Policy

Seniors need to examine insurance plans carefully to avoid devastating financial surprises. It's not easy, though, as insurance becomes increasingly complex with sometimes widely disparate rules for various scenarios.

Health plans are sending hundreds of thousands of cancellation letters to people who buy their own coverage, frustrating some consumers who want to keep what they have and forcing others to buy more costly policies.

Benefits consultant Aon Hewitt predicted that healthcare premium costs for large U.S. employers would rise about 6 percent in 2013, but when it tallied up its numbers for the year, the increase was only about 3.3 percent.

Dual eligibles-the class of Americans that qualify for both Medicaid and Medicare coverage-are mostly older adults with low incomes and tend to be the sickest beneficiaries covered by either Medicaid or Medicare.

The dynamic landscape of healthcare and managed care pharmacy will be deeply impacted by new and emerging specialty medications. The ever-spiraling costs of specialty medications have led many experts to question whether these treatments translate into true improvements in health outcomes or patients' quality of life.

Not surprisingly, Thomas Merrill, lead researcher, Center for Accountable Care Intelligence, Leavitt Partners, LLC, said that cost is a major work flow challenge associated with Accountable Care Organizations.

In this interview, Curtis Triplitt, PharmD, associate professor and assistant dean of research, Texas Tech University Health Sciences Center, Permian Basin, explains why diabetes should be treated with a patient-centered approach.

Physicians' access to a health information exchange saved more than $1 million in emergency care costs over a one-year period, according to a study released Monday by the American College of Emergency Physicians,

Community health centers will pay a steep price for states' decisions not to expand Medicaid under the federal health law.

Since 2010, the growth and proliferation of accountable care organizations (ACOs) has increased, and the rise of this collaborative care model is not without reason. Lack of consumer engagement, lack of competition, and misaligned incentives have made care less affordable.

Suzanne Tschida, PharmD, vice president, specialty benefits & outcomes, OptumRx, said that at UnitedHealth Group a tiering system is used for the management of specialty medications with a cost-share or copay structure.

Expansion or not, it is obvious that states must consider how to make their Medicaid programs more sustainable.

Most Americans don't want the government to decide if medical treatments are economical before letting patients use them, a new survey suggests.

In the past few years, efforts to lower costs and improve care have proliferated.

Clinical trials and treatment in multiple sclerosis (MS) place an unwelcome economic burden upon countries with MS prevalence. With rising costs and a growing interest in MS clinical trials from emerging countries, new studies are needed to evaluate the significance of these factors.

Melanie Bella, director, Medicare-Medicaid Coordination Office, Centers for Medicare & Medicaid Services, says the sole focus of the Medicare-Medicaid Coordination Office is to increase coordination and access to services from many fronts.

The Obama administration on Wednesday released a long-awaited report on premiums in Obamacare's federal insurance exchanges - the first look at the rates that will apply in the vast majority of states.

Jan Berger, MD, MJ, president & CEO, Health Intelligence Partners, and editor-in-chief of The American Journal of Pharmacy Benefits, says that historically medication adherence, when it pertained to PBMs, was really just about selling pills-it was an isolated, siloed issue.

It is up to physicians to seek education and training on genetics. Panelists agree that it is important for patients to speak with a genetic counselor even if it is over the phone.

MedPAC, the Congressional advisory committee on Medicare, discussed how to get patients more involved in their health decisions.

Health Information Technology (HIT) is expected to make patients' medical information not only more accessible, but easier to share among providers. Yet, despite the promising capabilities of HIT, providers are not entirely convinced about the costs that come with health technology.

A new study suggests that primary care providers participating in an accountable care organization (ACO) and having greater engagement with patients transparency into the cost of services and procedures have the ability to bend the healthcare cost curve by an 8 to 1 margin in terms of return on investment (ROI).

Panelists all agree that there needs to be evidence and guidelines for both payers and providers. There are not enough resources to try every drug on every patient. Although it will be costly, there needs to be evidence on putting these drugs together as combinations.

Two new studies have put a price tag on healthcare services considered of little benefit to patients. In both reports, researchers raised questions about the role that healthcare providers play in delivering potentially unnecessary care.

Hospitals and healthcare systems nationwide are increasingly buying more physician practices as health reform requires care delivery to move toward a more quality-based care model instead of a fee-for-service one. The reactions are mixed.

Bargaining leverage, not the cost of providing complex care, is the main reason why some hospitals can demand prices twice as high as their competitors' and still get contracts to treat privately insured patients, according to a new study.

A study estimates that total annual costs for five major health care-associated infections (HAIs) were $9.8 billion, with surgical site infections contributing the most to overall costs, according to a report.

Premium rates for health plan policies in the health insurance exchange (HIE) are expected to vary nationally, but they aren't likely to skyrocket - at least according to one research group.

Accountable care organizations (ACOs) and other coordinated care models present opportunities for improving quality as well as offering incentives that will drive lower-cost decision making among providers

As healthcare costs rise in Florida, insurers and hospitals vested in the success of the Affordable Care Act, are coming up with new ways to cut costs from buying services in bulk and piloting programs to lowering hospital readmission rates and limiting the number of doctors within a plan's network.