles. Implementing Lean Sigma (a complementary combination of Lean and Six-Sigma) in a hospital setting is not about fixing problem employees who fail to improve their work. It's about fixing the broken systems and processes that hinder medical professionals from doing what they do best. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515153null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/State+Report/State-Report-Vermont/ArticleStandard/Article/detail/515149?ref=25 In May 2006, Vermont became one of a handful of states to pass comprehensive health reform legislation intended to increase access to affordable healthcare while reducing cost through quality improvement measures. The plan requires employers to provide or help finance coverage for their workers. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515149null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Cover+Article/Welcome-Back-Network-Health-Plan-tracking-number-o/ArticleStandard/Article/detail/515156?ref=25 Higher-than-expected enrollment has challenged the budget and the administration of public health coverage in Massachusetts ever since its universal health plan took effect in April 2006. Christina Severin, executive director of Network Health in Medford, Mass., a private plan that covers subsidized Commonwealth Care members as well as MassHealth Medicaid members, believes programs will continue to struggle until one particular problem is solved: enrollment churning. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515156/severin.web2_thumbnail.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515156/severin.web2_main.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515156null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Desktop+Resource/Enrollment-process-offers-key-opportunities/ArticleStandard/Article/detail/515155?ref=25 The enrollment process offers opportunities to engage employees, but the tools themselves are not enough, according to one industry expert. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515155null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Report-card-standards-developed/ArticleStandard/Article/detail/515148?ref=25 Washington, D.C. — Health insurers and medical groups have agreed to work together to develop national standards for rating physician performance. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515148null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Letter+of+the+Law/Captive-insurance-arrangements-more-common/ArticleStandard/Article/detail/515151?ref=25 Many healthcare entities have explored certain alternative risk transfer arrangements as a means for insuring, or perhaps self-insuring, various exposures. The use of captive insurance arrangements has been a common approach, and thus, "protected cell companies" have become popular vehicles. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515151null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Special+Report/Early-Retirees-Consumer-driven-options-the-plans-o/ArticleStandard/Article/detail/515152?ref=25 As employers continue to cut back on health insurance for retirees (and might even stop offering it to new employees), early retirees are stuck in an expensive conundrum. More and more this group of retirees is turning to consumer-driven solutions. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515152null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Medicare-Medicaid-and-SCHIP-Extension-Act-of-2007-/ArticleStandard/Article/detail/514477?ref=25 On Dec. 29, 2007, President George W. Bush signed the multi-faceted Medicare, Medicaid, and SCHIP Extension Act of 2007. Section 111 of the bill, titled, Medicare Secondary Payor (MSP), mandated that effective Jan. 1, 2009, all Group Health Plans (GHP) or any related entity (i.e. insurer or third party administrator) serving on behalf of the GHP will be responsible for identifying and submitting "situations where the group health plan is or has been a primary plan to the program," according to Medicare. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/514477null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Visionaries/Merger-activity-Jon-Cohen-MD-addresses-state-of-ho/ArticleStandard/Article/detail/515157?ref=25 When Jon R. Cohen, MD, was recently appointed managing director of health industries advisory services for PricewaterhouseCoopers LLP, he says it was "complex solution solving" that drew him to the firm. Here, he discusses trends on hospital mergers, profitability and hospitals, and his thoughts on the 2008 presidential hopefuls. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515157null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Demand-grows-for-transparent-quality-measures/ArticleStandard/Article/detail/515150?ref=25 The health-quality measurement bandwagon is picking up steam these days as both public and private payers struggle to deal with rising costs and the need to ensure quality care. Medicare has greatly enhanced its "Hospital Compare" Web site by posting the results of a patient survey on satisfaction with care during hospital stays. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515150null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/For+Your+Benefit/Expert-protection-laws-to-follow-federal-parity-la/ArticleStandard/Article/detail/515147?ref=25 Long debates in Congress over mental health parity laws position the most human of health needs up against stretched budgets and market disagreements on treatment value. At the moment, arguments center on insurers' coverage obligations, but few are addressing another debate that is certain to follow. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515147null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Efficiency/Recognize-value-of-certified-case-managers-in-mana/ArticleStandard/Article/detail/514478?ref=25 Case managers provide services at critical junctures, whether facilitating discharge from acute care to a sub-acute facility or coordinating home healthcare services for an individual to prevent hospital readmissions. