Policy

Mike Koroscik, MBA, MHA, vice president of oncology, Allina Health and the Allina Health Cancer Institute, discusses the successes and challenges of a population health reimbursement model and gives advice for other health organizations considering a similar partnership within their practices.

Patients with Medicare were 5.08 times more likely than patients with private insurance, and 2.81 times more likely than patients with Medicaid, to face a financial barrier to obtaining varenicline and combination nicotine replacement therapy.

Margaret Liang, MD, MSHPM, gynecologic oncologist and program director for the gynecologic oncology fellowship program at Cedars-Sinai Cancer Center, discusses the Association of Community Cancer Centers' Financial Advocacy Services guidelines, which focus on providing financial support to patients with cancer.

Kathy Oubre, MS, CEO of Pontchartrain Cancer Center, speaks on the unique perspectives and challenges smaller health care practices may face when entering into alternative payment models and shares key insights for addressing these issues.

A poster presented at the 40th National Oncology Conference addressed several hot topics in the oncology treatment and research space: addressing medical mistrust in underresourced communities, partnering with trusted organizations to improve health equity, and increasing inclusivity in research.

Among Latino men who have sex with men (MSM), access to and use of pre-exposure prophylaxis (PrEP) remain at suboptimal levels, despite this population of individuals having disproportionately high rates of diagnosed HIV in the United States.

Jennifer Sturgill, DO, Central Ohio Primary Care, discusses how shortages of antibiotics and medications for attention-deficit/hyperactivity disorder have affected primary care, as well as addresses the impact on heart failure care of CMS’ recent announcement of the first 10 drugs up for price negotiation in 2026 under the Inflation Reduction Act (IRA).

Fee-for-service care is not really in line with how primary care physicians think or how primary care should be delivered; the crux of value-based care is wanting patients to have the care they want and need, noted Kristin Oaks, DO, Agilon regional medical director at Central Ohio Primary Care.

Major companies committed to joining Medicare drug price negotiations; Boehringer Ingelheim introduced a low-cost version of its adalimumab biosimilar; schools begin to stock naloxone amid rising opioid deaths among young people.

The October issue of Health Affairs examines the multifaceted aspects of structural racism in health care, exploring historical roots, policy implications, public biases, innovative solutions, and institutional challenges, urging action to confront and dismantle disparities.

Robin Shah, CEO of Thyme Care, which he founded in 2020 with Bobby Green, MD, president and chief medical officer, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, to discuss his evolution as an entrepreneur in oncology care innovation and his goal of positively changing how patients experience the cancer system.

A new grant aims to address maternal mortality in predominantly Black rural areas; Eli Lilly's drug to treat atopic dermatitis has not received FDA approval; a preliminary injunction is granted to Planned Parenthood South Atlantic.

FDA action is no longer expected in Q3 of 2023.

ViiV Healthcare is developing a self-injectable HIV drug similar to Cabenuva; HHS met with insurance companies to resolve COVID-19 vaccine coverage issues; the FDA has greenlit drugmaker Novo Nordisk to add reports of ileus, or intestinal blockage, to its Ozempic label.

A government shutdown could impact Medicaid and Medicare in important ways; new Medicare Advantage plans personalize offerings to special populations; nursing homes are still waiting for COVID-19 shots since the US government has stepped back.

Medicare Advantage and Medicare Part D prescription drug plans will maintain stability in 2024; a report found that women encounter disadvantages in cancer prevention and care; prescriptions for semaglutide, similar drugs surpass 9 million.

Chemotherapy drug shortages put young patients at risk; restrictions and challenges cause concerns of a rise in teen births; at least 28 companies failed to prove sufficient product testing for cough syrups.

The CDC recommends pregnant women receive RSV vaccinations; 6 states expand their Medicaid programs to offer dental coverage; a new bill aims to address issues in the US organ transplant system

On this episode of Managed Care Cast, we speak with the senior author of a study published in the September 2023 issue of The American Journal of Managed Care® on the importance of adequate and effective lung cancer risk factor documentation to determine a patient's eligibility for screening.

Drugmakers turn to artificial intelligence (AI); new reports of vaccine appointment cancellations or insurance issues; Biden plans to clear Americans’ credit scores of medical debt.

Public health professionals are the backbone of our health system, and their contributions are vital to the well-being of our communities. As a society, we must value their work, provide the support they need, and ensure that public health remains a rewarding and viable career choice.

A new study aimed to summarize publicly available coverage policies of commercial health insurers for digital medicine services.

Laurie Sobel, the associate director for women’s health policy at KFF, moderated a panel discussion with Christine Gilroy, MD, MPH; Victoria Nichols, MPH; and Don Downing, RPh, about insurance coverage of FDA-approved Opill and other OTC contraceptives.

We are in the midst of a transformative time in oncology that could also be a little scary if you are not prepared, said Nicolas Ferreyros, managing director of policy, advocacy, and communications, Community Oncology Alliance.

Ryan Haumschild, PharmD, MS, MBA, director of pharmacy at Emory Winship Cancer Institute, shares his unique perspectives as both a provider and payer on the use of prior authorizations (PAs) and "Gold Cards" in patients with rare diseases.

Various health programs may shut down at the end of September without congressional action; maternal health experts push for midwife workforce expansion amidst high maternal mortality rates in the United States; studies find that heightened screen time in teens and tweens before bed can result in a lack of sleep.

Medicare Advantage enrollment was higher among immigrants compared with US-born residents, but the highest enrollment was found among immigrants with limited English proficiency.

During this session at the National Comprehensive Cancer Network (NCCN) Policy Summit, Yelak Biru, MSc, and Crystal S. Denlinger, MD, explained the importance of screening for and addressing health-related social needs.

Artificial intelligence (AI) tools offer potential solutions to the growing demand in mental health; patients face weight loss drug shortages and insurance complications; updated mask guidelines cause worry among health care workers.

Medicare’s administered pricing system has never had to deal with labor scarcity before.