Insurance

This week in managed care, documents show Horizon Blue Cross Blue Shield of NJ rolled out OMNIA prior to receiving regulatory approval, 2 Harvard professors argue the merit of the annual physical, and experts weigh in on the successes and flaws of Medicare Part D.

Published in JAMA Oncology, the study found a significant difference in quality and access to care for black patients diagnosed with localized prostate cancer.

Wound care specialists, who treat burn victims and diabetics with foot ulcers, say the move to end coverage if a dressing is made of more than 50% honey by weight is arbitrary and makes no sense from a medical standpoint. A final LCD is pending.

A decade after the introduction of the Medicare Part D program and the program has seen great success-but that may be coming to an end. Panelists debated just that and discussed rising drug costs during a session at America's Health Insurance Plans' National Conference on Medicare.

While there are reports of high patient satisfaction and well-managed costs in the Medicare program, the next 50 years will be full of new challenges, said Andrew Slavitt, acting CMS administrator, during the opening session at America's Health Insurance Plans' National Conference on Medicare.

An update on recent progress in oncology managed care.

Even though the US spent far more on healthcare in 2013 than other comparable high-income countries, it has the lowest life expectancy and some of the worst health outcomes, according to a study by The Commonwealth Fund.

A new report found that while geographic gaps narrowed, they will likely persist because state policies to not expand Medicaid will mean the poor will continue to turn 65 with health issues having gone unaddressed.

Changes in the healthcare marketplace are steadily pushing changes for physicians and specialty practices of all kinds. Blaming the 340B drug discount program is both misleading and unproductive.

What we're reading on October 12, 2015: health insurance marketplaces may have challenges keeping customers they already have, but in California, consumers leaving the state insurance exchange are gaining coverage elsewhere, and the government is increasingly pursuing cases of potentially unnecessary procedures.

Integrated Medicare and Medicaid managed care may not sufficiently address the problems of inefficiency and fragmentation in care for hospitalized dual eligible enrollees.

A new study published in JAMA Oncology has identified disparate survival outcomes across sites of care.

Taking aim at payment models for patients on dialysis is the latest attempt to target high-cost areas of Medicare spending.

The announcement covered a final rule on interoperability for creators of Health IT, and a proposal to simplify current rules for providers. Both look ahead to implementation of the new Medicare and CHIP reimbursement models.

The PBM declined to list what discounts it had negotiated, but said it expected to spend $750 million on this cholesterol-lowering class in 2016.

The research raises questions whether Medicare Advantage plans are the solution to controlling spending on the patients who account for most healthcare costs.

One of the great aspects of the Medicare Shared Savings Program is that it provides an important opportunity directly to physicians, said Louis Morgenier, chief executive officer of Physicians ACO, LLC.

A new medication therapy management model being rolled out by CMS will test strategies to improve medication use among Medicare beneficiaries enrolled in the Part D drug program.

Most telling were the interviews with hospital leaders, who said the bonus payments did more to reinforce existing trends in quality care than alter them.