GLG News by Managed Care Experts

     The apparent abandonment of American Healthways DM by CMS is a big deal.  DM is one of the very few promising techniques available to curve costs, and yes, even improve wellness by preventing onset of disease attack.  The premise of limiting "admissions" is what...

The large employers have begun to coalesce around the notion that changes in the health care system may need to come from them.  This may ultimately drive the reform needed to correct the inefficiencies inappropriate utilization issues in the current system. It also points to the recognition...

Medicare has announced the end of the Medicare Health Support Phase I pilots.  None of the pilots to date has met requirements for cost or clinical improvements. Phase II was not discussed. Can the current DM model of a highly telephonic approach demonstrate improvements and continue to sell?

The status quo will be maintained during the election year.  But, what will happen to the funding for physicians and hospitals after the election?   Healthcare and defense are the two largest components of the Federal budget.  Congress will likely act to gain budget reductions in both...

Increased FDA warnings on ESAs, suchas Epogen, Procrit and Aranesp will provide payers the ability to further restrict these agents.   Restrictions will come in the form of prior authorizations and other utilization management techniques.

1. A system that pays solely fee for service encourages overutilization. 2. A system that pays solely capitation encourages underutilization. 3. A system that gives incentives for certain kinds of behavior encourages that behavior. 4. Medicine is more art than science. No one knows if encouaraging certain...

While Wellcare has rebounded somewhat since it's critical fall following the FBI raid, there is still the likelihood of serious repercussions.  Should the WSJ story be true, the problems go to the top. The Board may be preparing to admit to serious problems and through this action demonstrate to...

Somebody really smart once said, "Sleep, riches and health to be truly enjoyed must be interrupted."  However flawed P4P, EBM, TQM, critical pathways, centers of excellence, and outcomes measurement are, they at least attempt to define QUALITY. The argument rages and usually ignores the most...

The uninsured are often not the risky market that one presumes, in addition, various states, counties and cities are proposing systems that compensate all of or a portion of the uninsured health care costs. This will be a growing market and early entrants will do well. 

    MiniMed aka Limited Medical aka Scheduled Medical Benefits are not new.  They derive from the disease specific plans of old.  The article suggests that the uninsured have been ignored which is incorrect.  Many major players have rushed this market niche to find...