Teen dating violence is just as serious as adult domestic violence. And it’s common. About 2 in 10 teen girls say they have been physically or sexually abused by a dating partner. About 1 in 10 teen boys reports abuse in dating relationships.

Teen dating abuse is a pattern of abusive behavior used to control another person. It can be:
•Any kind of physical violence or threat of physical violence to get control.
•Emotional or mental abuse, such as playing mind games, making you feel crazy, constantly texting you, or constantly putting you down or criticizing you.
•Sexual abuse, including making you do anything you don’t want to do, refusing to have safer sex, or making you feel bad about yourself sexually.

Who’s at risk?

Like adult domestic violence, teen relationship abuse affects all types of teens, regardless of how much money your parents make, what your grades are, how you look or dress, your religion, or your race. Teen relationship abuse occurs in straight, gay, and lesbian relationships.
Relationship abuse is not just dangerous for you physically and emotionally. It can also put you at risk for other health problems, such as:
•Eating disorders.
•Depression.
•Low self-esteem.

Teens in abusive relationships are also more likely to take sexual risks, do poorly in school, and use drugs, alcohol, and tobacco. Girls are at higher risk for pregnancy and sexually transmitted infections (STIs).

Is it abuse?
Abusive relationships can have good times and bad times. Part of what makes dating violence so confusing is that there is loved mixed with the abuse. This can make it hard to tell if you are really being abused. But you deserve to be treated in a loving, respectful way by your boyfriend or girlfriend.

Does your boyfriend or girlfriend:
•Act bossy and make all the decisions?
•Put you down in front of friends?
•Try to control who you see and talk to?
•Threaten to hurt or kill himself or herself?
•Blame you for “making” him or her treat you badly?
•Pressure you to have or force you to have unprotected sex?
•Stalk you? This can include constantly texting or calling you to find out where you are and who you’re with. You might think that’s about caring, but it’s really about controlling the relationship.

Do you:
•Feel less confident about yourself when you’re with him or her?
•Feel scared or worried about doing or saying “the wrong thing”?
•Find yourself changing your behavior out of fear or to avoid a fight?

If you answered “yes” to any of these questions, you might be in an abusive relationship. There are people who can help you. You’re not alone. Talk to your parents or another adult family member, a school counselor, a teacher, or someone else you trust. Call a help center or hotline to get help.

How parents can help

Teens may not have the experience or maturity to know if their relationships are abusive. A teen may think of dating violence as only physical violence—pinching, slapping, hitting, or shoving. Teens may not realize that any relationship involving physical violence, sexual violence, emotional abuse, or the threat of violence is an unhealthy relationship.

For example, a teen may think his or her partner cares when he or she calls, texts, emails, or checks in all the time. But that kind of behavior is about controlling the relationship.

Talk with your teen about what makes a healthy relationship. Explain that a caring partner wouldn’t do something that causes fear, lowers self-esteem, or causes injury. Let teens know that they deserve respect in all of their relationships. Think about values and messages that you want to pass on.

You might start by asking your teen:
•Is your boyfriend or girlfriend easy to talk to when there are problems?
•Does he or she give you space to spend time with other people?
•Is he or she kind and supportive?

Hotlines for help
These national hotlines can help you find resources in your area.
•National Domestic Violence Hotline toll-free: 1-800-799-SAFE (1-800-799-7233), or see the website at www.ndvh.org.
•National Teen Dating Abuse Hotline toll-free: 1-866-331-9474 or (1-866-331-8453 TTY) or see the website at www.loveisrespect.org.

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People from all walks of life drink to cope with stress from work. While the rate of alcohol abuse varies by industry and occupation, no workplace is immune. In the short term, drinking can result in feelings of relaxation, but ongoing reliance on alcohol to manage stress often leads to physical and psychological problems.

Prevalence of Binge Drinking

According to the 2017 National Survey on Drug Use and Health (NSDUH), 26.4 percent of people ages 18 and older reported that they engaged in binge drinking in the past month, and 6.7 percent reported heavy alcohol use in the past month. Binge drinking is defined as having 5 or more drinks within 2 hours for men, and 4 or more drinks within 2 hours for women. Heavy alcohol use is defined as binge drinking on 5 or more days in the past month, or 60 days a year.

