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In This Issue


This edition of the Leading Edge begins with a look at telemedicine: is it at a “tipping point?” Then we look at Medicare Advantage, covering 1/3 of Medicare insureds. Next an update on the healthcare exchanges. MA and exchanges are both expanding use of narrow networks. A final feature updates population health initiatives. A host of specialty articles include coding and reimbursement updates and many other topics.

On a personal note, this is my last issue since as most know I’m retiring in October. But the LeadingEdge remains in good hands with Hannah and Mike. Enjoy!

–Bill Gilbert

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Telemedicine: At a Tipping Point?

Telemedicine has been around in one form or another for many years. But the convergence of technology and need (care coordination, medical services in rural areas, etc.) is now driving rapid expansion. Whether this continues to the point where telemedicine is mainstream will be determined by regulatory action and provider inertia.

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Medicare Advantage: Positioned to Expand Rapidly?

Despite debates over Medicare Advantage (MA) costs and benefits vs. traditional Medicare, MA continues to expand. It continues to be attractive for insurers and is increasingly attractive to provider-sponsored plans. MA is expected to exceed 40% of Medicare within a few years.

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Healthcare Exchanges Evolve with Narrow Networks

Narrow networks are steadily becoming the primary way for insurance companies to be profitable on the exchanges. These plans are half of all Marketplace offers in the first two years, and nearly 90% of consumers had the option of buying such a plan.

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Population Health: Slow but Steady Progress

Managing the health of diverse populations with often complex and disparate needs is no easy task. And though Population Health Management (PHM) may be a difficult challenge, the healthcare industry is starting to see early success stories.

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