Health Care Delivery

The guidance comes after advocacy groups and members of Congress complained of widespread violations of the Affordable Care Act's requirement that all forms of birth control be covered without a co-payment, not just the low-cost methods. The action also responds to recent reports that payers have balked at requests for BRCA testing even when indicated.

Carolinas HealthCare System monitors ICUs in 10 of its hospitals from a command center near Charlotte. The command center is staffed 24/7 with a rotating crew of 7 to 9 nurses and doctors who specialize in critical care.

Medicare's new payment formula is set to begin in 2019. The problem is no one's agreed on standards for measuring quality or efficiency of patient care.

The White House is moving to address 2 of the most common consumer complaints about the sale of health insurance under the Affordable Care Act: that doctor directories are inaccurate, and that patients are hit with unexpected bills for costs not covered by insurance.

It's an incorrect, but convenient, shorthand to say that the Affordable Care Act establishes state-based health insurance markets. Actually, the markets are finer grained than that.

It is unclear at this time what role President Barack Obama's healthcare law, the Affordable Care Act, played in the slowdown of healthcare spending and how much can be attributed to the Great Recession.

Health and Human Services Secretary Sylvia Mathews Burwell yesterday rejected Governor Rick Scott's proposal to extend the current funding mechanism, which this year brought $1.3 billion in federal funds to hospitals that care for high numbers of uninsured patients.

Among other topics, panelists discussed the connection between mental health and diabetes, and the need to treat these conditions together.

The Affordable Care Act provided funds for 10 states to experiment with incentive programs in Medicaid. Researchers hope to learn what steps will motivate beneficiaries to take steps to improve their health.

MNsure's chief executive announced his resignation Monday, paving the way for a third leadership shakeup at the beleaguered agency in less than 2 years.

A hospital closure can send tremors through a city or town, leaving residents fearful about how they will be cared for in emergencies and serious illnesses. But a new study found that when hospitals shut down, death rates and other markers of quality generally do not worsen.

When 5% of Medicaid recipients account for 54% of spending, cost is just the beginning of the problem.

The Pioneer ACO Model successfully reported smaller increases in total Medicare expenditures and reductions in health service utilization, for savings of approximately $385 million during the first 2 years compared with general Medicare fee-for-service.

The number of Americans finding coverage through Medicaid expansion equals those who signed up for private insurance on the exchanges, according to new data. Montana has just passed legislation to become the 29th state to expand Medicaid.

The increased availability of urgent care centers, retail clinics, and telephone triage lines has not affected emergency department (ED) visits. In fact, three-fourths of emergency physicians report ED visits are going up.

As accountable care organizations work to deliver population health, patient satisfaction, and cost savings, the need to engage patients as partners in their own healthcare has never been more essential. The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, gathered this week at the historic Hotel del Coronado in San Diego, California, to explore ways to make patients the starting points of healthcare, not just its recipients.

Patients at hospitals with high rates of skilled nursing facility discharge usually have poorer outcomes and higher downstream spending, according to researchers from Massachusetts Institute of Technology and Vanderbilt University.

Nearly half of the 17 insurance marketplaces set up by the states and the District under President Obama's health law are struggling financially. Many of the online exchanges are wrestling with surging costs and tepid enrollment numbers.

Patient access, supply chain, adherence, and comorbidities are only a few of the challenges associated with oral anticancer agents, which are included distributed by specialty pharmacies.

As hospitals and health systems work to develop population health strategies to better serve their communities and rein in the overall cost of care, behavioral health patients cannot be ignored.

The lackluster uptake of the special enrollment period for exchange coverage is driven, in part, because for most people individual mandate penalties are much lower than actual costs of coverage.

A one-minute look at managed care news during the week of April 27, 2015, including more good news for the much-anticipated PCSK9 inhibitors and growth in the individual insurance market enrollment.

In 2014, low- and moderate-income consumers were able to use premium subsidies to buy health coverage on Marketplaces under the Affordable Care Act. The individual health insurance market had been relatively flat for 3 years' prior.

Accessing patient information in a health information exchange system during the 30 days after hospital discharge reduced the odds of readmission, according to a study in the Journal of the American Medical Informatics Association.

Although the Supreme Court oral arguments of King v. Burwell mostly went the way people were expecting, there were a few surprises, said Thomas P. Miller, JD, resident fellow at the American Enterprise Institute, who was able to sit in the courtroom the day of the arguments.