As Sequencing Moves into Clinical Use, Insurers Balk
Once strictly the domain of research labs, gene-sequencing tests increasingly are being used to help understand the genetic causes of rare disease, putting insurance companies in the position of deciding whether to pay the $5,000 to $17,000 for the tests.
ACO Initiatives Test Pharma's Traditional Sales Model
The US healthcare system’s shift from volume- to value-based reimbursement for treatment in order to lower costs and improve patient care is disrupting healthcare business models. The high-profile government–led accountable care organizations (ACOs), which put financial pressure on payers and providers to share responsibility for meeting quality and cost goals, is no exception.
AJMC Sets Infectious Disease Meeting for Atlanta
The American Journal of Managed Care will host a two-day event September 25-26, 2014, to take on some of healthcare’s biggest challenges: Treatments that cure hepatitis C are making news but upending balance sheets. A recent recommendation seeks preventive therapy to stop new cases of HIV. Hospitals and public health officials are grappling with how to prevent the spread of MERS. Only AJMC will bring payers, clinicians, policy leaders, and pharmaceutical representatives together to share ideas.
3D Mammograms More Powerful than 2D
In community-based radiology practice, mammography screening with 3D digital breast tomosynthesis (DBT) yielded lower recall rates, an increased overall cancer detection rate, and an increased detection rate for invasive cancer compared with 2D digital mammography (DM).
Insurer Begins Huge Palliative Care Program
“Person-centered care” is the buzz phrase floating around the health care industry, and a Pacific Northwest-based giant insurer thinks it has hit the mark with a new palliative care program coming this summer.
Former ONC Chief Mostashari Heads ACO Startup
Dr. Farzad Mostashari, former head of the Office of the National Coordinator for Health Information Technology, is starting a new firm, Aledade, to help independent primary-care physicians form accountable care organizations.
Personalized Mouse TumorGrafts to Evaluate Treatment Benefits
Icahn School of Medicine at Mount Sinai and Champions Oncology have initiated a study evaluating TumorGrafts' ability to predict treatment benefit in patients with triple-negative breast cancer. A side-by-side genomic analysis of patients' tumor and TumorGraft mouse avatars, before and after treatment, will also be conducted.
3 ACO Lessons from Integrated Systems
Integrated healthcare systems, with associated providers and health plans, have a leg up on implementing accountable care organizations to improve care and lower costs. Leaders from two Washington-based integrated systems shared some best practices and lessons learned for ACO success during a panel discussion Thursday at the AHIP Institute in Seattle.
HHS Fights Back to Keep Expanded 340B Drug Discounts
The drug industry scored a victory last month against the Obama administration's plans to give hospitals millions of dollars in discounts through the 340B program on orphan drugs. But HHS is sticking to its position that the Patient Protection and Affordable Care Act promises breaks on the expensive drugs when they're used for non-orphan indications.