Payers

To be sustainable and successful, Medicare alternative payment models (APMs) have to attract and retain high and low performers. That requires a different approach to pricing and evaluation.

On this episode of Managed Care Cast, we speak with the chief strategy officer for Well Being Trust, one of the authors of a recent report about how well health insurers and state Medicaid programs are covering mental health care for children and compliance with federal law. We discuss the unique challenges that youth face, the health disparities, racism, and community trauma that has been experienced in the past year, and some creative ways that organizations and communities can consider increase access to mental health supports.

Given that some patients may need to travel out of state to access CAR T sites of care, some may not have a clear understanding of their insurance benefits, including requirements for out-of-state or out-of-network treatment, as well as adequate assistance with the costs of medical-related travel.

A poster at the Academy of Managed Care Pharmacy 2021 meeting examined the impact of high-deductible health plans (HDHPs) on access to health care and resource use in the United States and the interaction of race, ethnicity, and income.

The pandemic reduced visits to specialists last year, which in turn reduced the volume of prescriptions, according to a presentation at the Academy of Managed Care Pharmacy 2021 meeting.

New research presented at AMCP 2021, the annual meeting of the Academy of Managed Care Pharmacy, evaluated treatment patterns and costs related to hospitalization for patients with pulmonary arterial hypertension (PAH).

Patients enrolled in Medicare Advantage had better outcomes and lower cost following skilled nursing facility (SNF) discharge than patients enrolled in traditional fee-for-service Medicare.

Compared with when Medicare Part D launched, therapies today are more expensive. A panel at the Academy of Managed Care Pharmacy 2021 meeting discussed how the benefit needs to adapt to keep up with the future.

A Medicaid managed care organization developed a machine learning model to identify opioid use disorder (OUD) risk factors and predict OUD incidence in its multistate population.

Jonathan Silverberg, MD, PhD, MPH, is an author of the poster, “Efficacy of Ruxolitinib Cream Among Patients With Atopic Dermatitis Based on Previous Medication History: Pooled Results From Two Phase 3 Studies,” which will be presented at this year’s American Academy of Dermatology Virtual Meeting Experience (AAD VMX).

Hospital reimbursement deals slow the adoption of biosimilars in oncology, but cost concerns contribute to the incentives to use these agents.

On day 2 of this year’s Community Oncology Conference, a panel of government and health policy experts gathered to discuss the hot-button issue of political influence on cancer policy and the damage community oncology has suffered this past year.

In the debate of administrative expenses for public and private Medicare, we show incompatibility and extend the analysis to income, benefits, and loss ratio comparisons.

FH Healthcare Indicators reveal trends and patterns in the places where patients receive health care.

Accelerated approval drugs account for less than 1% of Medicaid spending, but states seek CMS approval to avoid coverage of these drugs and cut costs.

Medicare Advantage plans have a clear opportunity to improve quality by delivering more comprehensive, timely medication reconciliation services to recently discharged members.

The bipartisan bill spells out 5 step therapy exemptions for patients by amending the Employee Retirement Income Security Act of 1974.

As the first quarter of 2021 ends, patients choosing to keep using secukinumab may be offered an inducement to switch to another biologic, ixekizumab.

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.

Generally, life sciences companies are aligned around the benefit of using value-based insurance design (VBID) to address health care costs and ensure that medications get to the patients who need them.

The authors describe federal and state provider network adequacy standards and discuss how regulators should adapt these standards and accompanying monitoring processes in response to coronavirus disease 2019 (COVID-19).

Pharmacists from the Cleveland Clinic discuss the impact of payer dispensing requirements, known as white bagging and brown bagging, on oncology practices and on patients.

Minimal residual disease (MRD) is being used more frequently in clinical trials and to identify the best treatment course for patients, but unknowns remain about the optimal use of MRD testing.

Xavier Becerra, California's attorney general, will become the next secretary of HHS after the Senate voted 50-49, split by party lines.

The study examined the cost to Medicare when patients with end-stage renal disease switched from their employer-based health insurance to Medicare between 2007 and 2017 before the end of the 30-month coordination period.

This article describes a recently finalized CMS rule addressing the permissibility of co-pay accumulator adjustment programs (CAAPs) when no generic is available.

A panel of experts provided consumer insights into value-based insurance design (VBID) and how the COVID-19 pandemic may have changed consumer behaviors in a way that VBID may be able to address as the country emerges from the pandemic.

A desire to remove barriers to high-value care and provide services that would improve health and quality of life drove early adopters of value-based insurance design (VBID).