Binge drinking has been on the rise over the past twelve years, particularly in women ages 30 to 44. While most excessive drinkers don’t meet the clinical criteria for alcohol dependence, binge or heavy drinking can still take a toll on workplace productivity, health, and relationships.

A Paradoxical Effect

Using alcohol to relieve stress and anxiety can have a paradoxical effect. Drinking may provide temporary feelings of relaxation, but habitual use alters the balance of chemicals in the brain that regulate mood. Alcohol can contribute to and worsen symptoms of depression, anxiety and other mental health disorders, and it can interfere with sleep. It becomes a vicious cycle: the person drinks in response to stress, feels worse later on, and turns to alcohol again to avoid dealing with painful feelings instead of learning healthy coping skills.

Drinking to self-medicate can also have serious health consequences. Heavy drinking is linked to higher risk of developing an alcohol use disorder or alcohol addiction, characterized by tolerance, withdrawal symptoms, strong cravings and an inability to cut down on drinking. Other medical conditions associated with excessive drinking include heart and liver disease, stroke, high blood pressure and cancer. Long-term alcohol use can also cause neurological problems such as cognitive deficits and dementia.

Impact on Employers

Most people who drink excessively or have an alcohol use disorder are employed, and many try to hide the problem. Nevertheless, U.S. companies lose billions of dollars a year due to lost productivity, workplace accidents and injuries, absenteeism, and illness related to employees’ alcohol and drug use.¹

An Employee Assistance Program is a valuable resource for employers. EAPs are designed to address work-related stress, substance use, mental health issues and other problems that negatively impact employees’ well-being and job performance. Besides offering confidential counseling and referral services for employees, EAPs can provide a range of health promotion activities and help for supervisors dealing with troubled employees.

¹”National Drug-Free Workplace Alliance.” National Drug-Free Workplace Alliance, https://www.ndwa.org/drug-free-workplace/industry-statistics/.

Post Traumatic Stress Disorder, commonly known as PTSD, comes in many forms and affects children and adults alike. Early descriptions of PTSD are found throughout literature. The hallmarks of war-related PTSD were described in Homer’s The Iliad. Shakespeare wrote of the symptoms in Henry IV and A Midsummer Night’s Dream. In recent times, books such as The Things They Carried (Tim O’Brien) describe the effects of war and the risk for PTSD-related suicide. Movies such as Ordinary People and Mystic River portray the effects that loss and abuse have on families and individuals. The daily ease of access to images on the internet and television puts the fodder for PTSD in front of all exposed to electronic media. We have only to listen to the news to learn of all the possible inputs that can cause PTSD—the tornado that sweeps through a Midwest town, atrocities happening to people in places such as Syria, beheadings, and stories of abused children. PTSD can affect one individual at a time, or a lone event can bring PTSD into the lives of many with a single swath.

Prevalence of PTSD in the U.S.

PTSD is common. The lifetime prevalence of PTSD among adult Americans is 6.8 percent (National Comorbidity Survey Replication). For adolescents, the six month prevalence was estimated to be at 3.7 percent for boys and 6.3 percent for girls (Kirkpatrick, 2003). The prevalence is much higher among Veterans. Men and women who had served in the Vietnam War have a lifetime prevalence of 30.9 percent and 26.9 percent, respectively. Studies of Gulf War Veterans reported a current prevalence of 12.1 percent, and 13.8 percent for Veterans of Operation Enduring Freedom/Operation Iraqi Freedom (Kang, et al 2003; RAND Corporation 2008). Unfortunately, PTSD is often underdiagnosed in the medical setting—with symptoms being attributed to a “normal” response to a trauma, misdiagnosed as depression, or altogether missed because of the physical presentation of the condition.

PTSD Symptoms and Impacts

PTSD symptoms are not limited to only the emotional, but also bring physical impairment in many forms. The condition affects those people supporting the individual with PTSD, often causing distress to family, friends, and colleagues. It is important not to approach PTSD with a single point of view — the victim of a natural disaster may have different experiences and risk factors than a combat veteran, for example. What is the same, however, is a set of symptoms based in some form of exposure to a traumatic event, resulting in significant distress and impairment in an individual’s ability to perform in her or his roles, whether within family, employment, or other social units.

