Drugs are killing us, literally and financially. The Centers for Disease Control (CDC) reports that “opioids (including prescriptions opioids and heroin) killed more than 33,000 people in 2015, more than any year on record. Nearly half of all opioid overdose deaths involve a prescription opioid.”[1] Abuse of tobacco, alcohol and illicit drugs costs our country […]
Read More »
As healthcare organizations continue to transition to value-based care, provider relationships with patients and payers alike will be affected. Value-based care, at its very core, redefines old methodologies and relies on evidence-based outcomes, which is good news for all parties involved. Historically contentious relationships between providers and payers have an opportunity to improve as both […]
Read More »
A Minnesota District Court judge’s ruling “has huge implications for wrongful denial of coverage cases,” and may have long standing implications for the external review industry.[1] The case of James Linn et al. v. BCBSM, Inc., addressed a plaintiff seeking damages against a health plan for its initial refusal to pay for proton-beam radiation therapy […]
Read More »
Genomics and Utilization Management Genetic testing has revolutionized healthcare by providing clinicians with the tools necessary to predict disease. Sequencing and mapping DNA and other bioinformatics brings huge potential to medicine. Cancer, for example, can be hereditary. Knowing one’s predisposition to cancer could mean the difference between life and death. In the case of Li-Fraumeni […]
Read More »
Should an Independent Reviewer’s Identity be Disclosed? Mention reviewer anonymity and you’ll uncover strong opinions for and against the practice. It’s hard to find a middle ground on the matter of whether to reveal an independent reviewer’s identity. And even though the Centers for Medicare and Medicaid Services (CMS) do not permit insurers to “provide […]
Read More »