Payers

Given the constraints prevalent post-COVID-19, Dr Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design, stresses that it is now more important than ever for the health care industry to prioritize payment reform, value-based benefit design, and novel policy initiatives.

Despite concerns, legislation to cap out-of-pocket payments for specialty drugs has not been shown to shift costs to health plans, thereby increasing insurance premiums, according to a study published in New England Journal of Medicine.

Hinge Health announced the expansion of its clinical and technical musculoskeletal (MSK) capabilities to cover the full continuum of MSK care. The move will provide the most complete back and joint health solution to employers and health plans.

The coronavirus disease 2019 (COVID-19) vaccines that are leading the pack are utilizing a new vaccine technology that has never been approved for human use by the FDA. As a result, there are a lot of unknowns.

Patients with myeloproliferative neoplasms (MPNs) have high disease burden, and management of their disease can vary widely to include watchful waiting, phlebotomy, or drug therapy.

The race for a coronavirus disease 2019 (COVID-19) vaccine is one of the most urgent public health challenges, with multiple vaccine candidates entering phase 3 trials and case counts around the world steadily climbing. MJH Life Sciences™ will host a free webinar with the top minds in infectious disease, virology, and vaccinology to discuss the latest trial information on vaccines.

The researchers noted that these results can help inform therapeutic decision making and identify opportunities to address barriers to disease-modifying drug (DMD) adherence, which not only improves clinical outcomes but also reaps benefits when it comes to health care costs.

The study measures satisfaction among members of 149 health plans in 21 regions of the United States.

Researchers called for new guidance to address the underreporting of patient engagement in rare disease clinical trials after finding a dismal amount of patient-reported outcome measures listed in orphan drug labeling claims.

Patients with HIV who have been heavily treated but are failing their current regimen have few treatment options and are at risk of progressing to AIDS and death.

A recent article in the Journal of Head and Face Pain outlines strategies for migraine treatment without face-to-face visits, and describes ways health insurance companies can remove barriers to migraine care during the coronavirus disease 2019 (COVID-19) pandemic.

Technology has made it easier to deliver health care in the home in recent years, but the financing models have not caught up just yet.

Based on the safety and efficacy outcomes from the PREVENT phase 3 study, the FDA has approved secukinumab (Cosentyx) from Novartis for the treatment of active nonradiographic axial spondyloarthritis.

Leaders from several different accountable care organizations (ACOs) describe their experience of creating programs to care for Medicare beneficiaries using the skilled nursing facility (SNF) waiver process.

Compared with use of originator products, use of biosimilars in the United States is apparently still not a priority of commercial health plans, according to the results of a recent JAMA study.

The International Olympic Committee postpones the 2020 games slated for this summer; the American Society of Clinical Oncology (ASCO) urges Congress for increased protection and support for medical practices; AHIP will allow its member payers to transfer patients with coronavirus disease 2019 (COVID-19) from hospitals to other clinical settings, if appropriate, without prior authorization.

"We want to make sure practices have time to learn, understand, adapt, and modify, to a new Oncology Care Model," said Michael Diaz, MD, president of Community Oncology Alliance.

There are shortcomings in the ways we have approached value assessment to date, writes the executive director of the Innovation and Value Initiative.

It's time for curated, customer-centric thinking to come to healthcare, writes healthcare industry executives.

Financial barriers and perceived implicit biases were both barriers that families of children with acute leukemia raised regarding access to care issues that might have delayed diagnosis, said Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco.

On this episode of the podcast, we speak with Peter Bonis, MD, chief medical officer, Clinical Effectiveness, Wolters Kluwer Health, which recently released the survey, Mending HealthCare in America 2020: Consumers & Cost.

While efforts to abate surprise medical billing, such as the kind that come from out-of-network emergency department visits, are currently being debated in Washington, DC, the kind of billing discussed here occurs when patients struggle to understand the difference between preventive health services, which are covered at no cost under the Affordable Care Act, and billing for services at a doctor’s visit for an illness, condition, or injury.

Amy Ellis, director of quality and value-based care at Northwest Medical Specialties, and Amanda Hodges, director of implementation for ReVital Cancer Rehabilitation, who acts as a bridge between the oncology world and the rehabilitation world, discuss overcoming barriers in practices to help patients with cancer get the rehab care they need, how patients with cancer can benefit from rehab, and defining value.