Insurers Reluctant to Cover Costly but Lower-Risk Painkiller Alternatives
Although there are opioid and non-opioid painkillers available that lessen the risk of abuse, a new investigation finds that these costlier drugs are often not covered by insurers. The report published by the New York Times and ProPublica featured interviews with patients who were denied access to less-risky opioids, like buprenorphine patches, or non-opioid alternatives by their insurers, who were more likely to cover opioids like morphine that have a higher potential for abuse and addiction. The article also raised concerns about limited insurer coverage of addiction treatments.
After Heat Deaths, Florida Nursing Home Ejected from Medicaid Program
After Hurricane Irma’s power outages led to the deaths of 8 residents in a Florida nursing home who were exposed to excessive heat, the state is taking measures like suspending the facility from participating in Medicaid. Reuters reported that the state’s health agency also prohibited the Rehabilitation Center at Hollywood Hills from accepting new patients, and the building has been sealed by police after all residents were evacuated. State and federal authorities have begun conducting a criminal investigation into the loss of life that occurred at the facility.
Patients With Sickle Cell Disease Face Uphill Battle for Adequate Care
A new report published by STAT revealed the unmet care needs among patients with sickle cell disease, who can face delays in emergency treatment, biased judgments, and inadequate primary care. The 12 patients interviewed in the article said that clinicians often consider them drug-seekers due to their race, as the painful condition predominantly affects African Americans. They also described how many primary care physicians are not equipped to manage the condition, which leads to patients seeking treatment in the emergency department when they experience an episode, although they do not always receive appropriate care from emergency clinicians.
Urticaria Diagnosis Challenged by Overlapping Pruritic Skin Conditions
April 23rd 2025Urticaria is complicated to diagnose by its symptomatic overlap with other skin conditions and the frequent misclassification in literature of distinct pathologies like vasculitic urticaria and bullous pemphigus.
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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.
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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.
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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.
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