Medicare

Almost half of insured Americans report receiving unexpected medical bills, leading to financial strain and contributing to worsening health outcomes for many patients, The Commonwealth Fund report reveals.

The 2025 Physician Fee Schedule includes a conversion factor reduction, expanded behavioral health services, extended telehealth waivers, new Quality Payment Program pathways, and measures to address suspect billing, alongside a Biden administration initiative introducing federal maternal health standards for hospitals.

Beneficiaries who switched from traditional Medicare to a Medicare Advantage plan experienced no additional protection from medical costs compared with those who stayed in a traditional Medicare plan.

The Center on Health Equity & Access shares the latest news, research, and expert insights on developments related to health disparities, gaps in care, and initiatives to address them.

New estimations show a historic increase in health spending last year, which is projected to account for 19.7% of the gross domestic product by 2032.

During the CMS Health Equity Conference, health care leaders shared groundbreaking strategies to integrate health equity into value-based care models, aiming to enhance patient outcomes and reduce costs.

The Medicare trust fund is now expected to deplete in 2036, with the Inflation Reduction Act being credited for at least some of the extension.

Researchers also estimated that more than 700,000 Americans with diabetes could lose insurance coverage if these proposed retractions are put into place, with some new policies already in effect.

Accounting for 32% of all Medicare enrollees in 2019, high-need beneficiaries were more likely to be in traditional Medicare than Medicare Advantage.

Based on a comparison of prices for drugs up for Medicare price negotiations, there is a long way to go to reach the prices of 7 comparable countries.

Fresenius Vascular Care's own research reportedly showed these surgeries not only failed to benefit patients with end-stage renal disease, but also potentially damaged their ability to receive essential dialysis treatment.

Increases in Medicare Advantage market share over the past 10 years are largely caused by an increased preference for managed care among Medicare beneficiaries.

Under preferred pharmacy networks, unsubsidized Part D beneficiaries faced substantial incentives and moderately switched toward preferred pharmacies, whereas subsidized beneficiaries were insulated and demonstrated little switching.

A health system transformational leadership framework and management system made visible and eliminated defects in value and was associated with reduced annual Medicare expenditures and increased quality between 2017 and 2020.

Health plans use data to decide on quality improvement initiatives. Having a dashboard that characterizes how equitably plans are serving their enrollees would promote health equity.

Over the next 18 to 24 months, Humana is exiting the commercial health plan business to focus on government-funded programs, like Medicare Advantage, and specialty businesses.

Coverage from the Institute for Value-Based Medicine® session with Astera Cancer Care in Edison, New Jersey, held November 3, 2022.

Improved outcomes associated with fidaxomicin compared with vancomycin suggest benefits from its greater use in Medicare patients, although uptake remains low despite its recommended use.

A panel discussion at the 70th Annual Roy A. Bowers Pharmaceutical Conference addressed recent care delivery initiatives in New Jersey that aim to address health inequities and other population health concerns.

Medication risk scores analyze an individual’s medication regimen to look for the potential for simultaneous, multi-drug interactions, which can cause adverse drug events and other medication-related harms.

Medication adherence is not the only area to focus on for older adults who have Medicare coverage. Optimizing treatment and medication access are also important.

This study attempts to identify the sources of the significant 2.5-fold variation found in home health expenditures, a possible indicator of inefficiency and waste.

Four large Medicare Advantage insurers manage access to expensive physician-administered drugs with a combination of prior authorization, step therapy, and Part D formulary design.

Social determinants of health present many health-related challenges for Medicare Advantage (MA) plan members, something these plans are looking to overcome by diversifying their service offerings.

Simplified treatments and patient-specific and systemic interventions can reduce nonadherence in patients.

Today, CMS unveiled its plan for a successor to the Oncology Care Model (OCM), its ambitious foray into value-based care delivery that has been credited with changing the landscape for patients with cancer, even if it received mixed reviews on achieving savings in its early years.

Oncologist and health tech veteran Bobby Green, MD, who practiced for 17 years in Florida and was previously with Flatiron, is now Thyme Care’s president and chief medical officer. He has relocated to Nashville, Tennessee, to launch Thyme Care.