Payers

On this episode of Managed Care Cast, we speak with the chief medical officer for Virginia’s Medicaid program about 4 ways payers can make sure that those with opioid use disorder get the treatment they need; the strategies are outlined in the March issue of The American Journal of Managed Care.

Whole-genome sequencing (WGS) is at least as accurate as conventional tests when it comes to genomic profiling in patients with acute myeloid leukemia and myelodysplastic syndromes.

This article documents a 100% increase in privately insured outpatient knee replacement surgeries following Medicare’s decision to remove knee replacements from its Inpatient Only list.

The $1.9 trillion spending package aimed at providing COVID-19 relief for those with low and middle incomes also represents the biggest investment in the exchange marketplaces created by the Affordable Care Act (ACA) since the landmark law was passed 11 years ago.

Investigators sought to better understand increasing price trends, including those seen among disease-modifying drugs to treat multiple sclerosis (MS) and other neurological diseases.

A review of evidence finds that oxygen therapy may be beneficial for all patients with pulmonary arterial hypertension, not just those who develop severe hypoxemia.

Direct inpatient and outpatient costs are significantly higher for patients with untreated spinal muscular atrophy (SMA) compared with matched controls.

The specialization program will teach fundamentals and offer real-world examples of value-based care through an online program.

Medicare Advantage enrollees are more likely to be treated with metformin and sulfonylureas and less likely to receive costly newer medications than those in traditional Medicare.

Kavita Patel, MD, MS, FACP, a fellow at the Brookings Institution Center for Health Policy, touched on key topics in health care at the ACCC 47th Annual Meeting and Cancer Center Business Summit.

Jeffrey Hogan, Northeast regional manager of the Rogers Benefit Group and member of the Board of Directors for the Connecticut Business Group on Health, discussed how his organization helped providers navigate some of the challenges posed by the pandemic.

Use of a specialty pharmacy to take over the management of prior authorization (PA) requests for a dermatology practice significantly reduced the time to a decision and also decreased the time it took to fill the medication.

From 1999 to 2015, permanent disability claims for patients with rheumatoid arthritis (RA) spiked during periods of economic recessions, suggesting that the COVID-19 pandemic may create a similar effect in the near future.

Donald M. Berwick, MD, MPP, the former CMS administrator who is president emeritus and senior fellow at the Institute for Healthcare Improvement, discusses cost variation in cancer care found through the digital classification system the COTA Nodal Address.

The coronavirus disease 2019 (COVID-19) pandemic has led to sharp declines in US life expectancy; a new CMS administrator nominee is selected; Biden administration announces funds to combat virus variants.

During a 2021 AcademyHealth National Health Policy Conference session, members of The Commonwealth Fund Task Force on Payment and Delivery System Reform discussed policy recommendations aimed at preparing the United States for future pandemics and addressing care inequities brought to light by the coronavirus disease 2019 crisis.

Sachin Jain, MD, MBA, FACP, president and CEO at SCAN Group and SCAN Health Plan, discusses how data can help ensure that vulnerable populations aren't harmed by value-based payment models.

In a panel at the 2021 AcademyHealth National Health Policy Conference, representatives from 3 community health plans across the United States discussed how payers are driving telehealth access and utilization in the wake of the coronavirus disease 2019 pandemic.

Former HHS secretary Kathleen Sebelius and Sachin Jain, MD, MBA, CEO of SCAN Group and Health Plan, took time to reflect on the advent of the Affordable Care Act (ACA) and examine the Biden administration’s opportunity to enact influential health policy on the first day of the 2021 AcademyHealth National Health Policy Conference.

Treatment of asthma with biologics was lower for those on public health insurance compared with those who had private insurance, with Blacks underrepresented relative to Whites in publicly insured visits where biologic treatment is used.

The Department of Justice (DOJ), under a new administration, on Wednesday dropped its previous position that the now-defunct tax provision in the Affordable Care Act (ACA) cannot be severed from the rest of the law, thus making the entire health law unconstitutional.

Experts outlined the impact value-based insurance design (VBID) has had on the coronavirus disease 2019 (COVID-19) pandemic response and future potential applications of the model.

To control the costs of managing a complex patient population, the market is turning to value-based contracting to drive positive outcomes.

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.

A 9% year-over-year increase was observed in the number of US Medicare beneficiaries who enrolled in a Medicare Advantage health plan in 2020, with the increase in enrollment influenced by the coronavirus disease 2019 pandemic and its related effects.

The Biden administration will reopen the health exchanges created by the Affordable Care Act (ACA); direct HHS and other agencies to reexamine other health policies, including Medicaid work requirements; and reverse the so-called global gag rule while affirming support for reproductive health.

Collaboration between a clinical laboratory and a managed care organization improved prenatal care and outcomes through real-time, actionable, laboratory-derived insights and care coordination.

President Joe Biden reportedly will take executive action to reopen federal marketplaces selling Affordable Care Act (ACA) health plans; Moderna investigating booster shot designed to be more effective against emerging variants of coronavirus disease 2019 (COVID-19); Brazil coronavirus variant is found in Minnesota.

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