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Health Reform

Family Doctor Visit Costs

November 25, 2015 by Matthew Taber

American healthcare is in crisis. Family doctor visit costs are rising. Primary care practices are incurring heavy levels of non-collectable debt, and the percentage is climbing every year.[read more]

United pulls out of ACA exchanges: Should we care?

November 24, 2015 by David E Williams

Recently, we’ve heard what could be interpreted as bad news about the viability of exchanges: UnitedHealth is considering withdrawing. In the highly politicized world of health reform, that information has Obamacare foes sounding the death knell. But I see things differently.[read more]

Head of the DOJ's Antitrust Division Raises Concerns About Two Proposed Mega-Mergers Between Leading Health Insurers

November 20, 2015 by Katie Brant

The anticipated mergers between four leading health insurers, namely, Aetna Inc. and Humana Inc., and Anthem Inc. and Cigna Corp., are causing quite a stir among the American Medical Association (AMA) and antitrust enforcers. They view these mergers as being detrimental to competition and a possible violation of antitrust laws and principles.[read more]

4 Healthcare Trends Set into Motion by the ACA

November 18, 2015 by Moira O'Connell

2015 marks the Affordable Care Act's 5th anniversary. Five years later, the ACA has sparked change in the healthcare ecosystem and is continuing to churn the wheel of change. But what changes should healthcare organizations expect for the future?[read more]


Five Factors Improving the State of Mental Health Care

November 17, 2015 by Cynthia Telles

Mental illness is a pervasive issue that harshly stigmatizes the millions of Americans who struggle with it every day. However, there are five key drivers of change that are improving or promise to improve the state of mental health care delivery, across the country:[read more]

HIPAA Basics For Licensed Health Care Professionals: Privacy, Security, and Breach Notification Rules

November 16, 2015 by Katie Brant

The Department of Health and Human Services (HHS) recently issued a HIPAA fact sheet for health care professionals and organizations. We could all use a little refresher from time-to-time.[read more]

5 Key Elements of the Peer Review Process

November 13, 2015 by Moira O'Connell

Lately we have been talking about the importance of Independent Review Organizations (IROs) and peer reviews in the healthcare ecosystem. Today we continue this discussion and delve deep into the importance of the peer review process. So let’s take a look at the 5 core building blocks of the peer review process.[read more]

How Powerful Patients Save the System Money

November 11, 2015 by Andrew Schorr

I recognize that keeping healthcare costs down takes a lot more than just patients being stronger, more knowledgeable self-advocates. But it should not be overlooked.[read more]

Florida Board of Medicine Declares Arizona Homeopathic Doctor "Very, Very Dangerous"

October 26, 2015 by Katie Brant

A doctor practicing homeopathic medicine was accused of administering a lethal dose of an unapproved drug to a toddler in Arizona.[read more]

Making The Decision To Outsource And Choosing The Right IRO Partner

October 19, 2015 by Josh Nelson

Outsourcing first-level physician review has become essential as health plans continue to face increased pressure to handle larger volumes while controlling cost. When making the decision to outsource, health plan executives must weigh both the advantages and disadvantages of moving their medical reviews to an external partner. Let’s...[read more]

Why Medical Device Regulatory Compliance is a Business Decision

October 19, 2015 by Nealda Yusof

The US Food and Drug Administration recently looked into complaints about a permanent birth control device called Essure. A medical team from Weill Cornell Medicine in New York reported a 10-fold higher occurrence of repeat operation during the first year of implantation. In Europe, the PIP breast implant remains an indelible scandal....[read more]

Bad Blood: Orthopedic Surgeons vs. Hospitals

October 15, 2015 by James Dias

If you have a radio, you’ve probably heard Taylor Swift’s most recent number one hit, “Bad Blood.” Swift was probably not talking about a workplace feud, but the song got me thinking about the ongoing conflict between hospitals and physicians.“Now we’ve got problems, and I don’t think we can solve them…”In running, I...[read more]