Insurance

What we're reading, December 16, 2015: a new study casts doubt on what experts thought they knew about healthcare costs; unprecedented interest in health insurance coverage has prompted the government to extend the deadline for full-year 2016 coverage; and a law to create multi-state health plans won't reach it's 2017 goal.

There are 3 potential solutions for reforming the 340B drug pricing program, according to Michael Kolodziej, MD, national medical director of oncology solutions in the Office of the Chief Medical Officer at Aetna.

HIMSS is working to determine the readiness of providers to participate in the types of value-based payment models that CMS is moving toward.

The National Coalition for Cancer Survivorship has submitted comments to CMS, providing feedback on the Merit-Based Incentive Payment System and Alternative Payment Models proposed by CMS as it transitions toward value-based reimbursement.

Health economist Austin Frakt, PhD, of Boston University, weighs in on Ben Carson’s healthcare plan to repeal the Affordable Care Act, implement personal savings accounts for all citizens, and reform Medicare and Medicaid.

Management of high and rising costs in oncology requires a multifaceted approach using both innovative strategies and pragmatic tools. In this article, we discuss several factors that influence the costs of oncology care.

What we're reading, December 11, 2015: CMS penalized hospitals for patient safety deficiences; MedPAC approved reducing Medicare Advantage plan reimbursement; and Kentuckians favor keeping Medicaid expansion.

Shopping around carefully for plans will be important for Medicare Part D enrollees.

What we're reading, December 10, 2015: the Affordable Care Act has signed up 1 million new enrollees; Medicare patients spend more on oral cancer drugs than food each year; and the CDC found life expectancy remains at 79 years for the third year in a row.

The 340B Drug Discount Program has rapidly expanded over the last few years and may be missing its original intent. Here are 3 possible steps that could enhance the program’s function and mirror Congress’ original intent to enhance access for the poor to essential medical services.

GOP presidential hopeful Ben Carson has presented his plan to overhaul the Affordable Care Act and replace it with a healthcare system that uses tax-sheltered personal savings accounts and reforms Medicare and Medicaid.

For several reasons, including meeting the HHS Secretary’s Medicare quality and value payment goals, the ACO program needs to reformed to equate with Medicare Advantage.

As Americans continue to struggle to afford their medical bills, and some newly insured under the Affordable Care Act find they can’t afford to use the coverage they purchased, finding the “right” health insurance plan is important.

During the 5-year value-based insurance design demonstration in Medicare Advantage, the hope is that the models will show that lower cost-sharing for high-value services and providers meets the triple aim, explained A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

The characteristics of the patients a hospital serves play a huge role in determining the readmission fines, according to a study.

What we're reading, December 8, 2015: Cigna remains committed to participation in Obamacare exchanges; Puerto Rico demands the US fix healthcare funding disparities; and fewer Americans struggle to pay medical bills.

After 5 years of low growth, CMS reports that national health spending grew 5.3% in 2014, which is still slower than most years prior to the implementation of the Affordable Care Act.

At the annual meeting of the American Society of Hematology, providers brooded over implications of quality measures and how they will influence clinical practice in the coming years.

Study looks at how cost-effective 2 drugs that prevent stroke are from a patient's viewpoint.

The 17% decline in hospital-acquired conditions from 2010 to 2014 is the result of a decades long campaign and means lives saved, the avoidance of pain and suffering, and less costly care, said David Blumenthal, MD, MPP, president of The Commonwealth Fund.

Targets for savings needed to cover retirees' healthcare expenses are rising.

Relaxed direct-to-consumer advertising restrictions for drugs by the FDA in 1997 has precipitated an increase in prescription drug utilization, not just among Medicare enrollees, but also among non-elderly users.

This week in managed care, CMS proposed changes to the health insurance marketplaces for 2017, AJMC highlights 5 takeaways from the HHS Pharmaceutical Forum, CVS chose to cover just 1 PCSK9, and industry reacts to FDA regulating diagnostic tests.

Diabetes is a growing epidemic in the United States and new research has indicated that half of healthy 45-year-olds will develop pre-diabetes and one-third will develop diabetes at some point.

The American College of Physicians has published a paper in the Annals of Internal Medicine that advices clinicians to prescribe generic drugs whenever possible.

The top stories in managed care were discussions of value-based care at the NAMCP Fall Managed Care Forum, hospitals are suing over Horizon Blue Cross Blue Shield of New Jersey's OMNIA plan, and CMS finalizes its bundled payments for joint replacement.

The findings suggest that addressing heart patients' social needs is the first step toward getting them to exercise more.

The HHS Pharmaceutical Forum brought together a diverse set of stakeholders to share ideas on delivering affordable but high-quality care, improving outcomes, and continuing to lead in innovation. Here are 5 things that came out of the daylong meeting.

Julie M. Vose, MD, MBA, FASCO, president of the American Society of Clinical Oncology (ASCO), and keynote speaker at this year's Patient-Centered Oncology Care meeting, discusses addressing cost of care, using value calculators, and the Medicare Access and CHIP Reauthorization Act.

What we're reading, November 20, 2015: CMS wants to penalize doctors for ordering routine prostate-cancer screening tests; lawmakers, patients, and advocates call for head of Drug Enforcement Agency to be fired; and specialty drug costs exceed household incomes.