Insurance

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.

Healthcare integration was associated with small declines in treatment, but no change in overtreatment of prostate cancer. Integrated care delivery alone may be insufficient to curtail overtreatment.

About 4 million patients need home-based medical care because they are frail, functionally limited, and homebound. New research finds out just how much are the home-based medical care providers geographically concentrated or spread out.

The current issue of Evidence-Based Diabetes Management explores studies and patient access issues surrounding this closely watched inhaled insulin.

An effort by the University of Utah health system created an "opportunity index" to identify areas of cost variability that would show physicians where they could find savings and improve quality.

The Medicare Shared Saving Program benchmark can be improved by following the example of Next Generation accountable care organizations, but with a larger adjustment level.

Patricia Salber, MD, MBA, of The Doctor Weighs In, interviewed James D. Chambers, PhD, to discuss his findings on the impact of formulary drug exclusion policies.

The authors said this is the first study to examine antihypertension nonadherence down to the county level. Recommendations include greater use of combination therapy to reduce pill counts for patients with multiple chronic conditions, and synchronizing pharmacy visits to avoid multiple trips.

Between individuals coming in and out of the market in a given year and those who switch plans, the majority of people in exchanges are enrolled in their plans for one year or less.

This week, the top stories in managed care were poll results that show Hillary Clinton is more trusted than Donald Trump when it comes to healthcare, multiple studies highlighting remaining disparities in healthcare, and results of a digital diabetes self-management program.

The C-suite of the healthcare industry has grown dramatically over the last several years, and has been spurred by legislation that ties reimbursement rates under Medicare and Medicaid to the use of technology in medicine.

The poll, which the Kaiser Family Foundation has done at intervals since the Affordable Care Act passed in 2010, once again found Americans divided on how they felt about the healthcare law.

What we're reading, September 2, 2016: California taxpayers will cover 70% of the state's healthcare costs in 2016; President Barack Obama supports recommendations to reform the Veterans Affairs healthcare system; and California is close to criminalizing undercover stings against Planned Parenthood.

A diverse group of 1242 patients received diabetes self-management education either in-person or online and achieved lowered blood glucose and depression levels, had fewer symptoms of hypoglycemia, and exercised more.