Insurance

Patients with cancer, many who are older and on Medicare, are finding their medications are becoming unaffordable, Michele McCourt, senior director of the CancerCare Co-Payment Assistance Foundation, explained at the Cost-Sharing Roundtable, co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care®.

Coverage from the National Community Oncology Dispensing Association Spring Forum 2018.

Since 2000, the number of patients undergoing gender-affirming surgery who identified as self-payers decreased. From 2012-2013 to 2014, coverage by Medicare and Medicaid of gender-affirming surgeries increased 3-fold.

In a joint letter, several organizations urged CMS Administrator Seema Verma to allow certain accountable care organizations to continue in the Medicare Shared Savings Program (MSSP) Track 1 for a third agreement period, warning that these ACOs are not ready to take on a 2-sided risk.

State variations in chronic obstructive pulmonary disease (COPD) outcomes suggest that the condition is more common in large rural areas compared with metropolitan areas, according to the Morbidity and Mortality Weekly Report from CDC.

New research has found that allogeneic hematopoietic stem cell transplantation is just as effective in patients with non-Hodgkin lymphoma who are age 65 and older as it is in patients between the ages of 55 and 64.

Coverage of value updates from Patient-Centered Oncology Care, November 16-17, 2018.

A symposium at Seton Hall Law School examined the role of care coordination and transitions in helping those with substance use disorder find success in treatment. Some experts say that managed care has not supported care coodination despite evidence that it works and ultimately saves money for health systems.

With formal integration initiatives, such as accountable care organizations, having modest effects, researchers analyzed the impact of informal clinical integration on cardiac surgery payments and found that patients who were treated in health systems with higher informal integration had greater savings.

A liberal think tank released a universal healthcare plan modeled on Medicare that would also preserve employer-based insurance coverage as an option for those who are satisfied with their current plans. The Center for American Progress (CAP) is calling its program “Medicare Extra for All” and said it would be available to everyone regardless of income, health status, age, or insurance status.

CAR T- cell therapies are among the most expensive ever invented. For now, there’s a lot of uncertainty, as both government and commercial insurers, and a handful of the nation’s leading cancer centers, navigate a reimbursement structure that truly has no precedent.

Driven by an aging US population and other economic and demographic factors, national health spending is projected to climb to 19.7% of the economy over the next 8 years, up from 17.9% in 2016, according to new estimates released Wednesday from CMS and published online in Health Affairs.

The Department of Justice is moving forward with a $1 billion lawsuit against UnitedHealth Group over Medicare claims; Oregon's legislature is considering adding healthcare as a right to the state's constitution; another trial for an Alzheimer disease drug is stopped.

From 2013 to 2016, Medicare Shared Savings Program accountable care organizations (ACOs) improved quality. Continued infrastructure development funding, better relationships with postacute care facilities, and shared learnings among diverse ACOs would maximize quality improvement.

The proposed budget released Monday would have winners and losers in Medicare; President Donald Trump's budget, a messaging statement, contains healthcare cuts; veterans in California risk eviction from veterans homes if they intend to use an aid-in-dying law.

Born as part of the Affordable Care Act (ACA) in 2010, the controversial Independent Payment Advisory Board (IPAB) was eliminated last week as part of the Bipartisan Budget Act of 2018 without ever having been implemented. The IPAB sought to reign in Medicare spending if targets went over certain levels, but it had almost universal opposition from the healthcare and medical communities.

From 2013 to 2016, successful Medicare Shared Savings Program accountable care organizations reduced spending by shifting expenditures from the inpatient and postacute care setting to the physician office setting.

According to the Medicare Payment Advisory Commission (MedPAC), hospital readmission rates have fallen following implementation of the Hospital Readmissions Reduction Program (HRRP), and HRRP did not have a negative impact on mortality rates.

After a brief shutdown in the dead of night, the Senate passed a spending bill, which was the result of a deal reached by Republicans and Democrats to fund military and domestic programs for 2 years. The House passed the bill shortly after.

The House's stopgap spending bill includes Medicare extenders; 40 patient advocacy groups oppose the right-to-try legislation that President Donald Trump is supporting; new research finds fetal alcohol syndrome and alcohol-related disorders may be more common than previously thought.

Despite an official policy since early 2017 that calls for Medicare to cover CGM for certain beneficiaries with diabetes, an attorney who won a landmark case prior to the policy change reports that beneficiaries are still being denied coverage.

Replacing the Merit-based Incentive Payment System (MIPS) with a voluntary program should encourage providers to move quicker into more risk-based payment models, according to Travis Broome, vice president for policy at Aledade.

Four telehealth bills could be signed into law over the next year by Congress; President Donald Trump mentioned "right-to-try" legislation in a favorable light in his State of the Union speech; the House Energy and Commerce Committee will hold legislation hearings on the opioid crisis February 26.

As a result of the Medicare Outpatient Prospective Payment System rule that took effect on January 1, 85% of 340B hospitals will see net payment increases in 2018. Rural hospitals will reap the largest benefits, according to an analysis conducted by Avalere and commissioned by Community Oncology Alliance.

Although it’s difficult to generalize the impact of social determinants of health, addressing them is fundamental to improving overall healthcare quality for member populations.

Officials at Omada Health said the PREDICTS trial was planned long before CMS decided not to include virtual providers in this spring's launch of the Medicare Diabetes Prevention Program. But a spokesperson said the company hopes the growing body of evidence in support of virtual programs will "assuage any concerns."

For many people on traditional Medicare plans, healthcare costs are a rising burden and are expected to consume a larger share of total income by 2030, according to an analysis from the Kaiser Family Foundation.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Medicare's refusal to expand physician education funding will exacerbate the staffing shortage that is growing as baby boomers retire.