Insurance

An e-mail, from Mark Merritt, president and CEO of the trade group Pharmaceutical Care Management Association, to the organization’s board, lays out a plan to develop an aggressive campaign to convince the new administration that the fault rests with pharmaceutical manufacturers.

Lawmakers from both parties have expressed their dislike for an entity that could take away their spending authority. But a leading Democrat also raised the fact that the new HHS Secretary, Tom Price, MD, would be harsh on the most vulnerable.

A program linking elderly cancer patients to lay navigators was shown to substantially reduce costs and decrease hospitalizations, making it an appealing tool for providing value-based oncology care.

Early in the morning on Friday, the Senate voted along party lines (52-47) to confirm US Rep. Tom Price, R-Georgia, as secretary of HHS. President Donald Trump nominated Price with the expectation that he will lead the charge to repeal and replace the Affordable Care Act.

Michael Abrams, managing partner for Numerof and Associates, said regions where states have taken a lead in promoting value-based care are further ahead in moving away from fee-for-service.

A long-term health study has found that seniors with a higher body mass index were less likely to make use of hospice care. Additionally, obese seniors spent significantly fewer days in hospice care than their nonobese counterparts.

Research into the financial performance of Medicare accountable care organizations (ACOs) has found that organizations benefit from having prior experience with risk-bearing contracts, but that organizations that had reduced growth in healthcare spending before joining an ACO would find it difficult to improve further and share in savings, according to Marietou Ouayogode, PhD.

Lung cancer screening rates in the United States remained low and unchanged in 2015 despite recommendations that high-risk current and former smokers be screened.

Buy in from physicians and lack of enthusiasm from payers are seen as barriers to moving quickly into value-based models.

Early discharge from the emergency department resulted in more than 10,000 Medicare patients dying, annually. Researchers determined that low-volume hospitals actually had higher rates of early death.

The University of Michigan Center for Value-Based Insurance Design (V-BID) celebrated significant initiative milestones in 2016.

A white paper commissioned by the Community Oncology Alliance (COA) delved into the practice of “direct and indirect remuneration” fees administered by pharmacy benefit managers and how they could drive up drug prices for Medicare Part D beneficiaries and taxpayers.

A study last year found that more than half of all California adults have diabetes or prediabetes.

CMS has tried to improve patient experience by tying payments to performance as part of the Value-Based Purchasing (VBP) program; however, a paper published in Health Affairs found no evidence that the program has had a beneficial effect.

While the Congressional Research Service calls for delaying new bundled payment rules, a webinar to explain them is still on CMS' website.

The Obama administration set in motion a process that called for Medicare to pay for the Diabetes Prevention Program starting January 1, 2018.

Disease status, MUD/MRD donor, myeloablative conditioning regimen, GVHD prophylaxis other than tacrolimus/sirolimus, and Medicare and/or Medicaid as payer are significant predictors for cost of care in patient with acute leukemia who undergo allogenic hematopoietic cell transplant (AHCT).

Shantanu Agrawal, MD, MPhil, pursued the use of analytics to prevent and identify fraud in public healthcare programs. He takes the helm of a 16-year-old group that has worked to bring consensus among stakeholders on what in healthcare should be measured.

Research published in the Journal of Oncology Practice has identified high treatment burden among Medicare patients with early-stage non—small cell lung cancer (NSCLC).

If the Affordable Care Act is repealed, providers of the Diabetes Prevention Program will need to replace the path to Medicare reimbursement that were covered in the law.

Described as a public—private partnership between the National Cancer Institute (NCI) and pharmaceutical and biotechnology companies, the NCI Formulary is expected to provide researchers rapid access to anticancer drugs for use in clinical trials.

Researchers have found that accountable care organizations with a higher proportion of minority patients tend to score worse on Medicare’s quality performance measures.

The study observed significant shifts in the treatment of advanced-stage non-small cell lung cancer (NSCLC), accompanied by only modest gains in survival and total Medicare spending.

The addition of new a chief medical officer and a new chief commercial officer comes as the digital health provider is poised to scale up delivery of the National Diabetes Prevention Program in Medicare.

Payments for catastrophic coverage under Medicare Part D have more than tripled since 2010, rising past $33 billion in 2015, according to a new report from the Office of Inspector General (OIG). The report identified high-priced specialty drugs as a major driver of the increase in spending.