Policy

Prior authorizations delay care, have a significant negative impact on clinical outcomes, and place a high burden on providers, according to a physician survey conducted by the American Medical Association (AMA).

In 2014, Maryland and CMS entered a 5-year agreement employing the All-Payer Hospital Model in the state to cut costs while improving quality. According to the year 3 performance data, Maryland has met or is on track to meet all model requirements, saving hundreds of millions of dollars as it lowers hospital readmissions and steers the state away from a volume-based system.

Currently, the FDA is evaluating 2 investigational drugs, both of which treat the underlying pathophysiology of hereditary transthyretin amyloidosis.

Discussing the integration of data from wearable technology into the electronic health record and utilizing telemedicine as a way to promote greater collaboration between the patient and their physician and health system with Jagmeet P. Singh, MD, PhD, FACC, deputy editor of JACC: Clinical Electrophysiology, and Fred Bove, MD, MACC, editor-in-chief of Cardiology magazine.

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

Estimating episodic target prices for each patient in the Oncology Care Model (OCM) can be challenging and time consuming. Applying that time to quality-focused care management tactics, based on observed utilization and patient outcomes, may wind up being more valuable, and help to reduce unnecessary spending.

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

Using a large database created by a center for actuarial studies, a psychologist and researcher is positing that people with the worst cases of attention-deficit/hyperactivity disorder (ADHD) will see a 25-year reduction in life expectancy, according to a presentation made Saturday at the annual meeting of the American Professional Society of ADHD and Related Disorders.

When patients with rheumatoid arthritis experience failure of an anti–tumor necrosis factor (anti-TNF) therapy, clinical guidelines support either cycling to a different anti-TNF agent or switching to a treatment with a different method of action (MOA). However, payers often require cycling of anti-TNF options before they will reimburse for treatments with a different MOA.

Multiple studies have demonstrated that black Americans tend to receive more intensive, higher-cost care at the end of life, and have higher rates of hospitalization and lower rates of hospice enrollment. A new study sought to determine whether racial variation exists among hospice enrollees in rates of hospitalization and hospice disenrollment, and whether that variation could be explained by systematic differences in hospice provider patterns.

As oncology practices transition to value-based care, they are challenged to take on more holistic responsibility for their patient. Fortunately, the examples of practices participating in CMS’ Oncology Care Model can offer valuable insight into the most impactful workflow changes providers can implement as they strive to achieve cost and quality improvements.

A chief medical officer for a major payer outlines the challenges making sure that certain high-cost therapies are directed to the patients who need them.

US healthcare spending is on the rise, and is expected to comprise over 20% of the gross domestic product by 2025. Current expenditures are expected to double by 2060 if the pace of spending in the past decade continues. In this healthcare landscape, in vitro diagnostics (IVD) have increasingly become the subject of scrutiny, as IVDs are perceived as contributing to soaring costs.

Is transfusion dependence a barrier to hospice utilization among older patients with leukemia who are enrolled in Medicare?

With the increasing emergence of less expensive biologic alternatives, some health systems are making the switch. For a large healthcare system, the arrival of a cheaper alternative to filgrastim prompted the conversion to using tbo-filgrastim as the preferrred granulocyte-colony stimulating factor. The results were shared in a study published by the Journal of Managed Care & Specialty Pharmacy.

Authors of the study found that the mean total, chemotherapy, and physician costs were all lower in community settings compared with hospital-based settings for patients with breast, lung, and colorectal cancer. There were also fewer emergency department visits both 3 and 10 days following treatment.

A study published in JAMA analyzed 155 health conditions, 36 age and sex groups, and 6 types of care to determine the impact of population growth, population aging, disease prevalence or incidence, service utilizations, and service price and intensity on healthcare spending increases in the United States from 1996 to 2013.

Among the most anticipated sessions at the 2017 meeting of the American College of Rheumatology in San Diego, California was “The Great Debate: Biosimilars…to Switch, or Not to Switch? That Is the Question.”

The reform will adjust payment for drugs purchased through the program, relieve some burden for rural hospitals, and exempt rural sole community hospitals, certain cancer hospitals, and children's hospitals.

In addition to the cost, the excessive overuse of laboratory testing causes patient discomfort and can lead to hospital-acquired anemia, which results in additional testing, prolonged hospitalizations, unnecessary transfusions, and increased mortality for patients with cardiopulmonary diseases.

With biosimilars being an everyday headline, Jason Bernstein, Epocrates Lead Strategist, outlined key reasons for pharma's growing interest in biosimilar development and key differences between generics and biosimilars.

With the clinical and financial implications of high-cost medications, and their impact on health system revenue, it is of utmost importance for all key stakeholders to be engaged in the complex revenue cycle.

On Monday, California Governor Jerry Brown (D) signed into law SB 17, which seeks to generate greater transparency concerning drug pricing.

Federally qualified health centers face significant financial and competitive pressures, but executives reported in a recent survey that they have identified areas for improvement and are planning a path to success.

This study found that brand price at launch and generic entry overstates long-run average pharmaceutical costs, with and without accounting for medical cost offsets.

The Hospital-in-Home program implemented at the Veterans Affairs Pacific Islands Health Care System in Honolulu, Hawaii, is associated with reduced costs with no compromise in quality.

Technology innovation drives expenditures. A Michigan Medicine, IBM, and AirStrip partnership demonstrates the hospital’s role in developing transformative technologies that deliver value.

A new report from the Kaiser Family Foundation examines preliminary data on premium rates and plan offerings on the Affordable Care Act’s exchanges.