Providers

At the Payer Exchange Summit V, sponsored by the Community Oncology Alliance (COA), 2 employer groups and a provider participated on a panel to provide practical insight into the extraordinary challenges and decisions faced by employers and employees with a cancer diagnosis.

Lawmakers have been working on the problem of what to do about out-of-network bills that result from emergency room care for more than a year.

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

Coverage from Patient-Centered Diabetes Care, April 7-8, 2016. Presented by The American Journal of Managed Care and Joslin Diabetes Center.

Marketplace consumers desire more health plan measures on how well plans support long-term patient—physician relationships. Consumers are skeptical of measures about rewarding providers for high quality.

The Affordable Care Act and additional legislation that has mandated extending mental health parity coverage are contributing to an increased demand for mental health services that the United States is not meeting.

Cancer pathways can potentially improve patient outcomes and reduce costs. Recent concerns about pathway adoption deserve attention, including excessive administrative burden to clinics.

Members of the American Society of Clinical Oncology (ASCO) have articulated concerns regarding the current proliferation of clinical pathways in oncology that could affect patient access and care quality. In response, ASCO established an ad hoc Task Force, which issued a policy statement to guide the future development and implementation of these treatment management tools.

The state's first-of-its-kind model for delivering Medicaid creates brings managed care concepts without commercial insurers to the one of the nation's poorest markets.

An accompanying editorial says doctors are not irresponsible; they lack access to information about patients'prior overdoses.

Sessions on obesity and the role of technology in disease management will be part of the annual gathering of stakeholders, presented by The American Journal of Managed Care, April 7-8, 2016, at the Teaneck Marriott at Glenpointe in Teaneck, New Jersey.

Providers and payers came together to discuss challenges and share success stories as they adapt to the changing healthcare realm.

Critics say there's little documentation for the $51.3 million in savings the Branstad administration says it will achieve in the first 6 months of 2016.

An earlier plan from Governor Gary Herbert that was paid for with existing state funds was rejected by the legislature. The current plan would add 95,000 Utahns to Medicaid, with hospitals paying most of the state's share after 2017.

An analysis of provider networks offered in the Affordable Care Act's marketplaces found large variation of the prevalence narrow networks among the states, according to researchers at the University of Pennsylvania.

With various healthcare stakeholders having different wants and needs from the healthcare system, meetings that bring all parties together in one room are important, according to Suzanne F. Delbanco, executive director of Catalyst for Payment Reform, and keynote speaker at the spring live meeting of the ACO and Emerging Healthcare Delivery Coalition.

Access to workplace wellness programs has been on the rise, but employers and providers still face steep challenges that can prevent these programs from being worth the investment.

Increasing health insurance enrollment is only one part of the goal of the Affordable Care Act-the law also aims to improve population health and lower healthcare costs, but less attention has been paid to these critical steps.

The Office of the National Coordinator for Health Information Technology will be awarding $38 million to 20 organizations in 3 health information technology grant programs working to further nationwide efforts to achieve better care, smarter spending, and healthier people.

A report released by the healthcare research group Avalere Health claims that health insurance exchanges have a significantly narrow network compared with their commercial counterparts.

Quality of care and relative resource use for patients with diabetes are not necessarily positively related. Further, the relationship varies by year, plan type, and region.

The findings of inadequate access to providers and outdated information were no surprise to healthcare advocates. Many of the issues are addressed in a giant proposed rule issued by CMS in late May.

This is the third year that CMS has released Medicare payment data, and this year the agency added information on prescription drugs.

The suits are on behalf of providers and health insurance customers and involve some famous plaintiffs' attorneys.

The authors discuss the success of the Pioneer ACO model and the Comprehensive Primary Care Initiative, among others. They outline an agenda that includes engaging managed care stakeholders, so that both public and private payers are moving toward value-based payment.

The American Journal of Managed Care's Patient-Centered Oncology Care meeting is an important event for anyone interested in "crossing the chasm" that appears between providers and the rest of the healthcare world, explained Peter P. Yu, MD, president of the American Society of Clinical Oncology.

Even though patient-centered medical home models are being implemented by multiple provider practices and health systems, little is known about what facilitates their implementation.

In 2014, Medicare telemedicine reimbursement totaled $13.9 million, a number that has steadily increased since 2008, according to the Robert J. Waters Center for Telehealth and eHealth Law.

Industry experts at the National Association for Healthcare Quality's National Quality Summit highlighted improving care through successful care transitions.

Despite a general sense that engaging in big data analytics is important for success in the current health information technology landscape, 51% of organizations do not truly know what kind of data-or how much of it-they need to collect