April 23rd 2025
Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
The authors examine how insurer and patient out-of-pocket payments for advanced prostate cancer differ by drug and health plan type and describe the relationship between these payments and utilization.
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US Health Care System Ranks Last Overall Among Other High-Income Countries
September 19th 2024The US health care system is underperforming despite high spending, and reform is needed in areas like insurance coverage, primary care, and equity to improve overall health outcomes and efficiency.
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It’s Time to Address Our Nation’s Health Care Price Crisis
September 18th 2024This commentary introduces Catalyst for Payment Reform’s and the Employers’ Forum of Indiana’s new campaign, Price Crisis, which will mobilize individuals, employers, and policy makers with evidence, guidance, and resources to take meaningful actions.
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Eliminating Low-Value Services Can Improve Access to Innovative Cancer Treatments
September 13th 2024With the advances in cancer care, focus has mostly been on lamenting the high cost of these innovations instead of making patients and populations healthier, said A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.
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Dr Jennifer Green Weighs in on CMS Drug Prices, the Future of Combination Therapies
September 12th 2024Jennifer Green, MD, of Duke University, explained that while CMS-negotiated drug prices under the Inflation Reduction Act (IRA) may not immediately lower patients' costs, they could improve access to expensive medications.
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Biden-Harris Administration Expands Mental Health Coverage Protections Nationwide
September 10th 2024Ali Khawar, Employee Benefits Security Administration, US Department of Labor, believes the final rule will be a benefit to employers and health plans that are trying to do the right thing and offer robust mental health benefits or substance use benefits.
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Optum Care's Dr Ken Cohen Advocates for Comorbidity-Based GLP-1 Tiering for Patients With Diabetes
September 10th 2024Ken Cohen, MD, of Optum Care, advocates for glucagon-like peptide 1 (GLP-1) tiering for patients with diabetes based on comorbidities, like body mass index (BMI) and cardiovascular disease (CVD).
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UPMC's Dr Manisha Jhamb Urges Better Kidney Disease Awareness, Integrated Care
September 4th 2024Manisha Jhamb, MD, MPH, of the University of Pittsburgh Medical Center (UPMC), is excited about CMS's negotiated drug prices under the Inflation Reduction Act (IRA) for patients with kidney disease; conversely, she highlights the challenge of low kidney disease awareness.
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CMS Negotiated Drug Prices: Cardiologist's View on Affordability, Future Innovation
September 3rd 2024Ty J. Gluckman, MD, FACC, FAHA, of Providence St. Joseph Health, reacted positively to CMS' drug price cuts under the Inflation Reduction Act, but he also expressed concerns about the potential future impact on drug innovation.
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Beyond Average Spending: Distributional and Seasonal Commercial Insurance Trends, 2012-2021
September 3rd 2024Analysis of 2012-2021 commercial claims demonstrates that spending growth was concentrated among the highest spenders and there was increasing subsidy across enrollees through cost-sharing design.
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Cost in Cardiovascular Care: ESC 2024
September 2nd 2024A heart failure program with a multidisciplinary team provides statistically significant improvements, and 2 countries determine the current prices of semaglutide are not cost-effective for secondary prevention of cardiovascular disease in patients with obesity, according to abstracts at the European Society of Cardiology (ESC) Congress 2024.
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Tackling Obesity for Heart Health: A Global Weight Crisis
September 1st 2024The obesity epidemic is a global crisis, with experts from around the world emphasizing the importance of short-term strategies, long-term solutions, and multidisciplinary collaboration as they advocate for the heart health of their patients.
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Aetna Announces Simplified Access to Fertility Services
August 27th 2024Aetna has become the first major US insurer to expand access to fertility services by covering intrauterine insemination as a medical benefit for all eligible plans, marking a significant move toward greater equity in family-building options for people of all backgrounds.
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Medicare Semaglutide Coverage: Millions May Gain Access That Could Cost $145 Billion
August 26th 2024Medicare has not clearly defined what constitutes "established cardiovascular disease," leading to variability in potential patient eligibility; therefore, researchers aimed to estimate the number of Medicare beneficiaries who would become newly eligible for semaglutide under different definitions.
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