Mari Edlin
Mari Edlin is a frequent contributor to Managed Healthcare Executive. She is based in Sonoma, California.
New payment models keep doctors focused on providing best care
There seems to be a growing consensus among healthcare stakeholders that despite new reforms, something still has to give in the way care is delivered. Episode-based payment may be a viable solution. It is an intermediate step between fee-for-service, which historically leads to overuse or underuse of services depending on reimbursement, and capitalization, which moves all the risk to the provider.
Don't pass up savings opportunities from OTC benefit programs
Adding over-the-counter products to the plan formularies is a simple way to save millions of dollars for payers.
Drugs are getting personal
As healthcare moves from a broader clinical mentality to more personalized, tailor medicine, pharmacogenomics is emerging as a best-practice therapy.
Medicare advisory board causing anxiety
The new Medicare Advisory Board will have broad responsibility to make recommendations to reduce spending in the Medicare program.
Alerts needed for adverse drug events
While awareness of the problem of drug safety has grown, the industry is still trying to make a dent in solving the problem.
Less than one-third of employers offer supplemental retiree benefits
Retirees can expect to shoulder more than half of the cost burden of health benefits—51% to 54%—according to Towers Watson's 2010 Retiree Health Care Cost Survey.
NPs and PAs extend the reach of PCPs
Physician assistants (PAs) and nurse practitioners (NPs) could solve the shortage of primary care physicians and the rising cost of healthcare.
Savings from biosimilars won't compare to today's generics
Generic drugs have certainly made their mark, but don't count on the same savings in the specialty market.
Calfornia HMOs must provide care within 10 days under new law
Timely access to treatment for HMO patients in California has been a long time in coming as HMOs, physicians, hospitals, and consumer groups battled it out.
Plans tread lightly when sharing utilization criteria online
There are pros and cons of posting UM criteria online. Information can be helpful, but it can also open up a can of worms.

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