Insurance

Changes in the healthcare marketplace are steadily pushing changes for physicians and specialty practices of all kinds. Blaming the 340B drug discount program is both misleading and unproductive.

What we're reading on October 12, 2015: health insurance marketplaces may have challenges keeping customers they already have, but in California, consumers leaving the state insurance exchange are gaining coverage elsewhere, and the government is increasingly pursuing cases of potentially unnecessary procedures.

Integrated Medicare and Medicaid managed care may not sufficiently address the problems of inefficiency and fragmentation in care for hospitalized dual eligible enrollees.

A new study published in JAMA Oncology has identified disparate survival outcomes across sites of care.

Taking aim at payment models for patients on dialysis is the latest attempt to target high-cost areas of Medicare spending.

The announcement covered a final rule on interoperability for creators of Health IT, and a proposal to simplify current rules for providers. Both look ahead to implementation of the new Medicare and CHIP reimbursement models.

The PBM declined to list what discounts it had negotiated, but said it expected to spend $750 million on this cholesterol-lowering class in 2016.

The research raises questions whether Medicare Advantage plans are the solution to controlling spending on the patients who account for most healthcare costs.

One of the great aspects of the Medicare Shared Savings Program is that it provides an important opportunity directly to physicians, said Louis Morgenier, chief executive officer of Physicians ACO, LLC.

A new medication therapy management model being rolled out by CMS will test strategies to improve medication use among Medicare beneficiaries enrolled in the Part D drug program.

Most telling were the interviews with hospital leaders, who said the bonus payments did more to reinforce existing trends in quality care than alter them.

The findings come as CMS is poised to finalize a rule to pay doctors to counsel patients about end-of-life treatment options.

As the country increases the pace of shifting to value-based payments, a significant question remains: how can independent primary care doctors operate in this new environment?

The technology was approved by FDA in June and unveiled at the Scientific Sessions of the American Diabetes Association.

Although CMS has introduced a strict timeline to move to value-based payments, its new Oncology Care Model is partially relying on fee-for-service, and that's a good thing in the case of oncology, said Ira Klein, MD, MBA, senior director of quality, Strategic Customer Group at The Janssen Pharmaceutical Companies of Johnson & Johnson.

Medicare beneficiaries undergoing dialysis who reach the Part D coverage gap have increased out-of-pocket spending, increased medical service utilization and costs, and increased mortality, according to a new study.

Healthcare groups and members of the Senate Judiciary Committee have weighed in with concerns about decreased competition and harm to consumers if the Aetna-Humana and Anthem-Cigna transactions are approved.

Public outrage over the 5000% price increase for Daraprim, a 62-year-old drug purchased by Turing Pharmaceuticals in August, prompted the company to promise it would lower the drug's cost. This is not the first time such an incidence has occurred.

Hillary Clinton unveiled a plan in Iowa that features a $250 per month cap on drug costs for patients with chronic conditions. This comes 2 weeks after her chief rival for the Democratic nomination, US Senator Bernie Sanders of Vermont, introduced a bill aimed at reining in drug costs. In the summer, The American Journal of Managed Care said polling showed that rising drug costs were poised to become a major issue in the 2016 campaign.

Today's report is a successor to the groundbreaking report, "To Err is Human," which launched the movement to make healthcare quality part of the nation's policy agenda. Until now, however, not enough attention has been paid to an essential element: getting the diagnosis correct and getting it quickly.

As enrollment in Medicare Advantage is expected to increase to a new all-time high for the sixth year in a row, CMS announced that Medicare Advantage premiums will remain stable in 2016.

Meaningful use stage 3 is not scheduled to start until 2017, but 41 medical societies are calling to delay the start of stage 3, especially given recent changes to Medicare.

The top stories in managed care include the nomination for the next FDA commissioner, a report reveals cancer drugs are driving growth in the 340B program more than initially thought, and nearly half a billion in ACA funds are made available to health centers.

When prices of the first 2 entrants of this new class of cholesterol-lowering drugs came in well above expectations, leading PBMs announced plans to limit who could gain access and sent a clear message to the drug makers: get ready to negotiate.

Initial medication filling during the first 2 to 4 months following initiation of a statin strongly predicted adherence patterns during the following year.

As CMS moves to value-based payments, having good measures of value that payers and providers trust will be critical, explained Stuart Guterman, senior scholar in residence AcademyHealth.

Evidence-Based Diabetes Management gained exclusive access to the Comprehensive Weight Management Program for a view of what "behavioral change" really means for patients overcoming obesity and for the clinicians managing their care.

Women bear greater costs related to Alzheimer's disease (AD) compared with men for 2 reasons: they are at greater risk of developing the AD and cost Medicare and Medicaid more, and they are more likely to provide informal, unpaid care to family members with AD.

The company's Prevent program is approved by CDC as meeting standards for obesity prevention counseling as required of payers by the US Prevention Services Task Force.

The American Journal of Managed Care spoke with Bruce J. Gould, MD, medical director of Northwest Georgia Oncology Centers on the impact of the 340B drug pricing program on private oncology practices.