Strategy: Adding Ancillaries - Cash Cow or Money Pit? Inspired by stories of lofty returns promulgated by aggressive marketers and the popular press, medical groups are delivering new patient services at a frenzied pace in a quest to revive their shrinking profits. “The financial return on some of these ancillaries is very high,” Craig Holm, senior vice president of Health Strategies and Solutions, affirms.
Along with the release of revised guidelines, several pharmacological therapies have become available or are under investigation to help improve outcomes in patients with osteoporosis.
Children with sickle cell disease (SCD) were shown to have annual medical costs of $9369 (Medicaid) and $13,469 (private insurance), which is significantly higher than that for children without SCD, according to a study led by Djesika D. Amendah, PhD, an economist at the CDC.1 SCD in children resulted in total medical costs of at least $335 million per year in the United States in 2005.
The effect of payment delays on the normal functioning of community pharmacy operations has been documented. We undertook a study to evaluate and compare pharmacists’ perception regarding reimbursement rates and processing time for prescription drug claims processed for Medicare Part D, Medicaid, and commercial managed care plans.
A 24-year-old man with an unremarkable medical history presented to the emergency department with abdominal pain and hematemesis of 3 days' duration. His symptoms were postprandial, and each episode yielded up to half a cup of blood without clots. He denied using NSAIDs or alcohol. He had had an episode of hematemesis 2 years earlier that resolved spontaneously, for which he had not sought treatment. His vital signs were normal, and his physical examination was notable only for moderate epigastric tenderness without rebound or guarding.
A39-year-old man with a history of AIDS and nonadherence to highly active antiretroviral therapy (HAART) presented with frontal headache and scalp pain of 2 weeks' duration. These symptoms were accompanied by nausea, weight loss, and generalized weakness. Physical examination revealed a small, tender scalp lump, 2 × 2 cm over the left parietal area. The findings from the rest of the examination were unremarkable.
Common behaviors of patients taking prescription drugs, such as forgetfulness and procrastination, may result in wasteful spending of $163 billion annually, according to the recently released 2009 Drug Trend Report from Express Scripts.
The US Department of Veterans Affairs (VA) invested in health information technology (IT) and produced a net savings of $3.09 billion, according to results of a new study conducted by the Center for Information Technology Leadership (CITL).1
Little progress has been made in eliminating health care–associated infections (HAIs), according to the 2009 National Healthcare Quality Report and the National Healthcare Disparities Report recently issued by the Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ).1
More than half of patients with rheumatoid arthritis who were treated with a biologic discontinued treatment, and another 12% switched to at least 1 other biologic within a 2-year treatment period, according to a study led by Chureen Carter, PharmD, of Centocor Ortho Biotech Services.
A study of Humana members enrolled in commercial and Medicare Advantage plans showed that patients with fibromyalgia have higher health care utilization and costs than those without the disease.1 This is because of higher use of office visits, testing, and procedures as well as pain-related medications.
Managed care pharmacists will play a key role in reforming the current health care system by continuing to develop innovative programs that reduce costs and improve quality of care, said Mark McClellan, MD, PhD, director of the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, DC. He discussed the effects of the recent health care reform legislation in a presentation at the Academy of Managed Care Pharmacy meeting.
A simple way to quickly assess a patient's functional status and social network is to ask at some point during the examination, "How did you get here today?"
Electronic prescribing resulted in greater generic and formulary drug use, according to Crystal Chang, PharmD, and colleagues at Blue Shield of California, San Francisco. It also led to an average cost savings of 17.3% for both the member and the payer.
Women are more likely to look for health information online, according to results of the 2009 National Health Interview Survey.1 Of all those who responded, 45.6% said they had looked up health information on the Internet within the past year. Those aged 25 to 34 years were most likely to seek information online, and those 65 and older were least likely.
The treatment of patients with autism spectrum disorders (ASDs) and their various complications has become one of the most discussed and demanded insurance coverage mandates in multiple states. Insurance mandates are being heavily pushed by advocacy groups, especially Autism Speaks, with good success.
On March 2, 2010, the Department of Health and Human Services secretary released a notice of proposed rulemaking for establishing a certification program for electronic health records (EHRs).1
Several months have passed since the publication of the latest US Preventive Services Task Force (USPSTF) breast cancer screening guidelines. The initial, sharp outcry, mainly over the task force’s recommendation against routine screening mammography for women aged 40 to 49 years, has somewhat subsided, but the overall significance of the group’s decision remains undetermined.
