Health Care Delivery

This week, the top stories in managed care included poll results that show growing numbers of Republicans want the Affordable Care Act scaled back instead of repealed, Jardiance received a new indication for patients with type 2 diabetes, and CareMore reported care coordination gaps for seniors.

Creating effective interventions to care for complex populations and making them available is only half the battle. That was the lesson gleaned from a workshop session at The National Center for Complex Health and Social Needs’ Putting Care at the Center conference, held December 7-9 in Philadelphia, Pennsylvania.

During the first plenary session of Putting Care at the Center, the inaugural conference of The National Center for Complex Health and Social Needs, panelists discussed building new models to care for high-need, high-cost patients.

The American Hospital Association and the Federation of American Hospitals sent a joint letter to President-elect Donald Trump and Vice President-elect Mike Pence highlighting the potentially devastating effects a repeal of the Affordable Care Act (ACA) could have on community hospitals.

The report finds that if the Affordable Care Act is repealed, many who stand to lose are low-income parents who gained coverage under reforms that extended healthcare to families and raised eligibility to 138% of the federal poverty level.

These are uncertain times in healthcare and the anxiety levels of stakeholders remain high as everyone waits to see how the appointments and policy changes within the new administration will impact healthcare in the United States in the near future.

It seems intuitive that people with higher incomes enjoy better health. But for researchers, this general relationship raises many questions, not the least of which relates to “causality.â€

A recently released report investigates the potential ramifications of partially repealing the Affordable Care Act through the process of budget reconciliation. The study by the Urban Institute Health Policy Center warned that such a move by Congress would double the number of uninsured Americans and significantly disrupt the insurance market, resulting in reduced access to care.

What we're reading, December 7, 2016: health insurers provide demands if Republicans repeal Obamacare; women face 20% higher healthcare costs in retirement; and immunotherapies are being considered for sepsis.

What we're reading, December 6, 2016: Members of the GOP are unhappy with the leadership's plans for a 3-year repeal and replace of Obamacare; California bill would require superbugs be listed on death certificates; and Novo Nordisk promises to limit drug price hikes.

Putting Care at the Center is bringing together innovators from across the country to network, learn from each other, and create a shared agenda for the emerging field of complex care.

The group that represents 5000 hospitals outlined a policy agenda that calls for regulatory reform but also seeks some certainty that patients who gained coverage under the Affordable Care Act will be able to retain it in the future.

What we're reading, December 5, 2016: insurers may be turning a corner with Obamacare plans; selling insurance across state lines may be a difficult initiative to implement; and older Americans are not diligent about getting vaccinations.

Immuno-oncology will be an important part of cancer care in the future, but probably not the only part, predicted Robert W. Carlson, MD, CEO of the National Comprehensive Cancer Network. He also explained how patient advocacy and an enduring healthcare system are essential to the advancement of cancer care.

Prescription drug spending didn't rise as much as it did in 2014, but it still outpaced all other categories.

What we’re reading, December 2, 2016: Johnson & Johnson must pay $1 billion to patients injured by Pinnacle hip implants; 3 organizations join forces on initiative to prevent suicides in physicians and medical trainees; the American Hospital Association has sent a letter to President-elect Donald Trump with a list of requests for his administration.

In a show of bipartisanship, the House of Representatives overwhelmingly passed the 21st Century Cures Act on November 30 by a vote of 392-26. Here are 5 things to know about the legislation.

What we’re reading, December 1, 2016: the percentage of Republicans that would like to see the Affordable Care Act scaled back instead of repealed has more than doubled since the election; smoking will soon be prohibited in all public housing nationwide; some physicians are incensed by the American Medical Association’s support for Rep. Tom Price as HHS secretary.

Though they may not directly provide patient care for their members, managed care organizations (MCOs) play a substantial role in the patient experience of millions of Medicaid enrollees.

The proposal from CMS may make it difficult for groups that have been providing the DPP to take part in Medicare reimbursement.

Awareness of Medicaid eligibility rules meant that in 2014 alone, more than 2 million people enrolled for benefits who belonged in the program but for some reason had never signed up.

A well-functioning healthcare system must be coordinated, efficient, cost-effective, and goal-oriented. Unfortunately, these words don’t summarize healthcare services in the United States.

What we're reading, November 28, 2016: The GOP is considering reforms to Medicare and Democrats are gearing up for a fight; the IRS will send letters to try to sign more people up for Obamacare; and the abortion rate reaches the lowest level in decades.

On average, many families are spending a larger share of their income on healthcare than they were prior to 2010. That is because median incomes, despite their recent surge, have not kept pace with healthcare costs.

Over the past 4 years, search interest for "urgent care" has risen steadily, while search interest for "hospital" has slowly declined.

The general stigma and bias circulating obesity hinders the ability to improve the patient’s health, explained Ted Kyle, RPh, MBA, principal at ConscienHealth. With number of individuals with obesity, patients, physicians, and payers can’t afford to think of obesity as a purely cosmetic condition.

There is significant uncertainty surrounding the healthcare system’s future in 2017 under a Republican Congress and President, but it’s unlikely that the Affordable Care Act will be repealed without some replacement that accommodates the individuals newly covered by it, said Robert W. Carlson, MD, CEO of the National Comprehensive Cancer Network.

The 5th Annual Patient-Centered Oncology Care Meeting closed out with a panel discussion with an eye on the future. Donald Trump's surprise election has caused turmoil in the healthcare industry as the Affordable Care Act seems certain to be repealed at least in part. However, the move to value-based care will likely continue as planned.

The 5th annual Patient-Centered Oncology Care® (PCOC) meeting, hosted by The American Journal of Managed Care, November 17-18, in Baltimore, Maryland, concluded with a panel discussion on the future of oncology care in 2017. The panelists concurred that value-based payment is here to stay despite the imminent changes in healthcare.

What we're reading, November 22, 2016: Virginia declares opioid addiction a public health emergency; House calls for a pause of ongoing Obamacare lawsuit; and Anthem-Cigna antitrust trial begins.