Integrated care aims to organize care around the patient instead of the provider. It is therefore crucial to understand differences across patients and their needs. Segmentation analysis that uses big data can help divide a patient population into distinct groups, which can then be targeted with care models and intervention programs tailored to their needs. In this article we explore the potential applications of patient segmentation in integrated care. We propose a framework for population strategies in integrated care—whole populations, subpopulations, and high-risk populations—and show how patient segmentation can support these strategies.

Through international case examples, we illustrate practical considerations such as choosing a segmentation logic, accessing data, and tailoring care models. Important issues for policy makers to consider are trade-offs between simplicity and precision, trade-offs between customized and off-the-shelf solutions, and the availability of linked data sets. We conclude that segmentation can provide many benefits to integrated care, and we encourage policy makers to support its use.

Learn about Dental PPO’s Preferred Provider Organizations:

Another true insurance plan, a preferred provider organizations ( PPO) falls somewhere between an indemnity plan and a dental HMO.  A PPO dental insurance plan will provide you with more freedom to choose your dentist than an HMO dental plan.  You will be able to seek dental services from a wider selection of dentists and may visit any dentist or specialist within the PPO network.

Preferred Provider Organizations

Another true dental insurance plan, a Preferred provider organizations ( PPO) falls somewhere between an indemnity plan and a dental HMO. This plan allows a particular group of patients to receive dental care from a defined panel of individual dental insurance dentists. This type could be used to provide dental gap insurance.

The participating individual or family office agrees to charge less than usual fees to this specific patient base, providing savings for the plan purchaser. If the patient chooses to see one who is not designated as a “preferred provider,” that patient may be required to pay a greater share of the fee-for-service.

A group of individual or family dentistry providers agrees to provide services at a deeply discounted rate, giving you substantial savings — as long as you stay in their network. Unlike the more restrictive DHMO, though, you can go out of network and still receive some benefits.

Although spending rates on health care and social services vary substantially across the states, little is known about the possible association between variation in state-level health outcomes and the allocation of state spending between health care and social services. To estimate that association, we used state-level repeated measures multivariable modeling for the period 2000–09, with region and time fixed effects adjusted for total spending and state demographic and economic characteristics and with one- and two-year lags. We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health—not only in health care but also in social services and public health—is warranted.

What is a Direct Reimbursement Plan

A dental insurance care plan now coming into vogue is the direct reimbursement plan. This is a self-funded benefit plan — not insurance — in which an employer pays for dental care with its own funds, rather than paying premiums to an insurance company or third-party administrator.

You, the patient, pay the full amount directly to the individual or family dentist who accepts dental insurance, then get a receipt detailing services rendered and the cost, which you show to your employer. The employer reimburses you for part or all of the dental insurance costs, depending on your specific benefits.

Your company might reimburse 100 percent of your first $100 of dental expenses and then 80 percent of the next $500, and 50 percent of the next $2,000, with a total annual maximum benefit of $1,500. Or it might reimburse only 50 percent of your first $1,000, resulting in a $500 yearly cap.

Cancer drugs account for a growing share of health care expenditure, raising questions about how much value is gained from their use. We used a proprietary international data set to examine real-world cancer drug consumption and expenditure in the period 2004–14 in Australia, Canada, France, Germany, Italy, Japan, Sweden, the United Kingdom, and the United States and to explore the value obtained. Even after adjusting for population and epidemiological factors, we found that the United States spent more than the other countries on cancer drugs, yet it often had lower utilization. All nine countries—most notably France and Japan—witnessed an improvement in neoplasm-related years of potential life lost, which suggests that although the costs of drugs have risen, their therapeutic benefits have increased as well. Net economic value derived from cancer drug expenditures appears to have remained positive, with base-case analyses indicating that the United States obtained an estimated $32.6 billion in net positive return from cancer drug care in 2014. However, the United States lags behind other countries in health gains obtained per dollar spent on cancer drugs, which suggests an opportunity to improve value in the oncology drug market.

More on Supplemental Dental Insurance Plans

A supplement dental insurance plan may also be purchased to cover the dental charges when there are annual dental benefit plan limits or exclusions. Say your primary policy has an annual maximum benefit of $1000 you may be able to purchase a supplemental dental plan to extend this benefit.

