Insurance

This week CMS released their third round of annual data, the value-based topics of the American Society of Clinical Oncology gained new ground, and The American Journal of Managed Care will travel to their 75th session of the American Diabetes Association in Boston.

This paper illustrates how Medicare Advantage plans and accountable care organizations could benefit from adopting innovative care delivery models, and suggests policy changes to accelerate spread.

The ruling finalizes risk-sharing for participating providers in accountable care organizations.

A study from the RAND corporation, published in JAMA, found clinical decision support tools increased the proportion of tests for Medicare fee-for-service patients rated as appropriate.

This is the third year that CMS has released Medicare payment data, and this year the agency added information on prescription drugs.

A new payment model through the Affordable Care Act seeks to decrease cardiovascular disease for tens of thousands of Medicare beneficiaries by assessing patient risks for heart attack and stroke and then helping them to reduce those risks.

A study of more than 195,000 Medicare clients who were in the hospital for observation in 2010 found that only a tiny fraction were discharged to a skilled nursing facility, and fewer still had their care covered by Medicare. The findings have implications in light of the two-midnight rule and other policies that may not affect large numbers of beneficiaries, but can have a sizable impact on those who are affected.

On January 1, 2015, the Centers for Medicare & Medicaid Service (CMS) introduced 4 Healthcare Common Procedure Coding System modifiers, known collectively as the - X(EPSU) modifiers, as a subset of Current Procedural Terminology (CPT) modifier 59 (distinct procedural service).

A bipartisan effort reintroduced legislation that would establish a demonstration in Medicare Advantage to evaluate the use of value-based insurance design's ability to reduce copayments and coinsurance for some Medicare Advantage beneficiaries, reported the University of Michigan Center for Value-Based Insurance Design.

A discussion on meaningful measurement and driving greater value in healthcare, and the role of the National Quality Forum.

While there's been controversy around the drug discount program for some time, the Health Resources and Services Administration plans to release a "mega-guidance" that will address several aspects of the 340B program.

The authors discuss the success of the Pioneer ACO model and the Comprehensive Primary Care Initiative, among others. They outline an agenda that includes engaging managed care stakeholders, so that both public and private payers are moving toward value-based payment.