No matter the cause, the response to a traumatic event is similar, whether described in the 8^th Century BC, or in 2016. In 2013, the American Psychological Association updated the criteria used to diagnose PTSD. According to current diagnostic criteria, the diagnosis of and symptoms attributable to PTSD must include at least one month of:

• Direct exposure to a stressor; witnessing the stressor in person; indirectly learning of a loved one exposed to a violent or accidental circumstance; and/or repeated or extreme indirect exposure to aversive details of the event, typically by a professional exposed to the stressor (e.g. first responders)
• Persistent and intrusive re-experience of the event through memories, nightmares, flashbacks (e.g. dissociative reactions), distress after exposure to a reminder of the stressor, and physiological reactivity after exposure to a trauma-related stimuli (e.g. jumping up after hearing a door bang unexpectedly)
• Avoidance of distressing trauma-related stimuli, including thoughts or feelings, and/or trauma-related external reminders such as situations or people
• A negative effect on thoughts and mood, including an inability to recall features of the trauma; persistent negative beliefs; persistent and distorted self-blame and/or blaming others; persistent negative emotions such as fear or anger; diminished interest or pleasure in activities; feeling detached or estranged from others; and having a persistent inability to experience positive emotions
• Alterations in physiological arousal or reactivity including irritable or aggressive behavior; self-destructive or reckless behavior; hypervigilence; exaggerated startle response, problems in concentration, and/or sleep disturbance
• Distress or functional impairment in relationships, social, and occupational roles

What PTSD Feels Like

PTSD doesn’t always occur immediately after the traumatic event. In fact, in some cases, the diagnosis may not be made for up to six months with the gradual onset of the full symptoms. Some individuals with PTSD develop dissociative symptoms as the primary feature of the condition. Those affected describe a sense of being an outside observer or detached from oneself (depersonalization), and/or the sense that things are not real or are distorted (derealization). See the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition for a detailed description of the diagnostic criteria for PTSD.

Unfortunately, PTSD predisposes affected individuals to other behaviors that can be emotionally and physically harmful. Persons with PTSD are more likely than persons without PTSD to develop alcohol use disorder (AUD) and substance use disorder, including tobacco, pain medications, and illicit drugs. Nearly half of people with PTSD can suffer co-occurring depression. Physical symptoms and conditions associated with PTSD include cardiovascular conditions such as hypertension, pain, gastrointestinal symptoms, and musculoskeletal symptoms.

While it is very difficult to predict who will develop PTSD, some factors may increase the risk of developing the symptoms, including:

• Getting physically hurt during the trauma
• Seeing another person get hurt or killed
• Having childhood trauma
• Having a sense of horror or helplessness during the trauma
• Having little or no social support after the event
• Dealing with additional stressors after the event, such as losing a loved one, ongoing pain or injury, or loss of one’s job or home.

Taking Care of Oneself after Trauma

While trauma impacts everyone differently, there are some ways to reduce the risk of developing PTSD. Examples include:

• Seeking out support from other people, including friends and family
• Talking about the trauma soon after it occurs
• Attending a support group with others who may have had similar experiences
• Learning how to acknowledge and accept your actions in the face of the trauma
• Having a positive coping strategy; being able to act and respond effectively despite feeling fear

PTSD does not have a cure, but symptoms can be managed to help an individual function better in day to day life. The recommended treatment of PTSD largely is based on the use of medication and psychotherapy. The earlier treatment is started, the more likely the treatment will have positive effects. Combinations of medication, psychotherapy and support are typically the most effective way to ameliorate symptoms.

Therapy for PTSD

Several therapy types have been shown to reduce the physiologic responses to stimuli, or alleviate intrusive thoughts by teaching a person the skills to identify triggers in order to better manage their symptoms.

• Cognitive behavioral therapy has been shown to be effective in treating PTSD. In addition to educating people of their symptoms, cognitive behavioral therapy can also include prolonged exposure (PE) therapy to address the traumatic event. During PE one gradually approaches trauma-related memories, feelings, and situations that have been avoided since the trauma. By confronting these challenges, PTSD symptoms decrease.
• Novel treatments for PTSD include Eye Movement Desensitization and Reprocessing (EMDR). This is a form of psychotherapy that involves the patient paying attention to a back-and-forth movement or sound while thinking about the upsetting memory long enough for it to become less distressing. During EMDR, one learns about their physical and emotional reactions to trauma, targeting the upsetting memory, discussing the memory, and ultimately focusing on a positive belief or feeling while the memory is in one’s mind.
• Cognitive restructuring or processing therapy helps the affected person work through faulty memories of the trauma, and challenges their interpretations of the event, experience of the event, and beliefs that life is full of ongoing danger. Cognitive processing therapy teaches new ways to handle upsetting thoughts and to develop a new perspective on both past and future.

