Insurance

A study last year found that more than half of all California adults have diabetes or prediabetes.

CMS has tried to improve patient experience by tying payments to performance as part of the Value-Based Purchasing (VBP) program; however, a paper published in Health Affairs found no evidence that the program has had a beneficial effect.

While the Congressional Research Service calls for delaying new bundled payment rules, a webinar to explain them is still on CMS' website.

The Obama administration set in motion a process that called for Medicare to pay for the Diabetes Prevention Program starting January 1, 2018.

Disease status, MUD/MRD donor, myeloablative conditioning regimen, GVHD prophylaxis other than tacrolimus/sirolimus, and Medicare and/or Medicaid as payer are significant predictors for cost of care in patient with acute leukemia who undergo allogenic hematopoietic cell transplant (AHCT).

Shantanu Agrawal, MD, MPhil, pursued the use of analytics to prevent and identify fraud in public healthcare programs. He takes the helm of a 16-year-old group that has worked to bring consensus among stakeholders on what in healthcare should be measured.

Research published in the Journal of Oncology Practice has identified high treatment burden among Medicare patients with early-stage non—small cell lung cancer (NSCLC).

If the Affordable Care Act is repealed, providers of the Diabetes Prevention Program will need to replace the path to Medicare reimbursement that were covered in the law.

Described as a public—private partnership between the National Cancer Institute (NCI) and pharmaceutical and biotechnology companies, the NCI Formulary is expected to provide researchers rapid access to anticancer drugs for use in clinical trials.

Researchers have found that accountable care organizations with a higher proportion of minority patients tend to score worse on Medicare’s quality performance measures.

The study observed significant shifts in the treatment of advanced-stage non-small cell lung cancer (NSCLC), accompanied by only modest gains in survival and total Medicare spending.

The addition of new a chief medical officer and a new chief commercial officer comes as the digital health provider is poised to scale up delivery of the National Diabetes Prevention Program in Medicare.

Payments for catastrophic coverage under Medicare Part D have more than tripled since 2010, rising past $33 billion in 2015, according to a new report from the Office of Inspector General (OIG). The report identified high-priced specialty drugs as a major driver of the increase in spending.

As the team at CMS prepares to hand the reins over to the next administration, Andy Slavitt, acting administrator of CMS, took the time to speak with Mandi Bishop, MA, CEO of Aloha Health, in the latest podcast of Managed Care Cast about what he learned in his role and what the next administration should keep in mind.

There are signs that some Republicans are uncomfortable with repealing President Barack Obama's signature law without taking steps to keep those who gained coverage from becoming uninsured.

As we approach the January 20 inauguration of Donald J. Trump as the 45th president of the United States, we come to the end of an all-too-brief era of unparalleled government transparency and leadership accessibility: Acting Administrator of CMS Andy Slavitt will be stepping down from his post.

Contrary to popular opinion, hospitals that receive lower reimbursements from public programs often cut fees to private payers to adjust to the new normal. Medicaid expansion, in particular, has had a net positive effect because hospitals are faced with less uncompensated care.

In a podcast that goes live today, The American Journal of Managed Care® paired Mandi Bishop, MA, the CEO of Aloha Health, with Andy Slavitt, MBA, who is finishing his tenure as acting administrator of the Centers for Medicare & Medicaid Services. Bishop asked Slavitt about the lessons of payment reform, the impact of MACRA, and what the new administration should expect.

As Andy Slavitt, MBA, acting administrator of CMS, comes to the end of his tenure, he spoke with Mandi Bishop, MA, CEO of Aloha Health, about the task of making health policy translatable and the legacy of payment reform he leaves behind.

What we're reading, January 4, 2017: Republicans in Congress may also make changes to Medicare; churches and faith-based organizations launch syringe exchanges; and judge rules Amgen's PCSK9 patent is valid.

January 1, 2017, marks the beginning of a new way of being paid in Medicare. And while the final rule of MACRA was released in October, and many providers and practices are still trying to parse out what it will mean to them.

Why a mobile health coaching company sees its move from per member per month to outcomes-based payment as the right thing-for employers and for consumers.

After the passage of the Affordable Care Act in 2010, hospital readmission rates decreased nationwide, most dramatically for the lowest-performing hospitals, according to an analysis of readmissions data published in the Annals of Internal Medicine.

This week, the top managed care stories included CMS announcing more mandatory bundled payment models and a new track in the Medicare Shared Savings Program, the FDA approving a new use for Dexcom's continuous glucose monitor, and a greater emphasis on lifestyle management in the American Diabetes Association's care standards.

There's no shortage of reader interest in Afrezza-the inhaled, meal-time insulin from MannKind-despite reports from Wall Street that the prescription count is climbing slowly.

Until there is more data to support the outcomes of using telemedicine, payers will be more cautious about getting into reimbursing for the technology, said Anne Schmidt, MD, associate medical director at Blue Cross and Blue Shield of Alabama.

With the Medicare Access and CHIP Reauthorization Act (MACRA) set to take effect January 1, 2017, The American Journal of Managed Care has created a resource center, the MACRA Compendium, where payers and providers can find updates on the transition to value-based care.

Wide price variation in hospital prices for the care that they render-up to a 2.7-fold difference-is driven by the hospital's market leverage, according to a new report by the New York State Health Foundation (NYSHealth).

On the day of the approval, top FDA and CMS officials write in JAMA of the need to share data for better healthcare delivery.

The findings come as CMS targets cardiac procedures in both its hospital readmission reduction program and in a bundled payment model set to take effect July 1, 2017.