Insurance

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.

This week, the top managed care news included insurers staying away from HealthCare.gov, where you live can affect your chance of surviving cancer, and a new deal could help people on Medicare with diabetes.

Digital providers have been seen as crucial to scaling the Diabetes Prevention Program to the 22 million seniors with prediabetes. Medicare spends $1 out of every $3 on diabetes, and disease prevention is essential to lowering overall healthcare spending.

A partnership of federal departments announced a coordinated takedown of hundreds of defendants accused of perpetrating schemes to defraud Medicare and illegally distributing opioids.

The agreement paves the way for those over age 65 to gain access to continuous glucose monitoring, following a historic policy change.

The authors make a case that using messengers to reach vulnerable populations isn't just a good idea. In the age of value-based reimbursement, it's becoming a necessity.

Administration officials say fewer insurers filing an intent to offer coverage for 2018 shows the ACA is failing.

CareMore has launched an integrated delivery model that provides primary care to patients while at the dentist’s office, with the idea of maximizing the value of each encounter with the healthcare system, explained Sachin H. Jain, MD, MBA, president and CEO.

Nina Brown-Ashford, MPH, CHES, deputy group director at the CMS Innovation Center, discusses how Medicare’s Diabetes Prevention Program will help improve population health and contain the high costs of diabetes care.

An understanding of risk-adjusted outcomes for percutaneous coronary interventions for both inpatient and 90-day postdischarge events is necessary for the redesign of care outcomes.

In the June issue of The American Journal of Accountable Care®, authors described how their accountable care organization achieved impressive shared savings.

Compared with lower-cost plans, Medicare Advantage enrollees pay more for their plans the longer they remain enrolled.

The offer of free medications to low-income Medicare beneficiaries with diabetes enrolled in Part D plans has no impact on generic prescribing rates.

In response to trepidation from clinicians, CMS has announced a proposal to alter the rules of the Quality Payment Program established by the Medicare Access and CHIP Reauthorization Act (MACRA). The changes will exempt thousands of physicians from quality reporting requirements and allow small practices to form “virtual groups” with one another.

Cardiovascular outcomes trials and a photography ban that dominated social media were big news at the 77th Scientific Sessions of the American Diabetes Association.

The collaboration between a digital behavioral health provider and an insurer comes as CMS admits challenges setting up the Medicare Diabetes Prevention Program.

A light-hearted format for the discussion at the 77th Scientific Sessions of the American Diabetes Association still brought out the seriousness of the issue: too many with type 2 diabetes have poor glycemic control, and another medication may not be the answer.

The Diabetes Prevention Program (DPP) has demonstrated that it can improve the quality of care for Medicare beneficiaries with diabetes while saving or maintaining costs, explained Nina Brown-Ashford, MPH, CHES, deputy group director at the CMS Innovation Center. Next, CMS will finalize the DPP’s expansion in another round of rulemaking.

No one questions the long-term savings that the Diabetes Prevention Program will bring to Medicare, but getting it off the ground will require several steps that have never been done before, including a new payment model.

Patients with comorbid depression and chronic obstructive pulmonary disease (COPD) have low rates of adherence to their COPD management medications, putting them at increased risk of emergency department visits and hospitalizations.

In testimony before the US House Ways and Means Committee’s Health subcommittee, Mark Fendrick, MD, co-director of the University of Michigan Center for Value-Based Insurance Design, discussed the importance of allowing for flexibility and clinical nuance when it comes to encouraging value in Medicare Advantage plans.

CMS is giving seniors until September 30, 2017, to request a waiver from all or part of the penalties they face for not enrolling on time for Medicare.

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.

This week, the top managed care stories include an announcement that CMS will take Social Security numbers off Medicare cards; a national plan to combat chronic obstructive pulmonary disease was released; and a nutrition advocacy group calls on FDA to stick with the schedule for a new nutrition facts label.