Providers

To improve formulary design processes and support payers in providing more effective healthcare, policy makers should consider involving commercial payers in the development of comparative effectiveness research and creation of research and treatment guidelines.

Comparative effectiveness research and pragmatic clinical trials are valued methods to address the limitations of traditional randomized trials, answer questions of cost-effectiveness or noninferiority, and inform data-driven dialogue and decision making by stakeholders.

Journal of Oncology Practice (JOP) and The American Journal of Managed Care (AJMC) join efforts to highlight work focusing on issues affecting payers and providers.

Mr. Geraghty points out a variety of ways to engage a health plan's members.

In this segment, Dr. Farzad Mostashari highlights both the financial and non-financial challenges providers face when implementing electronic medical records.

Marcus D. Wilson, PharmD, President, HealthCore, states that there is variability within and between different organizations that utilize comparative effectiveness research.

Institution of paperless credentialing is analyzed on a pre-/post-implementation basis to understand the impact on business and productivity.

This study examines variation among health plans in resource use and quality of care for patients with diabetes mellitus or cardiovascular disease.

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.

Economic evaluations of adjuvant trastuzumab were reviewed. Three primary shortcomings were identified including incorporation of local data and estimation and representation (visual) of decision uncertainty.

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