Insurance

The top story was Marilyn Tavenner became the nation's top healthcare lobbyist when she was named the new president and CEO of America's Health Insurance Plans, plus the controversial new guidelines that called for more Americans to take statins were validated, according to the results of a new study.

Long-term acute care hospitals provide better outcomes and more cost-effective care when treating critically ill and medically complex patients.

Approximately 9 million Medicare beneficiaries are considered "complex care" and they often incur high out-of-pocket costs. As lifespans lengthen, it becomes important for Medicare to adapt to serve these complex care beneficiaries.

Nearly 50 years after President Johnson signed the law that created them, Medicare and Medicaid have become part of the fabric of the US healthcare system. A Kaiser Family Foundation poll finds little support for proposals to alter the basic structure of the programs.

The link between getting patients to take medication correctly and keeping down healthcare costs is strong enough that adherence is being tied to reimbursement for healthcare providers. A study published recently in The American Journal of Managed Care examines connections at the health plan level between good plan-level adherence, lower rates of disease complications, and lower medical spending.

Using new data, the authors found that consumers in the Medicare Advantage market are fairly insensitive to premiums, but respond more strongly to reduced medical cost sharing.

Jennifer Malin, MD, medical director for oncology at Anthem, explains how both physicians and payers struggle with the high cost of some cancer treatment drugs.

Former CMS administrator, Marilyn B. Tavenner, will step into the role of president and chief executive of America's Health Insurance Plans.

Acting Administrator Andy Slavitt says the Fraud Prevention System has yielded a 10-to-1 return for taxpayers

The Patients' Access to Treatments Act of 2015 was introduced earlier this year to rein in the high cost-sharing requirements for specialty drugs.

The top story of the week was Aetna's purchase of Humana, which signals a growth in government managed care. In addition, the 340B drug discount program came under fire after a report from the Government Accountability Office.

President Barack Obama has nominated Andy Slavitt to become the new administrator of CMS.

Unlike ACOs or P4P, implementation of bundled payment for inpatient and post acute care in Medicare would modestly reduce geographic variation in spending.

A study of Kaiser Permanente cancer patients found that two-thirds of teen and young adult patients received aggressive care at the end of life. The special issue on the topic comes as CMS proposes paying doctors or nurses to discuss advanced care planning.

As CMS continues to transform the Medicare program to a quality- and outcomes-based system, the agency is proposing to support patient- and family-centered care for Medicare beneficiaries by enabling them to discuss advance care planning with their providers.

The report found that Medicare Part B spending per beneficiary in 340B hospitals was more than twice that of hospitals outside the program. Groups such as the Community Oncology Alliance have long warned that the 340B program, while essential, has grown beyond its original intent.

CMS has released additional guidance allowing for flexibility in claims auditing and quality reporting during the transition to the International Classification of Diseases, Tenth Revision and is working with the American Medical Association to educate providers.

California's recent initiatives to address the impact of high priced hepatitis C drugs could not have come at a better time, as a new analysis estimates that the state's projected specialty drug expenditure would be $4.77 billion in the next year alone.

Aetna's purchase of Humana would create a managed care company with $115 billion in revenues, of which 56% would be from government business. In addition, the combined company would have the largest enrollment of members on public exchanges, with 1.7 million members.

The deal combines Humana's 3.2 million Medicare enrollees with Aetna's 1.26 million Medicare enrollees, giving the new combined company a strong position as the baby boomer population ages.

As co-pays and deductibles in Medicare and commercial health plans become more prevalent, so, too, does the temptation to waive them. But beware.

CMS has begun to implement risk adjustment and reinsurance programs, 2 premium stabilization programs of the Affordable Care Act. The report highlighted the estimated reinsurance payments issuer in addition to summary level information on the programs, which helps to keep premiums affordable as well as various coverage options available to consumers.

When The American Journal of Managed Care's ACO and Emerging Healthcare Delivery Coalition met for the most recent Web-based session, the speakers discussed the importance of accountable care organizations as CMS moves forward with new reimbursement schemes and managing high-risk patients through coordinated care.

Despite concerns that Medicare Advantage payment reductions included in the Affordable Care Act would lead to a decline in enrollment, the number and share of beneficiaries enrolling in Medicare Advantage has only continue to climb since the health reform law was enacted.

CMS Open Payments data for 2014 is now available and includes information on 11.4 million financial transactions attributed to over 600,000 physicians and more than 1100 teaching hospitals, totaling $6.49 billion.

Although GOP presidential hopefuls are all campaigning on promises to repeal and replace President Obama's Affordable Care Act (ACA), the last real chance to repeal may have been the 2012 election, according to Avik Roy, senior fellow at the Manhattan Institute.

Two new changes to CMS' ACO Investment Model will help practices in rural areas gain more access to the benefits of accountable care organizations.

The number of Medicare Advantage plans with $0 premiums has been on the decline since 2011, and dropped from 813 in 2014 to 726 in 2015, according to a recent analysis government data by HealthPocket.

Margaret E. O'Kane, president of the National Committee for Quality Assurance will join The American Journal of Managed Care for a Tweetchat on June 26 at 1 pm EST. Follow the discussion and ask your own questions using #AJMCchat.