Payers

Jeff Goldsmith, PhD, President, Health Futures, Inc, Associate Professor of Public Health Sciences, University of Virginia, says that the biggest barrier that accountable care organizations (ACOs) face is the lack of collaboration between physician communities and hospitals.

In "What Does the Affordable Care Act Actually Do?," presented by Ivor Douglas, MD, Associate Professor, University of Colorado Denver, Chief, Pulmonary Sciences and Critical Care Medicine Director, Medical Intensive Care, Denver Health Medical Center, at the ATS 2013 International Conference, Dr Douglas noted that fundamental issues driving the Affordable Care Act (ACA) include access, quality, and cost.

Scott Halpern, MD, PhD, discussed the Choosing Wisely campaign with his opening presentation on The History of and Rationale for the Choosing Wisely Campaign. As most healthcare providers know, healthcare spending per capita in the United States is significantly higher than most other countries.

Market Dynamics Change How Plans Manage Oral and Office-Administered Agents

The realities of the emerging healthcare marketplace are quickly being recognized. Layna Cook, with law firm, Baker, Donelson, Bearman, Caldwell & Berkowitz, PC, discussed these realities with her presentation, The Impact of Health Reform's State Exchanges.

This article outlines strategies insurers can use to mitigate their risks related to prescription opioid abuse by members, while addressing this serious public health problem.

Health plans are fundamentally transforming the delivery of healthcare for patients by reforming payment models, coordinating care, and partnering with providers.

Dr. Mark Fendrick, MD, Professor of Medicine and Health Management and Policy, Schools of Medicine and Public Health, University of Michigan, Co-Editor-in-Chief, The American Journal of Managed Care, says that there are levers organizations and stakeholders can pull to achieve the goal of improving quality and value in cancer care.

"Oncology is a very emotional area," says Jan Berger, MD, MJ, President & CEO, Health Intelligence Partners, Editor-in-Chief, The American Journal of Pharmacy Benefits.

In this video, Robert Bo Gamble, Director, Strategic Practice Initiatives, Community Oncology Alliance, Washington, DC, says that it is critical for payers and providers to come together in oncology management.

New revenue models in healthcare are causing innovative payer-provider partnerships. John Harris, MBA, spoke about some of these new partnerships and how all stakeholders must consider each other's mindsets when choosing a model that works for them.

Implementing an accountable care organization model can be a rigorous process. With so many stakeholders, it is necessary for all those involved in the process to collaborate and communicate effectively throughout the transition. For these reasons, it is essential for any organization to have the proper leadership in place to ensure a smooth implementation.

Michael E. Chernew, PhD; Lee N. Newcomer, MD, MHA; and Sandra M. Swain, MD; examine the treatment benefits, cost concerns, and insurance coverage strategies for pertuzumab.