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What We're Reading: 2 More Co-Ops Sue Obama Administration
What we're reading, August 2, 2016: co-ops in New Mexico and Massachusetts sue the government over the risk-adjustment formula and why hospital ratings should be viewed with a bit of skepticism.
Co-ops in New Mexico and Massachusetts are suing the Obama administration over the management of the program. The states join Maryland, which filed a similar lawsuit in June, arguing that the “risk adjustment” formula overly rewarded big insurers, reported The Wall Street Journal. The co-ops are alleging that CMS hindered their success through the risk-adjustment program. The executives are saying they shouldn’t have to make payments to the government for 2015 based on the current system.
CMS recently released its “Star” ratings for hospital quality, but hospital ratings should be viewed with a bit of skepticism. While information may seem objective, the data points used and how they are weighted can lead to contradictory conclusions, STAT explains. Furthermore, opponents of CMS’ rating system have already made the case that the system penalizes hospitals that treat more low-income patients.
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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Neurologists Share Tips for Securing Patient Access to Gene Therapies
March 19th 2025Tenacious efforts at every level, from the individual clinician to the hospital to the state to Congress, will be needed to make sure patients can access life-saving gene therapies for neuromuscular diseases.
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How Access to SMA Treatment Varies Globally and by Insurance Type
March 18th 2025Posters presented at the 2025 Muscular Dystrophy Association (MDA) Clinical & Scientific Conference show that therapeutic advances in treating spinal muscular atrophy (SMA) are not uniformly making it into the hands of patients who could benefit.
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