Jill Sederstrom
Jill Sederstrom is a Contributing Editor
Expect Medicaid expansion to relieve some cost shifting
Reduction in uncompensated care benefits insurers
Hawaiian plan adopts shared-risk model
A large health insurer in Hawaii is taking an aggressive step away from the traditional fee-for-service delivery system.
Employers consider direct contracts, sidestepping traditional payers
More employers are interested in exploring direct contracting arrangements with providers, according to healthcare experts.
Pricing must move beyond context of existing market
Healthcare experts say a move away from the fee-for-service payment model can't happen too soon.
Mistakes to avoid in risk sharing
Private payers have the most experience with managing risk, but each stakeholder must achieve a perfect balance of risk and reward.
How to save Medicaid
In 2011, Medicaid financed care for 70 million people at a cost of $432 billion. Broader eligibility requirements are expected to bring another 16 million into the pool.
Consumers want more choices but are confused by plan options
New benefit summaries sure to ad administrative costs
Encourage lab testing to confront conditions early
According to experts, improving accessibility to laboratory tests and results improves patient engagement in their health and could have significant cost saving implications for managed care.
Plans make coverage decisions in light of PSA testing guideline
The U.S. Preventive Services Task Force (USPSTF) is no longer recommending the prostate-specific antigen (PSA) screening test for healthy men
Coverage policy for genetic tests should reflect clinical utility
Adding to the complexity is the emerging science of smart medicine, that is, the delivery of effective care based on personal attributes of the patient