Policy

News from Strategic Alliance Partners of The American Journal of Managed Care.

Large insurance sales agency call centers are accused of enrolling individuals in plans without consent; more young adults are choosing permanent contraception procedures; widespread frustration with prior authorization requirements hints at potential future measures.

As provider and payer organizations pursue the Quadruple Aim, it is important that they take into account not just the contracting but also the transformation in staffing, clinical workflows, and culture as these organizations evolve.

By prioritizing well-being, both the public and private sectors can come together in partnerships to address social needs and social determinants of health.

As CMS’ suite of value-based and accountable care models evolves, leaders from across the agency detailed how they are working together to streamline quality reporting and encourage the move to a population health mindset while addressing providers’ concerns.

This feature series delves into how biases shed light on deeply ingrained stereotypes and prejudices that exist within the structure of US maternal health care, according to experts.

Lawmakers are under pressure to decide the fate of COVID-era telehealth payment changes; the CDC reports an alarming increase in sexually transmitted disease (STD) cases among Americans 55 years and older; new regulations aim to reduce harmful exposure to per- and polyfluoroalkyl substances (PFAS), also known as “forever chemicals.”

There is discrepancy between the FDA’s accelerated approval decisions and clinical benefits in cancer treatments; former President Donald Trump’s video statement avoids a clear stance on national abortion legislation; 40% of therapists say they will increase their fees this year.

The annual legislative update at the Community Oncology Alliance Community Oncology Conference identified what Congress may focus on prior to the upcoming election.

CMS finalizes policies to enhance consumer protections, promote competition, and expand access to care for Medicare Advantage (MA) and Medicare Part D; digital therapeutic Rejoyn receives FDA clearance for adults with major depressive disorder (MDD); study reveals minimal symptom reduction from nirmatrelvir–ritonavir (Paxlovid) in high-risk, fully vaccinated patients.

President Joe Biden and Senator Bernie Sanders continue their push to cut the cost of asthma inhalers and prescription drugs in the US.

The newest treatment approved for amyotrophic lateral sclerosis (ALS) will be withdrawn from the market due to negative clinical trial results; former President Trump’s surgeon general is advocating for conservative states to support needle exchanges; new US hepatitis C infections dropped slightly in 2022 after more than a decade of steady increases.

To deliver on the promise of value-based care, organizations need to return to the fundamental objective: to deliver high-quality, affordable care to our communities.

Antismoking groups sued the US government over the long-awaited menthol cigarette ban; the fill rate for Adderall and Vyvanse dropped more than 10% in 2 years despite soaring demand; the Biden administration has responded to offers from the manufacturers of drugs selected for Medicare pricing negotiations.

Insurance plan members find themselves involuntarily switched between plans; the Senate investigates patient safety concerns resulting from private equity practices; base payments to Medicare Advantage (MA) plans will decrease in 2025.

Engaging specialty physicians is an emerging area of focus for Medicare accountable care organizations. Enhanced data on specialist costs and outcomes are essential to addressing alignment challenges.

On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.

Part 1 of a 3-part feature series on the history, evolution, and current state of LGBTQ+ health care is focused on the unique needs and journey of transgender patients in the US health system, as well as the policies and social influences that have shaped their access to care.

In this investigation, outcomes of interest were morbidity rate and length of hospital stay or a traumatic injury among a homeless population, and whether age and/or injury severity had an influence on that relationship—with implications for improving the discharge process for these patients.

CMS released a final rule to help patients obtain Children’s Health Insurance Program (CHIP) coverage and issued a proposed rule to update Medicare payment policies and rates for inpatient rehabilitation facilities; debate over if gift card incentives are acceptable in health care marketing.

The Supreme Court seems likely to reject a challenge to the abortion pill mifepristone; the FDA is inspecting far fewer pharmaceutical companies conducting clinical research; AstraZeneca has sued to block an Arkansas law that it said would unlawfully expand the 340B program to include for profit-pharmacy chains.

Flat funding for HHS leaves critical health initiatives stagnant; Supreme Court weighs tightening regulations on abortion pill; manufacturing delay sparks access concerns for insulin medication.

A comprehensive analysis by the Patient Access Network (PAN) Foundation explores the state of patient access for adults living with chronic conditions in the US.

The White House has called out the Republican Study Committee’s budget proposal for backing legislation that would put restrictions on abortion access; nearly 108,000 Americans died of drug overdoses in 2022; surgeons in Boston have transplanted a kidney from a genetically engineered pig into an ailing 62-year-old man.

A global AIDS program that was in limbo for months got temporary relief after congressional negotiators agreed to a 1-year renewal in the next government funding package; the outcome of the November presidential election could determine the state of fetal tissue research in the US; federal officials and industry executives failed to make improvements that stop hacking attacks.

For more than a decade, certain high-value preventive care services have been covered at no cost to patients under the Affordable Care Act, but a current legal challenge has the coverage at risk.

UnitedHealth Group aims to restore services amid investigations; providers advised to administer measles vaccine to infants before international travel; study finds significant increase in medication abortions after Supreme Court decision.