Insurance

During the CMS Health Equity Conference, health care leaders shared groundbreaking strategies to integrate health equity into value-based care models, aiming to enhance patient outcomes and reduce costs.

Jeff Levin-Scherz, MD, MBA, population health leader at WTW, explains that obesity care in the US is inconsistent and costly, with significant gaps across Medicare, Medicaid, and employer-based insurance.

This cross-sectional analysis of commercially insured delivering mothers suggests that greater out-of-pocket spending is incurred when pregnancy spans 2 years, causing them to face out-of-pocket limits twice.

Uninsured rates among minority groups plummeted between 2010 and 2022; Democrat lawmakers are challenging drug patents that they believe are deliberate attempts to eliminate low-cost, generic competitors; the National Institutes of Health (NIH) is piloting a nationwide network for primary care research.

During the CMS Health Equity conference, the “Implementing Health Equity Through Value-Based Care for People in Medicare” session featured a series of expert speakers who shared insights on pioneering strategies designed to advance health equity.

The Bundled Payments for Care Improvement program was associated with improved quality of skilled nursing facilities in hospital referral networks for patients undergoing surgery for joint replacement.

FDA advisers have voted against the use of MDMA as a post-traumatic stress disorder (PTSD) treatment; House members have expressed support for the 340B drug discount program but disagreed on whether it needs tighter regulation; a federal judge sided with SCAN Health Plan over CMS about incorrect 2024 Star Rating calculations.

Expansion of Medicaid coverage will now include all-in-one mental health and substance use clinics; 61% of adults are estimated to have cardiovascular disease (CVD) by 2050; the FDA has taken a historic step in potential psychedelic drug approval.

Fauci’s first testimony since leaving government service set to address alleged misconduct and pandemic management; vaccine makers advised to focus on JN.1 and derived subvariants; AstraZeneca and Boehringer Ingelheim introduce $35 monthly cap on inhalers.

This week, the Center on Health Equity and Access covers news related to AI integration, disparities in pediatric hospitalizations, new advancements presented at the 2024 CMS Health Equity Conference, and an expert discussion on the cardiovascular field.

Presenters from CMS and the CDC explored the importance of standardizing health equity data collection at the 2024 CMS Health Equity Conference.

There has been a lack of visible progress from RECOVER, the $1.6 billion initiative launched by the National Institutes of Health to research long COVID; the CDC has detected a third human case of bird flu linked to sick dairy cows; small businesses and their workers are struggling to receive weight-loss drug insurance coverage.

According to data from HHS' Office of Minority Health, Asian Americans are 60% less likely to utilize mental health services, even though 16.8% of those in the community experience mental illness.

A new program from Optum Rx would offer greater predictability by using a guarantee-based pricing model.

Patients struggle to afford glucagon-like peptide-1 (GLP-1) medications for diabetes; doctors see potential and pitfalls in new ChatGPT model’s humanlike conversations; Medicare payment reform efforts focus on inflation adjustments and payment model overhauls.

The results of T1International’s 2022 Out-of-Pocket Expenses survey highlight many huge inequities in the US and around the world relating to insulin and diabetes care supplies.

The US Senate hosted a panel addressing physician and health care shortages and efforts to increase minority representation in the medical field. An expert discussed initiatives to prevent senior homelessness. Advocates called for the repeal of the Comstock Act. Regulatory reforms are called for to improve rural cancer patients' access to pharmacies. Research reveals the impact of denials on patient access to immunology treatments.

Concerns arise over primary care shortages; women struggle with coverage for effective nonhormonal treatments; FLiRT variants drive concerns amidst waning surveillance and immunity

Other findings from the latest Kaiser Family Foundation Health Tracking Poll shed light on public awareness, use, and opinions on Medicare coverage of glucagon-like peptide-1 (GLP-1) drugs.

Covering antiobesity medications like semaglutide could save Medicare around $500 million annually; preliminary CDC data showed a 3% decline in the number of US overdose deaths last year; the Biden administration recently announced the first national maternal mental health strategy.

At the spring conference of the New Jersey Health Care Quality Institute, speakers discussed how health policy, affordability, and transparency may play a role in voters’ decisions.

The senate hearing held by the US Senate Committee on Health, Education, Labor, and Pensions, led by Sen. Bernie Sanders (I, Vermont), chairman of the committee, and ranking member Sen. Bill Cassidy, MD, (R, Louisiana), addressed the critical issue of physician and health care worker shortages, as well as the maternal health crisis, in the US.

On this episode of Managed Care Cast, experts from Illinois CancerCare discuss CMS regulations limiting the access of rural patients with cancer to medically integrated pharmacies.

A new study highlights significant disparity in reimbursement rates across states between hospitals and Medicare; the first patient to receive a genetically modified pig kidney has died; research examines outcomes of over 500 patients receiving medication abortion pills by mail.

The CEO of SCAN Health Plan discusses its first-ever Environmental, Social, and Governance Report.

This week's topics include frameworks for improving health equity nationwide, addressing social determinants of health, discussing CMS's Medicare rules, investigating breast cancer treatment refusal, and exploring HIV and major depressive disorder in underrepresented groups.

Results featured at the Academy of Managed Care Pharmacy 2024 annual meeting revealed a pattern of prior authorization rejections that could delay necessary therapeutic treatments for various patient groups.

Gaps in the delivery and coverage of behavioral health care can be addressed through continued advocacy for better policies and financial incentives surrounding treatment.

Ascension Health was hit with a cyberattack; a new federal policy is aimed at integrating Medicare and Medicaid coverage; the CDC is planning to post data on influenza A found in wastewater in a public dashboard.

On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.