BS86_chart1.gif' alt='Favorable Selection Risk Adjustment And The Medicare Advantage Program' title='Favorable Selection Risk Adjustment And The Medicare Advantage Program' />Competitive Markets in Health Care The Next Revolution1 Meghan Mc. Carthy, 6,4. 00 Question, National Journalhttp nationaljournal. July 2. 4, 2. 01. August 2. 4, 2. 01. Kenneth J. Arrow. Uncertainty and the Welfare Economics of Medical Care, American Economic Review, Vol. No. 5 December 1. For a brief discussion of some of the academic literature on competition in health care, see Kevin Dayaratna, Medicare Reform Debate What Really Works in Health Care Competition, The Heritage Foundation, The Foundry, September 1. For a comprehensive review of the extensive academic literature on competition in health care, see Martin Gaynor and Robert Town, Competition in Health Care Markets, in Mark V. Pauly, Thomas G. Mc. Guire, and Pedro Pita Barros, eds., Handbook of Health Economics, Vol. OFRUpload_OFRData_2013-28610_PI.png' alt='Favorable Selection Risk Adjustment And The Medicare Advantage Program' title='Favorable Selection Risk Adjustment And The Medicare Advantage Program' />Please note that once you make your selection, it will apply to all future visits to NASDAQ. If, at any time, you are interested in reverting to our default. Read the latest Cardiology news, opinion, conference coverage, thought leader perspectives, medical journal articles and more from theheart. Medscape. CROI Impressions from CROI Pablo Tebas, MD University of Pennsylvania. Genital Inflammation HIV Acqusition Associated in Women. STIs also. Oxford, U. K. North Holland, 2. Joseph P. Newhouse, Free for AllThe Prostate Cancer PCa Guidelines Panel have prepared this guidelines document to assist medical professionals in the evidencebased management of PCa. Lessons from the RAND Health Insurance Experiment Cambridge, MA Harvard University Press, 1. Jonathan Skinner and Elliott S. Fisher, Reflections on Geographic Variations in U. S. Health Care, The Dartmouth Institute for Health Policy Clinical Practice, updated May 1. SkinnerFisherDA0. Stealth Euthanasia Health Care Tyranny in America Hospice, Palliative Care and Health Care Reform. Favorable Selection Risk Adjustment And The Medicare Advantage Program' title='Favorable Selection Risk Adjustment And The Medicare Advantage Program' />August 7, 2. Mc. CarranFerguson Act, 1. U. S. Code 1. 01. David Boaz, Cato Handbook on Policy,7th ed. Washington, DC Cato Institute, 2. Michael D. Tanner, Bad Medicine A Guide to the Real Costs and Consequences of the New Health Care Law, Cato Institute, 2. September 1. 4, 2. Stephen T. Parente et al., Consumer Response to a National Marketplace for Individual Insurance, Journal of Risk and Insurance, Vol. No. 2 June 2. 01. Goutam Chakraborty, Richard Ettenson, and Gary Gaeth, How Consumers Choose Health Insurance, Journal of Health Care Marketing, Vol. No. 1 Spring 1. 99. Adam Atherly, Bryan E. Dowd, and Roger Feldman, The Effects of Benefits, Premiums, and Health Risk on Health Plan Choice in the Medicare Program, University of Minnesota, Division of Health Services Research and Policy, 2. Jean Marie Abraham and Roger Feldman, Taking Up or Turning Down New Estimates of Household Demand for Employer Sponsored Health Insurance, Inquiry, Vol. No. 1 Spring 2. 01. Austin B. Frakt and Steven D. Pizer, Beneficiary Price Sensitivity in the Medicare Prescription Drug Plan Market, Health Economics, Vol. No. 1 January 2. Anne Beeson Royalty and Neil Solomon, Health Plan Choice Price Elasticities in a Managed Competition Setting, Journal of Human Resources, Vol. No. 1 Winter 1. 99. Bruce A. Strombom, Thomas Buchmueller, and Paul J. Feldstein, Switching Costs, Price Sensitivity and Health Plan Choice, Journal of Health Economics, Vol. No. 1 January 2. Thomas Buchmueller and Paul Feldstein, The Effect of Price on Switching Among Health Plans, Journal of Health Economics, Vol. No. 2 April 1. 