e-CareManagement blog

Chronic Disease Management • Technology • Strategy • Issues and Trends

Aetna, Cigna, Wellpoint Recreating Their Business Models

Major U.S. health insurers, including Aetna Inc., Humana Inc. and WellPoint Inc., are retooling to become more than just health plans, in the wake of the federal health-care overhaul that is changing the rules for the industry’s core business. Diversification plans, touted in meetings with investors this year, include stepped up acquisitions and partnerships that […]

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BlogTalkRadio Interview — Is Hospital-Physician Alignment Sustainable?

Why have hospitals increasingly been buying physician practices?  Are these marriages based on true love or convenience? Will these marriages survive? To address these questions, let’s take the long view (50–100 years) and revisit 7 assumptions that have driven us to today’s healthcare non-system: Healthcare payment systems have rewarded piecemeal work. Despite uneasiness, hospital-physician relationships have been cooperative. Physicians […]

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Is Hospital-Physician Integration Sustainable?

Reprinted courtesy of MCOL. Perspectives on a Selected Key Topic |     April 2011/May 2011     |   Volume Three Issue Two Will a material number of hospitals and their core medical staffs, that are relatively independent, evolve into highly integrated delivery systems during this decade, and why? William J DeMarco MA, CMC President and CEO, Pendulum HealthCare […]

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List of Top 10 Health Plan Issues — Out of Whack!

Healthcare IT News just published its list of top issues for health plans in 2011: 1. Administrative Mandates (Compliance HIPAA 5010, ICD-10, etc.). 2. Care Management, Data Analytics, and Informatics. 3. Health Insurance Exchanges and Individual Markets. 4. New Provider Payment & Delivery Systems (ACOs, PCMHs, etc.). 5. Bend the Cost Trend. 6. Medicare and […]

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Tire Kickers Need Not Apply: 8 First Impressions of the Medicare ACO Rule

On March 31, CMS released the long-awaited “Medicare Shared Savings Program: Accountable Care Organizations” document (ACO Rule). Read the details here (strong suggestion: unless you’re working on your PhD in ACOs, start with the fact sheets). There are many surprises. Here are eight first impressions on this 429 page tome: The bar has been set […]

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Health Plan Strategy Options in Two Sentences

  “If you’re a health plan, you either become a care delivery system or an information services company,” said David Brailer, a former George W. Bush administration health official who now leads an investment firm. “The traditional business is dead.”   Read more at Kaiser Health News. . Tags: health plan, strategy

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Is Economic Credentialing A Tool for Primary Care to Lead ACOs?

Is economic credentialing — the use of economic factors such as loyalty and utilization rates in the physician credentialing process — a potential tool for primary care physicians to lead ACOs?   and reestablish the vitality of primary care in American health care? Keith Wright and Gregory Drutchas’ incisive article Economic Credentialing: A Prescription To Secure Shared […]

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Complimentary Webinar — An Impending Marriage: Electronic Health Records (EHRs) and Care Management Software

Webinar Title: An Impending Marriage: Electronic Health Records (EHRs) and Care Management Software The presentation will be geared at practicing clinical case managers in health plans, hospitals, disease management companies, and similar organizations: Describe market forces driving integration of EHRs and care management software.  Review care management software survey data and stimulus funding for EHR adoption.  […]

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Care Coordination Metrics: One Can of Worms that NEEDS to be Opened

“Track who is on a care team — and share info with the patient.” That’s just one of the summary recommendations coming from expert testimony given in a recent public hearing on how to improve care coordination through the use of health information technology. The Meaningful Use workgroup and Quality Measures workgroups are now wrestling with how to translate this […]

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