Insurance

Democratic lawmakers who signed a letter to Mylan this week say that the practice of offering coupons masks the high drug prices that are paid by commercial health plans. The practice is not allowed in Medicare or Medicaid.

A new report by the law firm Frier Levitt, commissioned by the Community Oncology Alliance, has found that restrictive tactics by pharmacy benefit managers, particularly in the specialty pharmacy arena, could restrict patient access to much needed medications.

What we're reading, August 31, 2016: 51% of Americans have a negative view of the pharmaceutical industry; the CDC is running out of funds to fight the Zika virus; and Pennsylvania chooses 3 private companies to manage Medicaid plans.

What we're reading, August 29, 2016: Audit finds Medicare Advantage plans overcharged the government; enrollment on the Affordable Care Act's exchanges less than half of initial prediction; and California bill to protect consumers from surprise medical bills divides physicians.

In this podcast Margaret E. O'Kane discusses how she got into quality measurement, the beginning of the National Committee for Quality Assurance, and the next frontier in quality measurement.

Healthcare as we have known it doesn’t work cooperatively, which is one reason it costs way too much, according to Donald M. Berwick, MD, MPP, president emeritus and senior fellow of the Institute for Healthcare Improvement and co-originator of the term the Triple Aim. Berwick spoke with The American Journal of Managed Care as it publishes reports on Aligning Forces for Quality, funded by the Robert Wood Johnson Foundation.

Margaret E. O'Kane has been making lasting impacts on healthcare quality measurement for years. But when she founded the National Committee for Quality Assurance, the organization was sometimes underestimated and not taken seriously.

Researchers found that changing cooking methods could allow people at risk of developing diabetes to reverse damage done by things like grilling and frying their food.

The study in JAMA represents the largest effort to date to integrate mental health and primary care services across a health system and measure both clinical outcomes and savings.

A majority of hospitals that may be required to participate in the new Medicare cardiac bundled payment models would not experience losses or gains over $500,000 per year, according to a recent analysis by Avalere Health.

Medicare accountable care organizations have either not yet focused on mental illness or have been, for the most part, unsuccessful in early efforts to improve their management of it.

Reducing barriers to hematopoetic stem cell (HPC) transplant is critical to supporting patients with one of the more than 70 blood cancers and other blood disorders (such as leukemia, lymphoma, and myloplastic dysplasia) for which a transplant may be the only therapy remaining with curative intent.

Questions about hospitals or their foundations paying for premiums of sick patients to keep them out of Medicaid are as old as the exchanges themselves.

As the nation's largest pharmacy benefit managers leave more therapies off formularies, some ask: are patients harmed? A new review in The American Journal of Managed Care, covering 26 studies about drug exclusions, found that most policies saved money without fallout for patients-but there were some exceptions.

The authors review empirical evaluations of drug exclusion policies to examine their impact on patients and on healthcare costs.

More than 3500 sites offer diabetes self-management education, and speakers at the annual meeting of the American Association of Diabetes Educators discussed how this system could be engaged to bring the Diabetes Prevention Program to all 50 states.

The transition to a value-based payment system may ultimately reward diabetes educators, but right now these professionals see challenges on the front lines.

CMS unveiled the results of its new star rating system for hospitals amid great controversy. Here are 5 things to know about the new Medicare stars rating program for hospitals.

Adding more states and conditions to the Medicare Advantage value-based insurance design model will allow CMS to reach a more diverse group of plans and patients, in both rural and urban settings.

The step comes in the wake of reports from Pro Publica, which found 47 incidents since 2012, and signs the problem was getting worse.

Healthcare may not be the leading focus in the 2016 presidential race, but the candidates agree that there are issues that need to be addressed. This infographic breaks the difference between health policy proposals from Donald Trump and Hillary Clinton.

What we're reading, August 8, 2016: a new Medicare law would require hospitals to notify patients about loopholes in nursing home coverage; e-cigarette makers flooded the market ahead of new regulation implementation; and California bill on nurse-midwife independents causes controversy.

The 2016 presidential race has been mostly about the candidates' personal qualities and less about their policies. But that doesn't mean Donald Trump and Hillary Clinton don't have debate-worthy ideas in their healthcare platforms.

In an attempt to appease the Department of Justice and save their proposed merger, Aetna and Humana make deals to sell certain Medicare Advantage assets to Molina Healthcare.

Both Express Scripts and CVS Health said they were taking aim at prescription drug prices that keep going up even when competitors are available.

What we're reading, August 3, 2016: Medicare penalties for hospital readmissions reach a new high; the importance of down-ballot races this election; and Virginia's Bureau of Insurance comes out against the Anthem-Cigna merger.

With Medicare preparing to reimburse for the Diabetes Prevention Program in January 2018, companies are forming or expanding to make this evidence-based program scalable to reach 86 million people with prediabetes.

What we're reading, August 2, 2016: co-ops in New Mexico and Massachusetts sue the government over the risk-adjustment formula and why hospital ratings should be viewed with a bit of skepticism.

Using longitudinal Medicare claims data, this study quantified the association of the Medicare Part D coverage gap with medication adherence among beneficiaries with chronic obstructive pulmonary disease.

The successor to an earlier value-based effort in primary care could reach 5000 practices and 3.5 million patients. The original model showed transformation but had not yet shown savings after 2 years.