Policy

On this episode of Managed Care Cast, Nadereh Pourat, PhD, MSPH, and Alex Sripipatana, PhD, MPH, discuss research on care complexity and utilization patters of patients at federally qualified health centers (FQHCs).

A new lawsuit aims to block a $13 billion health insurance acquisition; the CDC is expected to release updated mask guidelines; the European Medicines Agency supports boosters among teenagers for COVID-19.

In this National Press Club address, American Medical Association President Gerald E Harmon, MD, outlines what steps need to be taken to better prepare the nation for the next pandemic.

On this episode of Managed Care Cast, we discuss how already wide health care inequities in cancer are becoming much worse because of the COVID-19 pandemic, with guest Monica Soni, MD, associate chief medical officer at New Century Health.

Speaking during a webinar presented by the National Alliance of Healthcare Purchaser Coalitions, experts weighed the pros and cons of employer high-deductible health plans (HDHPs) and outlined steps to address challenges raised.

A proposed probe of pharmacy benefit managers (PBMs) by the Federal Trade Commission did not win enough votes to go forward; California exits the crisis phase of the pandemic; Abbott infant formula has been recalled after 1 death.

Pfizer and BioNTech’s Omicron vaccine development has been delayed; a US judge said HHS violated procedural rules in a dispute with AstraZeneca over the 340B drug discount program; Texas filed suit against the CDC’s mask mandate for airline passengers.

The president’s aim is a 50% reduction in age-adjusted cancer deaths by 2047. This goal seems audacious, but it is likely achievable.

The Senate voted 50-46 to confirm Robert Califf, MD, as commissioner of the FDA, which has been without a permanent leader for more than a year.

President Joe Biden's FDA nominee reaches final confirmation vote; Georgia bill that extends Medicaid coverage for low-income moms advances to House of Representatives; New Mexico bill aims to legalize test strips to detect the presence of fentanyl.

By making diligent compliance efforts a priority in the years ahead, health plans can shore up existing processes to achieve financial success and ensure risk adjustment as regulatory bodies take aim at organizational missteps.

The National Clinical Care Commission (NCCC) issued 39 recommendations to improve diabetes prevention and care in the United States.

A new study from North Carolina has investigated individuals’ experiences with and perspectives on their receipt of HIV-related care while incarcerated in 1 of 21 jails in the state.

The FDA delays its decision on Pfizer/BioNTech’s COVID-19 vaccine in young children; the Federal Trade Commission (FTC) will vote on whether to investigate pharmacy benefit managers (PBMs); nearly half of high-volume antibiotic prescribers are located in Southern states.

The national coverage determination will help detect early non-small cell lung cancer, CMS said.

CDC releases a draft of updated opioid prescribing rules; abortions in Texas drop 60% in first month of new law as patients travel out of state; COVID-19 infections can kill an unvaccinated mother's placenta.

The CDC laid out a plan for mass rollout of COVID-19 vaccines for children under 5 years old, pending FDA authorization; President Biden pivots focus onto drug pricing to revive his social spending agenda; Teva opioid settlements could total $3.6 billion when all’s said and done.

On this episode of Managed Care Cast, Amy Moy, the chief external affairs officer at Essential Access Health, outlines measures needed to address the sexually transmitted infection (STI) epidemic in the United States.

This study compares the impact of the 3 different out-of-pocket maximums proposed in Congress and by the Medicare Payment Advisory Commission.

A meta-analysis from 3 economists concluded that nonpharmaceutical interventions in response to COVID-19 failed to have a large, significant effect on mortality rates.

New CDC data highlight urban-rural health differences; mental health providers object to some parts of the No Surprises Act; COVID-19–associated stroke most likely within 3 days of diagnosis.

Among a patient population defined by CMS postacute care transfer regulations, home health vs no postacute care was associated with reduced 30-day readmissions and costs.

On this episode of Managed Care Cast, we speak with Meghan Gutierrez, CEO of the Lymphoma Research Foundation, about financial toxicity, how the pandemic has affected patients’ financial needs when they have cancer, health care disparities and care gaps, and more.

Medicaid managed care utilization review data for mental health services were analyzed for the calendar years 2017 and 2018. These data indicate low rates of utilization review denials for both inpatient and outpatient mental health services.

Americans who are boosted are 95 times less likely than unvaccinated people to die of COVID-19, the FDA approved the first generic drug for Restasis to treat dry eye syndrome, and CMS is putting a greater focus on health equity for Medicare Advantage and Part D plans.

The rise in popularity of genetic testing brings along a myriad of challenges ranging from concerns on data privacy to insurance coverage, but, when utilized correctly, it could mark a step forward for significant advancements in individual and population health.

Up to one-fifth of Medicare beneficiaries were unable to access health care due to the COVID-19 pandemic in 2020.

The Oncology Care Model (OCM) is set to expire June 30, 2022. With no successor on the horizon, respondents to a recent survey by the Community Oncology Alliance (COA) say features such as dedicated navigators and weekend appointments could be reduced or lost if revenues that supported them are eliminated.

Little-known drugs are now contributing to the US overdose epidemic; the Government Accountability Office finds HHS is at "High Risk Alert"; Moderna begins HIV vaccine trial.

In its annual Medicare Shared Savings Program (MSSP) report, CMS said the number of accountable care organizations joining increased, but a trade group said the results should have been better.