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Managed Care October 2004 John Carroll	DM Industry Jumps for Joy Over Medicare's Leap of Faith The Center for Medicare and Medicaid Services has implemented 10 pilot programs that may very well be viewed as a make-or-break test for disease management.
Managed Care September 2004 John Carroll	Pfizer: DM Did Not Fizzle In Florida Medicaid Ruckus Medicaid officials close the books on a program the pharmaceutical giant contends that soon-to-be-released data will verify its disease management program's effectiveness.
Managed Care March 2005	'This Country Cannot Continue With the System We Now Have' As a vice president of Pfizer Health Solutions, a major disease management company, John Sory knows how difficult it is to bring systematic care to the chronically ill. He discusses Pfizer's work with Florida's Medicaid program.
Managed Care April 2005 John Carroll	Can Managed Care Programs Rein in Medicaid's Runaway Budgets? Cadillac or Yugo care for the poor? Fee-for-service or managed care? The states have a lot on their minds as the Medicaid monster grows and grows.
Managed Care August 2005 Maureen Glabman	12 DM Trends You Should Know About The government joins health plans, providers, employers, and pharmaceutical companies in seeking to establish disease management's value
Managed Care November 2000 John Carroll	Health Plans Demand Proof That DM Saves Them Money Can disease management vendors really show a strong return on a health plan's investment, or are the data just too malleable to be useful?
Managed Care June 2002 John Carroll	DM and Medicare: A Marriage Made in Heaven? With a budget of about $230 billion for 40 million patients, many with chronic ailments, is it any wonder that disease management and Medicare are courting?
Managed Care September 2000 John Carroll	Mergers, Acquisitions Afoot In Disease Management Industry Within a few years, there may be only 30 DM companies left, says one expert. HMO customers want vendors to handle more than one condition...
Managed Care July 2004 Martin Sipkoff	Managed Medicaid Business Might Be Worth the Difficulties Financial, regulatory, and access problems continue. Still, this remains a growth industry and some have found a way to profit.
Managed Care June 2003 Alison Johnson	Measuring DM's Net Effect Is Harder Than You Might Think Disease management is God's gift to managed care. Or is it? Here is a discussion of areas that make evaluating a DM program a complex, if not ineffable, proposition.
Managed Care September 2005 John Carroll	DM Industry Confident It Can Hit Medicare Goals Though there are challenges to serving the elderly, the movers and shakers of disease management say that they should be able to cut costs in pilot populations by 5%.
Managed Care October 2001 Bob Carlson	Trying To Get Control of Drug Costs, Florida Earns Kudos -- and a Lawsuit Pharmaceutical Research and Manufacturers of America (PhRMA) filed suit against Florida's Agency for Health Care Administration, challenging a new Medicaid formulary that requires manufacturers to pay supplemental rebates to have their drugs included...
Managed Care April 2006 Maureen Glabman	'Take My Word for It': The Enduring Dispute Over Measuring DM's Economic Value While disease management is now mainstream, it can still be difficult to judge a program's worth. Health plans faced with renewing these contracts have a lot to think about.
Managed Care August 2000 Carey Lee Straetz	Managing Medicaid Rolls Often State-by-State Affair Despite the strong economy, Medicaid enrollment may be slowly rising after a three-year decline. The challenges for serving this population are huge.
Managed Care December 2001	Disease Management Outsourcing As DM shifts its focus to outcomes-based care, the EVP of American Healthways suggests that larger health plans consider outsourcing care of chronic patients.
Managed Care July 2006	Education Concerns Push Back Florida's Medicaid Experiment The greatly anticipated meeting between Medicaid and managed care that's expected to take place in Florida has been delayed.
Managed Care September 1999 Frank Diamond Senior Editor	Florida Medicaid Moves Toward Direct Contracting Florida will soon test a program that could provide competition for HMOs serving the Medicaid population. Other states are watching.
Managed Care December 2004 John Carroll	Pfizer Touts Medicaid Data In Arguing That DM Works The pharmaceutical giant Pfizer says that its disease management program saved Florida $42 million, but a state watchdog group remains unconvinced.
Managed Care February 2006	Managed Care Offered to More Medicaid Enrollees A chart illustrates the percentage of medicaid enrollees in managed care, for the years 1996 to 2004.
BusinessWeek February 21, 2005 Howard Gleckman	The New Face Of Medicaid Seniors and the disabled are pushing the program to the breaking point.
Managed Care November 2004 Frank Diamond	DM's Cost-Effectiveness Doubted in CBO Report Congress's financial review agency says that not enough evidence exists to prove that disease management saves money. Many beg to differ.
Managed Care March 2002 John Carroll	DM Vendors Start To Address Costs Created by Comorbidities Some vendors are moving from offering just a few programs to embracing systems that try to deal with all the complicated overlaps...
Managed Care September 2005	New Research Throws Doubt On DM's Cost-Effectiveness Health plans and other providers of disease management services might do better to emphasize the pursuit of better outcomes, rather than guaranteed savings, a new study implies.
Managed Care September 2005	There's Now a Correct Method For Defining ROI in Disease Management Health care consultant Al Lewis, the godfather of disease management, talks about how the industry went wrong, and is now going right, in describing its own value to health plans, public employers, and the government.
Managed Care January 2001 Bob Carlson	Ohio Struggles To Rescue Managed Medicaid Program Health plans and providers in Ohio's beleaguered Medicaid managed care program, OhioCare, welcomed its per-member, per-month payment increases of more than 25 percent over the last two years...
HBS Working Knowledge July 14, 2006 Regina E. Herzlinger	The Case for Consumer-Driven Medicaid The Medicaid program is a health insurance safety net for 52 million Americans, but the price tag threatens the financial stability of the states. South Carolina provides a model in consumer-driven healthcare.
