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More Providers, Insurers Showing Appetite for Narrow Networks
Providers and insurers across the country are partnering to launch narrow-network plans even as controversy continues over whether these plans offer adequate provider access for consumers.
Malpractice “Immunity” Does Not Prevent Wasteful Spending
Legal reforms that enact stronger protections against malpractice claims do not necessarily reduce defensive care, according to a new study by the RAND Corporation published in the New England Journal of Medicine.
Massachusetts Caught in Scheme to Over-Charge Medicaid by $106 Million
Massachusetts health officials over-billed Medicaid for almost $106 million by filing claims from as far back as 1988 as current expenses, according to an HHS inspector general's report.
Reducing Hospital Readmissions May Prove Tougher than CMS Expects, AJMC Study Finds
The Centers for Medicare and Medicaid Services wants hospitals to find ways to keep patients from returning to the hospital, and the agency has created rewards and punishments in pursuit of this goal. A study in The American Journal of Managed Care is just one of a pair of recent clinical trials that finds readmissions may be beyond some hospitals’ control, and policymakers might need to rethink their approach.
AMA Calls for More Meaningful Use Flexibility in Letter to CMS, ONC
The strict rules of the Meaningful Use (MU) program are preventing physicians from participating, according to the American Medical Association, which is calling for more flexibility and some relief from penalties.
Policy Changes May be Slow on State Exchanges as IT Systems Evolve
A blog published by The Commonwealth Fund points to digital technology glitches being responsible for slower policy adoption by several state exchanges. But states are fixing their technology glitches and also setting examples for other states to follow, say the authors.
Success of Medicare's Prescription-Subsidy Program Among Low-Income Women
A study presented at ASCO's Quality Care Symposium in Boston found increased medication adherence to prevent breast cancer recurrence in those availing of the subsidies.
Exciting Clinical Results With Novartis' Leukemia Immune Therapy
The regimen, based on reprogramming the patient's immune T cells to attack the cancer cells, led to the disappearance of cancer in 90 percent of patients, according to a study published in the New England Journal of Medicine.
For the Basics, Retails Clinics Just as Good or Better Than Urgent Care or Emergency Rooms, Study Finds
With a shortage of primary care physicians and the costs that come with a trip to the emergency room, can retail clinics fill the gap? A study published today in The American Journal of Managed Care finds they can, offering care that is just as good or better for common ailments like ear infections or strep throat.
CMS Offers Upfront Investment to ACOs Through New Initiative
Accountable Care Organizations participating in the Medicare Shared Savings Program will have access to a new initiative that will support care coordination across the country, according to CMS. Up to $114 million in upfront investments will be made available.
ICD-10 Would Help US Better Track Ebola
If Congress had not pushed back the deadline for implementing ICD-10 last spring, the United States now would have a specific code for tracking Ebola, according to an infographic from the Coalition for ICD-10.
Medicare Advantage Star Ratings Increasing Overall Plan Quality
Quality in Medicare Advantage plans is increasing, and CMS credits the improvement to its star rating system. A growing number of Medicare enrollees are in plans receiving at least 4 out of 5 stars, according to a new fact sheet.
Exact Sciences' Cologuard Receives CMS National Coverage
The non-invasive nature of the test makes it a very attractive alternative to the uncomfortable colonoscopy used to detect colorectal cancer. In a New England Journal of Medicine study of 10,000 patients, the test identified 92% of colorectal cancers in average-risk patients and 42% of polyps.
After Roche, Celgene Faces Value Push-Back From NICE
After Roche saw 2 product rejects a few weeks back from NICE, based on a value argument, Celgene is in a similar boat with it's multiple myeloma drug pomalidomide.
A Look at Coverage Eligibility in Medicaid Nonexpansion States
In states that chose not to expand Medicaid eligibility under the Affordable Care Act, residents with a median income of less than $800 a month are now ineligible for coverage assistance while those with more than $2000 a month are eligible for subsidies, according to a report from the Urban Institute.
Blue Cross and Blue Shield of Illinois Pioneers First Specialty Intensive Medical Home Program
Blue Cross and Blue Shield of Illinois announces the first specialty intensive medical home program in the state, with the Illinois Gastroenterology Group, the state's largest independent gastroenterology practice, effective September 1, 2014.
Study Identifies Gender Bias in HPV Vaccination
Fewer than 15% of physicians routinely recommend HPV vaccination to male patients, according to the study published in the journal Cancer Epidemiology, Biomarkers & Prevention.
Few Organizations Have Infrastructure in Place to Handle Big Data
Although many providers are looking to implement cloud, big data, social, and mobile technologies within the next 2 years, if they haven't done so already, few healthcare organizations feel their infrastructures are prepared for this evolution of electronic medical records, according to a new study.
Obamacare Website Won’t Reveal Insurance Costs for 2015 Until After Election
Those planning to purchase health insurance on the Obamacare exchange will soon find out how much rates have increased—after the November 4 election.
Are EHRs to Blame in the Dallas Ebola Case?
With the enormous amount of data being collected and entered into EHRs, the human brain (in this case the physician brain) is probably tuning out information that would probably stay if there was a conversation with the patient instead.
ASCO Endorses CAP/IASLC/AMP Guideline on Molecular Testing for Lung Cancer
The American Society of Clinical Oncology has endorsed the joint guidelines established by the 3 Associations to help physicians make evidence-based decisions when selecting patients to administer some of the targeted therapies developed for lung cancer.
CMS Star Ratings’ Quality Bonus Payments Can Mean Survival for Health Plans
The quality bonus payments tied to CMS’ star ratings makes it critical that health plans receive a 4 or better, Jonathan Harding, MD, chief medical officer of the Senior Products Division at Tufts Health Plan, said at the America’s Health Insurance Plan’s National Conferences on Medicare and Medicaid, and Dual Eligibles Summit in Washington, DC, from September 28 to October 2.
Gilead's Harvoni Less Expensive, but Still a Burden on State Medicaid Programs
Gilead Sciences’ Harvoni represents the first once-a-day, complete treatment pill approved by the FDA to treat the hepatitis C virus (HCV). And for some patients, the drug will be less expensive than Gilead’s other HCV treatment, Sovaldi.
BMS' PD-1 Inhibitor, Nivolumab, to be Evaluated With Jansenn's Ibrutinib in NHL
Opdivo (nivolumab), which was approved in Japan in July 2014, is being globally developed for evaluation in non-small cell lung cancer (NSCLC), melanoma, renal cell carcinoma (RCC), head and neck cancer, glioblastoma, as well as NHL.
Priority Review for Pfizer's Palbociclib in Patients with Advanced Breast Cancer
The NDA submitted by Pfizer requests approval of palbociclib as a first-line therapy in combination with letrozole for ER+, HER2- advanced breast cancer.