What we're reading, February 29, 2016: hospital readmission declines tied to Obamacare program; Medicare negotiating powers may not have a large impact; and Aetna is on board with Affordable Care Act exchanges again.
Declines in the hospital readmission rate can be tied to the Affordable Care Act (ACA)’s Hospital Readmission Reduction Program. Readmissions quickly declined shortly after the ACA was passed, and a study in New England Journal of Medicine attributes the decline to the incentives and penalties introduced. There was no evidence that changes in observation-unit stays could account for the decrease in hospital readmissions.
Granting Medicare the ability to negotiate drug prices—a proposal that has been endorsed by Democratic presidential candidates Senator Bernie Sanders and Hillary Clinton, as well as Republican candidate Donald Trump—may not have as large of an impact as people hope. According to US News & World Report, the government would likely only focus on the expensive medications covered by Medicare and not all new drugs that enter the market. Furthermore, because the US doesn’t have a single-payer system, the effects in countries where the government covers all citizens and negotiates drug prices can’t really be extended to the US.
After questioning the sustainability of the ACA’s health insurance exchanges, Aetna’s CEO is now saying he supports the exchanges. After HHS Secretary Sylvia M. Burwell called him, Mark Bertolini has changed his tune and is even considering entering Covered California, reported Kaiser Health News. However, Bertolini said he wants the government to consider more flexibility in rates and benefit design to attract young, healthy consumers, who will offset the costs of older, chronically ill patients.
Shaping Dermatology's Future by Increasing Access, Data, and Advocacy
March 7th 2025Thy N. Huynh, MD, FAAD, Bruce A. Brod, MHCI, MD, FAAD, and Melissa Piliang, MD, FAAD, discussed expanding access to pediatric dermatology, dermatology data aggregation, and advocacy for Medicare physician payment reform, respectively.
Read More
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.
Listen
Eliminating Enhanced PTCs Would Have Cascading Economic Impacts, Report Estimates
March 6th 2025Enhanced premium tax credits (PTCs) have made marketplace health insurance more affordable, and eliminating them could have sweeping impacts on consumers and the health care industry, according to a new report.
Read More
Reducing Readmissions in the Safety Net Through AI and Automation
March 6th 2025Artificial intelligence (AI) and electronic health record–based automation tools helped a safety-net health system meet performance-based readmission metrics, thereby retaining critical funding while improving clinical and equity outcomes.
Read More