Reimbursement

While a majority of national lives are covered by vertically integrated insurers, the proportion varies widely at the state level from as low as 6% to as high as 97% of covered lives, according to a new American Medical Association (AMA) report about competition in the pharmacy benefit manager (PBM) sector and insurance.

Even though there is a 1-year gap between the Oncology Care Model and the Enhancing Oncology Model, there remain value-based oncology payment programs with private payers, said Glenn Balasky, executive director of Rocky Mountain Cancer Centers.

In a recent opinion published in JAMA, health policy researchers reviewed the advantages and disadvantages of prior authorization in Medicare Advantage (MA) to identify key areas that need improvement.

Enrollees who join Medicare Advantage undergo significant turnover in the years following enrollment.

The Enhancing Oncology Model (EOM) will be the successor to the Oncology Care Model.

Co-hosted by Memorial Sloan Kettering Cancer Center, the most recent Institute for Value-Based Medicine® event took place on September 22, with a focus on improving cancer care delivery through innovation.

The topline results showed the phase 3 trial met both the primary endpoint and all secondary endpoints.

The ruling by the Supreme Court on 340B reimbursements was narrow, but it sets up a future reimbursement reduction by HHS that is even greater based on survey data, said Ted Okon, MBA, executive director, Community Oncology Alliance.

Coverage from the Association of Community Cancer Centers 2022 Annual Meeting and Cancer Center Business Summit, held in Washington, DC, March 2-4.

"No matter where you go, there you are." Buckaroo Banzai

Survey responses of 320 US hospitals highlight the dire consequences of the COVID-19 pandemic on facilities and point to a future of ongoing financial and staffing challenges.

To ensure that value assessment accounts for patient needs, we need a better understanding of the outcomes that are most important to patients, write authors from COVIA Health Solutions and the University of Washington School of Pharmacy.

With the ongoing coronavirus disease 2019 pandemic, a rising number of uninsured Americans, and a new Democratic president and Senate majority, 2021 is shaping up to be a dynamic year for health care policy.

Pharmacy-led telehealth strategies will position Special Needs Plans (SNPs) for Star Ratings success during the pandemic and for years to come.

With so many different oncology alternative payment models (APMs) available, choosing the right ones to participate in might simply mean finding which ones already align with what a practice is doing, said Amy Ellis, chief quality officer at Northwest Medical Specialties.

Amid recent reforms on price transparency by CMS and the Trump administration, payers' workloads will substantially increase with notable challenges that include having to maintain accurate prices and the impact of exposed negotiated rates.

The US Surgeon General, Vice Admiral Jerome Adams, MD, and other officials urged for greater uptake of FDA-approved treatments for coronavirus disease 2019 (COVID-19) in an effort to slow the surge of cases requiring hospitalization. However, logistic, monetary, and efficacy concerns may have drastically limited the amount of biologic treatments actually administered to patients.

The statement is aimed at drug companies, policymakers, pharmacy benefit managers, employers, and others, and calls to attention soaring insulin costs, which were the subject of several Congressional hearings in 2019.

Barbara McAneny, MD, founding partner of New Mexico Oncology Hematology Consultants, discusses why putting risk on oncologists is not the way to fix cost issues in cancer care.

The coronavirus disease 2019 (COVID-19) pandemic disrupted many mental health services for children; a study on the long-term effects of COVID-19 will soon kick off; a $13-billion deal has been struck for UnitedHealth to buy Change Healthcare.

The economics of cancer care remain a major concern as practices try to figure out how to deal with the cost of providing cancer care, said Sibel Blau, MD, medical oncologist, Northwest Medical Specialties, and president and CEO, Quality Cancer Care Alliance (QCCA).

Barbara McAneny, MD, CEO of New Mexico Oncology Hematology Consultants, gives her insight on the potential pitfalls of bundled payment plans in oncology and how they could potentially work.

There is a lot of variation among commercial payers, but broadly speaking they are expected to start moving to adopt what Medicare does, said Basit Chaudhry, MD, PhD, founder of Tuple Health.