Policy

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.

The fiscal 2025 budget will prioritize investments in rapid tests and antimicrobial drugs; women who were pregnant as teenagers are more likely to die before 31 years; leaders push for reform as part of spending bill for federal health agencies.

Arizona is well suited to benefit from its 1115 demonstration waiver requested from CMS because it already has a robust justice-involved reentry initiative called the Residential Substance Abuse Treatment (RSAT) Program, which is emerging as an archetype of successful reentry programs that can serve as a template for other states to emulate.

After years of efforts to reduce low-value care, panelists at the 2024 Value-Based Insurance Design Summit proposed a new strategy: drawing a line in the sand that payers will not be on the hook for these services.

During a session of the 2024 V-BID Summit, panelists Stacie Dusetzina, PhD, and Inma Hernandez, PharmD, PhD, discussed how access to essential medications is curtailed not just by the longstanding complexities of insurance design but also by emerging threats such as supply chain weaknesses and cyberattacks.

An appeals court rules against the Pharmaceutical Research and Manufacturers of America in a 340B contract pharmacy dispute; for-profit investors’ acquisition of nursing homes has raised concerns about the quality of care provided in these facilities; President Joe Biden’s proposed budget for 2025 includes changes that would do away with the current system of biosimilar interchangeability.

The author calls on Congress to address reimbursement shortfalls that are contributing to a growing physician shortage, with rural areas the hardest hit.

Most private health insurers have yet to publish criteria for when they will cover postpartum depression drug, zuranolone; state lawmakers are increasingly opposing health care mergers that they believe do not serve the public interest; Medicaid extensions made in 2021 led to a 40% decline in postpartum lack of insurance.

The Affordable Care Act (ACA) Medicaid expansions increased health care coverage for American Indian/Alaska Native (AI/AN) women of childbearing age but had limited effects on prenatal care, birth outcomes, and health care supply.

In his State of the Union Address, the president called for expanding the number of drugs subject to Medicare price negotiations and extending a $2000 out-of-pocket cap beyond seniors.

Through accountable care organizations, physicians are leveraging data and partnerships to create an efficient, quality-oriented system focused on improving patient outcomes and addressing health disparities.

President Biden will preview his plan to more than double the size of Medicare’s new drug price negotiation program in the upcoming State of the Union address; Mexicans and Central Americans were most affected by the pandemic in terms of all-cause mortality; two Alabama fertility clinics said they expect to resume in vitro fertilization (IVF) services after a bill was passed to protect doctors.

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.

Getting weight loss drugs into the hands of those who need them could be a matter of changing pricing models to give more patients access to the medication they need.

When compared with patients on traditional Medicare, patients on Medicare Advantage had less intensive home health care, even if they had similar needs.

A new federal rule will provide higher Medicare payments for homeless patients, which may encourage hospitals to identify these patients and help them with their needs.

Demands for government action grow amid mounting pressures on health care; Opill offers convenient access to contraception without a prescription; the White House announces progress as drugmakers submit counteroffers for Medicare’s drug price negotiation program.

Appeals court to review ruling wiping out some cost-free preventative services; a new legislation aims to boost reimbursement rates for medical providers; changes to coverage may limit elderly home care access