Payers

For true comprehensive community wellness to take place, barriers must end between the old silos of what is considered “healthcare” and what is considered public health, in order to improve health outcomes and curb rising costs, according to a new report from The Health Care Transformation Task Force and The Public Health Leadership Forum.

Featured experts to discuss practical experiences, challenges, and successes from within the Oncology Care Model.

Which data, policy, and information gaps exist throughout the healthcare system and need filling in order to combat opioid use disorder (OUD) through better prevention and treatment strategies? Two recent reports discuss how these gaps are worsening efforts to fight OUD.

This week's announcement comes after cardiologists have spent several years sharing accounts of their difficulty gaining access to PCSK9 inhibitors for their patients.

Problems in healthcare seem overwhelming, with at least 17 different factors cited as driving unsustainable spending, according to a presentation at the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting held April 23-26, in Boston, Massachusetts. Two executives from Precision for Value LLC spoke about “Charting the Shifting Value-Based Healthcare Landscape: Emerging Developments for 2018 and Beyond” and offered their view on what healthcare companies can do to succeed.

Genomics-based precision medicine has the potential to transform healthcare delivery. However, effective collaborations among scientists, clinicians, and payers are needed to accelerate the translation of precision medicine to clinical practice and ensure its sustainability.

Adherence may play a role in the real-world findings of the study, which was sponsored by Janssen.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included Sanofi offering a deal to payers for its cholesterol drug; a “right-to-try” bill is defeated in the House; and a forum of oncology pharmacists discusses “health insurance” versus “healthcare.”

Sanofi–Regeron's offer to cut prices if payers improve access comes on the heels of the FDA Commissioner's critique of the "Kabuki" constructs that harm the sickest patients.

Since 2000, the number of patients undergoing gender-affirming surgery who identified as self-payers decreased. From 2012-2013 to 2014, coverage by Medicare and Medicaid of gender-affirming surgeries increased 3-fold.

Driven by an aging US population and other economic and demographic factors, national health spending is projected to climb to 19.7% of the economy over the next 8 years, up from 17.9% in 2016, according to new estimates released Wednesday from CMS and published online in Health Affairs.

Empagliflozin (Jardiance) and another SGLT2 inhibitor, canagliflozin (Invokana) have been competing aggressively; both have clinical trial results showing cardiovascular benefits.

Researchers were especially concerned about barriers for patients with familial hypercholesterolemia, whose needs would seem clear cut but who nonetheless faced costly hurdles, such as genetic testing.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

As oncology practices transition to value-based care, they are challenged to take on more holistic responsibility for their patient. Fortunately, the examples of practices participating in CMS’ Oncology Care Model can offer valuable insight into the most impactful workflow changes providers can implement as they strive to achieve cost and quality improvements.

A chief medical officer for a major payer outlines the challenges making sure that certain high-cost therapies are directed to the patients who need them.

The rate of healthcare spending in the United States slowed down last year to levels previously seen between 2008-2015, driven by much slower growth in spending for retail prescription drugs, as well as hospital care and physician and clinical services. Private payers, Medicaid, and Medicare­ also saw lower rates of spending growth.

Mind-body practices have increased in popularity,but the challenge of variation between teachers and classes has been a barrier to payer reimbursement.

The authors, both members of the Digestive Health Physicians Association, write about efforts in their home state and at the federal level to reform payer restrictions.

The rule has several proposals that may be attractive to insurers in the area of risk adjustment.

Representatives from 3 payers who partnered with providers on the Oncology Care Model (OCM) took the stage at Community Oncology Alliance (COA)’s Payer Exchange Summit on Oncology Payment Reform to outline their experience with OCM and how it has differed from other care models.

The implementation of the Oncology Care Model has brought profound culture changes to how oncologists take care of patients and how they operate practices, explained Lucio Gordan, MD, of Florida Cancer Specialists.

Scaling behavioral change and reducing diabetes at the population level were major themes of the meeting.

The CEO said the changes will finally allow the company to set the inhaled insulin apart from its rivals.

The move to give entrepreneurs access to patient-approved continuous glucose monitoring data fits with the company's prediction that insulin pumps will become a thing of the past, and most of the heavy lifting of delivery will be done by a smartphone.

The growing importance of quality ratings will put pressure on hospitals to meet ADA standards for insulin therapy without added manpower.

Studies presented at the American Diabetes Association Scientific Sessions showed that patients being treated with the ITCA 650 were less likely to need to take additional therapy to control their diabetes.

Patients, payers, and providers all view value in different ways, and they all need to be taken into account in value frameworks, said Ilene Hollin, PhD, MPH, the National Pharmaceutical Council and University of Southern California Schaeffer Center’s Postdoctoral Health Policy Fellow.