Health Care Cost

After years of efforts to reduce low-value care, panelists at the 2024 Value-Based Insurance Design Summit proposed a new strategy: drawing a line in the sand that payers will not be on the hook for these services.

Stress has potential links to worse outcomes in cancer, such as decreased quality of life and greater risks of disease progression and metastasis. There is a complex mix of emotions patients with cancer experience.

Most private health insurers have yet to publish criteria for when they will cover postpartum depression drug, zuranolone; state lawmakers are increasingly opposing health care mergers that they believe do not serve the public interest; Medicaid extensions made in 2021 led to a 40% decline in postpartum lack of insurance.

The critical issue of mental health in the workplace was discussed by experts in the field at the recent Midwest Business Group on Health (MBGH) Mental Health Forum, shedding light on the growing concern surrounding alcohol use disorder and the pressing need for innovative therapies.

The FDA has pushed back its approval deadline for donanemab, Eli Lilly’s experimental Alzheimer’s treatment; Cigna recently announced the launch of a program on aimed at capping annual weight-loss drug cost increases for health insurance providers and employers at 15%; a new monoclonal antibody product to protect against respiratory syncytial virus (RSV) was 90% effective at preventing children from being hospitalized.

President Biden will preview his plan to more than double the size of Medicare’s new drug price negotiation program in the upcoming State of the Union address; Mexicans and Central Americans were most affected by the pandemic in terms of all-cause mortality; two Alabama fertility clinics said they expect to resume in vitro fertilization (IVF) services after a bill was passed to protect doctors.

Getting weight loss drugs into the hands of those who need them could be a matter of changing pricing models to give more patients access to the medication they need.

Demands for government action grow amid mounting pressures on health care; Opill offers convenient access to contraception without a prescription; the White House announces progress as drugmakers submit counteroffers for Medicare’s drug price negotiation program.

Out-of-pocket costs of diabetes medications other than insulin can be quite high for individuals with employer-sponsored health insurance.

Payer costs for COVID-19 ranged from a mean of $505 for asymptomatic cases to $126,094 for severe cases with post–COVID-19 condition.

Appeals court to review ruling wiping out some cost-free preventative services; a new legislation aims to boost reimbursement rates for medical providers; changes to coverage may limit elderly home care access

A collaborative service model between a managed care organization and an affordable housing provider reduced acute care use and costs.

WHO warns of global obesity epidemic challenges; doctors advised to conserve a certain type of tetanus shot; a new set of rules will bar medical debt from consumer credit reports

Among a cohort of insured patients with cancer, the median total monthly cost of oral lenvatinib was $17,253, and 75% of patients paid $100 or less out of pocket per month for the drug.

Researchers of the review are underscoring the potential for economic policies to improve the management of hypertension for the millions of people throughout the United States with the condition who are at risk for cardiovascular disease.

At an Institute for Value-Based Medicine® event cohosted by The American Journal of Managed Care® and Optum, speakers emphasized that innovation is urgently needed in primary care delivery to address the broken US health care system.

Congress is unlikely to include many major health care priorities in the next government funding package; many adults continue to see racism as a problem across aspects of US society; the Endocrine Society will review its clinical guidelines for gender-affirming care.

In this final part of our interview with James Robinson, PhD, MPH, he underscores the need for employer education about the health plans they offer, fostering managed competition among hospital systems to drive down costs, and innovation in financing drug development.

Patients with cancer express shock and anxiety over the recent ruling by the Alabama Supreme Court regarding frozen embryos; doctors are beginning to charge fees for administrative tasks; some universities are implementing accelerated nursing programs to help with the shortage.

This week's news from the Center on Health Equity and Access discusses racial disparities in prostate cancer outcomes, the impact of access to cancer care on racial gaps in CLL/SLL outcomes, the effects of 340B programs on drug pricing and health care disparities, the role of mental illness in maternal mortality rates, and racial bias and diagnosis disparities in bipolar disorder.

In part 3 of our interview with James Robinson, PhD, MPH, he discusses the need for reforms to commercial insurance that reflect the changes to Medicare under the Inflation Reduction Act, how the 340B drug pricing program has veered widely from its original goals, and ongoing cost sharing struggles among patients, insurers, hospitals, and drug companies.

In honor of Black History Month, Leesha Ellis-Cox, MD, MPH, sheds light on the racial disparities in mental health care and the prevalence of misdiagnosis.

Intensive surveillance after resection on patients with colorectal cancer (CRC) was less cost-effective in stage I but most cost-effective in stage II and III disease.

Researchers suggest an alternative method to align drug prices with clinical benefits for patients with psoriasis.

Changing High-Risk Asthma in Memphis through Partnerships significantly decreased health care use related to asthma among children.

Insurers grapple with expanding overage for weight loss medications; a new analysis reveals a potential correlation between COVID-19 vaccinations and various adverse effects (AEs); reshaping Medicaid programs remains an ongoing debate about ensuring health care access.

Carrie Kozlowski, OT, MBA highlights 3 key trends shaping the future of health care: a focus on health equity with actionable strategies for equitable access to care, a transition toward responsible AI utilization, and a push to maximize the potential of patient data while addressing privacy concerns.

Discontinuation of asthma drug leaves patients in search of alternative; FDA’s approach to artificial intelligence (AI) raises opportunities and challenges; landmark FDA approval signals hope for millions with severe food allergies.

This week in health equity and access includes challenges for independent physicians due to Medicare cuts, inequities in access to State Health Insurance Assistance Program counseling, a study on patient experiences in national health plans, strategies for building trust in cancer care, and increasing breast cancer rates in young Black women.

Medicare beneficiaries are beginning to see the first savings from the Inflation Reduction Act; abortion pills prescribed to patients via telehealth and the mail are safe; nearly half of health care workers have witnessed racism or discrimination in their workplace.