Policy

Following a recent update to the diagnostic criteria for borderline pulmonary hypertension (PH), which is often associated with left heart failure (LHF), outcomes among patients with both conditions remain uncertain.

The authors describe a pay-for-performance initiative targeting behavioral health providers, which was introduced by a large Medicaid managed care organization across multiple states.

An editorial in response to the editor in chief’s December 2021 letter discusses alignment of specialist physicians with value-based care initiatives.

CVS announces its plan to buy Signify Health for $8 billion; government budgets and low reimbursement could limit the ability for new moms to stay on Medicaid for a year after childbirth; the long-lasting symptoms of COVID-19 could be keeping millions of people out of the workforce.

Medication-at-home pharmacy is an innovative method of medication management that is vital to the success of the health care system.

Understanding if local prescription patterns are influenced by guidance could help policymakers understand what is needed to further encourage a shift to asthma inhalers with less of a climate impact.

Do-it-yourself (DIY) automated insulin delivery systems have gained rapid uptake, yielding self-reported improvements in glycemic control and quality of life for patients, but creating unique challenges for health care providers (HCPs).

Patient confidentiality is a major reason why minors do not seek out prevention, testing, and treatment services for sexually transmitted infections (STIs) and HIV.

The FDA is considering Pfizer/BioNTech’s request for its updated COVID-19 booster; California Governor Gavin Newsom rejects bill allowing supervised injection sites; a new report from the CDC shows 2019-2020 life expectancy fell in all states.

As Medicare Advantage increasingly becomes the dominant form of Medicare coverage, Congress must improve transparency of programmatic costs and benefits to promote beneficiary choice.

On this episode of Managed Care Cast, we speak with the author of an article in the August issue of The American Journal of Managed Care® about the premium tax credits for health insurance purchased through the health care marketplace, which were recently extended for another 2 years with the signing of the Inflation Reduction Act.

The year of application predicts discharge from the Department of Veterans Affairs (VA) caregiver program. Unexpected, disallowed criteria also predict discharge, with significant others facing higher discharge risk than spouses.

This study investigated how an initial diagnosis influences delivery of second opinions concerning skin cancers, including the possibility of an incorrect diagnosis.

When the pandemic public health emergency eventually ends, so will the various waivers and regulatory flexibilities enacted by HHS during the COVID-19 pandemic, including the ability to provide acute hospital care at home, unless Congress acts.

Policy observers and industry stakeholders debate the possible spillover effects of Medicare drug pricing reform in the employer-based insurance market; a California federal judge rules Walgreens could be held liable for not investigating suspicious orders of opioids in San Francisco; a blood test performed the day of a traumatic brain injury (TBI) can predict which patients may die and who may survive with a disability.

In this episode of Managed Care Cast, we speak with Sachin Jain, MD, MBA, SCAN Group and Health Plan's president and CEO, about how the organization made 10% of senior managers’ annual bonuses dependent on how well the gap in medication adherence among diverse populations was reduced.

We estimate that the median 2021 premium tax credit for off-marketplace enrollees in California would be $311 if they switched to marketplace plans, with wide variation by age and plan size.

HR 5376, or the Inflation Reduction Act, is most significant piece of legislation affecting federal health policy since the passage of the Affordable Care Act in 2010; for Medicare beneficiaries, it caps insulin at $35 a month and includes other pricing reforms.

Medicaid expansion was associated with substantial changes in Medicaid managed care plan composition, which may influence a plan’s performance on enrollee experience metrics.

Efforts to close existing policy gaps and misaligned payment practices in current opioid management practices can promote greater utilization of multimodal opioid-sparing pain management options.

Limiting access to non–vitamin K antagonist oral anticoagulants through step therapy and prior authorization may exacerbate current underuse of anticoagulants and increase the risk of stroke in patients with newly diagnosed atrial fibrillation.

A recent study calculated the incidence and mortality rates for patients with Medicaid coverage who had nonventilator hospital-acquired pneumonia (NVHAP) and found possible associations between greater health care costs and NVHAP diagnosis.

Safety-net providers can benefit from demonstrations of condition-specific and defined-scope-of-practice alternative payment models that account for the nonfinancial as well as financial risks that providers face.

Despite the known potential benefits of newborn screening, the exact long-term clinical benefits and cost-effectiveness in large cohorts remain uncertain due to a lack of large-scale longitudinal research.

Social determinants of health are major drivers of the inequities seen in health outcomes, and racism is clearly a social determinant tied to life expectancy, said Karol Watson, MD, PhD, in talk Sunday at the 2022 Congress of the American Society for Preventive Cardiology, held in Louisville, Kentucky.