Health Care Delivery

Large employer health plans will now be required to cover in-patient hospitalization services, according to a notice from the Treasury Department and HHS on Tuesday morning. The final regulation will be issued next year.

At this time, the Supreme Court of the United States has declined to hear an appeal of one of the cases challenging the legality of making subsidies under the Affordable Care Act available to consumers on the federally run health insurance exchanges.

The Affordable Care Act expanded healthcare coverage to many low-income Americans, but this same demographic has a low health literacy that makes it difficult for them to navigate program eligibility systems, according to a study from The Urban Institute.

The toughest topics in cancer care will be on tap November 13-14, 2014, in Baltimore, Maryland, when AJMCLive presents Patient-Centered Oncology Care. If you've followed the discussion among pharmaceutical leaders, oncologists, and payers over access to care, you'll want to join stakeholders to discuss how to ensure patients get what they need while controlling costs.

The war of words between managed care and pharmaceutical manufacturers, which began when Gilead set the price for its drug to treat the hepatitis C virus (HCV), has taken off in October with the reclassification of a trio of cancer drugs from Genentech. Growth in the "specialty pharma" sector, where prices are rising much faster than drug prices generally, has drawn concern from payers and the umbrella group that represents them, while the trade group that represents drugmakers is pushing back against critics, saying that it faces challenges in bringing life-saving therapies to market.

US Health and Human Services Secretary Sylvia M. Burwell announces new progams and financial incentives to help accountable care organizations (ACOs) and professional medical associations make the transition from fee-for-service to value-based healthcare delivery.

A provision of the Affordable Care Act, the Sunshine Act provides for increased transparency in the healthcare realm.

Ending the subsidies offered under the Affordable Care Act would sharply increase costs for consumers, according to a study from the RAND Corporation. Furthermore, without the subsidies, more than 11 million Americans will lose their health insurance.

An article in the Journal of the American Medical Association outlines what both CMS and the Pioneer ACOs have learned in the early years of the program, such as the importance of engaging primary care physicians, not growing too quickly, and the need to find better ways to count which patients are in the ACO.

The Institute of Medicine announced yesterday that A. Mark Fendrick, MD, co-editor-in-chief of The American Journal of Managed Care and a national leader in efforts to reform healthcare reimbursement strategies, is among 70 new members elected to the prestigious body.

Congressional candidates may be still be talking about the Affordable Care Act, but a majority of the uninsured are still unaware of main components of the law, according to a poll from the Kaiser Family Foundation.

As accountable care organizations, or ACOs, proliferate across the United States, a question arises for both veteran healthcare leaders and consumers: is the ACO something new, or just a relabeling of managed care vehicles created during the last wave of healthcare reform? A well-run ACO offers something better than the managed care of prior years, according to presenters at the gathering of the ACO and Emerging Healthcare Coalition, which took place October 16-17, 2014, in Miami, Florida.

Providers and insurers across the country are partnering to launch narrow-network plans even as controversy continues over whether these plans offer adequate provider access for consumers.

Despite continued Republican opposition to the Affordable Care Act, sentiment is shifting from repeal to replace. Still, the fact that open enrollment on HealthCare.gov begins after the midterm elections does not seem like a coincidence to the GOP.

A majority of Americans covered by the Affordable Care Act are expecting to change plans for 2015, which may be a smart move, according to industry experts. People who simply re-enroll may not realize they are no longer among the lowest costing plans, which will affect how much their subsidies pay for.

In states that chose not to expand Medicaid eligibility under the Affordable Care Act, residents with a median income of less than $800 a month are now ineligible for coverage assistance while those with more than $2000 a month are eligible for subsidies, according to a report from the Urban Institute.

A survey by Kaiser Family Foundation projects 13.2% overall growth in Medicaid through fiscal year 2015, but the difference between states that expanded the program and those that did not will be stark. The survey of state Medicaid directors also finds 23 states plan expansion of managed care in the next year.

Those planning to purchase health insurance on the Obamacare exchange will soon find out how much rates have increased-after the November 4 election.

Without much fanfare, Massachusetts launched a new era of healthcare shopping last week. Anyone with private health insurance in the state can now go to his or her health insurer's website and find the price of everything from an office visit to an MRI to a Cesarean section. For the first time, healthcare prices are public.

The majority of low-income adults in 3 states favored Medicaid expansion, but knowledge about their states' plans for the program under the Affordable Care Act was low, according to a report from the Commonwealth Fund.

Even though roughly 9 million Americans have gained healthcare coverage, other forces related to the "anemic recovery" will keep healthcare spending under control, at least in the short term, writes Charles Roehrig, PhD, in a commentary published online yesterday in the New England Journal of Medicine.

A study of Colorado's own health insurance exchange for individuals identified 11 commonly cited barriers that have prevented eligible individuals from not enrolling in coverage.

Amid yesterday's good news from the CDC that Americans are living longer than ever was a sobering fact. Rates for the top 10 causes of death all fell from 2011 to 2012, save one: suicide. The death rate increased from 12.3 to 12.6 deaths per 100,000 people.

As the 2014 midterm elections near, healthcare could have an impact on voter decisions and campaign efforts, Avik Roy, senior fellow at the Manhattan Institute, said at the American Health Insurance Plans' National Conferences on Medicare and Medicaid, and Dual Eligibles Summit.

Nationwide, Pioneer ACOs saved the government $96 million last year, compared with $87.6 million in 2012, the Centers for Medicare and Medicaid Services said last month.

No state-run exchange, no subsidy for health coverage. That's what a federal judge in Oklahoma ruled yesterday, marking the second such ruling against a key component of the Affordable Care Act and setting up a potential return trip to the US Supreme Court to decide the fate of a key piece of the law.

Medicaid enrollment under the Affordable Care Act grew even in states that chose not to expand eligibility, making access to care a more pressing issue, according to a new report issued by HHS' Office of the Inspector General.

For most of the spring, news on the Affordable Care Act was all about the numbers, and to much surprise enrollment surpassed the magical 7 million mark. Now, Patricia Salber, MD, and Christobel Selecky report in The American Journal of Accountable Care what having coverage means, whether it makes a difference, and what are the unanswered questions.

Managed care has an answer to what happens when previously uninsured patients suddenly gain coverage: the cost of uncompensated care falls substantially, and so do the numbers of patients showing up at hospitals and emergency rooms without insurance.