Payers

Health plan pharmacists are in the perfect position to see overprescribing as it happens.

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.

On this episode of Managed Care Cast, we speak with the new chief financial officer of Strive Health, a value-based kidney care company that works with payers and providers to create an integrated care delivery system for chronic kidney disease and end-stage renal disease (ESRD). We discuss the changes coming to nephrology practices, as well as new ways of looking at the whole patient to halt the slide to irreversible ESRD.

Telehealth services have saw a spike in October as COVID-19 cases continued to rise, as seen in claims tracked by FAIR Health.

Addressing the social health needs of those ill with coronavirus disease 2019 (COVID-19) is a challenge for providers and health care systems. On this episode of Managed Care Cast, we speak with Bechara Choucair, MD, senior vice president and chief health officer for Kaiser Permanente, who discusses the organization's guide that walks clinicians through considerations to keep in mind when screening patients in order to improve health outcomes as well as reduce community transmission.

Feedback from the field is incredibly important when participating in new payment models like the Oncology Care Model, said Basit Chaudhry, MD, PhD, founder of Tuple Health.

Coronavirus disease 2019 (COVID-19) dominated 2020. This is a look back at how the pandemic evolved and progressed through the year, which closed with the arrival of vaccines, but also continued challenges.

Kashyap Patel, MD, associate editor of Evidence-Based Oncology, a publication of The American Journal of Managed Care, will serve a 1-year term beginning in January.

Insurance status can influence an individual’s ability to access care, stated Milena Murray, PharmD, MSc, BCIDP, AAHIVP, associate professor at Midwestern University College of Pharmacy.

The authors wrote that in states that expanded Medicaid health insurance coverage in 2014, there was an increase of early-stage colon cancer diagnoses compared with states that did not implement expansion.

Patients with COVID-19 and end-stage renal disease were 11 times more likely to be admitted to the hospital than patients without kidney disease.

We must rethink our one-size-fits-all approach to social determinants of health interventions and instead target patients who truly need and would benefit from these interventions.

During a period of rapid fluctuation in the intravenous iron market, there was increased use of a more expensive drug that afforded providers additional revenue.

Incorporating data from functional status assessments, we developed a Medicaid payment model for long-term services and supports in a community-dwelling population of older adults.

This case report of a novel methodology for the analytic development of bundled payments addresses statistical analysis, data visualization, and clinical consultation.

This study compared beneficiary characteristics and Medicare per capita expenditures among seriously ill Medicare accountable care organization (ACO) populations defined using prospective and retrospective claims-based attribution methods.

Relative readmission rates, a measure of care coordination, did not change over time for beneficiaries enrolled in Medicare Advantage and traditional Medicare.

COVID-19 created a striking rise in telehealth services over the past year, as seen in claims tracked by FAIR Health.

Although half of US rheumatologists have patients for which nonmedical switching has been suggested, only 35% were likely to switch patients with rheumatoid arthritis doing well on a reference product to a biosimilar.

Intravenous diuretic treatment of patients with decompensated heart failure can increase urine output, promote weight loss, and improve dyspnea.

During a webinar, experts discussed where health care has improved life expectancy and the relationship between cost and relative contribution that each area makes to life improvement and expectancy.

To mark the 25th anniversary of The American Journal of Managed Care®, each issue in 2020 will include a special feature: an interview with a thought leader in the world of health care and medicine. The November issue features a conversation with William H. Shrank, MD, MSHS, chief medical officer of Humana.

The patients must always come first, emphasized Milena Murray, PharmD, MSc, BCIDP, AAHIVP, associate professor at Midwestern University College of Pharmacy, who practices at the Northwestern Medicine Infectious Disease Center in Chicago.

Study results demonstrate the multimillion-dollar savings achieved among patients with heart failure with reduced ejection fraction (HFrEF) following treatment initiation with sacubitril and valsartan.

Pharmacists have an important role to play in the success of value-based payment models, according to panelists who discussed their health plan’s value initiatives at the Academy of Managed Care Pharmacy Nexus 2020 meeting.

In a panel discussion at the Academy of Managed Care Pharmacy Nexus 2020 meeting, experts discussed driving factors of and barriers to the use of real-world evidence by payers in oncology decision-making.

As the coronavirus disease 2019 (COVID-19) pandemic threatens to worsen the opioid crisis, payers must rapidly deploy policies to ensure care for individuals with opioid use disorder.

The authors, from RxCrossroads by McKesson, discuss the impact of copay accumulator and maximizer programs.

A new national study is highlighting disparities in morbidity and barriers to care that face patients with chronic obstructive pulmonary disease (COPD) living in in rural areas.

Natera’s Signatera ctDNA test will determine study eligibility and treatment effectiveness in HR-positive, HER2-negative breast cancer patients.