Insurance

CMS will test whether providing Medicare Advantage plans with the ability to integrate value-based insurance design increases enrollee satisfaction, improves enrollee clinical outcomes, reduces overall plan expenditures, and results in lower plan bids, thus saving money for Medicare and beneficiaries.

HHS is seeking new protections for vulnerable populations to protect them from discrimination and ensure they have equal access to healthcare and health coverage.

Men are opting for preventive breast surgery when diagnosed with unilateral invasive disease, a study published in JAMA Surgery has found.

CMS is making available grant funding for 100 organizations to provide enrollment assistance during the third open enrollment period under the Affordable Care Act.

In the second quarter of 2015 the healthcare spending growth rate was 5.9%, a decline from 6.6% in the first quarter of the year, but the health spending growth rate is still 2 percentage points higher than rates experienced between 2009 and 2013.

The use of hospital observation instead of hospital admission is becoming increasingly common for Medicare beneficiaries; however, it may mean unexpectedly higher out-of-pocket costs.

The Biosimilars Council wants CMS to hold back on Medicare Part B reimbursement for biosimilars.

The deadly nature of colorectal cancer merited attention in the Affordable Care Act, which called for eliminating cost-sharing for screening to prevent deaths. The future of colorectal screening, its cost-effectiveness, and a possible way to limit unneeded tests are the topic of a recent series of papers in The American Journal of Managed Care.

Patients with type 1 diabetes mellitus have been advocating for Medicare to cover CGM technology, which they say is more important as patients age and symptoms of dropping blood sugar become less noticeable.

As California reduced the number of adults ages 19 to 64 years without health insurance by 15.5% from 2013 to 2014, Medi-Cal enrollment among the same age group rose from 12.9% to 19.2% during the same time period, according to new data from the UCLA Center for Health Policy Research.

Analysis of publicly reported organizational characteristics, shared savings distribution plans, and early financial success of accountable care organizations in the Medicare Shared Savings Program.

Research conducted at the University of Texas has identified an important role of psychological disorders in the early readmission of patients with chronic obstructive pulmonary disease.

A report from the Government Accountability Office has found that a program for hospitals serving poor and uninsured patients has created perverse incentives to prescribe more drugs and more expensive drugs, particularly in the area of cancer care.

The recent mergers between healthcare payers continue the trend of consolidation that has swept the healthcare industry since passage of the ACA.

A study published in the Journal of the American Geriatrics Society found that older women with breast cancer have a poor response to chemotherapy, while older patients with advanced colon cancer (both men and women) did well.

After months of waiting, reimbursement for the Prolaris test will begin effective October 15, 2015.

Aledade, launched by former national coordinator for health information technology Farzard Mostashari, MD, is looking to expand its footprint throughout the United States to another 7 states in 2016.

Precision medicine will perhaps establish some of the most important biomedical innovations of our generation. However, for that future to become a reality, we have to create an access and reimbursement environment that is conducive to precision care.

Research published in the Journal of Oncology Practice found that factors unrelated to the individual patient accounted for the majority of variation in the cost of radiation therapy for breast, prostate, and lung cancer patients.

Medicare and Medicaid billing fraud scams-upcoding and unbundling schemes, double and triple billing, phantom billing and illegal kickback schemes -cost the United States an estimated $100 billion annually, inflating the size of government, escalating healthcare costs and burdening taxpayers.

An immunotherapy developed by Amgen and approved by the FDA for the treatment of acute lymhoblastic leukemia in December 2014 has now received coverage assurance from Medicare, following an initial rejection.

A recent Kaiser Family Foundation survey found 70% of Americans prefer that Medicare's benefit structure remain intact.

For many US community cancer centers, keeping the doors open has often meant making the difficult decision to consolidate with hospitals and large hospital systems. Site neutrality is a critical step in the journey toward better healthcare for all Americans and a healthy future for Medicare.

The approach for assessing hospital penalties under the Hospital-Acquired Condition Reduction Program might need to be reconsidered in order to achieve the intended goal of the program.

The top stories in managed care, including what providers really think about the use of quality metrics, readmission rates for Medicare patients, and preventing drug-resistant infections.

The study presented at the ADA Scientific Sessions found that raising out-of-pocket costs for diabetics with Medicare could reduce adherence and ultimately raise healthcare spending.

Defining what is "medically necessary" is a judgment call, and patients may lack access to the criteria insurers use to make coverage decisions.

In the fourth year of the Hospital Readmissions Reduction Program, which makes hospitals pay closer attention to their patients after discharge, half of the nation's hospitals will be penalized by Medicare because of their readmissions.

The diagnosis and management of patients with dementing illnesses can be challenging, but the cost of misdiagnosing dementia as Alzheimer's disease can be as high as $14,000 a year, according to a study published in Alzheimer's & Dementia.

The announced price for alirocumab, the first PCSK9 inhibitor approved for use in the US, was the top story in managed care this week. Also, HHS announced $100 million available to combat substance abuse, and Medicare and Medicaid turn 50 years old.