Insurance

To drive real innovation in Medicare Advantage—improvements that will result in better health outcomes and reduce costs—CMS should start with doctors.

Patients cared for by physicians in their first year as hospitalists have worse 30-day and hospital mortality when compared with more experienced hospitalists.

More than 700 hospitals were penalized for having the highest rates of patient injuries; the Physician-focused Payment Technical Advisory Committee backed 2 new alternative payment models; and experts outline the biggest challenges of implementing and maintaining electronic health records going into the new year.

Coverage from the Community Oncology Alliance (COA)’s Payer Exchange Summit on Oncology Payment Reform, held October 23-24 in Tysons Corner, Virginia.

A least one US payer, CareMore, has a program to combat loneliness in seniors to prevent chronic disease and other health problems.

A group of 7 organizations wrote to CMS Administrator Seema Verma, urging the agency to support independent physicians and practices in the move to value-based care.

"The Oncology Drug Marketplace: Trends in Discounting and Site of Care," commissioned by the Community Onoclogy Alliance and conducted by Berkley Research Group, found that 340B hospitals have a clear financial incentive to expand oncology services; 340B hospitals receive over one-third of all Part B oncology drug reimbursement; a disproportionate share of the shift in site of care is attributable to 340B hospitals; and between 2010 and 2015, statutory discounts and rebates paid by manufacturers have almost tripled and put upward pricing pressure on drugs.

Medicare is alleging laboratories improperly billed the government for improper tests; time is running out for children receiving healthcare from CHIP; the AMA extends its diabetes prevention model to Maryland and other states.

Commonwealth Fund researchers said Medicare Advantage plans will need enhanced incentives to make sure that high-quality care is provided at lower cost, as the number of beneficiaries in these plans is expected to climb by 2027.

A report from the Urban Institute traces CMS' evolving approach to compensating primary care physicians to treat those with multiple chronic conditions.

Is transfusion dependence a barrier to hospice utilization among older patients with leukemia who are enrolled in Medicare?

CMS' update to the Medicare Advantave Value-Based Insurance Design Model, demonstrate CMS’ continued commitment to expanding the demonstration and allowing participating plans more flexibility for customized benefit designs.

Diagnosis-related group coding determines eligibility for many Medicare bundled payment initiatives. This approach excluded many patients with chronic obstructive pulmonary disease likely to benefit while including others without the disease.

House Speaker Paul Ryan, R-Wisconsin, is eyeing spending cuts to Medicare and Medicaid; Louisiana's Medicaid program reported lower-than-expected spending and a potential surplus; ACA enrollment continues to climb, but expected to fall short of 2017 due to shorter enrollment period.

The rate of healthcare spending in the United States slowed down last year to levels previously seen between 2008-2015, driven by much slower growth in spending for retail prescription drugs, as well as hospital care and physician and clinical services. Private payers, Medicaid, and Medicare­ also saw lower rates of spending growth.

Humana may also make an acquisition deal and UnitedHealth buys a unit of DaVita; a look at the FDA's expedited review programs; how a billing code discrepancy may have cost taxpayers up to $102 million in Medicare payments to hospitals.

Mortality rates from opioid-driven hospitalizations in the United States quadrupled over 2 decades, especially among older, white, low-income populations, according to a study published in Health Affairs. The analysis showed that people enrolled in Medicare, and not those in Medicaid, accounted for the fastest-growing share of opioid and heroin poisoning.

Republican leaders begin work Monday reconciling the differences in the Senate and House tax legislation, hoping to send a final bill to President Trump before Christmas. Senate Republicans passed the bill by 51-49 just before 2 am on Saturday.

CMS is focusing on patient empowerment and unburdening physicians, said CMS Administrator Seema Verma during her keynote speech at the Office of the National Coordinator for Health Information Technology’s Annual Meeting.

A growing number of clinicians specializing in nursing home care indicates the beginning of a new trend in healthcare, but the impact of these new specialists on outcomes remains unclear.

Scaling back the Comprehensive Care for Joint Replacement model and canceling an expansion proposed under the Obama administration represents a shift in philosophy from mandatory to voluntary bundled payment models. But some say that commercial payers and employers will demand change no matter what CMS does.

A recently remeleased rule proposal for Medicare Advantage would give plans greater flexibiilty around the uniformity requirement and allow for the implementation of value-based insurance design principles.

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 stories included a new rule from CMS to address drug costs for seniors; a campaign to get payers to fund the artificial pancreas is working; and a new survey identifies how Americans prefer to treat pain.

Chief Togetherness Officer Robin Caruso, LCSW, highlights early successes of CareMore's program to address lonelineness in the senior population.

Federal regulators are asking for information that will get to the bottom of how drug discounting between pharmaceutical companies and health plans affect what seniors pay at the pharmacy counter.

Reimbursement policy has been a driver of change in the way hospitals handle heart failure patients.

Following the transition year and ahead of the full implementation in year 3, CMS made provisions to the Quality Payment Program to make it easier for clinicians to participate in the program, reduce burden, and to get clincians ready for full implementation.

CMS officials addressed a key concern that groups offering the Diabetes Prevention Program would bear too much financial risk, but they were unmoved on requests to let beneficiaries try the program more than once in a lifetime.

The reform will adjust payment for drugs purchased through the program, relieve some burden for rural hospitals, and exempt rural sole community hospitals, certain cancer hospitals, and children's hospitals.