Policy

CVS announces it will close around 900 stores; states in the upper Midwest are suffering another COVID-19 surge; Biden increases federal waterway protection.

On this episode of Managed Care Cast, we speak with MeiLan K. Han, MD, MS, the author of a book released this month called Breathing Lessons: A Doctor’s Guide to Lung Health. Han, a pulmonologist, gives an inside tour of the lungs and how they work, zooms out to examine the drivers of poor respiratory health, and addresses policy changes that are needed to improve lung health.

Implementing a proactive provider outreach program resulted in significantly more prior authorization recertifications and a reduction in time to submission.

This study identifies several factors shared by locally defined delivery system innovations that have been shown to reduce service use and lower health care spending.

COVID-19 prompted CMS to make major adjustments to the Medicare Advantage (MA) Star Ratings System, resulting in better-than-average performance for nearly all plans. However, these changes were temporary, and MA plans will have to reset their strategies for 2023 and beyond.

California is offering COVID-19 boosters to its entire adult population; FDA recalls millions of home COVID-19 tests over false positives; veterans’ access to health resources will be expanded.

Individuals who became eligible for Medicaid through Medicaid expansion have an increased likelihood of psychiatric readmission compared with their legacy-enrolled counterparts.

An overview of activities at the FDA to promote the use of biosimilars was presented by Jacqueline Corrigan-Curay, JD, MD, principal deputy center director for the Center for Drug Evaluation and Research (CDER) at the FDA.

While low- and middle-income countries remain desperate for a COVID-19 vaccine, the United States has entered a dangerous new phase of the pandemic, where antivaccine forces are exporting their antiscience beliefs to other countries, according to a keynote speaker at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

Pfizer releases promising data on its COVID-19 pill; Republican state officials push back on President Joe Biden's vaccine mandate; some spray deodorants may contain high levels of cancer-causing chemicals.

The CDC director endorsed a pediatric Pfizer COVID-19 vaccine for children aged 5 to 11 years; proposed drug pricing reform will allow Medicare Part D to negotiate directly with pharmaceutical companies; some employers may not send death benefits to families of employees who die of COVID-19 without being vaccinated.

To help close health equity gaps, CMS finalized a rule that will update payment rates and improve incentives for providers to encourage them to increase access to home dialysis and kidney transplants for low-income patients with end-stage renal disease.

On this episode of Managed Care Cast, we speak with one of the coauthors of a study that illustrates the changing outpatient trends in a primary care provider’s (PCP) panel of Medicare patients and how that translates to an increased workload for primary care doctors.

The annual report, from the American Cancer Society, National Cancer Institute, the CDC, and the North American Association of Central Cancer Registries, details US cancer trends.

In the years since its inception, debates around the 340B program have centered on whether savings actually benefit the underserved as intended. A new paper in The American Journal of Managed Care® analyzed secondary data on 340B participation and uncompensated care provision from general acute care and critical access hospitals between 2003 and 2015.

Physician and health policy advocates praised the emphasis on streamlining models and ending silos, but practices that invested in the Oncology Care Model (OCM) await key details.

The Biden administration moves to regulate certain toxic chemicals; the FDA is expected to endorse mixing and matching vaccine boosters; nurse shortages could lead to care rationing in New Mexico.

Nicole Herbst, MD, a pulmonary and critical care fellow, talks about how visitor restrictions and communication practices in intensive care units (ICUs) during the COVID-19 pandemic negatively impacted provider job satisfaction and were linked to job burnout, according to a survey presented at the CHEST Annual Meeting 2021.

Researchers at the CHEST Annual Meeting 2021 addressed the evolution of COVID-19 variants, how these emerging strains impact vaccines, and preventive recommendations for at-risk populations.

Medicare Advantage enrollees, particularly those with lower out-of-network benefits, may have restricted access to top-ranked hospitals for complex cancer care compared with traditional Medicare enrollees.

Evan L. Stepp, MD, FCCP, CPE, a pulmonologist at National Jewish Health, director of the Highlands Ranch Clinic, and an assistant professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, discussed the recent FDA decision to authorize an e-cigarette intended to help current smokers quit combustible cigarettes.

An independent FDA advisory panel endorses Moderna boosters for select groups; circuit court lets Texas abortion law stand, paving the way for appeals; Robert Califf, MD, is reportedly being eyed to head the FDA again.

Participation in the 340B Drug Pricing Program by general acute care hospitals and critical access hospitals has not been associated with increased provision of uncompensated care.

The Medicare Shared Savings Program (MSSP) has seen its growth slow, but CMS has an opportunity to act on proposals that would address benchmarking and more fairly allocate savings to accountable care organizations in the program.

Pfizer and BioNTech ask FDA to authorize their COVID-19 vaccine in children; the World Health Organization (WHO) recommended widespread use of the world’s first malaria vaccine; a US judge blocks Texas’ strict abortion law.

Although physicians’ clinical decisions serve as the biggest drivers behind the cost of care, hospitals have long been reluctant to take financial accountability. If such accountability is to be transformed from a diffuse fear to a manageable managerial task, institutional engagement with physicians will be a critical next step.

On this episode of Managed Care Cast, we speak with Susan Quaggin, MD, FASN, a nephrologist and the chief of nephrology/hypertension and director of the Feinberg Cardiovascular and Renal Research Institute at Northwestern University, as well as current president of the American Society of Nephrology (ASN). She discusses the recommendations of the National Kidney Foundation (NKF) and ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases and what comes next for laboratories, clinicians, and patients.

Results of a representative study of patients at federally qualified health centers found Medicaid expansion was associated with reduced rates of uninsurance, improved blood pressure and diabetes control measures, and progress in closing racial care disparities over 5 years.

Coverage of our peer-reviewed research and news reporting in the health care and mainstream press.

Long-awaited reports released Thursday call for eliminating race in estimated glomerular filtration rate equations and point to alternatives in an effort to eliminate disparities in chronic kidney disease.