Insurance

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.

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.