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Association Health Plans Offer Lower Premiums, But at What Cost? 协会健康计划提供较低的保费，但代价是什么?
Managed Care Pub Date : 2019-04-01
Joseph Burns
{"title":"Association Health Plans Offer Lower Premiums, But at What Cost?","authors":"Joseph Burns","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>AHPs are not required to cover all of the essential health benefits that ACA-compliant plans do, and they can base premiums on their expected or actual spending for health care rather than setting premiums at the community rate. But critics say you get what you pay for.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 4","pages":"16-17"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37324777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Emergency Medicine: The Origin Story. 急诊医学:起源故事。
Managed Care Pub Date : 2019-04-01
Robert Calandra
{"title":"Emergency Medicine: The Origin Story.","authors":"Robert Calandra","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Doctors returning home from World War II knew that critically ill or injured patients had a better chance of survival if they were treated in a hospital. In 1976, emergency medicine became the country's 23rd recognized medical specialty. A lot happened between points A and B.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 4","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37324781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
In Trump, HIV/AIDS Groups Find an Ally Who's Tough To Love. 在特朗普身上，艾滋病毒/艾滋病组织找到了一个很难爱的盟友。
Managed Care Pub Date : 2019-04-01
Richard Mark Kirkner
{"title":"In Trump, HIV/AIDS Groups Find an Ally Who's Tough To Love.","authors":"Richard Mark Kirkner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Adjusting their vision so it looks past the messenger and focuses on President Trump's stated goal to end AIDS by 2030 isn't easy for HIV/AIDS advocates. But they aren't being entirely dismissive, either. They have some faith in, and working relationships with, federal government health officials who will oversee implementation of the plan.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 4","pages":"30-32"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37324783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Thanks to CMS Rule Change, MA Takes SDOH to a Whole New Level. 由于CMS规则的改变，MA将SDOH提升到了一个全新的水平。
Managed Care Pub Date : 2019-04-01
Frank Diamond
{"title":"Thanks to CMS Rule Change, MA Takes SDOH to a Whole New Level.","authors":"Frank Diamond","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>CMS and insurers talked about what needed to be done to better address the social determinants of health (SDOH) for beneficiaries. That led to a policy, implemented last year by CMS, that allows for the provision of daily maintenance care using nonskilled in-home providers, the kind of services usually given in assisted-living facilities.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 4","pages":"40-41"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37319590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Are We Getting What We Pay For? 我们得到了我们所付出的吗?
Managed Care Pub Date : 2019-04-01
Michael D Dalzell
{"title":"Are We Getting What We Pay For?","authors":"Michael D Dalzell","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>For all the talk about rapid increases in health care costs, we just might be getting better value for it. So say David Wamble, director of health economics at RTI Health Solutions, and colleagues in a recent Health Affairs article.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 4","pages":"20-23"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37324779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hail, Not Frail! MA's Wellness Reach Expands. 万岁，不要脆弱!MA的健康服务范围扩大了。
Managed Care Pub Date : 2019-04-01
Frank Diamond
{"title":"Hail, Not Frail! MA's Wellness Reach Expands.","authors":"Frank Diamond","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>There was a time when insurers were accused (often rightly) of using wellness to lure healthier beneficiaries into MA. Now, the issue is whether wellness can help health plans manage medical spending. \"To the degree they do minimize medical spending, the beneficiaries will presumptively be better off healthwise,\" says Joseph Newhouse of Harvard.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 4","pages":"37-39"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37319589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Emergency Care Examined. 紧急护理检查。
Managed Care Pub Date : 2019-04-01
Peter Wehrwein
{"title":"Emergency Care Examined.","authors":"Peter Wehrwein","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>It is a high-tech wonder and the product of generations of heavy investment in trauma care. But the emergency department is also the backdoor of the American health care system-a kind of open wound that is symptomatic of deficiencies of how American health care is organized, delivered, and paid for.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 4","pages":"24-25"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37324780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Digitized Health Opens RWE Floodgates. Can Artificial Intelligence Harness the Power? 数字化医疗开启了莱茵集团的闸门。人工智能能驾驭这种力量吗?
Managed Care Pub Date : 2019-04-01
Thomas Reinke
{"title":"Digitized Health Opens RWE Floodgates. Can Artificial Intelligence Harness the Power?","authors":"Thomas Reinke","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Artificial intelligence is creating another new frontier in real-world evidence gathering and analysis. AI's algorithms can approximate-and maybe even surpass-human cognition and judgment in the analysis of complex medical data. Sure, humans will sign off, but AI software will do the heavy lifting.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 4","pages":"18-19"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37324778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Once-a-day HIV Treatment: Pricey But Perhaps Worth It. 一天一次的艾滋病治疗:昂贵但也许值得。
Managed Care Pub Date : 2019-04-01
Ed Silverman
{"title":"Once-a-day HIV Treatment: Pricey But Perhaps Worth It.","authors":"Ed Silverman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The annual pharmacy costs for single tablet regimens were $6,100 less compared with regimens involving multiple pills, at least among HIV patients who were taking the medicines as intended, according to an Express Scripts analysis. On average, the company found that health plans could save about $4,160 per patient per year.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 4","pages":"33-34"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37324784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Air Ambulance Turbulence: Consolidation, Cost Shifting, and Surprise Billing. 空中救护湍流:整合、成本转移和意外计费。
Managed Care Pub Date : 2019-04-01
Jan Greene
{"title":"Air Ambulance Turbulence: Consolidation, Cost Shifting, and Surprise Billing.","authors":"Jan Greene","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>It is a heroic part of the American health system. Lives are saved, the dire consequences avoided. But the air ambulance industry is consolidating, prices are soaring, and insurers and providers continually fight over network issues. One consequence: Surprise billing that leaves patients owing tens of thousands of dollars.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 4","pages":"27-29"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37324782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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