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Editorials

Industry ducks bullets in 2016 Medicare Advantage rate proposal

John Gorman

This was the most anticipated Advance Notice of Medicare Advantage Payments in years, and the industry unexpectedly ducks bullets, in risk adjustment, Star Ratings and elsewhere. It's got a few unicorn farts in it, and a couple puffs of Chanel No. 5 as well.

The Republican alternative to Obamacare

Robert Laszewski

Voters, and the industry, may end up liking parts of both Republican and Democratic ideas. They might ask a reasonable question: Why can't we take the best from both sides?

Looking at the evidence of Tamiflu's benefits, risks

Andrew Lazris, MD

When CDC director Tom Frieden, MD, stated that neuraminidase inhibitors (NIs), such as Tamiflu, should be given to all elderly people with upper respiratory infection symptoms even before they have flu, I was appalled. Having read the Cochrane Review report on NIs, it seemed clear to me that at best Tamiflu was ineffective, and at worst it could cause more harm than good.

Building health plans for today and the future

Joe Marabito, ikaSystems

The industry has changed. What were strengths are now limitations, and new critical success factors have emerged. The status quo may be the path to extinction.

Analytics for proactive member and patient outreach

Jimmy Liu, Altegra Health

In January, the Department of Health and Human Services set a goal for 50 percent of all Medicare provider payments to be the result of value-based compensation models by 2018.

Why Medicare Advantage plans may be missing millions in premium revenue

Laura Cohen, Discovery Health Partners

Many health plans are looking for ways to maximize their performance in the new year. Payment integrity can help plans and other healthcare organizations operate more efficiently. But where to begin?  

Four considerations in weathering the healthcare security storm

Karin Ratchinsky, Level 3

"Credit monitoring for a breach of your identity data, medical or not, is like handing out umbrellas in a tornado." This is a fitting analogy, as healthcare is amidst a converging storm of cyber security; four forces fairly unique to other industries seem to plague the healthcare ecosystem at a confluence.

What is home care worth?

Clare L. Stacey

In the U.S. there are two million home care workers, who make a world of difference to the elderly or disabled trying to age at home.

How payers can help providers in the value evolution

Dawn Aston, Healthx

There is little disagreement that moving healthcare reimbursement from fee-for-service reimbursement to a model based on quality and outcomes is the right thing to do. This is true for patients, for the industry, and for the economy.

Why would competition between physicians lead to more antibiotic prescriptions?

Eili Klein and Ramanan Laxminarayan

Two million people become infected with antibiotic resistant bacteria each year, leading to at least 23,000 deaths. And these infections cost a lot: $20 billion in extra healthcare costs each year.

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