Other therapies include training in relaxation and anger-control skills, group therapy, couples therapy, family therapy, implementing an exercise program, and sleep hygiene. While often tempting in the short-term, it is essential to avoid self-medication with alcohol or other substances such as pain killers that often are habit forming, and may exacerbate symptoms.

When approaching our programs, we at Magellan recognize the importance of identifying PTSD symptoms early on. We hope to spread the understanding that one’s response to trauma does not reflect failure, or weakness in character. Rather, we believe that raising awareness and understanding of PTSD is essential to tackling this condition, which affects so many Americans. As we move forward in developing and integrating new programs, we are keenly interested in supporting individuals, families and healthcare providers to increase access to resources for PTSD education, treatment and support.

Looking for more information on PTSD support? Click here for a list of resources and tips, or call 1-800-273-TALK if you are in crisis.

During National Depression Awareness Month, we wanted to take some time to discuss the very normal stress and mental health challenges working families experience as we are increasingly connected to our jobs. As our connectivity to work has grown – between email, texting, chats, phone calls, video conferencing calls, and a myriad of social networking sites – so has the challenge to separate work from our personal lives. Employees are spending an increasing amount of time both at work and thinking about work. Habits such as checking email during a family dinner or ruminating about that email that you’d forgotten to write in bed at night are common experiences for many. Add on top of that a child who’s acting out and a parent who needs a little extra care both physically and financially, and you have a recipe for stress that affects your own health and mindset, as well as potentially relationships with family, friends or colleagues.

Employee assistance programs (EAPs) have been adopted by many employers to reduce the impact of mental health disorders, workplace stress and other work/life issues on workplace productivity. Despite the ubiquity of this employee benefit, which is offered by 97 percent of large employers, utilization hovers around five percent industry-wide. A primary barrier is the stigma of utilizing EAP programs, which were historically grown from occupational substance abuse programs.

While great strides have been made in reducing stigma, a great opportunity lies in changing the premise that stands in the way of employees tapping into services that might help them move forward and find their best self. What if we were to fundamentally remove the premise that there are people with “issues” and people without? The reality is that every employee is faced with their own brand of “juggle,” and stress and anxiety continue to be on the rise as working families live increasingly busy lives.

As Magellan transforms the EAP benefit for modern day workers and their families, we’re driven to provide resources and tools to help people address their mental health challenges before they severely impact their lives and productivity. The pivot lies in helping employees take care of their mental health as a practice of self-improvement and in helping employers position EAP services in their culture of well-being.

There are three essential components to powering this shift in the transformed EAP:

• Clinically-validated online programs and mobile apps that help employees track and change habits and mindsets
• When employees experience a bump in the road, convenient access to a coach or therapist that can fit into their harried day
• Content that inspires, motivates and helps employees feel validated in the normalcy of their stress and feel connected to others tackling similar experiences

Imagine a world where employees give each other a high five for taking some “me” time, leveraging a convenient method of choice, just as they do for someone sticking to their gym routine or running their first 5k. We certainly do!

In late January, Magellan held its second annual Magellan Open Vision Exchange (MOVE) conference in Scottsdale, Ariz. MOVE brings together a large cast of voices from the healthcare industry to discuss the future of healthcare for patients, plans and providers. Over two days, we heard from private industry experts, government leaders, as well as other subject matter experts and thought leaders both from inside and outside the healthcare industry.

The Future of Healthcare Beyond the Affordable Care Act

Obviously, the continuing debate over the future of healthcare and the Affordable Care Act were a central topic of the conversation at this year’s MOVE. A number of speakers talked about the impact of the Trump Administration’s efforts to repeal the Affordable Care Act. Former Utah Governor Michael Leavitt, who also served as the secretary of the Department of Health and Human Services, said that while he expects repeal and replace legislation will pass, significant parts will be deferred for three or four years. Brian Coyne, VP of federal affairs at Magellan Health, said that he feared gridlock over the next couple of years.

