Blog

March 13th, 2017

Drugs are killing us, literally and financially. The Centers for Disease Control (CDC) reports that “opioids (including prescriptions opioids and heroin) killed more than 33,000 people in 2015, more than any year on record. Nearly half of all opioid overdose deaths involve a prescription opioid.”[1] Abuse of tobacco, alcohol and illicit drugs costs our country […]

addiction
CDC
death
mental health
MHPAEA
NIDA
opioid
parity
Patrick Kennedy
substance abuse
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March 6th, 2017

As healthcare organizations continue to transition to value-based care, provider relationships with patients and payers alike will be affected. Value-based care, at its very core, redefines old methodologies and relies on evidence-based outcomes, which is good news for all parties involved. Historically contentious relationships between providers and payers have an opportunity to improve as both […]

evidence-based medicine
McKesson
UM
utilization management
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February 27th, 2017

A Minnesota District Court judge’s ruling “has huge implications for wrongful denial of coverage cases,” and may have long standing implications for the external review industry.[1] The case of James Linn et al. v. BCBSM, Inc., addressed a plaintiff seeking damages against a health plan for its initial refusal to pay for proton-beam radiation therapy […]

adverse determination
cancer
court
ER
experimental treatment
external review
lawsuit
litigation
MAXIMUS
medical necessity
Minnesota
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February 17th, 2017

Genomics and Utilization Management Genetic testing has revolutionized healthcare by providing clinicians with the tools necessary to predict disease.  Sequencing and mapping DNA and other bioinformatics brings huge potential to medicine. Cancer, for example, can be hereditary. Knowing one’s predisposition to cancer could mean the difference between life and death. In the case of Li-Fraumeni […]

cancer
genomics
hereditary
personalized medicine
UM
utilization management
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February 6th, 2017

Should an Independent Reviewer’s Identity be Disclosed? Mention reviewer anonymity and you’ll uncover strong opinions for and against the practice. It’s hard to find a middle ground on the matter of whether to reveal an independent reviewer’s identity. And even though the Centers for Medicare and Medicaid Services (CMS) do not permit insurers to “provide […]

anonymity
ER
external review
independent review organization
IRO
reviewer
transparency
UM
utilization management
utilization review
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