April 14, 2020
With the economic upheaval and unemployment brought by the coronavirus disease 2019 (COVID-19) pandemic, observers anticipate a large influx of new members into Medicaid programs. We spoke with Russ Fendley, former Medicaid commissioner for Kentucky, and Patrick Sturdivant, president of the Amerigroup Texas Medicaid plan, to find out how states and plans are preparing for this challenge and its lasting effects.
March 03, 2020
Implementing alternative payment models in oncology is a complicated process. The models are not perfect, especially the Centers for Medicare and Medicaid Services’ Oncology Care Model (OCM), although several panelists saw improvements in the proposed successor model, Oncology Care First (OCF).
January 13, 2020
It's time for curated, customer-centric thinking to come to healthcare, writes healthcare industry executives.
August 06, 2019
Home visits can be an important best practice for delivering care to patients with chronic conditions, and a new partnership between Anthem Blue Cross, CareMore Health, and River City Medical Group will launch a new model of care providing comprehensive, home-based services for Medicaid patients in the Sacramento area.
May 14, 2019
Accompanying editorial calls for further refinements in value-based insurance design to reduce unintended use of low-value care, reports the latest issue of The American Journal of Managed Care®.
February 22, 2019
Employers are placing an increased focus on healthcare benefits and integrating or expanding healthcare offerings. With healthcare costs rising, employers are focusing not only on health plans but also on ways to improve employee experience with healthcare.
December 23, 2018
Jeff White, PharmD, MS, staff vice president, Anthem, discusses what role Anthem has in addressing the opioid epidemic, as well as how important collaboration with other stakeholders is for addressing the epidemic.
December 10, 2018
Jeff White, PharmD, MS, staff vice president, Anthem, outlines best practices for preventing opioid misuse.
December 05, 2018
There are a number of nonopioid options, as well as nondrug options, for pain management, explained Jeff White, PharmD, MS, staff vice president, Anthem.
October 23, 2018
In reponse to rising healthcare prices and emergency department (ED) visits, insurers have implemented policies that apply financial disincentives for ED visits that could presumably be cared for in alternative settings. However, 87.9% of commercially insured ED visits present with the same primary symptoms as visits that result in nonemergent diagnoses.
October 20, 2018
A recent study looked to use real-world data to support the value of pathway regimens designed to create high-quality, affordable treatment in breast cancer care.
August 22, 2018
Patients with chronic obstructive pulmonary disease (COPD) with a history of at least 1 emergency department visit or hospitalization are eligible for a new digital health initiative announced by Anthem Blue Cross and Blue Shield for its Ohio Medicare Advantage (MA) plans, where it will cover digital sensors from Propeller Health.
February 20, 2018
Anthem says that most cataract surgeries can be conducted without an anesthesiologist or nurse anesthetist involved; the GOP-controlled House of Delegates in Virginia will support the expansion of Medicaid, but their plan will also include work requirements; the federal government has released an interim final rule for the Common Rule that governs the processes of conducting medical research, including protection for human subjects involved in research.
February 16, 2018
Anthem said that it was adjusting its policy on paying for emergency department (ED) visits, but some advocates and healthcare associations said Friday the changes by the insurer don’t go far enough. In addition, lawmakers in the Missouri House and Senate will consider legislation that would require a board-certified emergency physician to review the patient’s medical history regarding the ED visit before sending a bill, according to a published report.
November 21, 2017
The Coverage2Control campaign has worked to convince payers of the value of life-saving technology and the need to control out-of-pocket costs.
November 06, 2017
CDC released a report showing a more than 17% increase in drug overdose deaths last year; Gail K. Boudreaux will step in as new Anthem CEO; and the first glucose-monitoring system that doesn’t require a blood sample will hopefully be introduced by the end of 2018.
April 18, 2017
In a recent blog post, CareMore CEO Sachin Jain, MD, MBA, FACP, and his co-authors wrote that 1 in 5 Americans wants better dental care, but they lack access, often due to finances.
February 14, 2017
Aetna's CEO said it made no sense to proceed in the "current environment." Federal judges have blocked both the Aetna-Humana merger and a separate deal involving Anthem and Cigna.
February 11, 2017
Every week, The American Journal of Managed Care¬ģ recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
February 09, 2017
A judge has blocked the proposed merger of Anthem and Cigna, saying consolidation would likely result in higher prices and have other anticompetitive effects. The ruling comes just 2 weeks after another judge blocked the Aetna-Humana merger.
January 20, 2017
What we're reading, January 20, 2017: Minnesota will help residents with steep insurance premium hikes; the director of the National Institutes of Health appointed by President Barack Obama will stay on under the new administration; Anthem will end pre-authorization for opioid use disorder treatments.
November 22, 2016
What we're reading, November 22, 2016: Virginia declares opioid addiction a public health emergency; House calls for a pause of ongoing Obamacare lawsuit; and Anthem-Cigna antitrust trial begins.
November 14, 2016
The study finds one-quarter of the patients stop taking anticoagulants within 3 months and nearly three-quarters have stopped after 2.25 years.
November 02, 2016
What we're reading, November 2, 2016: Donald Trump attacks Obamacare while drug makers pour funding into Republican candidates, and Anthem considers reducing Affordable Care Act participation and is under fire in California for auto-renewals.