BusinessWeek February 21, 2005	Mooching Off Medicaid The state-run medical-care programs originally designed to help poor mothers and their children now increasingly pay for nursing-home care for seniors. While many of those seniors are genuinely poor, others are not. The rules should be tightened.
Managed Care March 2004	More State Medicaid Programs Use Preferred Drug Lists To Manage Costs Medicaid, enacted in 1965, is currently costing over $200 billion per year. With rapidly rising health care costs, including prescription drugs, state Medicaid budgets are feeling the strain. Here's what they're trying to do to manage.
Managed Care February 2004 John Carroll	DM Standards Off and Crawling When American Healthways posted a collaborative methodology on its Web site, not everyone in the industry applauded.
Managed Care July 2002	Despite Deficits, States Avoid Cutting Medicaid, CHIP Rolls Although states are straining to close budget deficits, they have refrained from introducing stringent eligibility requirements for the CHIP and Medicaid programs.
Salon.com October 21, 1999 Dena Bunis	Uninsured children A new report says there are still too many kids without health coverage.
Managed Care November 1999 Arthur L. Baldwin III	Financial and Risk Considerations for Successful Disease Management Programs Results for disease management programs have not been as positive as hoped because of clinical issues, lack of access to capital, and administrative issues....
Commercial Investment Real Estate Sep/Oct 2009 Andrew Dick	Understanding Federal Healthcare Laws Commercial real estate professionals who work with medical office development must be aware of the federal healthcare fraud and abuse laws.
Managed Care July 2000	NCQA To Accredit DM Programs, HEDIS Software The National Committee for Quality Assurance will soon offer its blessing to disease management programs. NCQA is developing a DM certification program intended to recognize regimens that effectively manage chronic illnesses. The program will go live next year.
Managed Care May 2001 John Carroll	Two Accrediting Organizations Prepare To Issue DM Standards It's probable that one will become the dominant judge: NCQA or URAC. After it happens, will vendors undergo less scrutiny by individual plans?
BusinessWeek August 8, 2005 Howard Gleckman	Radical Surgery For Medicaid? South Carolina Governor Sanford has a plan to slash costs - but a political battle looms.
Managed Care November 2005 John A. Marcille	Florida's Medicaid Waiver Will Be Scrutinized Closely Health and Human Services Secretary Michael Leavitt approved a Medicaid waiver application that will shift 210,000 beneficiaries in Broward and Duval counties into managed care beginning in July 2006.
Managed Care August 2001 Bob Carlson	States' Role as Policy Labs Tested as Resources Tighten State health-policy types point out that the State Children's Health Insurance Program (CHIP), the Health Insurance Portability and Accountability Act, the Patients' Bill of Rights and other federal initiatives came into existence only after states did the heavy lifting...
Managed Care April 2004	Medicaid DM To Get Boost From CMS The federal government plans to give Medicaid disease management a lift by matching the money states pay to run such programs.
American Family Physician February 15, 2003	Newsletter House Bill May Reclaim Title VII Family Practice Training Funds... Health Care Spending in the United States Increased by 8.7 Percent in 2001... Two Surveys Demonstrate Negative Economic Impact of Medicaid Reductions... AHRQ Releases Fact Book on Women's Health Care in U.S. Hospitals... FDA Establishes Task Force on Consumer Nutrition Health Information...
Financial Planning February 1, 2006 Marie F. Smith	AARP's Blueprint Americans can -- and should -- pull together to create a secure future for its citizens. To suggest that an older America will precipitate a crisis overstates the problem and fails to consider some major mitigating factors.
Managed Care May 2004 John Carroll	Bush vs. Kerry: Upcoming Election Offers Real Debate on Health Care Despite the focus on the international situation, Americans are still keenly interested in just how they'll get the medical care they need.
Managed Care October 2001	CMS Defends Plan To Let States Tailor Medicaid Benefits Centers for Medicare and Medicaid Services Administrator Thomas Scully has defended the Bush administration's plan to allow states to opt out of mandatory Medicaid-coverage requirements...
Registered Rep. September 18, 2013 Kevin McKinley	Having Money and Getting Medicaid Clients who want to have both their money and Medicaid may want to purchase a specific type of long-term care insurance known as a "partnership" policy, currently available to residents in 31 states.
Managed Care November 2002 John Carroll	Drug Companies Crying Foul Over Medicaid's Formulary Push With states' preferred drug lists spreading like a prairie wildfire, the manufacturers have mounted a furious legislative counterattack, funding grass roots campaigns aimed at fanning the opposition in state legislatures even as they wage a legal war in state and federal courts.
Managed Care May 2006 Martin Sipkoff	Health Plans Are Ill-Prepared for Looming Diabetes Epidemic The problem is outpacing insurers' resources and perhaps even their commitment. Can the chronic care model help?
Financial Advisor November 2005 Gail Liberman	Annuities May Cause Problems With Medicaid Medicaid, the state and federally funded public assistance program, might be off the radar screen for financial advisors selling annuities to senior clients for retirement planning, but it shouldn't be.
Reason February 2009 Ronald Bailey	E.R. Crowding A study blames a rising population, a falling number of emergency departments, and understaffing that prevents stabilized patients from being admitted to other parts of the hospital.
BusinessWeek July 14, 2003 Robert J. Barro	Medicare: Forget the Drug Benefit, and Face Up to Real Reforms Washington seems poised to make a major error on Medicare. The program's costs are out of control, and the situation will deteriorate further as the population ages. We should be considering basic changes to the structure of the health-care market.
Managed Care February 2005 John Carroll	Just What Can We Expect From New Head of HHS? How much will plans have to "be like Mike" -- Leavitt, that is. The influence of the secretary of health and human services reaches beyond the public sector.