Policy

A new study suggests that primary care providers participating in an accountable care organization (ACO) and having greater engagement with patients transparency into the cost of services and procedures have the ability to bend the healthcare cost curve by an 8 to 1 margin in terms of return on investment (ROI).

Panelists all agree that there needs to be evidence and guidelines for both payers and providers. There are not enough resources to try every drug on every patient. Although it will be costly, there needs to be evidence on putting these drugs together as combinations.

Two new studies have put a price tag on healthcare services considered of little benefit to patients. In both reports, researchers raised questions about the role that healthcare providers play in delivering potentially unnecessary care.

Hospitals and healthcare systems nationwide are increasingly buying more physician practices as health reform requires care delivery to move toward a more quality-based care model instead of a fee-for-service one. The reactions are mixed.

Bargaining leverage, not the cost of providing complex care, is the main reason why some hospitals can demand prices twice as high as their competitors' and still get contracts to treat privately insured patients, according to a new study.

A study estimates that total annual costs for five major health care-associated infections (HAIs) were $9.8 billion, with surgical site infections contributing the most to overall costs, according to a report.

Premium rates for health plan policies in the health insurance exchange (HIE) are expected to vary nationally, but they aren't likely to skyrocket - at least according to one research group.

Accountable care organizations (ACOs) and other coordinated care models present opportunities for improving quality as well as offering incentives that will drive lower-cost decision making among providers

As healthcare costs rise in Florida, insurers and hospitals vested in the success of the Affordable Care Act, are coming up with new ways to cut costs from buying services in bulk and piloting programs to lowering hospital readmission rates and limiting the number of doctors within a plan's network.

The nation as a whole is facing a physician shortage. The Association of American Medical Colleges estimates that the United States will have a shortfall of 90,000 physicians within the next decade.

The most important piece of legislation in Michigan, and perhaps the country, remains idle on the floor of the Michigan Senate.

While the employer mandate delay and other stalls in the implementation of the Affordable Care Act have raised a few eyebrows, a recent report from the Kaiser Family Foundation brings forth some encouraging news.

Opinions rage about whether health insurance costs will rise or fall with implementation of the Affordable Care Act, commonly known as Obamacare.

Health services are now expected to deliver quality care with a shrinking budget. The digital 'channel shift' could be the answer, but attitudes to technology in the sector must change.

David Lansky, PhD, President & CEO, Pacific Business Group on Health, says that Accountable Care Organizations (ACOs) must truly be accountable for the care they provide.

Roger B. Fillingim, PhD, president of the American Pain Society is one advocate speaking out about the problem faced by patients who suffer from chronic pain, defined as being present for 3-months or more. But he's not the only expert who is talking about finding better ways to help people in pain.

Shelley Toreson had health insurance for years, but not anymore. Instead, she is part of an unusual Nevada nonprofit that helps connect 12,000 uninsured residents to doctors and hospitals who are willing to accept a lower-cost, negotiated fee for their services.

Mr. Shopenn, 67, an architectural photographer and avid snowboarder, had been in such pain from arthritis that he could not stand long enough to make coffee, let alone work. He had health insurance, but it would not cover a joint replacement because his degenerative disease was related to an old sports injury, thus considered a pre-existing condition.

Delaying the employer insurance mandate until 2015 has cost the government an estimated $12 billion in fees. This coming after an assessment conducted by The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) on the impact the delay will have on the Affordable Care Act (ACA) implementation.

It was the late C. Everett Koop, a former U.S. surgeon general, who once famously said: Drugs don't work in patients who don't take them. That's a simple way to look at a costly and complex problem - medication non-adherence - where the failure to take drugs on time in the dosages prescribed is both dangerous for patients and costly to the health care system.

Washington state won't pay for medical procedures that are unsafe, unproven or cost too much. Why can't Medicare do that?

Panelists agreed that the cost of the new agents discussed to treat melanoma will be a challenge, just as the cost of healthcare as a whole in the United States is a major challenge.

Dr Fendrick asked panelists what they think about the idea of centers of excellence for specific cancers and an evidence-based steerage.

It's very, very complex to try to envision how you would come up with a single payment for an episode and not have a thousand different types of episodes in order to capture the heterogeneity of these diseases and the cost, said Dr Malin when asked to discuss the bundled payment method in oncology.

In this portion of the panel discussion, Dr Fendrick asked the panel whether or not they have noticed cost-related lack of access or nonadherence with the new agents being discussed.

Dr Weber said that despite all of the newer agents in development, the NCCN still offers comprehensive guidelines for the treatment of melanoma.

Dr Ribas opened this segment by discussing the new immunotherapy agents used in the treatment of metastatic melanoma. Specifically, he discussed the agents vemurafenib (Zelboraf), dabrafenib (Taflinar), and trametinib (Mekinist).

Panel moderator and AJMC co-editor-in-chief Dr Mark Fendrick introduced panelists Jennifer Malin, MD, PhD, manager and medical director of oncology, WellPoint; Jeffrey Weber, MD, PhD, senior member, H. Lee Moffitt Cancer Center Director, Donald A. Adam Comprehensive Melanoma Research Center; and Antoni Ribas, MD, PhD, Jonsson Comprehensive Cancer Center, UCLA.

In Miami, a new healthcare model - the ACO - rewards physicians for patient health, controlling costs

Consolidation reduces competition in markets and gives hospitals more leverage to raise prices.