Medicare

The Global and Professional Direct Contracting model is going to be replaced with a new accountable care organization (ACO) model, which addresses some of the pushback there had been on the direct contracting model, said Michael Chernew, PhD.

Medicare advantage beneficiaries who received care from providers in 2-sided risk payment models had lower rates of acute care use, according to new study findings.

Medicare Advantage plan members could save $12 billion if enrolled in fee-for-service (FFS) plans instead; Black patients were classified as low priority for intensive care unit (ICU) triage twice as often as other patients; Moderna and Pfizer face lawsuits over potential COVID-19 vaccine patent infringement.

The authors found an association between Medicare’s wage index adjustment and the differential use of labor-intensive surgical procedures and medical device–intensive minimally invasive clinical procedures across the United States.

Medicare beneficiaries attributed to small practices in accountable care organizations (ACOs) achieve greater savings than beneficiaries attributed to large practices in ACOs.

This article examines the association between a large-scale primary care redesign—the Comprehensive Primary Care Plus Initiative—and ambulatory care patterns of Medicare beneficiaries with highly fragmented care.

Polypharmacy was associated with a nearly doubled increase in health care expenditures and a tripled increase in pharmacy expenditures among older patients with cardiovascular diseases (CVD).

Natalie Dickson, MD, president and chief strategy officer of Tennessee Oncology, discusses Tennessee Oncology's role in the discussion to reform 340B.

A bill to provide late-fee warnings to Medicare beneficiaries was introduced; Pfizer is expected to provide 10 million COVID-19 antiviral pills to low- and middle-income nations; a Texas judge halts an investigation into a 16-year-old girl receiving gender-affirming treatment.

A new metric may help improve polypharmacy rates in older adults through identification of low-value prescribing practices.

During an AHIP webinar, Mark Hamelburg, senior vice president of federal programs at AHIP, explained the shifts coming to Medicare and Medicaid when the public health emergency finally ends.

The redesigned accountable care organization (ACO) model is called the Realizing Equity, Access, and Community Health model and is scheduled to begin in 2023.

Stephen Schleicher, MD, MBA, chief medical officer of Tennessee Oncology, discusses the practice's plans to continue providing quality oncology care to its patients after the end of the Oncology Care Model (OCM).

A woman is now the third person in the world to be cured of HIV; CDC data suggest vaccinating women against COVID-19 during pregnancy may protect infants after birth; provider groups push to keep Direct Contracting payment model.

By making diligent compliance efforts a priority in the years ahead, health plans can shore up existing processes to achieve financial success and ensure risk adjustment as regulatory bodies take aim at organizational missteps.

The FDA delays its decision on Pfizer/BioNTech’s COVID-19 vaccine in young children; the Federal Trade Commission (FTC) will vote on whether to investigate pharmacy benefit managers (PBMs); nearly half of high-volume antibiotic prescribers are located in Southern states.

How Value-based Care Is Changing Radiation Oncology for the Better

The changes come as Tennessee Oncology must now plan for a gap between the Oncology Care Model and a future alternative payment model from CMS.

Natalie Dickson, MD, president and chief strategy officer of Tennessee Oncology, discusses challenges for Tennessee Oncology and community oncology in general.

This study compares the impact of the 3 different out-of-pocket maximums proposed in Congress and by the Medicare Payment Advisory Commission.

Opioid utilization management in Medicare was associated with mixed effects on opioid prescribing, and prior authorization was associated with a decreased likelihood of subsequent overdose.

Among a patient population defined by CMS postacute care transfer regulations, home health vs no postacute care was associated with reduced 30-day readmissions and costs.

Results of a retrospective study conducted in Spain found that dialectical-behavioral therapy skills training can help mitigate polypharmacy in those with borderline personality disorder.

Americans who are boosted are 95 times less likely than unvaccinated people to die of COVID-19, the FDA approved the first generic drug for Restasis to treat dry eye syndrome, and CMS is putting a greater focus on health equity for Medicare Advantage and Part D plans.

Up to one-fifth of Medicare beneficiaries were unable to access health care due to the COVID-19 pandemic in 2020.

Geoffrey Boyce, CEO of Array Behavioral Care, discusses Array AtHome’s telebehavioral health services, which are now available to approximately 5 million Humana Medicare Advantage members.

Pfizer and Moderna announced commencement of trials for Omicron-specific booster shots; 14.5 million Americans gained health coverage since November 2021; Medicare’s website for consumers to research nursing home staffing is up and running.

In its annual Medicare Shared Savings Program (MSSP) report, CMS said the number of accountable care organizations joining increased, but a trade group said the results should have been better.

Results of a study carried out in Iran found those with a recent history of depressive disorders were more likely to suffer from polypharmacy, or taking 5 or more medications concurrently.

Unvaccinated older adults are 49 times more likely to be hospitalized after contracting COVID-19; nursing homes are experiencing a major staffing crisis; major Alzheimer groups plan to meet with federal officials and lawmakers to protest the CMS drug proposal.