Health Care Delivery

What we're reading, September 7, 2016: Allergan vows to limit drug price hikes; Senate votes again to block Zika funding bill; and CMS will institute a new process to screen people signing up for Obamacare coverage during special enrollment periods.

A report released by a group of sickle cell disease (SCD) stakeholders, including the American Society of Hematology, aims to identify unmet medical needs for those diagnosed with SCD to improve their quality of life.

Payment reform's impact on socioeconomic disparities may not matter if the growth in healthcare expenditures in the United States means the government or payers can’t afford to pay for the medicines, said Andrew L. Pecora, MD, FACP, CPE, chief innovation officer professor and vice president of cancer services at the John Theurer Cancer Center.

Although many more women have health insurance now than before the enactment of the Affordable Care Act, gaps in women’s health coverage persist, leaving them vulnerable to higher costs and denied claims.

Non-Hispanic blacks are less likely to receive opioid prescription at discharge during emergency room visits for back pain and abdominal pain compared with non-Hispanic whites, researchers found.

This week in managed care, the top stories included proposals from CMS to shore up the Affordable Care Act's marketplaces, research that highlighted the link between duration of obesity and cancer risk for women, and the results of an FDA diabetes workshop.

The city of Baltimore has released a blueprint for reducing health disparities in the city by half over the next decade. The Healthy Baltimore 2020 plan outlines priorities to promote health and well-being.

What we're reading, September 5, 2016: Zika virus remains a global health emergency and worsens in Asia; the government provides "simple choice plan" options for 2017's open enrollment season; and how hospitals are improving the workplace.

The American Journal of Managed Care recently published the findings of a 10-year initiative to improve the delivery of high-quality, cost-effective care. Here are 5 key takeaways from the research.

What we're reading, September 2, 2016: California taxpayers will cover 70% of the state's healthcare costs in 2016; President Barack Obama supports recommendations to reform the Veterans Affairs healthcare system; and California is close to criminalizing undercover stings against Planned Parenthood.

Since New Jersey's Republican governor shares power with a Democratic legislature, acceptance-if not full-throated support of Medicaid expansion-was not a surprise in 2013. But this week's event was seen by political observers as a sign Christie wants to be compared with Ohio's John Kasich.

A nationwide telemedicine diabetic screening program could help prevent diabetic retinopathy, the top cause of new-onset blindness in the United States.

CMS' new proposal to shore up the Affordable Care Act (ACA) marketplaces signals that federal officials have heard concerns that not enough has been done to prevent adverse selection or share risk for the sickest patients who gained coverage under the ACA.

Not only are patients with prediabetes benefiting from Omada Health’s Prevent program, Omada benefits as well by learning from the enrolled patients about how to better serve the Medicaid population, Mike Payne, MBA, MSci, chief healthcare development officer at Omada Health.

What we're reading, August 29, 2016: Audit finds Medicare Advantage plans overcharged the government; enrollment on the Affordable Care Act's exchanges less than half of initial prediction; and California bill to protect consumers from surprise medical bills divides physicians.

Despite coverage gains since the implementation of the Affordable Care Act, groups at risk of being uninsured before the law continue to have higher uninsured rates.

This week in managed care, the top stories included new reports on a 10-year experiment in payment reform, more results from the early years of the Affordable Care Act, and findings on employee wellness programs.

Healthcare as we have known it doesn’t work cooperatively, which is one reason it costs way too much, according to Donald M. Berwick, MD, MPP, president emeritus and senior fellow of the Institute for Healthcare Improvement and co-originator of the term the Triple Aim. Berwick spoke with The American Journal of Managed Care as it publishes reports on Aligning Forces for Quality, funded by the Robert Wood Johnson Foundation.

Advances in genetic technologies have a great potential to be used to advance treatments, especially through personalized medicine. However, there are concerns that disadvantaged groups do not have access to these advances.

As health insurers reduce their involvement in the Affordable Care Act (ACA)’s insurance exchanges and states approve sharp premium increases for 2017, HHS is trying to assuage fears that coverage under the ACA will be unaffordable for consumers next year.

In 2006, the Robert Wood Johnson Foundation launched Aligning Forces for Quality, which sought to improve the quality of healthcare using a regional approach. Findings on this massive undertaking, introduced by Donald M. Berwick, MD, MPP, former CMS administrator, reaffirm both the importance and challenge of implementing healthcare reform.

What we're reading, August 24, 2016: Tennessee signed off on high premium hikes as its exchange is close to collapse; 5 states sue the Obama administration over a transgender healthcare policy; and a new non—travel-related Zika case is identified in Tampa Bay.

Governor Phil Bryant's opposition to expansion contrasts with his public support for other healthcare initiatives, such as a new diabetes research center and telehealth research.

It’s a hotly debated question about healthcare reform: How does Medicaid expansion impact emergency department usage?

Researchers from Tufts Medical Center analyzed findings from 26 studies to determine how drug exclusion policies affect patients and healthcare costs.

Factors such as insurance status and being married are significant determinants of survival compared with race/ethnicity, in patients with multiple myeloma who are less than 65 years of age.

What we're reading, August 22, 2016: freestanding emergency clinics come under increased scrutiny; hospitals are being more open about medical mistakes; and regulations to blame for rising generic drug prices.

While Joe Antos, PhD, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, believes that the ACO model is here to stay, he said that the way these organizations operate are likely to change.

A new report by the American College of Physicians sheds light on the harsh truth that being underinsured is as big a challenge as being uninsured. Cost sharing, in particular deductibles, has caused patients to forgo or delay care, including medically necessary services.

This week, the top stories in managed care included Aetna's announcement that it was pulling back its participation on the Affordable Care Act exchanges, the annual meeting of the American Association of Diabetes Educators outlined how existing sites can help roll out the Diabetes Prevention Program nationwide, and hospital leaders gave their opinions on CMS' hospital readmission program.