Health Care Delivery

People who visit the emergency department (ED) for mental health care are transferred to another facility at a rate 6 times higher than people who visit EDs for non-psychiatric conditions, and they wait hours longer, as well

Ideally, the healthcare industry needs to be more consumer driven, so that solutions and programs are built with the patient in mind, said Jay Sheehy, senior vice president of product innovation at EmblemHealth.

Since the implementation of the Affordable Care Act, more and more individuals are gaining access to insurance. Therefore, part of the New Jersey Health Care Quality Institute's responsibility is to make the complexities of the healthcare industry more easily understandable for members, according to Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute

This week, the top managed care stories included news that Risa Lavizzo-Mourey, MD, MBA, will be leaving the Robert Wood Johnson Foundation, a report that obesity rate in the military are also on the rise, and CMS denied Ohio's proposal to charge fees for Medicaid.

Massachusetts achieved near-universal insurance coverage after enacting its own healthcare reform 10 years ago, but gains in improved access to and affordability of care faded over time.

The American Journal of Managed Care reached out to Daniel F. Hayes, MD, FASCO, 2016-2017 president of the American Society of Clinical Oncology (ASCO), to understand his perception of how the recommendations of the Cancer Moonshot initiative's Blue Ribbon Panel would impact cancer care in the United States.

Gaining access to Afrezza can mean battling with an insurer to cover it. Sometimes the first hurdle is getting a doctor to write a prescription, according to those who've been through the process.

Understanding patients’ capability for self-management is a key part of understanding the risk of health declines and avoidable utilization, researchers determine.

How does a state with almost no money launch Medicaid expansion? Louisiana health officials used data they already had, and in doing so, have created a model that could be used elsewhere.

Analysis of the rich data of US health insurers-pivotal players in the healthcare system-reveals continuing reductions in employer-provided group health insurance and increases in Medicaid members and utilizations following the Affordable Care Act.

What we're reading, September 14, 2016: CMS denies Ohio's proposal to charge Medicaid fees; steep costs of healthcare continue to push Americans into poverty; and Canada approves prescription heroin to treat severe addiction.

Between individuals coming in and out of the market in a given year and those who switch plans, the majority of people in exchanges are enrolled in their plans for one year or less.

Insurance companies are making it mandatory for individuals to speak with qualified genetic counselors prior to testing for some hereditary cancers.

What we're reading, September 13, 2016: GOP bill would exempt people who live in areas with 1 Obamacare plan or none from penalties for not having coverage; hepatitis C drugs threaten to bust prison budgets; and school challenges for children with mental illness.

Large insurers reducing their involvement in the Affordable Care Act health insurance exchanges doesn't necessarily indicate failure, but success is not guaranteed, said Michael E. Chernew, PhD.

While adoption of personal health records and electronic patient portals increased from 2012 to 2015, researchers at Weill Cornell Medical found that the adoption rates for Hispanics and low-income individuals have lagged behind non-Hispanics and higher-income individuals.

Two state-specific studies in Annals of Emergency Medicine provided insight into emergency department use and staffing since the implementation of the Affordable Care Act.

What we're reading, September 8, 2016: An Arizona county at risk of having no Affordable Care Act plans in 2017 gains an insurer; the difficulty of obtaining medical records; and Ohio county offers immunity for anyone turning in deadly drugs.

Uninsured rates are much higher in states that have not expanded Medicaid, according to a CDC report.

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.