Managing Transformation in the Healthcare World

One of the key topics discussed at this year’s event was the immediate future of the healthcare industry. After a long period of explosive innovation, there was consensus that disruptive change will continue. Magellan Healthcare CEO Sam Srivastava posited that we are currently in a tech-bubble that is about to burst. The industry is waiting to see which of the early healthcare technology entrants will survive and how technology and healthcare will continue to interface with each other.
Leavitt spoke extensively of the need to manage transformation, especially in healthcare. Leavitt stressed that systematic healthcare change takes hold over three to four decade cycle, and he believes we are less than mid-way through the current transformation. Using an analogy of a cattle herd, Leavitt made the point that you can’t drive a herd too quickly, or you risk a stampede. You also can’t push the herd too slowly or it will meander. Applied to healthcare, the idea is simple but true: If we push change too quickly there will be chaos, but if we fail to adapt and change, we will stagnate. Allowing ourselves to be “lulled into inaction” is a recipe for disaster.

Value-Based Healthcare

A critical area of discussion was the expansion of value-based care. Speakers agreed that demand for value-based care is accelerating. Leavitt said he believed this was true regardless of the Trump Administration’s plans for healthcare. Billy Millwee, President and CEO of BM&A Public Policy, cited broad bipartisan support for the value-based model and agreed that it was here to stay.

Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, spoke clearly on the approach that his company was taking: “We started and ended with common sense.” He went on to explain that they had built their model with the primary care physician at the center (PCP). The PCP knows the patient best and is therefore in the best position to make decisions regarding who to refer and to whom. By taking this approach, Burrell relayed, CareFirst was able to build a patient centered medical home model that improved care while reducing costs.

Despite the level of change being experienced throughout healthcare, a common theme was one of our industry being grounded in helping people get the high-quality care they need, affordably. This is the essence of why healthcare is our chosen industry and why we are driven to innovate.

An interesting takeaway was that across the conference and speakers, there was a clear common theme: while the ultimate structure of the pay-for-value transformation is uncertain, the movement will continue. Experimentation, promoted by both public and private payer initiatives, will drive innovation and change. Some will be better prepared than others to handle this paradigm shift.

According to the Kim Foundation, one out of four Americans experiences behavioral health issues. Of those, 60 percent are not receiving treatment.

Why are so many people not receiving treatment?

What does this mean for providers?

What more can be done to increase access to behavioral healthcare?

Learn more about this issue by downloading Magellan’s new infographic, “Mind the Gap: Increasing Access to Behavioral Healthcare.”

The full extent of this remarkably negative 2016 Presidential campaign might surprise you. Studies show that the campaign may have had a profound effect on the mental wellbeing of many people. This goes beyond the usual split of people who feel excited or disappointed following the outcome of any election. Across the country, healthcare providers are reporting an increase in patient stress.

It should be noted, this is not simply a result of the conclusion of the campaign. In October, the American Psychological Association reported that 52 percent of American adults identified the 2016 election as a very or somewhat significant source of stress. Worryingly, that announcement was based on a survey conducted in August when the final, and most contentious, part of the campaign was just getting started.

According to the APA survey:

• Across party lines, those registered as Democrats (55 percent) and Republicans (59 percent) are statistically equally likely to say the election is a very or somewhat significant source of stress.
• Nearly 4 in 10 adults (38 percent) say that political and cultural discussions on social media cause them stress.
• Men and women are equally likely (51 percent vs. 52 percent, respectively) to say the 2016 U.S. presidential election is a very or somewhat significant source of stress.
• Millennials and “matures” are the most likely to say the election is a very or somewhat significant source of stress (56 percent vs. 59 percent, respectively) — significantly more than Generation Xers (45 percent) but not boomers (50 percent).

In fact, the APA found that people were so stressed that it saw the need to release coping tips relating to the election.

Interestingly, given the result of the election, researchers have found that stress is not just limited to liberals. In an article for Wired, Maimuna Majumder a computational epidemiology research fellow for HealthMap at Boston Children’s Hospital explained that “some findings are consistent across red, blue, and swing states. Among them is the fact that increased searches explicitly for “presidential election” seem to be associated with searches for depression and anxiety, which suggests that the 2016 presidential election cycle may have been a source of emotional distress for Americans, irrespective of political leaning.”

