Insurance

Unaccounted for social and clinical characteristics of a hospital's patient population explain nearly half of the difference in readmission rates between the best and the worst performing hospitals when it comes to Medicare penalties for hospital readmission rates.

Healthcare policy experts gathered in Washington, DC, to discuss access, cost, and the definition of value in oncology care.

The top stories in managed care this week include value-based pricing of the new PCSK9 inhibitors, CMS unveiled a new health equity plan for Medicare, and the American Medical Association released analyses on proposed health insurance mergers.

Although a new report from The Commonwealth Fund raised concerns about the competition of Medicare Advantage (MA) programs available across the country, a new analysis from Avalere Health found that there has been a growing number of MA plan options for consumers.

As CMS pushes healthcare systems to move away from fee-for-service, the state's largest insurer makes a major move toward value-based payment.

At the end of CMS' comment period, the American Society of Clinical Oncology submitted its comments and recommendations for the proposed changes.

The California Public Employees' Retirement System saved $7 million on screening colonoscopies during a 2-year period following implementation of reference pricing.

CMS has released a new plan to address health equity in Medicare, which includes 6 priority areas aimed at reducing health disparities over the next 4 years.

With the comment period ending today, the proposed CMS cuts to radiation oncology reimbursement rates might have a substantial impact on community treatment centers.

An analysis of Medicare Advantage (MA) plan market shares finds little competition in counties across the nation, according to a report published by The Commonwealth Fund.

Research has shown that telehealth has the potential for better care at lower costs and with increased convenience, but the issue of paying for this service has yet to be addressed.

CMS will test whether providing Medicare Advantage plans with the ability to integrate value-based insurance design increases enrollee satisfaction, improves enrollee clinical outcomes, reduces overall plan expenditures, and results in lower plan bids, thus saving money for Medicare and beneficiaries.

HHS is seeking new protections for vulnerable populations to protect them from discrimination and ensure they have equal access to healthcare and health coverage.

Men are opting for preventive breast surgery when diagnosed with unilateral invasive disease, a study published in JAMA Surgery has found.

CMS is making available grant funding for 100 organizations to provide enrollment assistance during the third open enrollment period under the Affordable Care Act.

In the second quarter of 2015 the healthcare spending growth rate was 5.9%, a decline from 6.6% in the first quarter of the year, but the health spending growth rate is still 2 percentage points higher than rates experienced between 2009 and 2013.

The use of hospital observation instead of hospital admission is becoming increasingly common for Medicare beneficiaries; however, it may mean unexpectedly higher out-of-pocket costs.

The Biosimilars Council wants CMS to hold back on Medicare Part B reimbursement for biosimilars.

The deadly nature of colorectal cancer merited attention in the Affordable Care Act, which called for eliminating cost-sharing for screening to prevent deaths. The future of colorectal screening, its cost-effectiveness, and a possible way to limit unneeded tests are the topic of a recent series of papers in The American Journal of Managed Care.

Patients with type 1 diabetes mellitus have been advocating for Medicare to cover CGM technology, which they say is more important as patients age and symptoms of dropping blood sugar become less noticeable.

As California reduced the number of adults ages 19 to 64 years without health insurance by 15.5% from 2013 to 2014, Medi-Cal enrollment among the same age group rose from 12.9% to 19.2% during the same time period, according to new data from the UCLA Center for Health Policy Research.

Analysis of publicly reported organizational characteristics, shared savings distribution plans, and early financial success of accountable care organizations in the Medicare Shared Savings Program.

Research conducted at the University of Texas has identified an important role of psychological disorders in the early readmission of patients with chronic obstructive pulmonary disease.

A report from the Government Accountability Office has found that a program for hospitals serving poor and uninsured patients has created perverse incentives to prescribe more drugs and more expensive drugs, particularly in the area of cancer care.

The recent mergers between healthcare payers continue the trend of consolidation that has swept the healthcare industry since passage of the ACA.

A study published in the Journal of the American Geriatrics Society found that older women with breast cancer have a poor response to chemotherapy, while older patients with advanced colon cancer (both men and women) did well.

After months of waiting, reimbursement for the Prolaris test will begin effective October 15, 2015.

Aledade, launched by former national coordinator for health information technology Farzard Mostashari, MD, is looking to expand its footprint throughout the United States to another 7 states in 2016.

Precision medicine will perhaps establish some of the most important biomedical innovations of our generation. However, for that future to become a reality, we have to create an access and reimbursement environment that is conducive to precision care.

Research published in the Journal of Oncology Practice found that factors unrelated to the individual patient accounted for the majority of variation in the cost of radiation therapy for breast, prostate, and lung cancer patients.