Insurance

Healthcare attorney James M. Daniel, Jr, JD, MBA, explained how healthcare providers will be impacted by CMS’ newly released final rule on the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) in a session during the second day of the ACO & Emerging Healthcare Delivery Coalition.

The top stories in managed care included Vice President Joe Biden's released his report on the Cancer Moonshot initiative, complaints were filed against 7 insurers for discriminating against people with HIV, and Pfizer announced it plans to launch its Remicade biosimilar in November.

Current work seeks to perfect the algorithm that would someday let the insulin pump automatically make the multitude of delivery decisions that would have been made by a healthy pancreas. Advances are happening alongside a shifting landscape in payer coverage, with advocates worried that they might lack choice amid so much innovation.

Dr. Song is a resident at Massachusetts General Hospital and a clinical fellow at Harvard Medical School. The American Journal of Managed Care presents the award to an early-career researcher whose achievements show the potential for exceptional long-term contributions in the field of managed care.

Today, federal officials released the final rule for the Medicare Access & CHIP Reauthorization Act (MACRA), which will overhaul the way doctors are paid. To understand what this rule means to the future of value-based healthcare, join The American Journal of Managed Care October 20-21, 2016, in Philadelphia for the fall meeting of its ACO & Emerging Healthcare Delivery Coalition.

To discuss the progress in care collaboration and also what is currently lacking in care practices in oncology, The American Journal of Managed Care® invited Rebekkah Schear, MIA, LIVESTRONG Foundation, and Michael Kolodziej, MD, Flatiron Health.

In creating the final rule for the Medicare Access and CHIP Reauthorization Act, CMS did an excellent job listening to, and responding to, a vast array of comments from healthcare stakeholders.

This week, the top stories in managed care included HHS releasing the final rule for the Medicare Access and CHIP Reauthorization Act, a commentary on the downside of drug coupons, and the World Health Organization called on countries to enact a soda tax.

HHS has finalized the landmark Medicare Access and CHIP Reauthorization Act (MACRA), which reforms payment for Medicare providers and replaced the sustainable growth rate formula.

The authors aimed to examine whether participation in Medicare managed care, compared with fee-for-service, has any effects on racial/ethnic disparities in diabetes care and healthcare expenditures among older adults.

Payment reform in the United States is moving quickly, but there are still a lot of unknowns among providers. Meetings like the ACO & Emerging Healthcare Delivery Coalition help accountable care organizations (ACOs) and providers share best practices and figure out how to succeed, said Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy and keynote speaker at the ACO Coalition's fall meeting in Philadelphia, Pennsylvania, October 20-21. Learn more about the meeting and register.

The pay-for-performance deal comes as Januvia faces increased competition from newer drug classes, especially SGLT2 inhibitors and GLP-1 receptor agonists.

A retrospective study in breast cancer patients suggests that patients can lower their out-of-pocket costs by speaking with their oncologist about alternate treatments that may be equally effective and understanding the drug coverage policy of their insurance plan.

Coupons seem like a good deal for consumers, but they mask the true costs of drugs and force up premiums for everyone.

Medicare beneficiaries still face huge out-of-pocket expenses because of uncapped cost sharing in the catastrophic coverage phase. This is especially true for beneficiaries who take specialty drugs.

Although hospitals in Medicare’s Value-Based Purchasing program already receive patient experience points based on achievement, improvement, and consistency, placing more emphasis on improvement points could benefit hospitals serving minority patients

Highlights of our peer-reviewed research in the healthcare and mainstream press.

A study published in the Journal of Clinical Oncology found an increased rate of resection and a reduction in the probability of emergent resection for colorectal cancer (CRC) as a result of insurance expansion in Massachusetts.

With 6 years under his belt, Patrick Conway, MD, is the longest serving chief medical officer in CMS history. During those 6 years, he has seen alignment with private payers increasing, Conway said during a plenary session at the fall meeting of the National Association of Accountable Care Organizations.

The former president said that Obama's signature law works well for those who are enrolled in Medicaid or who qualify for subsidies, but others have seen premium increases with lower benefits. The White House noted that Hillary Clinton supports improvements to the law.

CMS announced on Thursday that it would award $347 million in contracts to various hospital associations and quality improvement organizations as part of its ongoing effort to reduce hospital-acquired conditions and readmissions in the Medicare program. The Hospital Improvement and Innovation Network agreement sets high goals in hopes of continuing the progress that has already been made in patient safety.

During the plenary session on the first day of the fall meeting of the National Association of Accountable Care Organizations, CMS' Sean Cavanaugh discussed the outcomes of the Medicare ACO programs and members of 2 successful ACOs joined him on stage to provide their input.

CMS' star ratings for hospitals have been controversial because they penalize hospitals that disproportionately care for the poor and the sick, and efforts by CMS to adjust the methodology haven't really addressed the concerns, explained Ashish K. Jha, MD, MPH, the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute.

The new guideline comes as FDA weighs an advisory panel recommendation for CGM dosing, which many see as a first step toward Medicare coverage.

Older fee-for-service Medicare beneficiaries with dementia who have lower levels of continuity of care have higher rates of hospitalization, emergency department visits, testing, and healthcare spending.

Readmission rates for both safety net hospitals and other hospitals have decreased since Medicare’s Hospital Readmissions Reduction Program went into effect in 2013. However, disparate rates of improvement could show that these hospitals in low-income areas are still at a disadvantage.

UnitedHealth has posted a presentation on its website that provides an update to its pharmacy benefits and prescription drug lists for 2017.

Our peer-reviewed research in the healthcare and mainstream press.

What we're reading, September 22, 2016: a new bill would cap out-of-pocket costs for Medicare beneficiaries; world leaders agreed to a global effort to curb the spread of superbugs; and Mark Zuckerberg and Priscilla Chan, MD, will donate $3 billion over 10 years to cure disease.

This article provides a detailed description of a Medicare Shared Savings Program accountable care organization (ACO)'s actions and results, to increase understanding of the challenges and opportunities facing ACOs-particularly those comprised of independent practices.