Insurance

New rules for Medicare Advantage (MA) plans would protect elderly citizens who might otherwise lose access to their preferred network of doctors.

The prospects for a permanent doc fix prior to the March 31 deadline are looking increasingly remote.

Gary Liska, with Alere Home Monitoring Inc, says Alere's commitment to patients' safety is why they supported the STABLE study.

The American Journal of Accountable Care will be the media sponsor for a seminar set for March 27-28, 2014, at Innisbrook Golf and Spa Resort in Palm Harbor, Fla., sponsored by TripleAim ACO Consulting Group. TripleAim's mission for the event is to share how the 29 ACOs that experienced shared savings of $126 million in 2012 accomplished the task, and to guide newer ACOs to success.

As Congress tries to reform Medicare, the program's independent advisor has its own suggestions, including a call to end to what has become a revenue buffer for many hospitals and an integral part of their physician acquisition strategies.

This study examines disparities in important patient-reported functional outcomes not routinely assessed among diverse racial/ethnic groups in Medicare managed care.

After the disastrous rollout of the healthcare exchanges last October, Kathleen Sebelius has hit the road to pump up enrollment-and it just might be working.

Medicare doctors are accustomed to wearing the white coats and diagnosing others' problems. But in coming months they may feel more like they're the ones wearing backless hospital gowns, as the federal government reveals previously undisclosed information about doctors' finances and performance.

The Sustainable Growth Formula (SGR) Repeal and Medicare Provider Payment Modernization Act has been framed as a bipartisan solution to establishing a permanent doc fix. The only problem, it seems, is how Congress will pay for the SGR's elimination.

The White House has decided to reverse roughly $10 billion in cuts to the cost-sharing subsidies that were part of the Patient Protection and Affordable Care Act. That program was originally expected to be slashed by 7.3 % in fiscal 2015 and beyond as part of the sequester cuts.

Under pressure from the industry and Congress, the Centers for Medicare & Medicaid Services is withdrawing several proposed changes to the Medicare drug program, but still charging ahead with others that could prove disruptive.

Prescription records show that as use of opioids like OxyContin and Vicodin soared in the 2000s, so did the use of "benzos" such as Xanax, Klonopin, and Ativan, as opioid users discovered tranquilizers could enhance "the high."

Accountable care organizations (ACOs) and other population health initiatives cannot succeed without health information being able to flow between healthcare organizations and providers.

A Centers for Medicare & Medicaid Services (CMS) proposal would remove a number of prescription drug classes from Medicare Part D drug plans, while also limiting the number of plans insurers could offer to seniors.

he lower chamber is expected to vote on legislation that would permanently repeal Medicare's sustainable growth-rate formula for physician payment, which might also include a provision to either repeal or delay the ACA's individual insurance mandate as a way to pay for the SGR fix.

Sen. Ron Wyden (D-Ore.), in his first speech as the new chairman of the powerful Senate Finance Committee, said it's important for Congress to pass legislation that would permanently repeal Medicare's contentious physician payment formula, but did not say how lawmakers intend to pay for it.

Open enrollment for the 2014 state and federal health insurance exchanges will end this month, but various findings contest their anticipated success.

President Barack Obama is proposing more than $400 billion in cuts to Medicare over the next decade in his fiscal 2015 budget, an almost identical amount to what he recommended last year. But those cuts are heavily weighted toward future years, with only $3.5 billion occurring in 2015.

More than 400 accountable care organizations (ACOs) exist across the country, and physician groups have overtaken hospitals as the largest backers of ACOs.

'In order to get technology to truly work for physicians, it must drive productivity'

It's one of the most impressive statistics about the new health care law. The Obama administration says more than 8.9 million people have been, quote determined eligible for Medicaid from Oct. 1 through the end of January.

When it comes managing the long-term care of dual eligibles, many health systems are looking toward managed long-term supports and services (MLTSS). Unlike traditional Medicare and Medicaid, MLTSS would expand managed healthcare medical services to include personal support and other assistance.

Although highly touted, the patient-centered medical home model failed to lower use of services or total costs and produced little quality improvement over three years, research has found.

Doctors and other health providers wrote about 11 million fewer prescriptions for narcotic painkillers in 2013 than in 2012, but some experts expected a bigger drop-off given the brighter spotlight on the nation's opioid epidemic.

Laura Beerman, director, customer segment analysis, Decision Resources Group, presented a discussion that highlighted the early results of accountable care organizations (ACOs). She said that while the Pioneer ACOs created a large initial buzz, their cost savings has varied widely.

Raulo S. Frear, PharmD, general manager, OmedaRx, says pharmacy benefit managers are aligning benefit designs for delivery system reform in a few ways. With respect to the delivery system reform, if you look at ACOs as a specific example, our experience has been that the ACOs are not really ready to talk about different benefit designs, Dr Frear says. They're still learning what it means to accept risk and that means risk across a lot more areas than just pharmaceuticals.

Session highlights from the Managed Markets Summit in Orlando, FL, February 25-27.