Insurance

Since its inception, the Center for Medicare and Medicaid Innovation (CMMI) has implemented 37 models testing healthcare delivery and payment reform. A new Goverment Accountability Office assessment found that CMMI has partially met goals for performance targets.

Patients who get care at a hospital often receive bills that are bigger than they were expecting. In the case of Medicare, this can happen when a beneficiary receives care at a hospital for several days but was never formally admitted to the hospital.

Formulary restrictions on brand name noninsulin antihyperglycemic drugs have little impact on treatment intensification patterns among low-income patients with diabetes in Medicare Part D.

CMS Administrator Seema Verma called on qualified providers of the National Diabetes Prevention Program to become Medicare suppliers. But in last year's rulemaking process, commenters warned that the program CMS had designed was too bureaucatic and did not pay enough upfront to attract small, community-based providers.

Reducing specialty leakage is promoted as crucial for accountable care organizations (ACOs). This study finds that Medicare ACOs had modest reductions in specialty use and minimal changes in leakage.

Charitable organizations are seeing more and more patients who need financial assistance, said Dan Klein, President and CEO, Patient Access Network (PAN) Foundation.

Social determinants of health are being carefully tended to in the Medicare populations, explained Lee Newcomer, MD, MHA, private consultant.

At the 15th Annual World Health Care Congress, CMS Administrator Seema Verma highlighted new policies and initiatives from CMS to ensure that programs are delivering high-quality care in a sustainable way as healthcare spending continues to grow at a faster rate than the overall US economy.

Results on bundled payment models are mostly promising, but not consistent. However, while most program results trend in the positive direction, many of studies on bundled payments may not capture the full picture.

A California foundation recently released a policy brief about 10 questions it hopes will serve as a guide for the rest of the country seeking to improve care for older populations with complex health needs in Medicaid managed long-term services and supports programs.

There are 6 key issues that market access teams are facing amid evolving marketplace trends in the pharmaceutical industry, said Douglas Long, BS, MBA, vice president, industry relations, IQVIA, when speaking at the headline session of the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting held April 23-26, in Boston, Massachusetts.

A new report suggests ways policy makers can support and advance value-based payment models so payment innovations can catch up to healthcare delivery innovations.

Leigh Purvis, director of Health Services Research at AARP Public Policy Institute, addresses the burdens of high prescription drug costs on Medicare beneficiaries.

An analysis of a hypothetical bundled payment that included drug costs would unfairly penalize practices based on patient mix and could destabilize the cancer care delivery environment, according to research published in the Journal of Oncology Practice.

President Donald Trump will deliver his first major speech on drug prices on April 26; a recent Medicare Payment Advisory Commission proposal would cut Medicare payment rates by 30% for some services at hospital-affiliated free-standing emergency departments; nursing homes routinely turn away patients seeking care if they are using medication-assisted treatment to treat substance use disorder for opioids.

Researchers found that cost-effectiveness calculations shifted dramatically when they assumed people with diabetes used continuous glucose monitoring (CGM) sensors for 10 days instead of 7 days. This is significant because Dexcom just received approval for a next-generation CGM system with a factory-calibrated 10-day sensor.

As increasing numbers of children with special healthcare needs move into Medicaid managed care, health plans can improve care coordination using evidence from Medicare.

In order to make Medicare drug price negotiation a reality, the government has to have additional leverage to negotiate that it doesn't have, explained Ed F. Haislmaier, the Preston A. Wells Jr senior research fellow at the Institute for Family Community, and Opportunity at The Heritage Foundation.

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 President Donald Trump signing an executive order requiring the poor to get jobs or lose food and healthcare benefits; a CMS report found ethnic, racial, and gender disparities in Medicare Advantage plans; CDC highlighted the impact of HIV on America's youth.

House Speaker Paul Ryan is leaving Congress at the end of the year without success on spending cuts to Medicare, Medicaid, and Social Security; the FDA is conducting a criminal investigation into research by a Southern Illinois University professor who injected people with his unauthorized herpes vaccine; the National Institutes of Health (NIH) is "aggressively" looking into reports that it solicited funding from the alcohol industry for a study on the benefits of moderate drinking.

President and CEO Kevin Sayer said the company will file for Medicare coverage of the G6, while it continues to work out an issue that prevents beneficiaries from using a feature that lets data be displayed or shared on cell phones.

On Monday, CMS announced that it has finalized policies for Medicare health and drug plans for 2019 aimed to lower the cost of drugs for beneficiaries and provide additional plan choices.

Dan Klein, president and CEO of the Patient Access Network (PAN) Foundation, lists possible policy changes that would strengthen the safety net.

With food insecurity attributing to $77 billion in excess healthcare expenditures annually, support services such as meal programs have been implemented. A study in Health Affairs found that meal delivery programs reduce the use of costly healthcare services, such as emergency department (ED) visits, and help cut costs for dually eligible Medicare and Medicaid beneficiaries.

Government programs, especially Medicare, are stuck in the past and are not designed to accommodate advancements in modern technology, said Ed F. Haislmaier, the Preston A. Wells Jr senior research fellow at the Institute for Family Community, and Opportunity at The Heritage Foundation.

The governor of Iowa signed a law allowing health plans that are not compliant with the Affordable Care Act; custom medically designed meals keep patients healthier, a study found; the CDC is probing a teen suicide outbreak in an Ohio county.

CMS finalized its 2019 Medicare Advantage rates, raising payments it pays to insurers, and also made changes to a final rule aimed at curbing opioid misuse and abuse by Medicare beneficiaries. Payments to Medicare Advantage plans will rise an average of 3.4%, and with another 3.1% adjustment coming from a change in risk scores (which are a measure of the sickness or health of the population served) the payment increase could be as high as 6.5%.

Black–white disparities in hospital readmission rates in the United States narrowed after the introduction of the Hospital Readmissions Reduction Program (HRRP), but hospitals that serve a large number of minority patients continue to disproportionately receive penalties for their readmission rates, a study published in Health Affairs said Monday.

Some Medicare Advantage plans may not be fully ready for the requirements of this history-making preventive service.