Health Care Delivery

The top stories in managed care this week include value-based pricing of the new PCSK9 inhibitors, CMS unveiled a new health equity plan for Medicare, and the American Medical Association released analyses on proposed health insurance mergers.

Creating a statement that mental health and physical health have parity is important for achieving outcomes in patients with chronic illnesses, said Trishan Panch, MBBS, MPH, chief medical officer at Wellframe.

House Republicans won a minor victory in a new lawsuit against the Obama administration for the legality of spending money from the Treasury for health insurers under the Affordable Care Act. Arguments will be heard this fall.

Kim Thiboldeaux, chief executive officer of the Cancer Support Community, discusses the importance of providing strong community support, the misconceptions of clinical trials, and creating a tailored care plan.

At the end of CMS' comment period, the American Society of Clinical Oncology submitted its comments and recommendations for the proposed changes.

The California Public Employees' Retirement System saved $7 million on screening colonoscopies during a 2-year period following implementation of reference pricing.

CMS has released a new plan to address health equity in Medicare, which includes 6 priority areas aimed at reducing health disparities over the next 4 years.

With the comment period ending today, the proposed CMS cuts to radiation oncology reimbursement rates might have a substantial impact on community treatment centers.

For individuals who have not made the sort of risk-averse decisions in their lives that lead to better jobs and wealth accumulation, making treatment decisions after a cancer diagnosis can be very difficult, said Amy Davidoff, PhD, MS, senior research scientist in public health at the Yale School of Public Health

An analysis of Medicare Advantage (MA) plan market shares finds little competition in counties across the nation, according to a report published by The Commonwealth Fund.

Predictive modeling determined that the needle exchange in Washington, DC, prevented 120 new cases of HIV in 2 years, according to researchers.

HHS is seeking new protections for vulnerable populations to protect them from discrimination and ensure they have equal access to healthcare and health coverage.

The difference between "heart age" and chronological age indicates risk of events like heart attacks and strokes, and could motivate younger patients to improve unhealthy lifestyles.

Leah Binder, president and CEO of The Leapfrog Group, will be the keynote speaker at the upcoming meeting of the ACO and Emerging Healthcare Delivery Coalition, to be held October 15-16, 2015, in Palm Harbor, Florida. The Coalition, an initiative of The American Journal of Managed Care, brings together stakeholders from across healthcare to share ideas for navigating the changing reimbursement landscape.

CMS is making available grant funding for 100 organizations to provide enrollment assistance during the third open enrollment period under the Affordable Care Act.

Personalized telephone counseling and tailored educational materials can improve colonoscopy rates among at-risk family members of patients with colorectal cancer.

Awareness of the ACA has brought out more recipients eligible for Medicaid than the state knew it had.

The Cancer Prevention and Ethics Committees of the American Society of Clinical Oncology have made several recommendations that address genetic and genomic testing policies for cancer risk assessment.

The ruling will most likely be appealed by the government. The ACA requires coverage for contraception as a preventive service.

Only about one-fourth of all patients with behavioral health issues are diagnosed by a primary care provider and receive the appropriate treatment, said Paul Ciechanowski, MD, MPH.

Research from The Commonwealth Fund found little indication that risk segmentation is causing adverse effects in the insurance market either in coverage sold on the exchanges and coverage sold off the exchanges.

Although hospital consolidation has not shown the benefits proponents had touted, it is inevitable that there will be consolidation in healthcare, because the environment is too challenging for smaller hospitals and many physician practices, explained Paul Ginsburg, PhD.

Although the fee-for-service model of reimbursement has been blamed as an reason for high healthcare costs in America, a report from HealthPocket found that eliminating this payment model in provider-owned health plans did not produce the cheapest health plans.

In the second quarter of 2015 the healthcare spending growth rate was 5.9%, a decline from 6.6% in the first quarter of the year, but the health spending growth rate is still 2 percentage points higher than rates experienced between 2009 and 2013.

Fears of health insurance premium hikes during the third year of the Affordable Care Act may not be unfounded. In Tennessee, the state's insurance commissioner just approved BlueCross BlueShield of Tennessee's 36.3% increase.

Both surveys and peer-reviewed research show patients like telehealth services. CVS' announcement comes after a successful pilot program showed a collaboration of telehealth and the retail clinics produced good results for patients.

An analysis of provider networks offered in the Affordable Care Act's marketplaces found large variation of the prevalence narrow networks among the states, according to researchers at the University of Pennsylvania.

The results for 2014, which was Year 3 of the program, revealed winners and losers and showed that ACOs may not be the only solution to hold down the cost of healthcare.

The deadly nature of colorectal cancer merited attention in the Affordable Care Act, which called for eliminating cost-sharing for screening to prevent deaths. The future of colorectal screening, its cost-effectiveness, and a possible way to limit unneeded tests are the topic of a recent series of papers in The American Journal of Managed Care.

Republican presidential hopefuls may all be ready to repeal and replace the Affordable Care Act, but new reports in August found the health law continues to make big changes to the US healthcare system.