Medicare

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 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.

How Value-based Care Is Changing Radiation Oncology for the Better

The changes come as Tennessee Oncology must now plan for a gap between the Oncology Care Model and a future alternative payment model from CMS.

Natalie Dickson, MD, president and chief strategy officer of Tennessee Oncology, discusses challenges for Tennessee Oncology and community oncology in general.

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

Opioid utilization management in Medicare was associated with mixed effects on opioid prescribing, and prior authorization was associated with a decreased likelihood of subsequent overdose.

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.

Results of a retrospective study conducted in Spain found that dialectical-behavioral therapy skills training can help mitigate polypharmacy in those with borderline personality disorder.

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.

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

Geoffrey Boyce, CEO of Array Behavioral Care, discusses Array AtHome’s telebehavioral health services, which are now available to approximately 5 million Humana Medicare Advantage members.

Pfizer and Moderna announced commencement of trials for Omicron-specific booster shots; 14.5 million Americans gained health coverage since November 2021; Medicare’s website for consumers to research nursing home staffing is up and running.

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.

Results of a study carried out in Iran found those with a recent history of depressive disorders were more likely to suffer from polypharmacy, or taking 5 or more medications concurrently.

Unvaccinated older adults are 49 times more likely to be hospitalized after contracting COVID-19; nursing homes are experiencing a major staffing crisis; major Alzheimer groups plan to meet with federal officials and lawmakers to protest the CMS drug proposal.

An analysis conducted in Japan among patients with acute decompensated heart failure (HF) revealed excessive polypharmacy at hospital discharge is associated with an increased risk of mortality after 1 year.

Medicare Advantage plans must leverage data-driven insights and omnichannel telepharmacy software to guide meaningful interactions with high-risk members and boost Star Ratings performance.

The randomized study consisted of an intervention delivered by general practitioners in the Republic of Ireland.

In a National Coverage Determination decision memo released Tuesday, CMS said it will gather public comment for 30 days about its plan to limit coverage for Alzheimer disease (AD) biologics that target plaque buildup in the brain to patients enrolled in certain clinical trials.

A Danish study observed emergency department (ED) health care providers and identified 5 factors that could play into patient involvement in medication discussions, particularly in older patients with polypharmacy.

CMS proposed rulemaking Thursday that would pass pharmaceutical price concessions to beneficiaries in Medicare Part D plans and make the medical loss ratio in Medicare Advantage plans more robust.

The most-read AJAC papers of 2021 analyze real-world programs to transform health care and provide insight into physician perspectives of health care and insurance.

This year’s most-read articles on Medicare covered topics including accountable care organizations, value-based payment, and star ratings.

Coverage from the 2021 COA Payer Exchange Summit.

Coverage from the 2021 COA Payer Exchange Summit.

The findings come from an algorithm that was based on 4 criteria-based tools, including 2 widely-used measures designed to ferret out inappropriate medication prescribing in older adults.

Three policies to revamp insurance consumer protections for health care delivery are explored, with highlighted areas for improvement being maternal health coverage and loosening of network adequacy requirements.

Antibodies produced by vaccinated people may be less successful at fighting against Omicron compared with other variants; Congressional leaders created a plan to lift the debt limit with only Democratic votes in the Senate, staving off Medicare cuts; cases of depression and anxiety among youths both doubled during the pandemic.

People aging with HIV have more drug–drug interactions compared with those without HIV, according to results of an observational study.