Payers

Health plan accounting data are used to test how well the CMSHCC risk adjustment system tracks relative costs of treating various diagnoses: not very well.

Three approaches to prospective patient identification for care management programs were compared: predictive modeling, selection by primary care physician, and a combination of both.

India's emerging health insurance sector faces significant operational challenges that managed care models can help to address.

A coinsurance rate decrease can result in increased adherence to oral antihyperglycemic agents and improved clinical outcomes and cost savings for the healthcare system.