Insurance

Michael Chernew, PhD, professor of health care policy and director of the Healthcare Markets and Regulation Lab, Harvard Medical School, shares how cost-sharing policies shape access to critical health care services and influence value-based insurance design.

The second Trump administration is expected to bring changes to Medicaid, Medicare Advantage, and the health insurance exchanges, as well as highlight the Make America Healthy Again (MAHA) movement, speakers at the Value-Based Insurance Design Summit said.

Flood exposure was more strongly associated with increased health care use and cost during the summer months and among Medicare beneficiaries aged 85 or older.

A new report shows most Americans believe the government is too involved in health care regulation and want to see a ban on pharmaceutical company advertisements in the US.

Older, generic medications, including ones for cyclosporine, nicotinamide, and dapsone, can effectively treat patients with various dermatological conditions while helping to reduce insurance and cost barriers.

Thy N. Huynh, MD, FAAD, Bruce A. Brod, MHCI, MD, FAAD, and Melissa Piliang, MD, FAAD, discussed expanding access to pediatric dermatology, dermatology data aggregation, and advocacy for Medicare physician payment reform, respectively.

Information on health equity was removed by the federal government for both the Children’s Health Insurance Program and Medicaid.

Enhanced premium tax credits (PTCs) have made marketplace health insurance more affordable, and eliminating them could have sweeping impacts on consumers and the health care industry, according to a new report.

In this qualitative investigation, leaders of Medicaid managed care plans were interviewed to identify facilitators of and barriers to electronic consultation for specialty care delivery.

Expanding coverage and access to glucagon-like peptide-1 (GLP-1) medication can be beneficial for all with the cooperation of multiple parties in health care.

The Health Insurance Disparities Index allows stakeholders to assess progress in addressing health care disparities using publicly available, validated, reported health plan quality metrics results.

Delays in receiving coverage for essential medications like insulin and albuterol can worsen symptoms, increase costs, and add stress for patients.

Building trust with patients who are dually eligible for Medicaid and Medicare can help to improve their lives as they navigate receiving care to address their clinical and behavioral health needs.

Of the surveyed physicians, 93% reported that prior authorization delays patient care, and 89% said it contributes to burnout.

These findings support the claim that Medicare Advantage (MA) payments may be driven more by diagnosis and coding practices rather than differences in disease burden between MA and fee-for-service (FFS) Medicare beneficiaries.

Higher telemedicine adoption among Medicare beneficiaries was associated with a slight increase in total visits but a reduction in certain low-value tests and related spending.

The Trump administration argues that HHS Secretary Robert F. Kennedy Jr can overrule the US Preventive Services Task Force to determine the preventive services covered under the Affordable Care Act.

Among hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.

President Donald J. Trump pushed for significant health care changes during his first month back in office, through executive orders affecting managed care, drug pricing, and clinical trial diversity guidance.

The House budget includes cutting $880 billion from programs under the House Energy and Commerce Committee's jurisdiction, which include Medicaid.

Comparing plans with similar characteristics, such as size, geographic location, or demographics served, allows for more meaningful insights and improvement opportunities.

For this retrospective study, the authors examined data on more than 3 million screening mammographies for more than 1 million female patients; of the screenings, 23.6% had abnormal results and only 6.7% were recommended for biopsy.

The number of psychiatrists submitting more than 10 claims to Medicare Part B decreased by 16.8% from 2014 to 2022.

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

During the unwinding of continuous Medicaid provisions, 8.7% of pediatric patients at community-based health organizations became uninsured, with higher rates among older children, females, and those with chronic medical conditions.

Relying on veteran survey responses and novel actuarial data, the authors examine the relationship between benefit value and reliance on the Veterans Health Administration.

This week, Robert F. Kennedy Jr sat before the Senate for 2 separate hearings, to decide the fate of his confirmation as secretary of HHS.

Medicare Advantage enrollees, particularly Hispanic and Asian or Pacific Islander decedents, use less end-of-life home health care than those enrolled in traditional Medicare.

The high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.

President Donald Trump's initial executive orders target previous efforts to reduce health care costs, pandemic preparedness, and international partnerships, showing a stark contrast to the Biden administration.