August 05, 2016
What we're reading, August 5, 2016: judge assigned to Anthem-Cigna and Aetna-Humana cases said he would likely only rule on one by the end of 2016; aversion to late-term abortion plummets when Zika infection is a factor; and the National Institutes of Health proposes lifting ban on research funds for human-animal stem cell research.
July 27, 2016
A study by researchers at the University of California, Berkeley, found that patients who have access to both the prices charged by a testing laboratory as well as reference pricing, they choose lower-cost laboratories, resulting in overall cost savings.
July 21, 2016
The US Department of Justice (DOJ) has filed an antitrust lawsuit to prevent planned megamergers in the health insurance industry.
July 19, 2016
The transactions were announced a year ago right after a Supreme Court decision that left subsidies for the federal health exchange intact.
June 29, 2016
When comparing a private practice with a larger healthcare system, Linda Bosserman, MD, assistant clinical professor and staff physician, City of Hope, said that the challenges can run across the system.
June 29, 2016
Jennifer Malin, MD, staff vice president, Clinical Strategy, Anthem, spoke about her health planís requirements on quality measures and whether they resonate what CMS requires providers to submit.
June 29, 2016
Measuring quality is important in determining whether patients are getting the appropriate care they need, and according to Linda Bosserman, MD, assistant clinical professor and staff physician, City of Hope, quality measures should cater to the patientís unique needs.
June 29, 2016
From a health plan perspective, the key to effectively using electronic health records, or EHRs, is to leverage the infrastructure in a manner that takes the burden away from the physician and his or her practice, said Jennifer Malin, MD, staff vice president, Clinical Strategy, Anthem.
June 29, 2016
Data interoperability remains a challenge among practicing physicians and health plans, mainly because each system operates on its own standards and vocabulary, explained Jason C. Goldwater, MA, MPA, senior director, National Quality Forum.
June 29, 2016
Patient-reported outcome measures help providers and health plans better understand what the patient wants and needs; however, there are still many challenges standing in the way of reaching its full potential, said Jason C. Goldwater, MA, MPA, senior director, National Quality Forum.
June 29, 2016
While the science of quality measurements is still in its infancy, Jennifer Malin, MD, staff vice president, Clinical Strategy, Anthem, said these metrics have allowed her and her team to open the door of communication among providers on how important quality truly is.
June 29, 2016
Jason C. Goldwater, MA, MPA, senior director, National Quality Forum, explained that quality metrics exist for 3 purposes: to ensure the best science and practices are being utilized, to set the bar for what good quality looks like, and to keep up with the evolving nature of healthcare.
June 20, 2016
Improving the healthcare services that an organization provides can be challenging unless one gathers information on the service, collates it, improves on it, and implements the changes in the field. A panel of experts invited by Evidence-Based Oncology discussed processes that help identify the most valuable metrics and the importance of making them relevant for use in the clinic.
April 20, 2016
What we're reading, April 20, 2016: Tufts Health Plan will pay for hepatitis C drugs for all patients with the disease; drug advertisements don't sway consumers; and Express Scripts countersues Anthem.
March 21, 2016
According to reports, the dispute centers on the terms of a repricing provision in the current contract.
October 15, 2015
The analysis by Anthem Inc, has identified a need for more widespread implementation of these interventions aimed at reducing healthcare utilization.
September 25, 2015
Healthcare groups and members of the Senate Judiciary Committee have weighed in with concerns about decreased competition and harm to consumers if the Aetna-Humana and Anthem-Cigna transactions are approved.
August 18, 2015
Winning bids reflect the trend of national insurers securing a large share of Medicaid managed care business as states seek savings and the Affordable Care Act allows for expansion.
August 03, 2015
The introduction of biosimilars into the US market will not have a large impact on treatment costs until the volume of biosimiliars for different therapies increases, predicted Jennifer Malin, MD, medical director for oncology at Anthem.
July 31, 2015
Proposed mergers of Aetna and Humana, and Anthem and Cigna, raise questions of whether consumers will continue to see competition in health insurance markets.
July 23, 2015
Health plans are top targets for cyber attacks. Fortunately, more are taking steps to prevent a data breach.
July 16, 2015
Jennifer Malin, MD, medical director for oncology at Anthem, explains how both physicians and payers struggle with the high cost of some cancer treatment drugs.
May 29, 2015
Two lawsuits have been filed against Anthem Blue Cross for denying coverage to 2 women for the hepatitis C medication Harvoni.
April 24, 2015
A late afternoon session on the first day of the 2015 Community Oncology Conference was a panel discussion called, "The Pathway Conundrum: How Many Do We Need and How Restrictive?"
February 13, 2015
Data breaches in the healthcare industry happen more often than you might think. Financial institutions, retailers, and other organizations have all suffered major breaches, but the healthcare sector is an increasingly attractive target for hackers.
January 16, 2015
Covered California's leader says its decision is only fair to those insurers who took on the risk of a brand new marketplace in 2014. But the state's insurance commissioner says limiting choices is unfair to consumers.
January 10, 2015
Health insurer Anthem Inc has reached a deal under which Gilead Sciences Inc's hepatitis C drug Harvoni will be the primary treatment for patients infected with the most common strain of the liver-destroying virus.
January 17, 2012