Insurance

Utilizing real-world evidence that applies to the specific care needs of certain patient populations can promote timely decision-making among payers and providers on the use of effective cancer therapies available on the market, said panelists at the 2022 Patient-Centered Oncology Care® (PCOC) meeting.

In this column, a health insurance executive discusses 2 ways to address rising inflation, including moving past the traditional fee-for-service payment model.

The government is allowing Medicare Advantage (MA) plans to delay returning hundreds of millions of dollars or more in government overpayments; a proposed new extension of the Affordable Care Act (ACA) might make birth control coverage more accessible for certain private insurance plans; a study found that students lost around 33% of their school year because of the pandemic’s educational barriers and are struggling to regain that lost time.

The Biden administration has said it would give 60 days notice before ending the public health emergency, which was set to end April 11, and the national emergency was set to end March 1.

Adults with diabetes who were forced to switch from an employer-sponsored health plan to a high-deductible health plan (HDHP) were 25% more likely to require an emergency department (ED) or hospital visit for hyperglycemia, but not for hypoglycemia, than those who did not switch plans.

Jodi Fenner, senior director at Elevance Health, speaks on the key themes she presented during her session at the 2023 Health Equity Summit in San Diego, California, titled, "Promoting Health Equity through Primary Care."

Coverage of our peer-reviewed research and news reporting in the health care and mainstream press.

A session at the 2022 American Society of Health-System Pharmacists Midyear Clinical Meeting & Exhibition reviewed some trends in the 340B drug pricing programs and Medicaid.

In a recent study, it was found that individuals with public health insurance had worse health competence beliefs, reducing transition goals, expectations, and beliefs.

The groups who told researchers they would be more likely to skip additional testing had lower levels of income or education and were more likely to be on Medicaid or be uninsured, among other factors.

A survey conducted by the Health Care Payment Learning and Action Network found that “more plans are using incentives in value-based care arrangements to improve health equity.”

While those with Medicaid insurance were more likely to have an insurance transition before or after giving birth, those with private insurance were also found to have insurance changes.

Joseph Alvarnas, MD, vice president of government affairs at City of Hope and chief clinical adviser of AccessHope in Duarte, California, spoke on how the California Cancer Care Equity Act will allow oncologists to escalate the care of patients with advanced cancers toward established centers that can better meet their needs, as well as implications from the decision to exclude genomic testing coverage in the bill.

An analysis of Medicaid coverage found that Mississippi was the only state not to provide coverage for human papillomavirus (HPV) vaccination in adults aged 27 to 45 years.

The Department of Veterans Affairs (VA) will give cancer claims priority when a new law takes effect in January 2023; Pfizer is looking to use its COVID-19 profits to grow other blockbusters; the probable loss of Medicaid coverage for millions next year is setting off debate.

Daniel E. Weiner, MD, MS, board certified nephrologist and lead navigator at Tufts Clinical and Translational Science Institute, spoke on the limitations and future potential of value-based payment systems for chronic kidney disease (CKD), including the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model and the Kidney Care Choices (KCC) Models.

A poster presented at the Academy of Managed Care Pharmacy Nexus 2022 showed that patients with recurrent Clostridioides difficile infection (rCDI), who had Medicare Advantage Part D coverage or were enrolled in a commercial health plan were associated with significantly greater health care resource utilization, including emergency department and inpatient visits, compared with those without rCDI.

Jim H. Rhodes, deputy county administrator, Camden County, New Jersey, spoke on how his organization’s membership with the Greater Philadelphia Business Coalition on Health (GPBCH) has aided their value-based initiatives in improving health equity in the region.

Emergency department (ED) readmission was more common than dermatology follow-up among patients with hidradenitis suppurativa (HS) within 30 and 180 days of initially presenting to the ED, with patients with Medicaid coverage and those who had an opioid prescribed were more likely to return.

Female physicians identified cost and access barriers to fertility care, which are especially relevant as more US women are choosing to delay childrearing.

Joseph Alvarnas, MD, vice president of government affairs at City of Hope and chief clinical adviser of AccessHope in Duarte, California, discusses the recently passed Cancer Care Equity Act in California that provides access to clinical trials and advanced care for Medi-Cal beneficiaries.

In an interview, the section chief of hepatology at Rush University Medical Center discussed why the addition of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code K76.82 is necessary.

Black and Latino Americans saw surges in health care insurance enrollment through the Affordable Care Act (ACA) between 2020 and 2022; Medicaid enrollment and spending is expected to slow in 2023; the Biden administration is preparing a national hepatitis C treatment plan.

While a majority of national lives are covered by vertically integrated insurers, the proportion varies widely at the state level from as low as 6% to as high as 97% of covered lives, according to a new American Medical Association (AMA) report about competition in the pharmacy benefit manager (PBM) sector and insurance.

This study evaluates impact of a real-time benefit tool on medication access and physician and pharmacy workflows at a large academic medical center.

Offering a high-deductible health plan (HDHP) led to a 6.6% reduction in the probability of using substance use disorder services and a shift in spending from the plan to the enrollee.

Enrollees who join Medicare Advantage undergo significant turnover in the years following enrollment.

Hospital price transparency data suggest that health insurance exchange (HIX) plans get lower negotiated rates than commercial group plans and higher negotiated rates than Medicare Advantage plans.

Only low-income male Medicare beneficiaries had worse patient experience than their female counterparts. The authors discuss opportunities to improve experiences for all patients.

The authors describe a pay-for-performance initiative targeting behavioral health providers, which was introduced by a large Medicaid managed care organization across multiple states.