Insurance

A recent survey indicates healthcare providers are eager to adopt a chronic care management platform that would qualify them for newly available Medicare reimbursements.

Proposed payment cuts to Medicare Advantage (MA) could cause many beneficiaries to lose access to MA plans and cause great disruption to the market, according to a new report by Oliver Wyman for America's Health Insurance Plans.

Budget cuts mean county health clinics will be unable to fill hundreds of jobs, leaving smaller staffs to serve low-income people in state that declined to expand Medicaid despite pleas from its hospitals and business leaders.

CMS has released proposed changes for the Medicare Advantage and Part D Prescription Drug Programs that help build a better, smarter healthcare system and move the Medicare program toward paying providers based on quality of care.

For decades, hospital executives across the country have justified expensive renovation and expansion projects by saying they will lead to better patient reviews and recommendations.

A study published today in JAMA suggests that former long-term smokers who have quit for more than 15 years would benefit from access to the lung cancer screening recently approved for coverage by Medicare; however, these smokers no longer meet the criteria.

The Medicare prescription-drug benefit introduced in 2006 saved an estimated 19,000 to 27,000 lives in its first year by expanding access to medications that treat cardiovascular killers like strokes and heart disease.

According to a healthcare consultant, hospitals that handle high patient volume tend to receive lower patient satisfaction scores than the smaller, specialty hospitals. The discrepancy in the patient demographic and the kind of procedures being conducted need to be considered when evaluating hospitals, experts think.

Hospital super utilizers in Pennsylvania account for $761 million of the state's Medicare and Medicaid expenditures for inpatient stays, according to a new report from the Pennsylvania Health Care Cost Containment Council.

A Wall Street Journal analysis found many long-term hospitals discharge a disproportionate share of patients during the time when hospitals stand to make the most.

Published in the Journal of Nuclear Medicine, the authors show that a fourth and subsequent follow-up PET/CT scan in lung cancer patients was associated with treatment change.

Two PCSK9 inhibitors under development-one by Amgen and the other jointly by Sanofi and Regeneron-could eventually cost the US healthcare system $150 billion per year. William Shrank, the chief scientific officer of CVS thinks these costs would be unsustainable for the healthcare industry that is already rattled by the burgeoning cost of specialty medications.

This retrospective cohort study in a Medicare Advantage population posits that type 2 diabetes mellitus complications pose an excess burden on healthcare resource use and related costs.

A new Affordable Care Act initiative from HHS will better coordinate cancer care with the intention of improving the quality of care provided and reducing the money spent on healthcare, according to an announcement from HHS.

The idea has been floated that the government should try buying the patent rights for Harvoni from Gilead Sciences in an attempt to improve access, but even if such a move was feasible, no one seems to think it's a good idea.

It has a long way to go, but Medicare's Hospital Compare initiative may go a long way in reducing the cost of care, according to the findings of one research study.

Harvoni has shown results within the first 8 weeks of treatment, which would save costs, Matthew D. Harman, PharmD, MPH, does not think many patients or providers will be making cost-based hepatitis C treatment decisions.

While formularies should provide physicians the ability to treat any patient that walks into the office, there also need to be clinical exceptions that allow patients with mitigating circumstances to get any product clinically necessary.

Despite studies suggesting higher spending levels do not necessarily produce better health outcomes, a new paper to be published in the Journal of Political Economy found the opposite to be true with regard to emergency care.

A one-minute look back at the week of February 2, 2015, in managed care, including another top resignation from a federal agency and budget proposals affecting Medicare and Medicaid.

The National Association of Accountable Care Organizations has teamed up with physicians, hospitals, medical associations, and almost all Medicare Shared Savings Program accountable care organizations in the country to pen a 36-page letter to CMS.

Following an announcement that Medicare would cover preventive low dose computes tomography for lung cancer screening, CMS released a final national coverage determination today that includes details on eligibility criteria.

The Medicare STAR medication adherence measures exclude diabetes patients at high risk for poor cardiovascular outcomes, and underestimate the prevalence of medication nonadherence in diabetes.

More than 400,000 Medicare beneficiaries who may have been confused or misinformed about the pharmacy details of their 2015 Aetna prescription drug plans have until the end of this month to find participating pharmacies or switch plans, according to CMS.

The President's budget proposal for 2016 seeks to gain the ability to negotiate drug prices under Medicare Part D, which will definitely face resistance from the Republican-controlled Congress.

A one-minute look back at the week of January 26, 2015, in managed care, including anticipated moves from volume-based to value-based payments and expected push back on cancer drug costs.

After calls for changes and more flexibility from physician groups, CMS announced it intends to modify requirements to meet meaningful use in the Medicare and Medicaid Electronic Health Record Incentive Programs.

A new health policy issue brief from the Brookings Institution has outlined specific modifications that would enable to legislation in Congress to support better care and more value in Medicare.

OIG recommends training for inspectors and amending contracts with stand-alone pharmacies to ensure improved quality and safety.