Insurance

Healthcare integration was associated with small declines in treatment, but no change in overtreatment of prostate cancer. Integrated care delivery alone may be insufficient to curtail overtreatment.

About 4 million patients need home-based medical care because they are frail, functionally limited, and homebound. New research finds out just how much are the home-based medical care providers geographically concentrated or spread out.

The current issue of Evidence-Based Diabetes Management explores studies and patient access issues surrounding this closely watched inhaled insulin.

An effort by the University of Utah health system created an "opportunity index" to identify areas of cost variability that would show physicians where they could find savings and improve quality.

The Medicare Shared Saving Program benchmark can be improved by following the example of Next Generation accountable care organizations, but with a larger adjustment level.

Patricia Salber, MD, MBA, of The Doctor Weighs In, interviewed James D. Chambers, PhD, to discuss his findings on the impact of formulary drug exclusion policies.

The authors said this is the first study to examine antihypertension nonadherence down to the county level. Recommendations include greater use of combination therapy to reduce pill counts for patients with multiple chronic conditions, and synchronizing pharmacy visits to avoid multiple trips.

Between individuals coming in and out of the market in a given year and those who switch plans, the majority of people in exchanges are enrolled in their plans for one year or less.

This week, the top stories in managed care were poll results that show Hillary Clinton is more trusted than Donald Trump when it comes to healthcare, multiple studies highlighting remaining disparities in healthcare, and results of a digital diabetes self-management program.

The C-suite of the healthcare industry has grown dramatically over the last several years, and has been spurred by legislation that ties reimbursement rates under Medicare and Medicaid to the use of technology in medicine.

The poll, which the Kaiser Family Foundation has done at intervals since the Affordable Care Act passed in 2010, once again found Americans divided on how they felt about the healthcare law.

What we're reading, September 2, 2016: California taxpayers will cover 70% of the state's healthcare costs in 2016; President Barack Obama supports recommendations to reform the Veterans Affairs healthcare system; and California is close to criminalizing undercover stings against Planned Parenthood.

A diverse group of 1242 patients received diabetes self-management education either in-person or online and achieved lowered blood glucose and depression levels, had fewer symptoms of hypoglycemia, and exercised more.

Democratic lawmakers who signed a letter to Mylan this week say that the practice of offering coupons masks the high drug prices that are paid by commercial health plans. The practice is not allowed in Medicare or Medicaid.

A new report by the law firm Frier Levitt, commissioned by the Community Oncology Alliance, has found that restrictive tactics by pharmacy benefit managers, particularly in the specialty pharmacy arena, could restrict patient access to much needed medications.

What we're reading, August 31, 2016: 51% of Americans have a negative view of the pharmaceutical industry; the CDC is running out of funds to fight the Zika virus; and Pennsylvania chooses 3 private companies to manage Medicaid plans.

What we're reading, August 29, 2016: Audit finds Medicare Advantage plans overcharged the government; enrollment on the Affordable Care Act's exchanges less than half of initial prediction; and California bill to protect consumers from surprise medical bills divides physicians.

In this podcast Margaret E. O'Kane discusses how she got into quality measurement, the beginning of the National Committee for Quality Assurance, and the next frontier in quality measurement.

Healthcare as we have known it doesn’t work cooperatively, which is one reason it costs way too much, according to Donald M. Berwick, MD, MPP, president emeritus and senior fellow of the Institute for Healthcare Improvement and co-originator of the term the Triple Aim. Berwick spoke with The American Journal of Managed Care as it publishes reports on Aligning Forces for Quality, funded by the Robert Wood Johnson Foundation.

Margaret E. O'Kane has been making lasting impacts on healthcare quality measurement for years. But when she founded the National Committee for Quality Assurance, the organization was sometimes underestimated and not taken seriously.

Researchers found that changing cooking methods could allow people at risk of developing diabetes to reverse damage done by things like grilling and frying their food.

The study in JAMA represents the largest effort to date to integrate mental health and primary care services across a health system and measure both clinical outcomes and savings.

A majority of hospitals that may be required to participate in the new Medicare cardiac bundled payment models would not experience losses or gains over $500,000 per year, according to a recent analysis by Avalere Health.

Medicare accountable care organizations have either not yet focused on mental illness or have been, for the most part, unsuccessful in early efforts to improve their management of it.

Reducing barriers to hematopoetic stem cell (HPC) transplant is critical to supporting patients with one of the more than 70 blood cancers and other blood disorders (such as leukemia, lymphoma, and myloplastic dysplasia) for which a transplant may be the only therapy remaining with curative intent.

Questions about hospitals or their foundations paying for premiums of sick patients to keep them out of Medicaid are as old as the exchanges themselves.

As the nation's largest pharmacy benefit managers leave more therapies off formularies, some ask: are patients harmed? A new review in The American Journal of Managed Care, covering 26 studies about drug exclusions, found that most policies saved money without fallout for patients-but there were some exceptions.

The authors review empirical evaluations of drug exclusion policies to examine their impact on patients and on healthcare costs.

More than 3500 sites offer diabetes self-management education, and speakers at the annual meeting of the American Association of Diabetes Educators discussed how this system could be engaged to bring the Diabetes Prevention Program to all 50 states.

The transition to a value-based payment system may ultimately reward diabetes educators, but right now these professionals see challenges on the front lines.