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/514478null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Pharmacy+Best+Practices/Plan-PBM-programs-help-identify-prescription-drug-/ArticleStandard/Article/detail/515154?ref=25 How much attention is being paid to abuse of prescription drugs? One group, pharmacy benefit managers, are beginning to take a closer look by creating programs to identify members who may be abusing prescription drugs. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515154null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/WellPoint-acquires-Resolution-Health/ArticleStandard/Article/detail/513359?ref=25 WellPoint Inc.’s acquisition of Resolution Health Inc., a data analytics-driven personal healthcare guidance company, is yet another reflection of the interest in consumer-driven tools such as EHRs, PHRs, and health-related search engines, among others. 2008-04-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/182008/513359null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Blue-Cross-of-California-now-known-as-Anthem-Blue-/ArticleStandard/Article/detail/513363?ref=25 Blue Cross of California, one of the state’s largest health plans, has changed its name to Anthem Blue Cross, the San Francisco Business Times reports. Anthem Blue Cross has 8.4 million members in California. 2008-04-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/182008/513363null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Obesity-weighs-heavily-on-employers/ArticleStandard/Article/detail/513367?ref=25 The rate of obesity in the United States has doubled in the last 30 years, and is weighing down companies’ bottom lines, according to a new report from the Conference Board, a business membership and research organization in New York. 2008-04-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/182008/513367null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Medicare-Advantage-rates-holding-steady/ArticleStandard/Article/detail/513353?ref=25 Medicare Advantage plans will see payment rates increase by 3.6% in 2009, slightly higher than last year’s rise of 3.5%, but not as much as the 3.7% boost previously predicted. This slight drop from earlier estimates is a result of lower-than-expected plan expenditures for 2007, according to analysis by the Centers for Medicare and Medicaid Services (CMS). 2008-04-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/182008/513353null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/FDA-would-regulate-tobacco-under-new-legislation/ArticleStandard/Article/detail/513370?ref=25 Congress is looking to give the Food and Drug Administration the controversial and complex job of controlling tobacco marketing and advertising. FDA would not be able to ban cigarettes or require zero nicotine products, under legislation recently approved by a key House committee. But it would gain authority to approve cigarette labeling, limit certain promotional claims and curb marketing to minors. The measure provides legal authority for a regulatory approach devised more than 10 years ago under former FDA Commissioner David Kessler, but subsequently struck down by the courts. 2008-04-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/182008/513370null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/May-Enews-art/ArticleStandard/Article/detail/513399?ref=25 2008-04-30T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/182008/513399null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Drug+Safety/Creating-drug-monographs-and-drug-class-reviews-in/ArticleStandard/Article/detail/512496?ref=25 P&T committees can create evidence-based formularies with a variety of tools and proven methods of evaluation 2008-04-25T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/172008/512496null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/bpastatementpdf/ArticleStandard/Article/detail/511375?ref=25 bpa_statement.pdf for Request a Media Kit, Rate Card, or BPA Statement form 2008-04-21T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/172008/511375null PDF http://managedhealthcareexecutive.modernmedicine.com/mhe/Newswire/Texas-employers-gain-more-access-to-health-records/ArticleStandard/Article/detail/506560?ref=25 Federal law allows insurers to pass along disidentified health information to employer plan sponsors, however, a law that went into effect in Texas in January now forces insurers to pass the information along. 2008-04-03T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/142008/506560null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Insurersrsquo-marketing-promises-draw-support-skep/ArticleStandard/Article/detail/506566?ref=25 Medicare Advantage plans are supporting efforts to halt inappropriate marketing tactics, partly to head off more stringent federal and state oversight designed to stop abusive practices. Last month, America’s Health Insurance Plans (AHIP) adopted a proposal urging enactment of new rules to prohibit certain marketing practices that violate Medicare policy. 2008-04-03T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/142008/506566null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/New-Jersey-considers-coverage-mandate/ArticleStandard/Article/detail/506572?ref=25 If a new proposal is adopted, New Jersey would be the fourth state to enact mandatory coverage. About 1.4 million residents currently are uninsured. 2008-04-03T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/142008/506572null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Medicare-eyes-reporting-of-industry-physician-rela/ArticleStandard/Article/detail/506570?ref=25 The Medicare Payment Advisory Commission (MedPAC) has been examining the feasibility of requiring hospitals and medical product manufacturers to report financial relationships with physicians on a national basis. 