Where is this election stress having an impact?

Day-to-day, one of the most noticeable places where this stress is felt is in the workplace. A noticeable change in this election, compared to those in the past, is a willingness to discuss it at work. In the APA survey, nearly half (47 percent) of all respondents said people are more likely to discuss politics in the workplace this election season than in the past. With these types of discussions happening in the workplace, employers are rightfully concerned about what all of this is doing to their workforce.

In short, a high level of employee stress does not lead to an engaged, productive workforce. In fact, the result is very much the opposite. According to a study by Fairleigh Dickerson University, “Workplace stress costs U.S. employers an estimated $200 billion per year in absenteeism, lower productivity, staff turnover, workers’ compensation, medical insurance and other stress-related expenses.” Other estimates, put the number at more than $500 billion. Studies have shown that businesses with a high-stress or high-pressure environment spend as much as 50 percent more than average on healthcare. There is also a strong link between high employee stress and low employee engagement.

Supporting Employees through External Stressors

Whether it is an election or a traumatic event or emergency, there are always going to be external events that are impossible to control. It is however, feasible to provide an environment and toolkit for employees to allow them to better manage their stress levels and emotional well-being.

Employers should lean on their Employee Assistance Programs (EAP) to provide resources for employees who are feeling stressed by the election (and the rest of the news cycle). This can range from simple advice about how to manage stress to more holistic therapy options. An EAP can also provide guidance and training for management-level employees for creating a cohesive and inclusive workplace.

You’re buying a car. Before you hit the lot, you do your planning and research, establish a budget, figure out what features you want and what style you’re looking for. You probably search online for car and dealer reviews, prices and sales. Based on all of that work, you make a decision, negotiate and pay for your new car.

Your car research was relatively easy. But finding a healthcare provider? Not so much.

While you may know what you want in a provider, very little information is available about the services they provide, appointment costs, reviews and other important details to help you make an informed choice about your care. And if you ARE lucky enough to find someone who seems to fit your needs, you’re often still left wondering what kind of quality you can expect from your treatment experience.

The bottom line is that it’s easier to buy a car than it is to find a healthcare provider. Silly, right? We think so, too – which is why Magellan is bridging these information and quality gaps by employing value-based purchasing models.

Rewarding quality care yields informed choices

Value-based purchasing takes various forms. But it generally operates on the premise that aligning providers’ incentives and reimbursement with organizational and individual goals incents behavior and drives positive outcomes, ultimately benefiting all involved in the healthcare continuum. This includes consumers, customers and payers, in addition to the providers themselves, who also enjoy improved reputations through public reporting.

In fact, one of the key tenets of Magellan’s value-based collaboration and purchasing models is to ensure stakeholders become more informed as a result of these initiatives:

• Customers benefit by knowing whom to partner with for network management;
• Payers benefit by knowing whom to pay for value; and
• Consumers, of course, benefit by having those online provider reviews become a lot less elusive, enabling them to make an informed decision about whom to choose for their care.

Magellan’s models also center on:

• Engaging and empowering providers in compensation model evolution. We partner with provider leaders around compensation design, employ transparency to ease the compensation shift and create meaningful incentives for providers to encourage active engagement. (1)

• Building provider compensation for an evolving healthcare market. Our priorities center on population management, team-based care and member access. We integrate new quality and efficiency standards into compensation, and remove compensation barriers to population goals. (1)

Why do we give value-based purchasing strategies the green light?

Take our Assertive Community Treatment (ACT) program as just one example. Through program data analysis and close collaboration with our ACT provider teams, we developed a three-tiered rate structure based on overall program goals to support recovery, wellness, and to improve community tenure. As a result, we saw a 21 percent decrease in inpatient admissions and a 24 percent decrease in the inpatient readmission rate.

Our drive for engagement continues

Providers nationwide are in different phases of readiness, so we keep our wheels in motion by providing a graduated maturity model to move them from the most basic stage—learning the behavior through activity incentives—to the most complex arrangements, which transform care delivery through outcomes-based incentives or other payment structures (2). We look forward to working with stakeholders, providers and consumers as we continue to expand this innovative and exciting model.

(1) Medical Strategy Group Council: “Next-Generation Physician Composition,” The Advisory Board Company

(2) Physician Quality Reporting Initiative: The Advisory Board Company