Most importantly you need to check with your dental office to see if they will coordinate the dental coverage since the dentist is the one most likely to bill the insurance company and ask you to pay any difference or the co-pay. Thus, a supplemental policy can come in handy.

People living with mental illness are overrepresented in the criminal justice system. Interventions to help this population, such as mental health courts, are becoming popular across the country. New research finds that for mental health courts to be successful, every professional engaged in the process should be aware of the relationship between psychiatric symptoms and participant engagement within the system and connect participants with comprehensive treatment and services as early as possible.

Understanding Supplemental Dental Insurance

Supplemental dental insurance is an individual or family insurance policy purchased to cover a portion of the dental costs generally up and above or beyond the primary dental plan. Supplemental dental insurance will normally not cover the entire dental care procedure. But instead is synchronized or works hand-in-hand with your basic dental policy.

If you have a primary dental insurance plan that you purchased or your employer provided, the supplemental dental policy typically covers the remaining dental bill.

For example, if the dental plan policy covers half of the dental cost, the secondary or supplement dental insurance plan should cover the remaining balance of your dental procedure subject to any co-payments or deductibles already included in the policy.

Research led by SUNY Downstate Medical Center has identified a brain receptor that appears to initiate adolescent synaptic pruning, a process believed necessary for learning, but one that appears to go awry in both autism and schizophrenia.

Dental Insurance – Dentures

There are plenty of dental insurance plans that will cover dentures, but you need to plan ahead. Many but not all dental insurance plans have waiting periods from 6-18 months.  As an example: Replacing teeth with dentures is classified as major dental services. The average benefit is 50% co-insurance for your dentures. Dentures are covered by some dental discounts dental plans. Remember discount dental plans are not insurance dental plan.

Buprenorphine is a critical part of treatment for the growing epidemic of opioid abuse–but also carries the potential for misuse and diversion. The debate over whether ‘to expand or not to expand’ prescribing of buprenorphine for opioid abuse is discussed in an expert review in the Journal of Psychiatric Practice, published by Wolters Kluwer

Dental insurance plan help and information – ShareofCost.com is a specialist in dental insurance, dental discount plans, vision and prescription coverage programs for individuals, families and groups. We have been serving the dental community since 1983, you will find our licensed dental insurance agents are well informed and ready to assist you.

Compare dental insurance plans and decide which one is right for you and your family. Many of our dental plans have next day benefits including vision and prescription. ShareofCost.com offers quotes for individual and family dental insurance plans including an option to compare dental national coverage plans. Remember, buying dental insurance does not have to be a painful process. We offer dental benefit coverage in all 50 states.

Researchers from the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS), the University of California Santa Barbara, and Washington University in St. Louis have shown for the first time how neurons in the SCN are connected to each other, shedding light on this vital area of the brain. Understanding this structure — and how it responds to disruption — is important for tackling illnesses like diabetes and posttraumatic stress disorder. The scientists have also found that disruption to these rhythms such as shifts in work schedules or blue light exposure at night can negatively impact overall health.

Benefits of Dental Insurance

Dental insurance benefits vary depending on the type of dental insurance plan.  When reviewing the benefits of dental insurance especially when selecting a dental insurance plan, keep in mind there are various policy coverage options, dental plan deductibles, co-payments, limitations, restrictions and exclusions.

It is extremely important that you read the list of benefits provided by the dental insurance provider and be sure you are getting a dental insurance plan if that is what you wanted to purchase.

A reminder discount dental plans are not dental insurance plans. A discount plan partners with specific dentists to provide customers with a savings on visits to the dentist office much the same as dental insurance. The downside to discount dental plans is that they are not regulated and you have limited recourse if you experience dental problems.

DHMO Dental Network

What is a DHMO dental network? When one is insured with an HMO medical plan the term means a health maintenance organization. In the dental industry the title is similar except that the DHMO refers to a dental health maintenance organization instead. Dentist in a DHMO belong to a network and if you are a client in that network then in theory you can see any dentist within the network.

Just remember, the administrator of the DHMO or the company that manages the plan pays the dental office once a month, normally based on a per person fixed amount rate.