Providers

With healthcare payers increasingly relying on narrow provider networks to contain costs and achieve quality, California regulators are pressing health plans to blunt out-of-network costs and maintain accurate provider directories.

A new pay-for-performance method would adjust payments in such a way that providers would not be discouraged from caring for disadvantaged patients, according to researchers at RAND.

Although more than 70% of physicians use electronic health records, up to half don't routinely receive the patient information needed to coordinate care effectively.

At Patient-Centered Diabetes Care, hear stakeholders across the whole ecosystem of healthcare delivery discuss solutions for diabetes with the patient always at the center of the discussion.

Although there is a clear link between nonadherence and outcomes of a patient with chronic myelogenous leukemia (CML), some patient intentionally stop taking their medication, said Giora Sharf, co-founder of the CML Advocates Network.

Providers and patient advocates nationwide are deeply worried about a US Supreme Court case that they say could restrict their ability across the country to seek judicial relief from low Medicaid reimbursement rates.

HHS has submitted a proposed rule for stage 3 of meaningful use for the Medicare and Medicaid EHR Incentive Programs, which includes changes to the reporting period, timelines, and structure of the program.

The quality-measurement enterprise in US healthcare is troubled. Measure developers are creating ever more measures, and payers are requiring their use in more settings and tying larger financial rewards or penalties to performance.

Nearly half of the patients who had access to electronic medical records withheld clinically sensitive information from some or all of their healthcare providers, according to a new study.

Although Virginia Gov Terry McAuliffe failed to pass a Medicaid expansion plan during his first year in office, the governor's health secretary has indicated that the fight will begin again.

The use of medical scribes hired to enter information into electronic health records (EHRs) has increased substantially, but can pose potential risks, according to a new article in JAMA.

To address the lack of standards in public reports of provider performance, the authors outline a model to ensure the integrity and transparency of reports.

The rule being published tomorrow not only grants same-sex spouses the right to act as medical decision-makers, but it also requires Medicare and Medicaid providers to inform patients of these rights.

As Medicaid enrollment grows under the program's expansion, there are not enough providers to serve the increased amounts of enrollees, according to a new report from the Office of the Inspector General that measured the availability of specific providers in Medicaid managed care networks.

Optimal use of pharmaceuticals is often overlooked for accountable care organizations (ACOs), but ensuring proper medication use, efficacy, and safety is critical to an ACO's success.

Rules issued today will help CMS keep fraudulent providers and suppliers away from Medicare, following a series of crackdowns in "hot spots" around the country.

Employers and employees are seeing eye-to-eye when it comes to integrated health benefits. Not only do employees see how an integrated plan can improve quality of care and health, but employers see how it makes good business sense.

The deadline for eligible hospitals and critical access hospitals to attest to meeting meaningful use requirements has been pushed back a full month, according to CMS.

Clinicians are showing increased openness toward using digital technology and are becoming more comfortable with trusting tools like at-home test results, according to a new report from PwC's Health Research Institute.

At its third annual conference, Patient-Centered Oncology Care 2014, The American Journal of Managed Care addressed new challenges in cancer care: more patients have coverage, but they may be "underinsured" or barred from academic centers. Amid rising drug costs and regulations that threaten community practices, the head of the largest oncology organization outlined a path toward value-based reimbursement.

Peter Yu, MD, president of the American Society of Clinical Oncology, (ASCO) discussed the organization's efforts throughout 2014 to reform reimbursement and take on issues of value and quality in cancer care during Patient-Centered Oncology Care, the annual gathering sponsored by The American Journal of Managed Care.

People in healthcare are learners by nature, which should be put to use when developing tactics to gain care delivery efficiencies, said Jordan Asher, MD, chief medical and chief integration officer at MissionPoint Health Partners.

Panelists discussed the price of pharmaceuticals and controlling the cost of care at the 64th Annual Roy A. Bowers Pharmaceutical Conference: A Measured Approach-Health Care Delivery and Transformation in a Metric Driven World, held by Rutgers University.

The categorization of lung allograft dysfunction is changing, David Nunley, MD, clinical director of lung transplant at the University of Louisville Health Care Outpatient Center, said at the 2014 CHEST meeting in Austin, Texas.

Fear is the biggest barrier preventing providers from using social media to its fullest potential, according to Christopher Carroll, MD, social media editor at CHEST and research director for the Division of Critical Care at the Connecticut Children's Medical Center.