April 16th 2025
The executive order targets lower drug prices through Medicare reforms, anticompetitive crackdowns, and transparency mandates.
Stakeholders' Interest in Bundled Payment Program Rises
August 1st 2014CMS has announced that it will nearly double the number of candidates in its bundled payment program. As part of the Affordable Care Act, the program aims to reduce care costs and improve patients' quality of care by offering providers with an alternative to the traditional fee-for-service reimbursement model.
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In Medicare, Connecting Medical and Drug Coverage Results in Richer Benefits, AJMC Study Finds
July 30th 2014A study just published in The American Journal of Managed Care examined how benefit design differences affected seniors who received prescription coverage through Medicare Advantage compared with a stand-alone Medicare drug plan. The review showed that integrating drug coverage with medical care resulted in fewer barriers to name-brand drugs, with lower copayments.
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Without Medicaid,Hospitals May Pay Patient Premiums
July 25th 2014Uncompensated care was supposed to be a thing of the past, but it's persisting in many states not expanding Medicaid eligibility. As an alternative, for some high-cost uninsured patients, hospitals are turning to a new option.
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Dual-Eligibles Not Opting Into State Care Coordination Programs
July 24th 2014To better align the care of beneficiaries insured under both the Medicaid and Medicare programs, CMS invited states to participate in a 3-year demonstration project. However, it seems that many beneficiaries have opted out of these care coordination programs that are offered across the country.
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Drug Plan Design Incentives Among Medicare Prescription Drug Plans
Medicare-Advantage Prescription drug plans (MA-PDs) and standalone PDPs appear to respond to different incentives for plan design.
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CMS Announces Changes to Medicare Hospice Drug Rule
July 21st 2014Changes to a hospice drug rule will reduce the types of medications that require prior authorization. Previous rules prohibited Medicare hospice patients from filling their Part D medications until they had confirmed that hospice providers did not cover them first.
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Lawmakers Urge CMS to Extend MU Hardship Exception for Pathologists
July 18th 2014Eighty-nine members of Congress have asked the Centers for Medicare & Medicaid Services to give pathologists a break and extend the hardship exemption they currently enjoy for all of Stage 3 of the Meaningful Use program.
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Hospitals, Regulators Spar Over In-Patient Care Policy
July 14th 2014Fewer patients linger for days in hospitals without being admitted because of a new federal rule, but hospital and consumer groups are suing the government because they say the policy compromises Medicare patients' care, and patients are often stuck with costly, unexpected bills.
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ACO Coalition Members Share Best Practices
June 24th 2014The American Journal of Managed Care followed up the first meeting of its ACO and Emerging Healthcare Delivery Coalition with its first interactive conference call, which was open to all members. Anthony Slonim, MD, DrPH, a Coalition co-chair who on July 1 will become president and CEO at Renown Health in Reno, Nev., moderated the roundtable discussion.
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Addressing Disparities in Minority Populations Starts with Better Data
June 14th 2014Two studies presented at the American Diabetes Association's 74th Scientific Sessions show that evaluating diabetes risk and patient health by nation of origin and ethnic background yields richer insights into how the disease affects populations.​
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HHS Fights Back to Keep Expanded 340B Drug Discounts
June 13th 2014The drug industry scored a victory last month against the Obama administration's plans to give hospitals millions of dollars in discounts through the 340B program on orphan drugs. But HHS is sticking to its position that the Patient Protection and Affordable Care Act promises breaks on the expensive drugs when they're used for non-orphan indications.
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Latest CMS Data Drop Shows Regional Variation in Spending on Inpatient, Post-Acute Care
June 4th 2014The CMS' release of per capita spending for Medicare beneficiaries shows that some states, particularly in the South, Midwest and Mid-Atlantic, are spending significantly more on inpatient and post-acute care than northern and western states.
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Hospital Charges Surge for Common Ailments, Data Shows
June 3rd 2014Charges for some of the most common inpatient procedures surged at hospitals across the country in 2012 from a year earlier, some at more than four times the national rate of inflation, according to data released by Medicare officials on Monday.
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Doc-Led ACOs Show Promise for Patients, Payers
June 2nd 2014In the search for meaningful patient care improvements and sustainable financing, some independent physician groups are charting unique approaches that may offer models for payers and providers in the age of cost-containment and risk-sharing.
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