Health Care Delivery

The partnership is expected to improve the quality of care and the overall care experience for Aetna members who seek care at Regional Cancer Care Associates (RCCA) clinics in New Jersey and Maryland.

Medicare beneficiaries still face huge out-of-pocket expenses because of uncapped cost sharing in the catastrophic coverage phase. This is especially true for beneficiaries who take specialty drugs.

What we're reading, October 11, 2016: USPSTF recommendations maybe shouldn't be tied to insurance coverage; growing dispute over homeopathy research; and the harm of pharmaceutical companies' copay assistant programs.

The second presidential debate, which took place Sunday night at Washington University in St. Louis, Missouri, allowed candidates Donald Trump and Hillary Clinton to spar over a multitude of issues, including the future of healthcare in America.

Although hospitals in Medicare’s Value-Based Purchasing program already receive patient experience points based on achievement, improvement, and consistency, placing more emphasis on improvement points could benefit hospitals serving minority patients

This week, the top managed care stories included conference coverage from the Academy of Managed Care Pharmacy's 2016 Nexus, Bill Clinton courted controversy when discussing the Affordable Care Act, and research finds fear of a job loss can increase the risk of diabetes.

Nationally, nongroup marketplace premiums are 10% lower than the average employer-sponsored insurance premiums, according to an analysis by the Urban Institute.

What we're reading, October, 6, 2016: UnitedHealth is sued for allegedly overcharging on prescription drugs; the Obama administration could point consumers to remaining insurance options as insurers leave the Affordable Care Act exchanges; and human life spans may have it a ceiling.

The former president said that Obama's signature law works well for those who are enrolled in Medicaid or who qualify for subsidies, but others have seen premium increases with lower benefits. The White House noted that Hillary Clinton supports improvements to the law.

Data released by HHS today revealed that up to 2.5 million Americans currently purchasing health insurance through an off-Marketplace plan could qualify for ACA tax credit assistance if they switch to a Marketplace plan for 2017.

Having a disability is not only a physical burden that can impair a person’s ability to run errands, such as going to the doctor’s office, but it is a cause of financial difficulty due to issues including unemployment and the cost of care.

States’ decisions not to expand Medicaid appears to be affecting the financial stability of rural hospitals in the United States more than in hospitals in urban areas, according to a study in Health Affairs.

A new trend in healthcare allows individuals to continuously measure various data points-from steps to sleep patterns-and have access to that information at their fingertips.

Two Viewpoint articles JAMA highlight continuing healthcare deficiencies and inequalities in the United States and present a call to action for bold new strategies to direct resources toward improvements in support of population health.

What we're reading, October 3, 2016: President Barack Obama's Affordable Care Act will have to change to survive; pharmacy benefit managers getting blamed for rising drug prices; and veterans could go without health insurance because states won't expand Medicaid.

While working for Horizon Healthcare Innovations, Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute, gained insights on how best to transition to a pay-for-outcomes system and was able to actively work with healthcare stakeholders who were engaging in these models.

CareSource is helping to bridge the gap in a patient’s care by working within that space to pull together the various stakeholders and put the patient’s care needs at the forefront of the conversation, said Karin VanZant, executive director of Life Services at CareSource.

After 2 years of extraordinary gains in Medicaid coverage due to expansion under the Affordable Care Act, coverage in the program has steadied. Private managed care covers nearly three-fourths of enrolled lives.

What we're reading, September 30, 2016: HHS prioritized payments to Obamacare insurers over the Treasury; the CDC is concerned flu vaccinations may be down; and UnitedHealth Group and University of California come together for new partnership.

Research has shown that care provided through teledermatology is comparable to that delivered in face-to-face appointments, and future dermatologists are being taught to deliver care this way to improve patient access to expert dermatological care, said Nellie Konnikov, MD, professor and chief of dermatology at the Boston Department of Veterans Affairs.

Data show that the biggest factor affecting distribution of uninsured rates was whether a state expanded Medicaid. Even with that limitation, uninsured rates have reached historic lows. The trouble is, only about one-fourth of Americans know this, and more have moved on to issues that affect them personally, such as the cost of premiums or high deductibles.

The effort to reach young adults will allow them to shop for coverage entirely on mobile digital technology. But an economist interviewed earlier this month says it might not be enough.

What we're reading, September 27, 2016: a panel of experts recommends expanding preventive services for women with no cost sharing; BlueCross BlueShield of Tennessee is exiting 3 Obamacare exchanges; and Pfizer will not split into 2 companies.

Analysis of prescription transaction data provided insight into reduced out-of-pocket spending and increased medical fill rates for people who gained coverage under the Affordable Care Act and had at least 1 chronic condition.

Patience and compromise will be key to healing political rifts caused by Medicaid expansion, explained Matt Salo, executive director of the National Association of Medicaid Directors.

Under the Affordable Care Act, health centers received federal funding to provide comprehensive primary care to patients in underserved communities. An analysis of Medicaid claims data in 13 states has found that these health centers reduced spending by 24% per Medicaid patient.

Readmission rates for both safety net hospitals and other hospitals have decreased since Medicare’s Hospital Readmissions Reduction Program went into effect in 2013. However, disparate rates of improvement could show that these hospitals in low-income areas are still at a disadvantage.

About half of people involved with the justice system are newly eligible for health insurance through the Affordable Care Act. While coverage is rising, one-third still lack insurance.

What we're reading, September 23, 2016: California's insurance commissioner wants to try a public option; Valeant avoids double-digit price hikes with 9.9% increases; maker of Suboxone being sued by 35 states and the District of Columbia for keeping generics off the market.

The integration of behavioral healthcare into a medical setting is being delayed by resistance from those benefiting from the current payment model, said Roger Kathol, MD, president of Cartesian Solutions, Inc., and adjunct professor of psychiatry at the University of Minnesota.