2008-04-03T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/142008/506570null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Pharmacy+Best+Practices/Off-label-prescribing-might-get-boost-from-FDA/ArticleStandard/Article/detail/507969?ref=25 Using drugs for conditions other than what's on the label is not new, but it may receive more encouragement if draft guidance from the Food & Drug Administration (FDA) is approved. Allowing more off-label use might also increase payers' pharmacy costs. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/507969null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Special+Report/Core-Competencies-With-many-options-outsourcing-en/ArticleStandard/Article/detail/507967?ref=25 Few words have become as vilified as "outsourcing." For some Americans, it might bring to mind low-paid and poorly trained workers working at an overseas call center. As competition and cost pressures worsen and the talk of recession continues, outsourcing is becoming an increasingly attractive option for healthcare payers. When done correctly, it can be both efficient and cost-effective. Despite popular belief, outsourced work doesn't have to go overseas; in some cases, the work can go across the city, or even across the street. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/507967null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Web-based-credentialing-streamlines-data-driven-pr/ArticleStandard/Article/detail/507964?ref=25 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. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/507964null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/House-mental-health-parity-bill-raises-issues/ArticleStandard/Article/detail/508239?ref=25 National reports—Recently approved legislation to boost insurance coverage of care for mental health disorders could have just the opposite effect, according to insurers. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/508239null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Cover+Article/Beware-of-barriers-to-care-Pitney-Bowes-increases-/ArticleStandard/Article/detail/507966?ref=25 Employers are finding themselves between a rock and hard place when it comes to health benefits. If they reduce or eliminate benefits, they lose quality workers as well as productivity. If they maintain or increase benefits, they're almost certain to spend beyond their budgets year after year. In trying to strike a happy medium, more employers are now remodeling their health benefit plans dramatically, hoping to see better results. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/507966/0408_1_thumbnail.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/507966/0408_1_main.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/507966null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Assess-the-value-of-medical-tourism/ArticleStandard/Article/detail/508244?ref=25 In a consumer-driven healthcare marketplace where Americans are taking a closer look at healthcare options and are comparing quality, price, and access between the United States and overseas, many are finding it pays to take that trip abroad. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/508244null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Grants-help-doctors-transition-to-e-prescribing-pl/ArticleStandard/Article/detail/508002?ref=25 Despite widespread enthusiasm for establishing interoperative electronic health records, progress has been slow in developing the standards, protocols and rules needed to move from small initiatives to a national e-health system. To stimulate action, the Bush administration and major players in the e-health community are promoting electronic prescribing systems as an achievable step toward broader interconnectivity. Health plans and insurers are backing these efforts as a way to prevent medication errors and improve quality of care. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/508002null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Personal-health-models-prevail-on-Web-as-plans-pon/ArticleStandard/Article/detail/508236?ref=25 National reports—As more health information becomes available in electronic formats, it is not surprising that companies such as Google, Microsoft and Revolution Health Group have latched on to this business opportunity in the form of personal health records (PHRs). 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/508236null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/For+Your+Benefit/Hospitals-speak-out-on-payers-behaving-badly/ArticleStandard/Article/detail/507965?ref=25 When the former owner of the NFL's Cleveland Browns announced he was moving the team to Baltimore in 1996, not only were Cleveland fans outraged, ironically, so were Pittsburgh Steelers fans—their biggest rivals. For the two seasons that the Browns franchise remained dark, the Steelers missed the Browns because they had enjoyed the competitive rivalry. The Browns team and its followers were the people they loved to hate. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/507965null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Technology%3B+Automation%3B+Software/Digital-hospitals-aim-to-document-better-outcomes/ArticleStandard/Article/detail/507970?ref=25 Technology has been a part of the hospital landscape for decades, and hospitals have now begun to implement digital technology to improve communications between physician and nurses, lessen the likelihood of medication errors, and improve the quality of care, leading to better patient outcomes. Some are investing as much as 25% of their budgets to become digital. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/507970null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/State+Report/State-Report-California/ArticleStandard/Article/detail/508001?ref=25 The recent failure of California's $14.9 billion healthcare proposal puts pressure for healthcare reform on Washington, pundits say. Lack of federal support for state reforms has proved to be a major hurdle. