Payers

Dr. Richard Rainey, Executive Medical Director at Regence Blue Shield in Idaho, talks about some of the factors that go into coverage decisions as they relate to genetic testing.

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

Aaron S. Kesselheim, MD, JD, MPH, Assistant Professor of Medicine, Harvard Medical School; Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, explains that academic detailing is the best way to deliver evidence-based information to various parties.

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.