Insurance

The Patients' Access to Treatments Act of 2015 was introduced earlier this year to rein in the high cost-sharing requirements for specialty drugs.

The top story of the week was Aetna's purchase of Humana, which signals a growth in government managed care. In addition, the 340B drug discount program came under fire after a report from the Government Accountability Office.

President Barack Obama has nominated Andy Slavitt to become the new administrator of CMS.

Unlike ACOs or P4P, implementation of bundled payment for inpatient and post acute care in Medicare would modestly reduce geographic variation in spending.

A study of Kaiser Permanente cancer patients found that two-thirds of teen and young adult patients received aggressive care at the end of life. The special issue on the topic comes as CMS proposes paying doctors or nurses to discuss advanced care planning.

As CMS continues to transform the Medicare program to a quality- and outcomes-based system, the agency is proposing to support patient- and family-centered care for Medicare beneficiaries by enabling them to discuss advance care planning with their providers.

The report found that Medicare Part B spending per beneficiary in 340B hospitals was more than twice that of hospitals outside the program. Groups such as the Community Oncology Alliance have long warned that the 340B program, while essential, has grown beyond its original intent.

CMS has released additional guidance allowing for flexibility in claims auditing and quality reporting during the transition to the International Classification of Diseases, Tenth Revision and is working with the American Medical Association to educate providers.

California's recent initiatives to address the impact of high priced hepatitis C drugs could not have come at a better time, as a new analysis estimates that the state's projected specialty drug expenditure would be $4.77 billion in the next year alone.

Aetna's purchase of Humana would create a managed care company with $115 billion in revenues, of which 56% would be from government business. In addition, the combined company would have the largest enrollment of members on public exchanges, with 1.7 million members.

The deal combines Humana's 3.2 million Medicare enrollees with Aetna's 1.26 million Medicare enrollees, giving the new combined company a strong position as the baby boomer population ages.

As co-pays and deductibles in Medicare and commercial health plans become more prevalent, so, too, does the temptation to waive them. But beware.

CMS has begun to implement risk adjustment and reinsurance programs, 2 premium stabilization programs of the Affordable Care Act. The report highlighted the estimated reinsurance payments issuer in addition to summary level information on the programs, which helps to keep premiums affordable as well as various coverage options available to consumers.

When The American Journal of Managed Care's ACO and Emerging Healthcare Delivery Coalition met for the most recent Web-based session, the speakers discussed the importance of accountable care organizations as CMS moves forward with new reimbursement schemes and managing high-risk patients through coordinated care.

Despite concerns that Medicare Advantage payment reductions included in the Affordable Care Act would lead to a decline in enrollment, the number and share of beneficiaries enrolling in Medicare Advantage has only continue to climb since the health reform law was enacted.

CMS Open Payments data for 2014 is now available and includes information on 11.4 million financial transactions attributed to over 600,000 physicians and more than 1100 teaching hospitals, totaling $6.49 billion.

Although GOP presidential hopefuls are all campaigning on promises to repeal and replace President Obama's Affordable Care Act (ACA), the last real chance to repeal may have been the 2012 election, according to Avik Roy, senior fellow at the Manhattan Institute.

Two new changes to CMS' ACO Investment Model will help practices in rural areas gain more access to the benefits of accountable care organizations.

The number of Medicare Advantage plans with $0 premiums has been on the decline since 2011, and dropped from 813 in 2014 to 726 in 2015, according to a recent analysis government data by HealthPocket.

Margaret E. O'Kane, president of the National Committee for Quality Assurance will join The American Journal of Managed Care for a Tweetchat on June 26 at 1 pm EST. Follow the discussion and ask your own questions using #AJMCchat.

Among the 20 chronic conditions with the highest impact on the Medicare population, some have no quality measure, which limits Medicare's ability to pay for value.

Concern from Congress about the potential cost of widespread use has kept telehealth from expanding in traditional Medicare. But things are starting to change as ACOs gain the ability to use telehealth, and rule changes allow its use for mental health and other services.

Variation in private spending reflects the ability of the local population to pay for healthcare, whereas variation in Medicare is more driven by health status.

Home healthcare transition from hospitals for diabetic Medicare home healthcare beneficiaries can be improved by identifying risk factors for 30-day readmissions due to ambulatory care—sensitive conditions.

Newly announced fraud charges against 243 individuals involved schemes of approximately $712 million worth in false billings, according to an announcement by HHS. CMS also suspended a number of providers.

The first year of CMS' Independence at Home Demonstration led to both higher quality care and and saved $25 million, an average of $3070 per participating beneficiary.

Aledade, founded by Farzard Mostashari, MD, announced on Monday that it had raised $30 million to support its mission of partnering with independent primary care physicians to create accountable care organizations and further fuel the company's growth.

Some hospitals in the United States are marking up costs approximately 10 times the Medicare-allowed costs. This equals a markup of more than 1000% for the same medical services.

The American Journal of Accountable Care recently interviewed Dr Jain about his decision to join CareMore, CareMore's innovative care model, and his perspectives on US healthcare.

The data-fueled healthcare revolution requires us to share data and share risk to ultimately share rewards andachieve Triple Aim goals.