Insurance

What we're reading, April 1, 2016: Federal Trade Commission files lawsuit to stop pay-to-delay deals; CMS' bundled payment initiative for joint replacement takes effect; and scientists confirm link between Zika virus and microcephaly.

The Society for Research on Nicotine and Tobacco and the Association for the Treatment of Tobacco Use and Dependence have developed a position statement recommending access to smoking cessation interventions for smokers in the high-risk group who undergo a lung cancer screen.

This week's top managed care stories include a lawsuit between Anthem and Express Scripts, trouble with Medicare's bidding program for diabetes test strips, and the cost of reporting quality measurements.

Individuals with Medicare Advantage plans have lower hospitalization rates than those with traditional fee-for-service Medicare plans.

There is a need for a new stop loss formula that ensures a level playing field and motivates accountable care organizations.

The move means the nation's largest payer will invest in diabetes prevention, which has been a focus of CDC, the American Medical Association, and the American Diabetes Association.

"Our analysis suggests that annual screens may not be warranted for patients who have had an initial negative scan, and future risk prediction and cost-effectiveness models could incorporate these data to improve screening guidelines," said the study's lead author.

A new study in JAMA Internal medicine has found that the concurrent use of interacting medications has increased since 2005 and that 15% of older adults are potentially at risk for a major drug-drug interaction.

What we're reading, March 22, 2016: the reduction of the uninsured rate was driven mostly by the Affordable Care Act, not economic recovery; heart disease rates dropped; and participation in meaningful use program declines.

Each year physician practices in 4 common specialties spend 785 hours per physician and more than $15.4 billion to report quality measures.

What we're reading, March 21, 2016: government action to lower drug prices unlikely; women live longer than men but face more years of disability; and the movement to give nurses more autonomy.

This case study from the National Community Oncology Dispensing Association (NCODA) focuses on a new dispensary in a moderately sized oncology community practice that prescribes to NCODA’s Quality Standards and outlines the processes developed to assist Medicare patients in accessing their oral cancer medications.

A Medicare claims analysis of patients newly diagnosed with chronic myeloid leukemia revealed that high cost sharing was associated with reduced and/or delayed tyrosine kinase inhibitor initiation under Part D.

The 42nd annual meeting of the Association of Community Cancer Centers ensured that none of the oncology care providers in the audience left without realizing that healthcare has slowly been migrating to include value in care delivery and reimbursement decisions.

The research puts data behind long-simmering complaints from patients and clinicians about availability of diabetes test strips.

A new report published by the American Society of Clinical Oncology has drawn a mixed picture of oncology care in the United States-reduced mortality, increased survivors, and progress in treatment coupled with unsustainable costs and an unstable clinical setting.

The top stories in managed care this week included a proposed new payment model for Medicare Part B and the swift criticism that followed the announcement, findings on variation in cost based on site of care, and cardiovascular results for Victoza.

The newly proposed Medicare Part B payment demonstration met immediate criticism from some in the healthcare industry. Chip Kahn, president and CEO of the Federation of American Hospitals, is also very hesitant about the demonstration and worries that it might be premature.

The United States loses approximately $100 billion to healthcare fraud annually. Up to $20 billion dollars are due to fraudulent practices in the mental health sector. One of the largest healthcare fraud cases in US history occurred in behavioral health -- one of healthcare’s smallest sectors.

What we're reading: California's assisted suicide law will take effect June 9; a majority of drugs in Medicare Part D require coinsurance; and Senate passes opioid abuse bill 94-1.

Patterns of meeting the minimum number of minutes to qualify for higher reimbursement rates were seen in 4 states: Texas, Mississippi, Arkansas, and Indiana. CMS said it will refer this matter to auditors for review.

Several healthcare organizations have sent a letter to HHS urging withdrawal of this reimbursement model.

CMS has announced its plans to evaluate a new value-based payment model for prescription drugs covered under the Part B program. This is yet another move by the federal body to ensure quality care for Medicare enrollees.

The idea to let Medicare negotiate drug prices has been kicked around for years, but a number of forces have prevented any legislation from being passed, explained Tricia Neuman, ScD, director of the Kaiser Family Foundation's Program on Medicare Policy and the Project on Medicare's Future.

Results of the study in JAMA underscore the importance of advance care planning.

Senators Amy Klobuchar (D-MN) and Jeanne Shaheen (D-NH) have sent a letter to the FDA urging the regulatory body to find efficient ways to distribute expensive cancer drugs.

Despite various attempts to increase the vaccination rate among adults, Medicare beneficiaries are still susceptible to extensive cost-sharing for recommended vaccines, according to a study by Avalere.

The health insurance marketplace’s application/verification process is vulnerable to fraud, found a report from the US Government Accountability Office.

The average cost per episode dropped $6708 from the first year of the pilot to the third year.