Health Care Delivery

Although millions of Americans have gained health insurance under the Affordable Care Act, the Commonwealth Fund recently found that 31 million individuals were underinsured in 2014.

While there's been controversy around the drug discount program for some time, the Health Resources and Services Administration plans to release a "mega-guidance" that will address several aspects of the 340B program.

The authors discuss the success of the Pioneer ACO model and the Comprehensive Primary Care Initiative, among others. They outline an agenda that includes engaging managed care stakeholders, so that both public and private payers are moving toward value-based payment.

Coverage of the 64th Scientific Sessions of the American College of Cardiology.

Coverage from the 64th Scientific Sessions of the American College of Cardiology.

The most sweeping overhaul of Medicaid regulations since 2002 is due soon. So far there are few hints at what CMS may require states to do as they award managed care contracts in an effort to better coordinate care and control costs.

The article, published in the Journal of Hospital Medicine, found that large urban hospitals that serve as a safety net for patients with lower socioeconomic status, are at a disadvantage due to factors outside of their control.

Although the uninsured rate among Americans between the ages of 50 and 64 years was already lower than the national average, the rate fell by nearly a third from December 2013 to December 2014, according to a study published by the AARP Public Policy Institute.

Risk factors associated with diabetic ketoacidosis typically do not change. Preventing DKA should focus on identification of those most at risk and educating them good self-care to avoid incidents.

The realm of cancer care remains a holdout in the movement toward value-based payment models, with implications for cost and health outcomes, according to authors of a new article in The American Journal of Managed Care. Authors from the Center for Health Policy at the Brookings Institution assert that new payment models can be adopted by all payer and provider types, with benefits over the traditional fee-for-service model.

Health insurance companies will be looking for consumers to pay more in 2016, according to Kim Holland, director for state affairs for Blue Cross Blue Shield Association, who called demands for lower premiums or monthly fees "unrealistic."

The findings in Diabetes Care served as early confirmation of what some had feared: a bifurcated Medicaid system will lead to an American of haves and have-nots in healthcare.

Although there has been improvement in the use of health information technology for care coordination, fewer than half of patient-centered medical homes routinely use computerized systems to identify patients seen in emergency departments or hospitals or to send care summary to other providers.

As of April 2015, 21 states have chosen not to expand Medicaid eligibility under the Affordable Care Act. All but one of those states have also chosen to rely on federally facilitated marketplaces.

This week The American Journal of Managed Care launched its new Managed Markets News Network, featuring the top stories in managed care and interviews with industry experts.

More than 1 in 4 adults who bought insurance for themselves or their families last year had to skip needed medical care because they couldn't afford it, according to a study released Thursday by Families USA, a consumer health group.

Gov. Rick Scott told agency heads to prepare for the worst Thursday, asking them to list only the state's most critical needs in the event the Legislature can't reach an agreement on a budget that doesn't expand healthcare to the poor.

The contractor tapped to rescue the flailing HealthCare.gov in the fall of 2013 declared its work finished Thursday and said it doesn't plan to continue overseeing the website that sells subsidized insurance to millions of Americans as part of the federal health law.

The theory that a lack of coordination leads to poor health outcomes and higher costs drives US healthcare policy. But for the first time, a new study in The American Journal of Managed Care measures this phenomenon-and confirms it.

A hospital visit prompts an exchange about an "Alabama plan" to expand Medicaid in a state that is trying for find new funding sources for adult mental health services.

According to Robert Pozen, non-resident senior fellow at Brookings, government healthcare plans were 17.5% higher cost than the average citizen's plan, while their employee contributions were 45% less than the average plan. If these patterns continue, many state and city healthcare plans will run up against the "Cadillac" tax in 2018, he predicts.

The Maryland Health Connection, the state's insurance exchange, employed a number of strategies in during the second open enrollment period to get consumers signed up, explained Carolyn Quattrocki, executive director of the Maryland Health Benefit Exchange, the agency that operates Maryland Health Connection.

The guidance comes after advocacy groups and members of Congress complained of widespread violations of the Affordable Care Act's requirement that all forms of birth control be covered without a co-payment, not just the low-cost methods. The action also responds to recent reports that payers have balked at requests for BRCA testing even when indicated.

Carolinas HealthCare System monitors ICUs in 10 of its hospitals from a command center near Charlotte. The command center is staffed 24/7 with a rotating crew of 7 to 9 nurses and doctors who specialize in critical care.

Medicare's new payment formula is set to begin in 2019. The problem is no one's agreed on standards for measuring quality or efficiency of patient care.

The White House is moving to address 2 of the most common consumer complaints about the sale of health insurance under the Affordable Care Act: that doctor directories are inaccurate, and that patients are hit with unexpected bills for costs not covered by insurance.