Aetna Says ACA Is in “Death Spiral”
Amidst news of insurers pulling out from the 2018 exchanges, the Affordable Care Act (ACA) did not receive a vote of confidence from Aetna. Chief executive Mark Bertolini said the ACA’s exchanges are in a “death spiral” and predicted that many more plans would withdraw this year due to the “deteriorating” risk pool, according to a Washington Post article. Aetna sells exchange plans in only 4 states this year, and has not yet announced whether it will continue on the exchanges in 2018.
HHS Secretary Price Delays Drug Treatment Record Sharing Rule
About a month after the Obama administration released a final rule that would have made it easier for healthcare providers to share patients’ substance abuse treatment records with one another, HHS secretary Tom Price is pumping the brakes. The rule was supposed to take effect on Friday, but the date has now been pushed to March 21. A Federal Register notice explained that the delayed implementation is meant to allow sufficient time for public comments on the rule.
CMS Projects National Health Expenditure Growth
CMS has released a report that projects national health spending will rise by an average 5.6% annually until 2025, outpacing the projected growth in gross domestic product by 1.2 percentage points. The report attributes the growth to a more rapid pace of increase in medical prices. Lead author Sean Keehan anticipated that because of these cost pressures, “employers, insurers, and other payers will continue to pursue strategies that seek to effectively manage the use and cost of health care goods and services.”
New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
Listen
Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
Listen
Integrated CKD Care Model Cuts ED Visits by 30%, Boosts Specialized Treatment
April 21st 2025An analysis of an interdisciplinary care model for managing chronic kidney disease (CKD) shows hospital admissions dropped by 26% and emergency department (ED) visits decreased by 30% after clinic initiation.
Read More