Payers

Payers acknowledge obesity as a public health issue and are working to establish offerings that align with USPSTF recommendations in order to treat and prevent obesity, says Jenny Bogard, MPH, director of healthcare strategies at the Alliance for a Healthier Generation.

All stakeholders stand to gain from the 340B program in different ways, but they also take on different risks, like the potential impact for health plans on rebate contracts, said Neil Minkoff, MD, chief medical officer of EmpiraMed.

The #Coverage2Control campaign begins a year after the announcement that UnitedHealth would shift most adult type 1 diabetes patients toward Medtronic technology, or require them to pay significant out-of-pocket costs. More significantly, JDRF reports payers are saying they will not fund the artificial pancreas.

The 340B program has evolved significantly since its passage, but there are still important changes needed, like clarifying the target patient population. The complicated rebate system for payers and drug manufacturers is also a consequence that should be addressed, said Neil Minkoff, MD, chief medical officer of EmpiraMed.

While it remains to be seen how the Trump administration deals with healthcare fraud, preventing fraudulent practices within your organization should be a priority-unless you want to be held personally liable.

The National Pharmaceutical Council (NPC) today published a letter outlining its thoughts on the FDA draft guidance regarding manufacturer communications about off-label uses of drugs. Today was the final day to comment on the draft before the agency begins to formulate the final version of the guidance.

At the American College of Cardiology Scientific Session, a study of prescriptions for PCSK9 inhibitors confirms what doctors say about trying to get their patients access to the cholesterol drug.

Recent studies have linked yoga and mindfulness with reduced stress, improved glycemic control, and even lower medical costs. Should these low-cost practices find ways to standardize to meet payers' needs? Or is it managed care that needs to adapt?

The Network for Excellence in Health Innovation finds potential areas of innovation and then tries to eliminate the obstacles to those ideas so its members can achieve the triple aim, according to Susan Dentzer, president and CEO of The Network for Excellence in Health Innovation.

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.

The biggest challenge in moving to value-based care is the mindset of providers accustomed to volume-based care, as they must work with payers to change the systems, said Susan Dentzer, president and CEO of The Network for Excellence in Health Innovation.

Until there is more data to support the outcomes of using telemedicine, payers will be more cautious about getting into reimbursing for the technology, said Anne Schmidt, MD, associate medical director at Blue Cross and Blue Shield of Alabama.

The American Journal of Managed Care and the American Association of Diabetes Educators have collaborated on a special joint issue of Evidence-Based Diabetes Management, which focuses on the growing evidence for payer coverage of Diabetes Self-Management Education and Support and the Diabetes Prevention Program.

The 2015 joint statement of the American Association of Diabetes Educators, the American Diabetes Association, and the Academy of Nutrition and Dietetics called for diabetes self-management education and support at 4 distinct points: at diagnosis, at annual assessments, when complications arise, and at transitions.

At the 5th annual meeting of Patient-Centered Oncology Care®, hosted by The American Journal of Managed Care, November 17-18 in Baltimore, Maryland, experts with diverse experiences and backgrounds discussed the contradiction presented by immuno-oncology agents in the world of precision medicine.

Many payers are incorporating Fitbit technology into healthcare plans as part of both prevention and clinical treatment programs, hoping that it can help members become healthier and more active, according to Ben Sommers, MBA, vice president of North America Business Development at Fitbit Wellness.

Last month, the healthcare payment network InstaMed announced that it was the first in the industry to achieve point-to-point encryption (P2PE) v2.0 validation. How important is this level of encryption for healthcare? What will this mean for those who seek better protection of their payment card data?

Coupons seem like a good deal for consumers, but they mask the true costs of drugs and force up premiums for everyone.

In the year since New Jersey regulators approved OMNIA, the state's health insurance market has experienced the same upheaval seen elsewhere: the number of options on the exchanges has shrunk from 5 to 2.

Professor R. Keith Campbell, MBA, BPharm, CDE, now retired from Washington State University College of Pharmacy, highlights the clinical advantages of Afrezza based on the evidence as well as his personal perspective.

Democratic lawmakers who signed a letter to Mylan this week say that the practice of offering coupons masks the high drug prices that are paid by commercial health plans. The practice is not allowed in Medicare or Medicaid.

While Mylan has steadily increased the price of EpiPens since 2007, the uproar from consumers is more recent. This suggests that for several years, payers masked the cost of the product, but that has changed with the popularity of high deductible plans.

Payers are making investments in care coordination to halt the overuse of services and medication. Certified diabetes educators (CDEs) are ideal candidates for this role, since so much of high healthcare spending is due to chronic disease.

There are signs that smaller providers, in particular, are not moving toward value-based reimbursement at the same pace as larger healthcare stakeholders.

A statewide all-payer claims database would permit more insight into what’s happening with cost and quality of providers, and possibly transform healthcare payment, explained Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition.