Insurance

Given the constraints prevalent post-COVID-19, Dr Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design, stresses that it is now more important than ever for the health care industry to prioritize payment reform, value-based benefit design, and novel policy initiatives.

Krisda H. Chaiyachati, MD, MPH, MSHP, discusses the study he co-wrote entitled “Economic Outcomes of Insurer-Led Care Management for High-Cost Medicaid Patients.”

The orders President Trump signed Friday include a deadline for the pharmaceutical industry to come up with their own plan by August 24 to lower prices.

The US government partners with biotech giants Pfizer and BioNTech to distribute a coronavirus disease 2019 (COVID-19) vaccine; the COVID-19 death record continues to be broken; could Medicare be in financial trouble?

End-stage renal disease has long been one of the most expensive and debilitating conditions that affects Medicare beneficiaries. Not only does dialysis cost $90,000 a year—those awaiting a kidney transplant automatically qualify for Medicare—but the need to travel to a dialysis center multiple times a week disrupts employment and home life.

Significant populations of seriously ill individuals are insured by all lines of business and have meaningfully different needs and medical histories in California.

Among Medicare enrollees, there was substantial between-practice variation in the use of second-generation diabetes drugs between 2007 and 2015, according to a study published in JAMA Network Open. Data also revealed a concentration of use among a few prescribers and practices, who were responsible for widespread early diffusion.

The objective of this research was to identify strategies that significantly lower unnecessary inpatient utilization among Medicare beneficiaries with chronic disease.

The announcement of a $35 per month out-of-pocket cap for insulin for some individuals with Medicare is a real victory for the American Diabetes Association and for people with diabetes, said Robert Gabbay, MD, PhD, chief medical and scientific officer of the American Diabetes Association.

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

Despite the Medicare Diabetes Prevention Program now being a covered benefit, there is inadequate availability of suppliers to reach Medicare beneficiaries with prediabetes.

A study released Monday used national Medicare data to try and understand disparities between black and white patients in avoidable hospitalizations for ambulatory care–sensitive conditions.

For patients with rheumatoid arthritis (RA), cost can play a role in patient adherence to medication, but the presence of comorbidities does not impact cost of care for patients, according to 2 abstracts presented at the Virtual 2020 International Society for Pharmacoeconomics and Outcomes Research meeting.

This week, the top managed care news included lower insulin costs for seniors in certain plans; discussions on the future of the Biologics Price Competition and Innovation Act; takeaways from Sharecare's Flatten the Curve Survey.

President Trump announced the plan today at the White House, accompanied by insulin manufacturers Eli Lilly, Novo Nordisk, and Sanofi, as well as AHIP and major health plans.

The presentation at Virtual ISPOR 2020 found that 7% of a group of Medicare beneficiaries with type 2 diabetes was experiencing food insecurity, a rate the lead author found "alarming."

Exacerbations of patients with chronic obstructive pulmonary disorder (COPD) can be costly if they are frequent, and early detection programs for COPD may help offset these costs, according to research from 2 studies presented at the 2020 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) virtual conference.

Although pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) is linked to better survival, a large study of fee-for-service (FFS) Medicare patients show it is underused, with less than 2% of those studied taking part in a 3-month program.

The American Journal of Managed Care® spoke with Lindsay Bealor Greenleaf, JD, MBA, Vice President of Policy, ADVI Health, about CMS’ recent enactment of the 2021 Medicare Advantage rate announcement, and the effects of COVID-19 on Medicare Advantage. This transcript has been edited slightly for clarity.

More than half of risk-based accountable care organizations (ACOs) currently enrolled in the Medicare Shared Savings Program said they are likely to drop out due to the fear of paying losses resulting from the coronavirus disease 2019 (COVID-19) pandemic, according to a survey conducted by The National Association of Accountable Care Organizations.

Benefits newly available under Medicare Advantage are not well-known to consumers and uptake has been limited. At the same time, CMS has propsed funding the hospice benefit differently, which would allow MA plans to “carve in” to this benefit, creating additional uncertainty.

Age and severe comorbidities were among the differences found when real-world data on Medicare patients receiving CAR T-cell therapy was compared to clinical trial outcomes, said Karl Kilgore, PhD, senior research analyst at Avalere Health.

The rate increase comes as the agency is easing up on quality reporting requirements to give health sytems breathing room amid the pandemic. Monday’s announcement also clarified some payment changes for end-stage renal disease.

Analysis of spending differences among accountable care organizations (ACOs) may help identify cost savings opportunities. We examined the magnitude and sources of spending variation among ACOs over 4 years.

The changes are aimed at helping hospitals increase their capacities for the sickest patients; expand the pool of local healthcare providers who are available to work; eliminating ordinary paperwork and documentation requirements; expanding Medicare coverage for respiratory-related devices and equipment for any medical reason; and expanding telehealth in Medicare by covering more than 80 additional services.

The Patient-Driven Payment Model addresses perverse incentives in Medicare’s previous payment system for skilled nursing facilities, but it includes new incentives that may be problematic.

The bill includes $100 billion for hospitals; some are concerned that the bill, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, does not go far enough, particularly for Medicaid.

Sharing records and encouraging conversation will promote better collaboration between primary care and cancer care, said Jeffrey Lowenkron, MD, chief medical officer of The Villages Health.

Several challenges arise when using real-world data derived from claims to study the impacts of CAR T-cell therapy on Medicare patients, said Karl Kilgore, PhD, senior research analyst at Avalere Health.

The temporary relaxation and expansion of CMS' telehealth rules, which allows the use of methods like FaceTime and Skype, is aimed at protecting both older patients and their providers from COVID-19, which has led to curfews, shuttered schools, deserted Main Streets, and ravaged financial markets.