What we're reading, February 9, 2016: Novartis signs 2 performance-based deals for its new heart drug; 8 states significantly reduced uninsured rates; and the Obama administration will ask for $1.8 billion to prepare to fight the Zika virus.
Novartis has made deals with Cigna and Aetna for performance-based pricing for the new heart drug Entresto. The agreement would link payments to Novartis to how well the drug improves the relative health of customers based on a reduction in the proportion of customers admitted to the hospital for heart failure, according to Reuters. Aetna’s agreement is based on the drug replicating the results achieved during clinical trials: reducing hospitalizations and the rate of cardiovascular death related to heart failure.
In 8 states, the rate of uninsured residents dropped significantly last year, according to a report from the government. The states—Arizona, California, Colorado, Florida, Illinois, Kentucky, Michigan, and New York—represent a mix of red and blue and 5 have Republican governors, reported AP. Another 10 states reported notable reductions, although were not categorized by the survey as statistically significant. Those states were Georgie, Idaho, Indiana, Louisiana, Mississippi, New Hampshire, New Mexico, North Carolina, Oklahoma, and Rhode Island.
As Zika virus panic spreads in the US, the CDC is now on the highest level of alert and President Obama will ask Congress for $1.8 billion to help fight the virus. Although, the US has not yet seen a case of Zika transmitted directly in the continental US, with spring, along with an increase in mosquitos, approaching the administration said it wants to be prepared, according to The Washington Post. In Atlanta, more than 300 CDC staff are working to monitor and coordinate the Zika response. However, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he does not expect a major outbreak in the US.
ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
Read More
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
Contributor: For Complex Cases, Continuity in Acute Care Is Necessary
April 23rd 2025For patients with complex needs and social challenges like unstable housing, the hospital has become their de facto medical home—yet each visit is a fragmented restart, without continuity, context, or a clear path forward.
Read More
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