99. Jonathan D. Ketcham et al., Sinking, Swimming, or Learning to Swim in Medicare Part D, American Economic Review, Vol. No. 6 October 2. Katherine M. Harris, Can High Quality Overcome Consumer Resistance to Restricted Provider Access Evidence from a Health Plan Choice Experiment, Health Services Research, Vol. No. 3 June 2. 00. Gerard J. Wedig and Ming Tai Seale, The Effect of Report Cards on Consumer Choice in the Health Insurance Market, Journal of Health Economics, Vol. No. 6 November 2. Vijay Bhangale, Marketing of Health Care Services in India A Study on Factors Influencing Patients Decision Making on Choice of a Hospital, Journal of Management and Marketing In Health Care, Vol. No. 4 November 2. Joseph Boscarino and Steven R. Steiber, Hospital Shopping and Consumer Choice, Journal of Health Care Marketing, Vol. No. 2 Spring 1. 98. Harold S. Luft et al., Does Quality Influence Choice of Hospital JAMA, Vol. No. 2. 1 June 6, 1. Health Grades, http www. August 9, 2. 01. 2, and Vitals, http www. August 9, 2. 01. 2. Medicare Prescription Drug, Improvement, and Modernization Act, Public Law 1. Paul Fronstin, Findings from the 2. EBRIMGA Consumer Engagement in Health Care Survey, Employee Benefit Research Institute Issue Brief No. December 2. 01. 2, http www. EBRIIB1. 2 2. 01. No. 37. 9CEHCS2. April 1. Greg Scandlen, EBRIs Consumer Engagement Survey, National Center for Policy Analysis, http healthblog. January 2. 3, 2. 01. Stuart Butler, Are Health Costs Really Slowing newsJAMA, January 1. February 1. 8, 2. Melinda Beeuwkes Buntin et al., Consumer Directed Health Care Early Evidence About Effects on Cost and Quality, Health Affairs, Vol. No. 6 November 2. April 1. 7, 2. 01. Anthony T. Lo Sasso et al., Tales from the New Frontier Pioneers Experiences with Consumer Driven Health Care, Health Services Research, Vol. No. 4, part 2 August 2. Gail R. Wilensky, Consumer Driven Health Plans Early Evidence and Potential Impact on Hospitals, Health Affairs, Vol. No. 1 2. 00. 6, pp. April 1. 7, 2. 01. Cory Gusland et al., Consumer Driven Health Plan Effectiveness Case Study State of Indiana, Mercer, May 2. CDHPcasestudy. pdf accessed August 1, 2. Kathryn Nix and Alyene Segner, The Promise of Consumer Directed Health Plans Studies Show Success at Reducing Costs and Maintaining Quality, Heritage Foundation Center for Policy Innovation Research Summary No. July 9, 2. 01. 2, http www. Dennis L. Kodner, Consumer Directed Services Lessons and Implications for Integrated Systems of Care, International Journal of Integrated Care, Vol. AprilJune 2. 00. April 1. J. Frank Wharam et al., Emergency Department Use and Subsequent Hospitalizations Among Members of a High Deductible Health Plan, JAMA, Vol. No. 1. 0 March 1. Adam Atherly, Bryan E Dowd, and Roger Feldman, The Effects of Benefits, Premiums, and Health Risk on Health Plan Choice in the Medicare Program, Health Services Research, Vol. No. 4, part 1 August 2. PMC1. 36. 10. 41 accessed April 1. Roger Feldman et al., Health Savings Accounts Early Estimates of National Take Up, Health Affairs, Vol. No. 6 NovemberDecember 2. April 1. 7, 2. 01. Stephen T. Parente, Roger Feldman, and Song Chen, Effects of a Consumer Driven Health Plan on Pharmaceutical Spending and Utilization, Health Services Research, Vol. No. 5, part 1 October 2. PMC2. 65. 38. 78 accessed April 1. Kavita V. Nair, Vahram Ghushchyan, and Joseph J. Saseen, Consumer Driven Health Plans Their Impact on Medical Utilization, Pharmacy Utilization, and Expenditures, Journal of Health Care Finance, Vol. No. 1 2. 00. 8, pp. Jessica Greene, Using Consumer Incentives to Increase Well Child Visits Among Low Income Children, Medical Care Research and Review, Vol. No. 5 October 2. Amelia M. Haviland et al., Growth of Consumer Directed Health Plans to One Half of All Employer Sponsored Insurance Could Save 5. Billion Annually, Health Affairs, Vol. No. 5 May 2. 