Insurance

Drug costs are a significant contributor to rising healthcare costs, along with the cost of healthcare services. How can providers and patients work together to find a solution to this problem?

An analysis by Avalere Health of Hillary Clinton’s proposal to allow Americans age 50 and over to Medicare estimates that 13 million adults who are uninsured or have individual coverage through the private market could be eligible for such a program.

The study highlights results from the population largely denied CGM coverage under Medicare.

The acquisition lets Myriad acquire the maker of EndoPredict, which just received reimbursement status from Aetna and meets ASCO guidelines for payment by Medicare contractors.

Hospitals that serve the more vulnerable population perform worse with their readmission rate following cancer surgery, and the subsequent penalties that they face can further strain the hospital’s already burdened finances.

Training seniors to manage their own diabetes takes many hands--most notably, those of the patients themselves. A look at how a diabetes management program serving a diverse population approaches this task.

As the most advanced accountable care organization (ACO) model, Next Generation ACO has its appeal. However, it is the riskiest model, and one ACO explains why it decided to stay with the Medicare Shared Savings Program.

When providers move from employing traditional practices to new methods that are steeped in evidence, this benefits patient health. The result is higher-quality, more affordable care, often stemming from lower rates of hospital infections, readmissions, and, in general, improved outcomes.

Authors from the University of Minnesota College of Pharmacy highlight the role that pharmacists can play in care optimization for seniors with chronic conditions.

Now that Medicare is poised to pay for the Diabetes Prevention Program, the next question is how to make it scalable.

How does the largest payer in a state with a large senior population respond to the rising need for diabetes care and prevention?

Finding diabetes and treating it early can prevent high healthcare costs in the long term, the authors day.

The authors discuss a simple strategy for payers to ensure more patients with type 2 diabetes achieve control of A1C.

A recent Diabetes Care study found flaws in Medicare's competitive bidding program for diabetes test strips. Two of that study's co-authors discuss the findings and why CMS should suspend the bidding program.

The sequence of events that led to Thursday's complaint points to a coordinated effort to challenge Myriad Genetics' long-held position that it does not share information on public databases.

The author, who has lived with type 1 diabetes for more than 50 years, shares his account of a successful appeal of Medicare's policy of refusing to pay for continuous glucose monitoring (CGM).

What we're reading, May 11, 2016: Hillary Clinton is floating the idea of letting more people buy into Medicare; American public not on board with speeding up FDA drug approvals; and Walgreens expands mental health treatment and service options.

The Medicare Part B demonstration has been controversial since its announcement, but Steven D. Pearson, MD, MSc, president of the Institute for Clinical and Economic Review, considers it a wise move on the part of CMS because it provides an opportunity to learn about different payment structures.

Two doctors have been found guilty of falsely certifying Medicare patients were terminally ill and qualified for hospice care. However, the vast majority of the patients actually were not dying.

What we're reading, May 6, 2016: Both Democrats and Republicans are pushing back against the recent Medicare Part B proposal; medical overdose risk is high among people ages 45 to 64; and the Cayman Islands are releasing genetically modified mosquitoes to combat disease.

This study analyzes the current coverage designs for hepatitis C virus drugs by Medicare Part D plans.

What we're reading, May 3, 2016: low-quality, low-cost hospitals received bonuses from Medicare; Brigham and Women's Hospital is publicizing its mistakes; and Tenet expects other insurers will fill the void when UnitedHealth leaves the exchanges.

What we're reading, May 2, 2016: new discoveries about why people struggle to keep off weight; first Zika-related death in the US; and Medicare Advantage needs more competition.

Oral anticancer agents are being launched at significantly higher prices compared with a decade ago, which can prove a barrier to patient access, according to a new analysis published in JAMA Oncology.

This sweeping proposal is the biggest step yet in shifting reimbursement from a volume-based to a value-based system. Stakeholders offered mixed opinions this week.

One leading expert called the proposal the most substantive change in decades, but some feared CMS is once again hastening the demise of the independent physician.

A company in Canada, Biolyse Pharma, has offered to manufacture a generic version of enzalutamide at a significantly lower price than what CMS paid in 2014.

Flatiron Health has announced the development of a cloud-based electronic health record and an analytics tool to support reporting requirements for those clinics that will be selected to participate in the Oncology Care Model.

According to Avalere Health, physicians who prescribe lower cost drugs would be reimbursed at a higher rate than those who use more expensive drugs, under the proposed Medicare Part B demo model.

The American Hospital Association is among those asking for a rating system that reflects socioeconomic differences in hospital populations.