Insurance

The top stories in managed care this week included increased insurer concerns over the sustainability of the Affordable Care Act's insurance exchanges, healthy policy experts convened in DC, and 2 warnings for women to heed regarding pregnancy.

Patrick Conway, MD, MSc, deputy administrator for innovation and quality and chief medical officer at CMS, describes the proposed changes to the Medicare Shared Savings Program and how they will assist accountable care organizations transitioning to tracks with more risks.

What we're reading, February 5, 2016: new legislation could expand the use of telehealth under Medicare; Massachusetts finds its physicians only screen for depression half the time; and Martin Shkreli pleads the Fifth during most of his testimony before Congress.

The latest piece in HHS’ roadmap to move the healthcare industry to value-based payments is the Accountable Health Communities model. Here are 5 things to know about how this model addresses social determinants of health.

One of the primary drivers of healthcare waste is administrative inefficiency. While the industry implements remedies and solutions with electronic prescriptions and electronic claims transfer and processing, the gorilla in the room that no one mentions is CMS.

While the costs of private Medicare Advantage plans are slightly less, on average, than traditional Medicare, broad determinations can be misleading, a new report finds.

Rising drug prices, the effect on the healthcare system, consumer push-back, and possible solutions were debated by the expert panel.

While the pace of payment reform is moving quickly, Patrick Conway, MD, MSc, deputy administrator for innovation and quality and chief medical officer at CMS, said he thinks about how to maintain that pace.

With increasing evidence of comparable efficacy and reduced toxicity of proton beam therapy, payers may have to reevaluate coverage policies.

At the annual meeting of the American Society of Hematology, physicians gathered to discuss the impact of alternate payment models on clinical practice.

CMS has proposed changes to accountable care organizations benchmarks in the Medicare Shared Savings Program, as well as a way to better facilitate the transition to performance-based risk.

Medicare Advantage beneficiaries were 1.06 times more likely to receive mammography compared with fee-for-service (FFS) beneficiaries. FFS providers were less likely to recommend mammograms to racial/ethnic groups.

The 3 prescriptions for reforming the 340B Drug Discount Program proposed by authors in the December issue of Evidence-Based Oncology would limit safety net hospitals' abilities to treat vulnerable patients.

Accountable primary care is essential in lowering healthcare costs as a whole and making it care more accessible to patients. Debbie Zimmerman, MD, chief medical officer of Lumeris, discussed how to improve primary care and get primary care physicians aligned with the delivery of accountable care.

What we're reading, January 27, 2016: Donald Trump joins Hillary Clinton and Bernie Sanders in calling for Medicare being given the ability to negotiate drug prices; $70 million approved for new patient-centered research projects; and the Zika virus likely to spread to the United States.

When patients cannot understand discharge instructions, it's questionable whether it's fair to penalize them when patients return to the hospital.

Personalized medicine has been the mantra in healthcare for quite some time, but finding health plans with blanket coverage policies for diagnostic testing is a struggle.

What we're reading, January 26, 2016: Republicans will use Congressional Budget Office report to justify steep spending cuts; Centene has misplaced 950,000 files of personal health information; and the US is facing a troublesome shortage of geriatricians.

What we're reading, January 25, 2016: Cigna faces sanctions from CMS; a Massachusetts senator blocks the nomination of Robert Califf, MD, for FDA commissioner; and hospitals and health systems are mostly unprepared for precision medicine.

As Americans as asked to pay a greater portion of their healthcare expenditures, new insurance design models are being implemented, such as value-based insurance design, to combat issues like nonadherence.

A look at the latest news in healthcare, including a study that identifies an increased risk of diabetes in cancer survivors, 2 FDA approvals, Senator Bernie Sanders released a plan for universal healthcare coverage in the US, and the economics of aging.

The profile of high-cost patients in a Massachusetts ACO differed greatly, depending on their enrollment in Medicare, Medicaid, or a commercial plan.

What we're reading, January 22, 2016: the average premium under the Affordable Care Act rose to $408 before tax credits; seniors will face higher Medicare Advantage premiums with a merge between Aetna and Humana; and Hawaii could be the first state to offer long-term care benefits.

This study examines the plan characteristics associated with generic risperidone use and spending and adherence outcomes associated with use among Medicare Advantage Part D beneficiaries.

The results of a new JAMA study underscore the importance of advance care planning in improving the quality of care that patients receive at the end of life.

A look at the economic implications of aging and what can be done to address the growing healthcare financial challenges.

A new study analyzes how much the difference in readmission rates between safety net and non-safety net hospitals can be explained by measurable factors, such as patient characteristics.

Radiologists and breast cancer specialists disagree with the US Preventive Services Task Force recommendation of raising the age of screening mammography to 50 years.

All this week, the healthcare industry, especially analysts and investors, focused their attention on presentations by CEOs and CFOs at the 34th annual JP Morgan Healthcare Conference.

A proposal to reduce Medicare Part B payment rates for hospitals participating in the 340B Drug Pricing Program has been approved 14-3 by the Medicare Payment Advisory Commission.