Insurance

What we're reading, November 20, 2015: CMS wants to penalize doctors for ordering routine prostate-cancer screening tests; lawmakers, patients, and advocates call for head of Drug Enforcement Agency to be fired; and specialty drug costs exceed household incomes.

The American Society of Clinical Oncology has made public its detailed guidance to CMS, supporting implementation of physician-focused and other alternative payment models under MACRA.

What we're reading, November 17, 2015: misunderstanding of antibiotics has fueled the rise of drug-resistant superbugs; healthcare leaders overwhelmingly support government intervention to curb rising cost of drugs; and the FDA wants more regulation on laboratory-developed tests.

CMS has finalized a rule for a bundled payment test for hip and knee replacements that will be mandatory for nearly all hospitals in 67 geographical areas across the country.

What we're reading, November 16, 2015: consumers face sticker shock on Affordable Care Act plans when they get sick and face high deductibles; Medicare spending on hepatitis C drugs nearly doubled in 2015; and US maternal mortality has worsened since 1990.

The Medicare Shared Savings Program is the perfect way for primary care physicians to get involved with alternative payments as Medicare moves to replace fee-for-service, explained Hymin Zucker, MD, chief medical officer of the Triple Aim Development Group.

This week in managed care the top stories include pivotal results from the SPRINT study on blood pressure, an analysis on how states successfully enrolled consumers in the insurance marketplace, and experts discuss value-based care.

Expanding and more representative participation in Medicare's Bundled Payments for Care Improvement initiative suggests potential for large impact, pending the results of risk-bearing participants.

Payment policy, health plan characteristics, and Medicare beneficiary characteristics come together to foster continued growth in the Medicare Advantage program.

As the healthcare industry positions itself for the change to value-based care, there needs to be a widespread change in terms of collaboration between physicians, hospitals, and payers.

According to the CDC, while smoking rates are seeing a steady decline, rates for uninsured and adults on Medicaid are more than twice those for adults with private health insurance.

What we're reading, November 12, 2015: nationwide ban on smoking in public houses could have a huge economic impact; CMS barrier to sharing patient records on drug and alcohol abuse; an urgent care—ED hybrid model could save unnecessary costs.

Enrollment in Medigap plans has continued to increase among senior citizens for the fifth year in a row, according to a new report from America's Health Insurance Plans.

Heterogeneity in quality of care and cancer patient survival based on insurance coverage are the highlight of a report by researchers at the Institute for Population Health Improvement at the University of California Davis.

The Better Medicare Alliance works to articulate the value of Medicare Advantage and the way it has improved access to care and the right kind of care for millions of beneficiaries, said Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance.

Findings being presented in San Francisco show which patients may be able to stop anti-TNF therapy, and which ones will do well with conventional drugs as second-line treatment.

Our homes should be sanctuaries-places of refuge and safety-but sadly, fraud is alive and thriving in home healthcare, endangering one of our most fragile and vulnerable patient populations: the homebound and often bed-bound. Defenseless people who may be totally alone, without family or friends.

An obscure notice on CMS' website outlines a proposed revised formula that would take effect in 2017.

What we're reading, November 3, 2015: off-label drug use is associated with a higher risk of adverse drug events; CMS finalizes its rule for advanced care planning for end-of-life care; and Californians send measure to cut drug prices to the vote.

As has been the case in other states, Virginia seeks a solution to rising costs for medically fragile patients. Lawmakers have been unwilling to expand Medicaid and likely will not until a cost-containment plan is found.

Advocacy groups say it's long past time for Medicare to cover continuous glucose monitoring, which is standard of care and funded by most commercial payers.

What we're reading, October 29, 2015: Pfizer and Allergan in talks to merge; the House passes a budget deal with implications for Medicare beneficiaries; and autism in children is being overdiagnosed.

What we're reading, October 28, 2015: Ben Carson plans to replace the Affordable Care Act, Medicaid, and Medicare; a homeless shelter utilizes telemedicine to alleviate emergency department visits; and researchers uncover gender gap in post-heart attack treatment.

Payer—provider teams presented updates on their cost-saving pilot projects and looked to the future of these models in oncology care.

Twenty-four states have received grants to improve the behavioral health of their citizens by providing community-based mental and substance use disorder treatment.

This study evaluates different strategies to identify high fall risk among community-dwelling elders using a combination of easily obtainable administrative data and patient screening questions.