- Center on Health Equity and Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Coordination of Patient Care in and out of ACOs
Patients who are members of an ACO are not likely to realize it, comments Dennis Scanlon, PhD, Summit moderator. He asks how providers can keep ACO members within the system, avoiding care providers who do not have the same incentives. Ateev Mehrotra, MD, MPH, associate professor of healthcare policy and medicine at Harvard Medical School, and a hospitalist at Beth Israel Deaconess Medical Center, agrees that patients probably do not know what type of system it is or the incentives being used within their ACO.
Coordination of care among any providers (within or outside of the system) improves quality, insists Arthur Vercillo, MD, FACS, a surgeon and regional president of Excellus Blue Cross Blue Shield. This is true of the sickest patients who utilize many services and those members who occasionally use the healthcare system.
Dr Scanlon points out that health information technology is supposed to help in this regard, and legislation (eg, the HITECH Act) and resources have been directed toward improving the utilization of HIT. Yet, he says, “I think critics would say this concept of ‘meaningful use’ has been anything but meaningful in terms of how HIT is being used…all of the investment we’ve made in HIT isn’t sort of moving us in that direction.”
Dr Vercillo notes that the money spent on HIT, the formation of regional health information organizations, “is supposed to reduce redundancy. Empirically, it makes so much sense, but so far, we’re having a hard time proving the ROI is there.”
Real-World Study Reveals Key Insights into DLBCL Treatment Patterns, Outcomes
April 18th 2024A recent study offers valuable insights into the characteristics, treatment patterns, and outcomes of diffuse large B-cell lymphoma (DLBCL) in patients across different lines of therapy, providing a look into the landscape of DLBCL management.
Read More
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
Pegcetacoplan for PNH More Cost-Effective Than Anti-C5 Monoclonal Antibodies
April 18th 2024A cost-utility analysis conducted from the perspective of the Italian health system found that pegcetacoplan was more effective and less costly than 2 complement 5 (C5) inhibitors for the treatment of paroxysmal nocturnal hemoglobinuria (PNH).
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
Gene and Cell Therapies Hold Potential—but How Can Payers Manage Their Costs?
April 18th 2024Presenters at the Academy of Managed Care Pharmacy (AMCP) 2024 annual meeting discussed the current promise and future potential of gene and cell therapies, as well as payer management strategies for these costly treatments.
Read More
Prices for care at hospital trauma centers vary across hospitals; drug shortages reached a record high during the first quarter of 2024; although 3 of the biggest makers of asthma inhalers pledged to cap out-of-pocket costs for some US patients at $35, these do not apply to daily inhalers used by the youngest kids with asthma.
Read More