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/508001null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Unions-retool-message-to-organize-nurses/ArticleStandard/Article/detail/507971?ref=25 Healthcare executives have seen a significant increase in efforts by unions to organize nurses in the last few years. The national rate of unionized nurses currently exceeds 23%; in 1998, that number was less than 17%. In contrast, the national rate of unionized workers is just 12%. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/507971null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Health+Management/Shared-decision-making-gains-recognition-as-patien/ArticleStandard/Article/detail/509178?ref=25 The practice of shared decision making (SDM)—the collaboration between patients and caregivers to arrive at an informed, value-based healthcare decision when treatment options have features that patients value differently—is gaining recognition among health plans as a key function of a patient-centric model of care. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/509178null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/April-E-news-art/ArticleStandard/Article/detail/506603?ref=25 2008-03-27T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/142008/506603null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Congress-questions-celebrity-endorsements-FDA-over/ArticleStandard/Article/detail/499836?ref=25 The campaign against drug TV advertising and marketing seems to be accelerating in Washington and around the country. The latest salvo comes from leaders of the House Energy & Commerce Committee who want information from pharmaceutical companies and the Food and Drug Administration about questionable marketing campaigns. 2008-03-05T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/499836null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/CMS-says-care-pilot-not-meeting-budget-neutrality-/ArticleStandard/Article/detail/499834?ref=25 The Centers for Medicare and Medicaid Services (CMS) has announced it will end Phase I of Medicare Health Support (MHS) program upon completion of the three-year pilot, meant to provide beneficiaries additional care-management services. Expansion to Phase II of any pilot is contingent upon improving the clinical quality of care, improving beneficiary satisfaction and achieving targets for savings. 2008-03-05T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/499834null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/March-E-news-art/ArticleStandard/Article/detail/499845?ref=25 2008-03-03T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/499845null HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Visionaries/Personal-prevention-Christopher-Fey-shows-why-dete/ArticleStandard/Article/detail/500102?ref=25 According to the 2007 Milken Institute Report, "An Unhealthy America: The Economic Burden of Chronic Disease," prevention, early detection and chronic condition management could save the nation $1 trillion annually by 2023. But in the mind of U.S. Preventive Medicine Founder (USPM), Chairman, CEO and Director Christopher Fey, there is something even more important that could be saved: lives. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500102null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Cover+Article/Basic-facts-Kaiser-Family-Foundation-puts-healthca/ArticleStandard/Article/detail/500100?ref=25 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. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500100/0308_thumbnail.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500100/0308_main.gif http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500100null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Special+Report/Emergency-situation-Working-harder-unlikely-to-sol/ArticleStandard/Article/detail/500101?ref=25 George Clooney's challenges make for good TV. While the former star of "ER" struggles with fictional patients, much of the drama in today's emergency department (ED) centers around the problems of overcrowding, increased utilization and increased wait times. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500101null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Payers-start-to-leverage-social-networking-media/ArticleStandard/Article/detail/500106?ref=25 Despite efforts of healthcare payers and providers, the vast majority of daily healthcare discussions have taken place outside of the industry. People talk to family and friends in varied settings — at home, parties, restaurants, health clubs, and religious and community institutions where the industry has no voice. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500106null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Letter+of+the+Law/States-face-ERISA-hurdle-on-employer-funded-univer/ArticleStandard/Article/detail/500099?ref=25 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. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500099null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Pharmacy+Best+Practices/Medication-therapy-management-bumps-up-pharmacists/ArticleStandard/Article/detail/500104?ref=25 MEDICATION THERAPY Management (MTM) services introduced in 2006 under Medicare Part D have prompted pharmacists to adopt expanded roles in the commercial setting, such as performing a comprehensive medication review and monitoring a patient's response to therapy. One of the main caveats, however, is the lack of standardized reimbursement for pharmacists' services. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500104null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Health+Management/Good-oral-care-evolves-into-new-preventive-disease/ArticleStandard/Article/detail/500103?ref=25 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. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500103null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Gum-systemic-disease-link-gains-traction-with-plan/ArticleStandard/Article/detail/500094?ref=25 The link between gum disease and systemic disease is becoming more top-of-mind with health plan and dental providers alike. