Payers

The implementation of the Affordable Care Act and its resulting market turbulence has not created the operation challenges for payers that was expected, according to a report from athenahealth, Inc.

This week The American Journal of Managed Care launched its new Managed Markets News Network, featuring the top stories in managed care and interviews with industry experts.

The guidance comes after advocacy groups and members of Congress complained of widespread violations of the Affordable Care Act's requirement that all forms of birth control be covered without a co-payment, not just the low-cost methods. The action also responds to recent reports that payers have balked at requests for BRCA testing even when indicated.

Since the introduction of the Oncology Care Model, oncologists have raised numerous questions as they weigh whether to apply for participation.

The pharmaceutical industry has learnt its lesson from the pushback that Gilead faced over the price of its hepatitis C drug, Sovaldi. The lack of a price discussion prior to the introduction of the regimen washed-out the excitement over a "cure" for the disease.

A general session at the Community Oncology Conference, Community Oncology 2.0, Moving Forward on Payment Reform, was a panel discussion that saw participation by 2 providers and a payer.

With a focus on improving quality while maintaining the cost of care, providers and payers are evaluating various payment models that could improve patient outcomes using evidence-based treatment at lower costs to the healthcare system.

As patents on some of the most lucrative medicines began to expire, many companies shifted money to rare-disease drugs, knowing that those medicines cost less to develop and will face limited competition.

When the first National Comprehensive Cancer Network Guidelines were developed 20 years ago, even the participating members who were there at the beginning were skeptical they would be able to come to an agreement and build something lasting.

A new analysis published by the RAND Corporation suggests strategies that the pharmaceutical industry could offer payers as they try to cover the front-loaded cost of newer breakthrough drugs.

Starting with a contract that works for both parties involved is the best way to ensure payers and providers will work together, said Craig Thiele, MD, chief medical officer of CareSource.

The Patient Access Network or PAN Foundation formed more than 10 years ago, partially in response to the Medicare Part D benefit. It helps patients meet cost-sharing requirements across dozens of diseases, including 25 in oncology; Evidence-Based Oncology, a publication of The American Journal of Managed Care, invited PAN Foundation President and CEO Dan Klein to discuss its role in immuno-oncology.

The goals of the new CMS Oncology Care Model align very nicely with what payers want, according to Ira M. Klein, MD, MBA, FACP, national medical director, clinical thought leadership, office of the chief medical officer, Aetna.

A lengthy report published by the Kaiser Family Foundation predicts widespread market disruption if ACA premium subsidies are lost under King vs. Burwell. Adverse selection, insurers exiting markets, and higher rates are just some of the possibilities.

With the March 4 Supreme Court hearing on King v. Burwell looming, big business is stepping up to defend the healthcare reform law.

The panelists discuss the evidence that is weighed when determining whether or not to include a particular therapy on their regimens.

Among publications in the managed care field, The American Journal of Managed Care (AJMC) is likely the leader, according to Mitch DeKoven, principal of health economics and outcomes research at IMS Health.

A new private-sector alliance of healthcare systems and payers will dedicate to accelerate the US healthcare system's transition to value-based models aligned with improving outcomes and lowering costs.

Although some price variation is to be expected between large cities and rural areas, "extreme" price differences sometimes existed within the same market.

Analysis of State Health Innovation Plans, funded by CMS, shows a variety of emerging approaches to healthcare reform. Accenture has identified the top 5 projected investment areas.

At Patient-Centered Diabetes Care, hear stakeholders across the whole ecosystem of healthcare delivery discuss solutions for diabetes with the patient always at the center of the discussion.

The United States could save approximately $375 billion annually by simplifying the nation's complex, multi-payer way of financing care, according to a study published in BMC Health Services Research.

The quality-measurement enterprise in US healthcare is troubled. Measure developers are creating ever more measures, and payers are requiring their use in more settings and tying larger financial rewards or penalties to performance.

At its third annual conference, Patient-Centered Oncology Care 2014, The American Journal of Managed Care addressed new challenges in cancer care: more patients have coverage, but they may be "underinsured" or barred from academic centers. Amid rising drug costs and regulations that threaten community practices, the head of the largest oncology organization outlined a path toward value-based reimbursement.

Yesterday, speakers opened Patient-Centered Oncology Care, sponsored by The American Journal of Managed Care, with a discussion of how to bring palliative care into the mainstream in cancer care. While progress has been made, a cultural bias against discussion end-of-life issue remains an obstacle.

Peter Yu, MD, president of the American Society of Clinical Oncology, (ASCO) discussed the organization's efforts throughout 2014 to reform reimbursement and take on issues of value and quality in cancer care during Patient-Centered Oncology Care, the annual gathering sponsored by The American Journal of Managed Care.