01. Anthony T. Lo Sasso, Mona Shah, and Bianca K. Frogner, Health Savings Accounts and Health Care Spending, Health Services Research, Vol. No. 4 August 2. 01. M. Beeuwkes Buntin et al., Healthcare Spending and Preventive Care in High Deductible and Consumer Directed Health Plans, American Journal of Managed Care, Vol. No. 3 March 2. 01. Bijan J. Borah, Marguerite E. Burns, and Nilay D. Shah, Assessing the Impact of High Deductible Health Plans on Health Care Utilization and Cost A Changes in Changes Approach, Health Economics, Vol. No. 9 September 2. Tumor Markers. Number 0. Policy. Aetna considers any of the following serum tumor markers for the stated indication medically necessary Prostate specific antigen PSA for prostate cancer screening see CPB 0. Prostate Cancer Screening, staging, monitoring response to therapy, and detecting disease recurrence. Carcinoembryonic antigen CEA for any off the following As a preoperative prognostic indicator in members with known colorectal carcinoma or mucinous appendiceal carcinoma when it will assist in staging and surgical treatment planning or Pancreatic cyst fluid CEA for distinguishing mucinous from non mucinous malignant pancreatic cysts or. To detect asymptomatic recurrence of colorectal cancer after surgical andor medical treatment for the diagnosis of colorectal cancer not as a screening test for colorectal cancer or. To monitor response to treatment for metastatic colorectal cancer. Oregon Trail 5Th Edition Crack on this page. CEA for cholangiocarcinoma, gallbladder cancer, lung cancer, medullary thyroid cancer, metastatic breast cancer, mucinous ovarian cancer, and occult primary. CEA for evaluation of jaundice, abnormal liver function tests LFTs or for obstructionabnormality on liver imaging. HIAA for neuroendocrine tumors. ALK gene fusion as a molecular biomarker in non small cell lung cancer. ALK gene rearrangement for diffuse large B cell lymphoma, peripheral T cell lymphoma, and post transplant lymphoproliferative disorder. ALK translocations for selecting candidates for crizotinib Xalkori in inflammatory myofibroblastic tumor. APC for familial adenomatous polyposis when criteria are met in CPB 0. Genetic Testing and for desmoid fibromatosis experimental for other indications. Afirma Thyroid FNA analysis for assessing fine needle aspiration samples from thyroid nodules that are indeterminate experimental for other indications. Repeat testing is considered experimental and investigational. Alpha fetoprotein AFP for the following indications hepatocellular carcinoma mediastinal mass ovarian cancer pelvic mass testicular cancer testicular mass thymic carcinoma and thymoma. Alfa fetoprotein AFP for testing for hepatocellular carcinoma in hepatitis B carriers, or for persons with cirrhosis and one or more of the following risk factors alcohol use alpha 1 antitrypsin deficiency Asian female at least 5. Asian male at least 4. HCC genetic hemochromatosis hepatitis C nonalcoholic steatohepatitis and stage 4 primary biliary cirrhosis. Alpha fetoprotein AFP serial measurements to diagnose germ cell tumors in members with adenocarcinoma, or carcinoma not otherwise specified, involving mediastinal nodes or the diagnosis and monitoring of hepatocellular carcinoma e. BCRABL fluorescent in situ hybridization FISH for lymphoblastic lymphoma, acute myeloid leukemia, acute lymphocytic leukemia and chronic myelogenous leukemia experimental for other indications. Beta 2 microglobulin B2. M for multiple myeloma, non Hodgkins lymphoma and Waldenstrms macroglobulinemia lymphoplasmacytic lymphoma. BRAF V6. 