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500094null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Desktop+Resource/Key-cardiovascular-conditions-decline/ArticleStandard/Article/detail/500105?ref=25 HEALTHCARE FORECASTERS might assume that because of demographics, heart disease would be a leading cause of increased demand for hospital services—and, therefore, healthcare costs. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500105null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Corporate-marketplace-evaluates-health-and-product/ArticleStandard/Article/detail/500107?ref=25 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. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500107null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Insurers-subpoenaed-by-NYs-Cuomo/ArticleStandard/Article/detail/500095?ref=25 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. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500095null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Wal-Mart-steps-into-pharmacy-benefits-arena/ArticleStandard/Article/detail/500096?ref=25 National Reports—Wal-Mart's recent announcement that it plans to enter the pharmacy benefits arena has perked up a few ears in the industry. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500096null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/CMS-beefs-up-MA-Part-D-marketing-oversight/ArticleStandard/Article/detail/500098?ref=25 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. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500098null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/State+Report/State-Report-New-Jersey/ArticleStandard/Article/detail/500097?ref=25 NEW JERSEY hospitals are facing financial pressures with no state relief in sight. Five hospitals have filed for bankruptcy in the past year and a half, and 18 hospitals have closed since 1992. Providing charity care to uninsured patients cost New Jersey hospitals $1.3 billion last year, but they received just $716 million in reimbursement. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500097null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Visionaries/Overseas-options-Jonathan-Edelheit-helps-prepare-U/ArticleStandard/Article/detail/489465?ref=25 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. 2008-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/062008/489465null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Technology/CIOs-deploy-business-strategies-as-technology-chan/ArticleStandard/Article/detail/489470?ref=25 When it comes to information technology, the more things change—the more work the CIO has to do. Once out of sight and out of mind in the basement mainframe rooms of corporate America, chief information officers are now sitting at the table in corporate boardrooms. 2008-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/062008/489470null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Desktop+Resource/Categories-driving-future-drug-trend/ArticleStandard/Article/detail/489472?ref=25 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. 2008-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/062008/489472null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Web+Exclusives/Crisis-preparation-calls-for-planned-protocols/ArticleStandard/Article/detail/490113?ref=25 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. 2008-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/062008/490113null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/MHE-and-Formulary-Media-Kit-PDF/ArticleStandard/Article/detail/489214?ref=25 See how MHE and Formulary can support your marketing efforts with a two-brand buy 2008-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/062008/489214null PDF http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/MA-plan-payments-practices-face-increased-scrutiny/ArticleStandard/Article/detail/489462?ref=25 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. 2008-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/062008/489462null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/For+Your+Benefit/New-guidelines-influence-wellness-incentives/ArticleStandard/Article/detail/489457?ref=25 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. 2008-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/062008/489457null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/State+Report/State-Report-New-York/ArticleStandard/Article/detail/489461?ref=25 In November, New York state lawmakers said they would pass a law that ensures health insurers use quality-of-care measures and not only cost in their physician ranking systems, according to the Albany Times Union. Insurers including UnitedHealth Group, ætna, CIGNA, and Empire Blue Cross Blue Shield, have agreed to adopt standards for the more transparent physician rankings. Four of the insurers said they would apply the standards to their entire network. Under the code, insurers must disclose their ranking criteria and use established national criteria. 2008-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/062008/489461null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Special+Report/The-art-of-medicine-Applying-evidence-based-medici/ArticleStandard/Article/detail/489464?ref=25 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. 2008-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/062008/489464null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Drug-approvals-slow-down/ArticleStandard/Article/detail/489460?ref=25 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. 2008-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/062008/489460null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Healthcare-spending-spurred-by-Part-D/ArticleStandard/Article/detail/489458?ref=25 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. 2008-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/062008/489458null XML