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MA Part B Makes Controversial Jump Into Step Therapy. MA部分B使有争议的跳入步骤治疗。
Managed Care Pub Date : 2019-02-01
Richard Mark Kirkner
{"title":"MA Part B Makes Controversial Jump Into Step Therapy.","authors":"Richard Mark Kirkner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Step therapy is common in commercial insurance but new to MA. Insurers defend it as an evidence-based way to put some guardrails on ill-advised, costly prescribing. Practitioners, medical societies, and drugmakers complain, though, that CMS's guidance is vague, and gives plans too much latitude in dictating step edits.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 2","pages":"13-18"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37067440","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
Heaps of Health Care Waste. In Washington State, They Are Sifting Through It. 成堆的医疗垃圾。在华盛顿州，他们正在筛选它。
Managed Care Pub Date : 2019-02-01
Michael D Dalzell
{"title":"Heaps of Health Care Waste. In Washington State, They Are Sifting Through It.","authors":"Michael D Dalzell","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A report from the Washington Health Alliance looks at 48 treatments, tests, and procedures identified by the Choosing Wisely campaign as having little clinical benefit in certain circumstances and, in many cases, the potential to cause harm.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 2","pages":"19-21"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37067441","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
HRT Has an Uncertainty Problem. Does Compounding Make It Worse? HRT存在不确定性问题。复利会让情况更糟吗?
Managed Care Pub Date : 2019-02-01
Jan Greene
{"title":"HRT Has an Uncertainty Problem. Does Compounding Make It Worse?","authors":"Jan Greene","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Hormone replacement therapy (HRT) has been around since the 1960s to help menopausal women who struggle with symptoms caused by the ebbing of estrogen. In 2002, a major study said that HRT could raise cardiovascular and breast cancer risks. Enter compounding. Too risky?</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 2","pages":"32-35"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37067444","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
Assessing the Legal and Practical Implications of Copay Accumulator and Maximizer Programs. 评估共同支付累加器和最大化程序的法律和实际影响。
Managed Care Pub Date : 2019-02-01
John S Linehan
{"title":"Assessing the Legal and Practical Implications of Copay Accumulator and Maximizer Programs.","authors":"John S Linehan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Drug manufacturers have relied on coupons to promote access to branded drugs by reducing patients' out-of-pocket costs. Insurers and PBMs, on the other hand, have opposed coupons because they undermine the effectiveness of cost-sharing requirements and benefit designs that incentivize cost-effective drug prescribing and purchasing choices.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 2","pages":"42-44"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37067447","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
More Medicare Advantage Plans Offering Post-acute Discharge Care. 更多医疗保险优惠计划提供急性出院后护理。
Managed Care Pub Date : 2019-02-01
Erik Johnson
{"title":"More Medicare Advantage Plans Offering Post-acute Discharge Care.","authors":"Erik Johnson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>As plans and providers collaborate to manage post-discharge care, they will also need to take heed of the nonclinical variables. Limitations in performing activities of daily living (ADLs) and social determinants of health (SDOH) have as great an impact on health care spending among the elderly as the presence of chronic conditions.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 2","pages":"48-49"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37066400","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
How Medicare Advantage Plans Are Paid: The Devils-and the Insights-Are in the Details. 医疗保险优势计划如何支付:魔鬼和洞察都在细节中。
Managed Care Pub Date : 2019-02-01
Timothy Kelley
{"title":"How Medicare Advantage Plans Are Paid: The Devils-and the Insights-Are in the Details.","authors":"Timothy Kelley","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Is Medicare Advantage a ripoff of taxpayers, a godsend for integrated, cost-effective care, or somehow both? Contributing Editor Timothy Kelley walks you through the details of quality star ratings, preliminary adjustments, the quartile system, regional plans, risk scores, coding intensity adjustments, and rebate percentages.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 2","pages":"22-29"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37067442","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
Taking Members From Disconnected to Engaged. 让成员从不联系到参与。
Managed Care Pub Date : 2019-02-01
Carrie Cowdin
{"title":"Taking Members From Disconnected to Engaged.","authors":"Carrie Cowdin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Members are looking for a customized health care experience. With analytics, health plans can deliver it. Three key areas will help plans to close gaps in care and improve outcomes. They are: identifying at-risk members, tailoring communications and care settings, and increasing member motivation.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 2","pages":"46-47"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37067448","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
Flying Blind With Medication Management. 盲目用药管理。
Managed Care Pub Date : 2019-02-01
Sanjiv Luthra, Danny Sands
{"title":"Flying Blind With Medication Management.","authors":"Sanjiv Luthra,&nbsp;Danny Sands","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The problem of nonadherence must be addressed. We must improve the sharing of a patient's real-time medication compliance with care teams so that they are able to intervene in the right way at the right time. We must also educate patients. Medications can't be effective if people don't take them.</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 2","pages":"41"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37067446","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
The Medicare Advantage Advantage-For Insurers, It's a Sweet Deal, Indeed! 医疗保险优势优势——对保险公司来说，这确实是一笔甜蜜的交易!
Managed Care Pub Date : 2019-02-01
Joseph Burns
{"title":"The Medicare Advantage Advantage-For Insurers, It's a Sweet Deal, Indeed!","authors":"Joseph Burns","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Let the good times roll! CMS overpays for MA coverage, and that allows insurers to give enrollees extra benefits that traditional Medicare does not cover. But there's this thing called \"politics,\" with rumblings that insurers have too sweet a deal. Will the spigot be turned off?</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 2","pages":"30-31"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37067443","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
U.S. Women's Health: Not So Great. 美国女性健康:不太好。
Managed Care Pub Date : 2019-02-01
Jan Greene
{"title":"U.S. Women's Health: Not So Great.","authors":"Jan Greene","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Commonwealth Fund reports that U.S. women have more chronic illness, are less satisfied with their care, and have more trouble affording it-often skipping needed care because of cost-than women in comparable nations. Could universal coverage be the cure?</p>","PeriodicalId":39329,"journal":{"name":"Managed Care","volume":"28 2","pages":"36-40"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37067445","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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