Insurance

During a session at World Health Care Congress 2019, Senator Bill Cassidy, MD, offered his alternative to Medicare for All, which is modeled after the Children’s Health Insurance Program, and discussed other healthcare issues on his radar.

Basit Chaudhry, MD, PhD, founder of Tuple Health, explains why it's important to evaluate the adequacy of the novel therapy adjustment under the Oncology Care Model (OCM).

During a session at the National Association of Accountable Care Organizations (ACOs), top performing ACOs shared lessons learned and best practices for ensuring compliance with quality measures while keeping the patient at the forefront.

Crescent Moore, PharmD, PhD, BCPS, senior consultant, BluePeak Advisors, discusses how CMS is planning on implementing care coordination programs in Medicare.

As part of CMS’ FY 2020 Medicare Hospital Inpatient Prospective Payment System and Long-Term Acute Care Hospital Prospective Payment System Proposed Rule and Request for Information, the agency is proposing an increase in how much it reimburses hospitals for chimeric antigen receptor (CAR) T-cell therapy, as well as wage index hikes for rural hospitals.

At the American Medical Association headquarters Monday, HHS Secretary Alex Azar and CMS Administrator Seema Verma announced 5 new Medicare primary care payment models designed to eventually incentivize the entire healthcare system to transition to value-based care, particulary for patients with chronic conditions.

With all the regulatory changes that CMS and HHS are rolling out, community oncology practices are facing significant changes in how they take care of patients, said Barry Russo, chief executive officer of The Center for Cancer and Blood Disorders.

Results of the landmark study, the first in a series of renal outcomes studies for SGLT2 inhibitors, will be of great interest to policy makers given the cost of dialysis to Medicare.

CMS has given plan sponsors the flexibility to choose which drug therapy categories they’d like to administer the Part B step on, explained Crescent Moore, PharmD, PhD, BCPS, senior consultant, BluePeak Advisors,

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Senator Bernie Sanders, I-Vermont, has reintroduced a Medicare for All bill while other Democrats eye an alternative; the Trump administration is appealing a federal judge's decision to toss out Medicaid work requirements in Kentucky and Arkansas; AIDS activists are pushing CDC to force Gilead to give the agency royalties for Truvada.

Pharmacy benefit manager executives told members of the Senate Finance Committee that rebates are not the cause of high drug prices, and that more must be done to end evergreening and pay-for-delay tactics. Senators were skeptical.

The first day of the 2019 Community Oncology Conference, the major annual meeting of the Community Oncology Alliance (COA), featured an update on its effort to find alternatives to CMS' Oncology Care Model.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included the Department of Justice siding with a federal judge in striking down the Affordable Care Act; FDA Commissioner Scott Gottlieb, MD, calling for stricter oversight of electronic health records; and a study finding that healthy eating in Medicare and Medicaid is cost effective.

Even when things go well, managing diabetes is not easy. Keeping tabs on this disease 24/7 takes planning, commitment, support, and the right tools. For years, a chief complaint among those living with diabetes has been that managed care nickel-and-dimes people over basic supplies, which are comparatively cheap—things like test strips and sensors for a continuous glucose monitor—but will shell out thousands for dialysis and amputations. In the years ahead, if Congress wants to understand rising costs for end-stage renal disease or an increase in emergency department visits for hypoglycemia, it should look directly to CMS’ foray into competitive bidding for blood glucose test strips.

Three years after results from a study in Diabetes Care revealed how flaws in CMS’ Competitive Bidding Program endangered Medicare patients who rely on supplies to test their blood glucose, the federal government has allowed contracts to expire for the dwindling number of suppliers, raising fears that the program for seniors with diabetes has reached the point of collapse.

Insurer Centene strikes a deal to acquire WellCare, creating a new giant in the healthcare market; a federal jury orders Monsanto to pay over $80 million to a plaintiff whose cancer was found to be caused by a common weed killer; surgeons perform a transplant using a kidney from a living donor with HIV.

Utilization management tools and formulary designs are components of a multifaceted strategy to curb opioid overdose death rates, but they must be applied in a flexible manner, according to speakers at the Academy of Managed Care annual meeting.

Crescent Moore, PharmD, PhD, BCPS, senior consultant, BluePeak Advisors, discusses changes to Medicare Part D expected to come in 2020 and their implications.

The Department of Justice now backs the ruling from a district court judge in Texas that said the entire Affordable Care Act (ACA) is invalidated without the individual mandate, which was removed when Congress reduced the penalty to $0.

Medical practices are leaving money on the table by not producing clean medical claims. Incremental improvement can improve cash flow and reduce accounts receivable days, important metrics to determine the health of a medical practice.

Researchers found that a prescription for healthy food can improve health outcomes for beneficiaries in Medicare and Medicaid.

CMS’ proposal that patients be enrolled in a clinical trial or registry to get Medicare coverage for chimeric antigen receptor (CAR) T-cell therapies will help improve access, for the most part, but there is the risk that some organizations will choose not to offer this treatment, said John W. Sweetenham, MD, of Huntsman Cancer Institute at the University of Utah.

Medicaid work requirements could have a severely negative effect on hospital finances, reducing total revenues, raising uncompensated care costs, and decreasing operating margins.

Some states are rethinking how to compensate hospitals for services, using Medicare reimbursement rates as a benchmark to control costs for state employee health plans; reported cases of mumps are on the rise at Temple University in Philadelphia; the Lancet Commission outlines a new plan for worldwide tuberculosis eradication.

Social determinants of health, including stress, social support and environmental hazards, among other factors, impact the lives of patients beyond the clinic door. It is unclear which health system stakeholders should own the responsibilities of improving these health-related measures, yet US payment systems are moving to hold individual providers accountable for associated health improvements. This represents a misalignment of accountability and capability, write two researchers in a viewpoint from the current issue of The American Journal of Accountable Care®.

A session at the 68th American College of Cardiology Scientific Session continues the ongoing debate whether a CMS reimbursement model has contributed to rising mortality in patients with heart failure.

The March issue of The American Journal of Managed Care® (AJMC®) featured research on immuno-oncology costs and Medicare Annual Wellness Visits in addition to studies on the issue’s theme of Medicaid. Here are 5 findings from research published in the issue.