Because of new reform-driven medical loss ratio requirements, now more than ever health plans’ primary lever on profitability is to reduce administrative costs. Rethinking utilization management (UM) processes, especially those that require payer–provider collaboration, could provide excellent targets for health plans to reduce their administrative costs and inappropriate medical costs.
Anticoagulation Bridging Therapy Patterns in Patients Undergoing Total Hip or Total Knee Replacement in a US Health Plan: Real-World Observations and Implications
An estimated 350,000 to 600,000 American patients experience venous thromboembolism (VTE) annually, which includes deep-vein thrombosis and pulmonary embolism.1-5 Patients undergoing total hip replacement (THR) or total knee replacement (TKR) surgery are at high risk for VTE, because the large veins in the legs carrying blood back to the heart are significantly injured during these procedures.6,7 As a result of the aging and increasingly obese US population, an estimated 500,000 THR operations and 3.5 million TKR operations are expected to be performed by 2030.8
Anticoagulation Bridging Therapy after Total Hip or Knee Replacement: A Missed Opportunity?
The Business Case for Payer Support of a Community-Based Health Information Exchange: A Humana Pilot Evaluating Its Effectiveness in Cost Control for Plan Members Seeking Emergency Department Care
Nowhere is this caveat from David Blumenthal, MD, MPP, the former National Coordinator for Health Information Technology, more applicable than in the emergency department setting. Although originally designed as the section of a hospital where only the most acutely ill persons should seek care for their maladies, the emergency department has become much more than that. It now serves as the primary care provider for many who have no such physician outside the emergency department.2,3
Health as a Sustainability Strategy: We Need a Healthcare System Focused on Keeping People Healthy Rather than Adding Layers to the Already Too Long, Fragmented Supply Chain
On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS) released regulations governing the establishment of accountable care organizations (ACOs) to mixed reactions from the provider community. Much of this reaction is driven by the governance, risk management, and operational complexities of establishing a Medicare ACO.
Modeling Costs and Outcomes Associated with a Treatment Algorithm for Problem Bleeding Episodes in Patients with Severe Hemophilia A and High-Titer Inhibitors
Patrick Bonnet, PharmD, Alessandro Gringeri, MD, Edward Gomperts, MD, Cindy Anne Leissinger, MD, Roseline d’Oiron, MD, Jerome Teitel, MD, Guy Young, MD, Meg Franklin, PharmD, PhD, Bruce Ewenstein, MD, Erik Berntorp, MD, PhD
Factor replacement therapy is the standard treatment for hemophilia. However, some patients with hemophilia develop inhibitors (alloantibodies) against the clotting factor administered. The development of these clotting inhibitors may render replacement therapy ineffective and, consequently, increase morbidity because of the inability to control or prevent hemorrhages. Inhibitor development has been reported to occur in as many as 33% of patients with hemophilia A, and as many as 7.5% of patients with hemophilia B.1-3
Potential Cost-Savings Using a Treatment Algorithm for Problem Bleeding Episodes in Patients with Hemophilia and Inhibitors
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