Insurance

In 2014, Maryland and CMS entered a 5-year agreement employing the All-Payer Hospital Model in the state to cut costs while improving quality. According to the year 3 performance data, Maryland has met or is on track to meet all model requirements, saving hundreds of millions of dollars as it lowers hospital readmissions and steers the state away from a volume-based system.

The report finds a connection between payment reform and hospital use patterns, but that connection may add to the debate that cardiologists have raised over the effect on patients.

The burden of high drug costs is something that everyone with health insurance coverage is facing, explained Leigh Purvis, director, Health Services Research, AARP Public Policy Institute.

Coverage of the 67th Scientific Session of the American College of Cardiology.

Healthcare reform pledged to do better for patients with heart failure, creating the incentives and team-based approaches these fragile patients need. In some cases, this has happened, but there have also been unintended consequences, according to a panel appearing Sunday at the 67th Scientific Session of the American College of Cardiology, being held in Orlando, Florida.

Savings hospitals had lower baseline spending than nonsavings hospitals during the first year of the Comprehensive Care for Joint Replacement (CJR) program, according to a Research Letter in JAMA.

In a keynote address at the 2018 National Health Policy Conference of America’s Health Insurance Plans (AHIP) in Washington, DC, HHS Secretary Alex Azar asked his audience to consider 4 areas that he said are key to “accelerating value-based transformation, and creating a true market for healthcare” through means of some sort of federal intervention that puts patients in control of their own health records.

Experts from healthcare policy organizations and advocacy groups that cater to Medicare enrollees exchanged best practices and proposed policies to help alleviate access issues during the Cost-Sharing Roundtable, co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care®, on February 23, 2018, at the Barbara Jordan Conference Center in Washington, DC.

Leaders from charitable organizations that provide the safety net so patients can meet their healthcare costs and access their required medical treatment have concerns with the widening gap between patient financial needs and available resources. They were speaking at the Cost-Sharing Roundtable in Washington, DC, co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care®.

The first results of the Oncology Care Model (OCM), a 5-year bundled payment demonstration from CMS, were released recently, and at a session at the National Community Oncology Dispensing Association Spring Forum 2018, Mike Fazio of Archway Health discussed the reconciliation statements from the first performance period of OCM, and where practices can look to make improvements going forward.

Patients with cancer, many who are older and on Medicare, are finding their medications are becoming unaffordable, Michele McCourt, senior director of the CancerCare Co-Payment Assistance Foundation, explained at the Cost-Sharing Roundtable, co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care®.

Coverage from the National Community Oncology Dispensing Association Spring Forum 2018.

Since 2000, the number of patients undergoing gender-affirming surgery who identified as self-payers decreased. From 2012-2013 to 2014, coverage by Medicare and Medicaid of gender-affirming surgeries increased 3-fold.

In a joint letter, several organizations urged CMS Administrator Seema Verma to allow certain accountable care organizations to continue in the Medicare Shared Savings Program (MSSP) Track 1 for a third agreement period, warning that these ACOs are not ready to take on a 2-sided risk.

State variations in chronic obstructive pulmonary disease (COPD) outcomes suggest that the condition is more common in large rural areas compared with metropolitan areas, according to the Morbidity and Mortality Weekly Report from CDC.

New research has found that allogeneic hematopoietic stem cell transplantation is just as effective in patients with non-Hodgkin lymphoma who are age 65 and older as it is in patients between the ages of 55 and 64.

Coverage of value updates from Patient-Centered Oncology Care, November 16-17, 2018.

A symposium at Seton Hall Law School examined the role of care coordination and transitions in helping those with substance use disorder find success in treatment. Some experts say that managed care has not supported care coodination despite evidence that it works and ultimately saves money for health systems.

With formal integration initiatives, such as accountable care organizations, having modest effects, researchers analyzed the impact of informal clinical integration on cardiac surgery payments and found that patients who were treated in health systems with higher informal integration had greater savings.

A liberal think tank released a universal healthcare plan modeled on Medicare that would also preserve employer-based insurance coverage as an option for those who are satisfied with their current plans. The Center for American Progress (CAP) is calling its program “Medicare Extra for All” and said it would be available to everyone regardless of income, health status, age, or insurance status.

CAR T- cell therapies are among the most expensive ever invented. For now, there’s a lot of uncertainty, as both government and commercial insurers, and a handful of the nation’s leading cancer centers, navigate a reimbursement structure that truly has no precedent.

Driven by an aging US population and other economic and demographic factors, national health spending is projected to climb to 19.7% of the economy over the next 8 years, up from 17.9% in 2016, according to new estimates released Wednesday from CMS and published online in Health Affairs.

The Department of Justice is moving forward with a $1 billion lawsuit against UnitedHealth Group over Medicare claims; Oregon's legislature is considering adding healthcare as a right to the state's constitution; another trial for an Alzheimer disease drug is stopped.

From 2013 to 2016, Medicare Shared Savings Program accountable care organizations (ACOs) improved quality. Continued infrastructure development funding, better relationships with postacute care facilities, and shared learnings among diverse ACOs would maximize quality improvement.

The proposed budget released Monday would have winners and losers in Medicare; President Donald Trump's budget, a messaging statement, contains healthcare cuts; veterans in California risk eviction from veterans homes if they intend to use an aid-in-dying law.

Born as part of the Affordable Care Act (ACA) in 2010, the controversial Independent Payment Advisory Board (IPAB) was eliminated last week as part of the Bipartisan Budget Act of 2018 without ever having been implemented. The IPAB sought to reign in Medicare spending if targets went over certain levels, but it had almost universal opposition from the healthcare and medical communities.

From 2013 to 2016, successful Medicare Shared Savings Program accountable care organizations reduced spending by shifting expenditures from the inpatient and postacute care setting to the physician office setting.

According to the Medicare Payment Advisory Commission (MedPAC), hospital readmission rates have fallen following implementation of the Hospital Readmissions Reduction Program (HRRP), and HRRP did not have a negative impact on mortality rates.

After a brief shutdown in the dead of night, the Senate passed a spending bill, which was the result of a deal reached by Republicans and Democrats to fund military and domestic programs for 2 years. The House passed the bill shortly after.