00 mutation for indeterminate thyroid nodules, hairy cell leukemia gastrointestinal stromal tumors Lynch syndrome testing for persons meeting criteria in CPB 1. Genetic Testing melamoma for vemurafenib, dabrafenib, and trametinib see CPB 0. Pharmacogenomic and Pharmacodynamic Testing and colorectal cancer if KRAS nonmutated experimental for other indications. Breast Cancer Index. Breast cancer is nonmetastatic node negative and. Breast tumor is estrogen receptor positive and. Breast tumor is HER2 receptor negative and. Adjuvant chemotherapy is not precluded due to any other factor e. Member and physician prior to testing have discussed the potential results of the test and agree to use the results to guide therapy. Cancer antigen 1. CA 1. 25 levels for any of the following As a preoperative diagnostic aid in women with ovarian masses that are suspected to be malignant, such that arrangements can be made for intraoperative availability of a gynecological oncologist if the CA 1. As a screening test for ovarian cancer when there is a family history of hereditary ovarian cancer syndrome a pattern of clusters of ovarian cancer within two or more generations, where testing is performed concurrently with transvaginal ultrasound and prophylactic salpingo oophorectomy has not been performed. For this indication, screening is considered medically necessary every six months beginning at 3. Diagnosis of ovarian cancer in women with new symptoms bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, or urinary frequency and urgency that have persisted for three or more weeks, where the clinician has performed a pelvic and rectal examination and suspects ovarian cancer or. In members with adenocarcinoma of unknown primary, to rule out ovarian cancer or. In members with known ovarian cancer, as an aid in the monitoring of disease, response to treatment, detection of recurrent disease, or assessing value of performing second look surgery. CA 1. 5 3 Serial measurements of CA 1. CA 2. 7 2. 9 or Truquant RIA in following the course of treatment in women diagnosed with breast cancer, especially advanced metastatic breast cancer an increasing CA 1. CA 1. 9 9 to monitor the clinical response to therapy or detect early recurrence of disease in members with known gastric cancer, pancreatic cancer, gallbladder cancer, cholangiocarcinoma or adenocarcinoma of the ampulla of Vater. CA 1. 9 9 to rule out cholangiocarcinoma in persons with primary sclerosing cholangitis undergoing liver transplantation. CA 1. 9 9 for evaluation of jaundice, abnormal liver function tests LFTs or obstructionabnormality on imaging. CA 1. 9 9 as a tumor marker for mucinous appendiceal carcinoma. CALCA calcitonin expression for medullary thyroid cancer or for adenocarcinoma or anaplasticundifferentiated tumors of the head and neck. CALB2 calretinin expression for lung cancer and occult primary. CD 2. 5, for determining eligibility for denileukin diftitox Ontak treatment. CD 3. 1 immunostaining, for diagnosis of angiosarcoma. CD 3. CD3. 3 gemtuzumab, Mylotarg treatment. CD 5. CD5. 2 alemtuzumab, Campath treatment. CD1. Gleevec.    CHGA Chromogranin A expression for neuroendocrine tumors, non small cell lung cancer, Merkel cell carcinoma and occult primary. Cyclin D1, for diagnosis and predicting disease recurrence of mantle cell lymphoma. Decision. Dx UM Castle Biosciences, Phoenix, AZ for risk stratification of persons with localized uveal melanoma. Endo. Predict also known as 1. Breast cancer is nonmetastatic node negative and. Breast tumor is estrogen receptor positive and. Breast tumor is HER2 receptor negative and. Adjuvant chemotherapy is not precluded due to any other factor e. Member and physician prior to testing have discussed the potential results of the test and agree to use the results to guide therapy. Epidermal growth factor receptor EGFR mutation testing for predicting response to EGFR targeting tyrosine kinase inhibitors erlotinib Tarceva, gefitinib Iressa, afatinib Gilotrif in non small cell lung cancer. FLT3 gene mutation testing for acute myeloid leukemia AML.