Policy

Two doses of the Moderna COVID-19 vaccine have reduced efficacy against the Omicron variant; a federal appeals court reinstates the Biden administration’s health care worker vaccine mandate in 26 states; a new combination therapy may reduce breast cancer progression.

Megan Olsen, MPH, principal at Avalere, discusses how the impact of small patient populations and other limitations may influence payer conversations about gene and cell therapies.

Next Gen ACO recently re-branded as the Value Based Care Coalition. To learn more about the organization's new phase, we spoke with executive director Mara McDermott.

Two doses of the Pfizer vaccine may only have 22.5% efficacy against the Omicron variant; as of 2018, less than 16% of orthopedic specialists are people of color; a mask mandate for stores and indoor spaces in New York state went into effect.

The Supreme Court will allow a challenge to Texas' controversial abortion law; the FDA broadens booster eligibility for teens; Kentucky declares an emergency over nurse shortages.

The CDC’s latest Morbidity and Mortality Weekly Report details the care and HIV service disparities that persist among sexual minority men.

This article describes the Philadelphia Medicaid Opioid Prescribing Initiative that was launched by a multidisciplinary team and mailed local Medicaid providers individualized prescribing report cards.

Pfizer predicts that a fourth dose of a COVID-19 vaccine may be needed to quell the Omicron variant; CMS officials share figures on enrollment for health coverage under the Affordable Care Act (ACA); City of Hope announces acquisition of Cancer Treatment Centers of America.

Hospitals reported widespread adoption of quality improvement (QI) changes to improve on CMS quality measures, and QI adoption was associated with improved performance on quality measures.

On this episode of Managed Care Cast, guests discuss why pharmacists are in a unique position to help address social determinants of health (SDOH) and the importance of incorporating patients’ perspectives into research agendas.

Misinformation about flu vaccines must be dealt with immediately, according to Leslie Kantor, PhD, MPH, chair and professor of the Department of Urban-Global Public Health, Rutgers School of Public Health.

New data suggest more children are being diagnosed with autism in the United States; Biden pushes for coverage of at-home COVID-19 tests; different pollutants may affect the ratio of boys to girls born.

The authors of this study examined expense reports to understand how participants in Medicare’s Accountable Care Organization Investment Model spent to achieve program goals.

The Alliance of Community Health Plans (ACHP) recently released its 2021 Report on Affordability. In this episode of Managed Care Cast, we speak with the organization about the steps that its payer members are taking to lower costs through offerings such as virtual-first care, remote patient monitoring, and other new products, some of which were created because of the pandemic.

The White House will invest $1.5 billion to bolster the nation's health care workforce; new data reveal long-term Pfizer COVID-19 vaccine efficacy in children; Idaho deactivates crisis standards of care for some portions of the state.

The different approaches to setting benchmarks for population-based payment models (empirical, bidding based, and administratively set) have unique advantages and challenges.

CMS' introduction of 3 new electronic clinical quality measures, 2 of which are focused on inpatient glycemic management, signal a strong commitment to shine a light on this often-overlooked area, according to the chief medical officer at Glytec.

Although acute promyelocytic leukemia is highly treatable in early stages, the medication needed stop hematologic emergencies, all-trans retinoic acid, is often not available, a new study says.

The FDA decision was followed by a CDC advisory panel meeting Friday, and as expected, CDC Director Rochelle Walensky, MD, MPH, who has spoken in favor of booster shots, signed off on the plan.

CVS announces it will close around 900 stores; states in the upper Midwest are suffering another COVID-19 surge; Biden increases federal waterway protection.

On this episode of Managed Care Cast, we speak with MeiLan K. Han, MD, MS, the author of a book released this month called Breathing Lessons: A Doctor’s Guide to Lung Health. Han, a pulmonologist, gives an inside tour of the lungs and how they work, zooms out to examine the drivers of poor respiratory health, and addresses policy changes that are needed to improve lung health.

Implementing a proactive provider outreach program resulted in significantly more prior authorization recertifications and a reduction in time to submission.

This study identifies several factors shared by locally defined delivery system innovations that have been shown to reduce service use and lower health care spending.

COVID-19 prompted CMS to make major adjustments to the Medicare Advantage (MA) Star Ratings System, resulting in better-than-average performance for nearly all plans. However, these changes were temporary, and MA plans will have to reset their strategies for 2023 and beyond.