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Innovation to Manage Specialty Populations
There is a lot of innovation in the US healthcare industry concerning ways to manage the care for specialty populations, but there still needs to be a way to regulate these innovative models. Matt Salo pointed out that for so long the financial incentives have not been there to get people healthy and keep them there, and meanwhile only a small part of the population accounts for half of the total costs.
“That’s the Holy Grail,” Salo said. “If we can figure out how to improve the care and bring the cost down for that group, then we’ll have figured all this out.”
Unfortunately, with all the emerging models out there, data is not being shared across boundaries and entities are caring for part of a person instead of the whole person, said Margaret E. O’Kane.
“I think the challenge is catching up with [current innovation], assessing it in a hard-nosed way, and really being able to make comparisons,” O’Kane said. “Part of the problem with a proliferation of innovation is that everybody’s doing something different and they’re all measuring it in a different way.”
ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Contributor: For Complex Cases, Continuity in Acute Care Is Necessary
April 23rd 2025For patients with complex needs and social challenges like unstable housing, the hospital has become their de facto medical home—yet each visit is a fragmented restart, without continuity, context, or a clear path forward.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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