Laura Joszt, MA

In a commentary for New England Journal of Medicine, Karen E. Joynt Maddox, MD, MPH, of Washington University School of Medicine, outlines key principles for designing alternative payment models (APMs) to avoid harming vulnerable populations and penalizing the providers who care for them.

Despite price tags well over $350,000 for treatment, tisagenlecleucel, approved for children with B-cell acute lymphoblastic leukemia, and axicabtagene ciloleucel, approved for adults with certain B-cell subtypes of non-Hodgkin lymphoma, are considered cost effective, according to a report from the Institute for Clinical and Economic Review.

On March 14, advocates for community cancer centers took to Capitol Hill to speak with legislators and advocate for the issues important to them and their patients.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Americans still believe prescription drug prices are a problem that need to be addressed, but a minority have confidence in the president and Congress to pass legislation addressing these costs, according to the latest Kaiser Health Tracking Poll.

Researchers have identified malignant cells that, if present, can predict whether a patient with acute lymphoblastic leukemia (ALL) will relapse after treatment.

New CDC Director Robert Redfield, MD, replaces the acting director, who led the agency through the severe flu season after Brenda Fitzgerald, MD, resigned at the end of January.

During a panel discussion presented by NPR and the Harvard T.H. Chan School of Public Health, experts highlighted the discrimination that the LGBTQ community faces, the health consequences of that discrimination, and how the healthcare community can improve care for this population.

As the US healthcare system searches for a way to address the poor health and high healthcare costs of American, one concept has risen to the top and received a lot of attention: social determinants of health. In this podcast, we focus on the issue of housing, and how communities are working to get people into housing so their health can improve.

Panelists discussed low-value care, unnecessary services, and what can be done to address overuse in healthcare during a panel at the University of Michigan Center for Value-Based Insurance Design’s (V-BID) annual V-BID Summit on March 14.

Panelists discussed low-value care, unnecessary services, and what can be done to address overuse in healthcare during a panel at the University of Michigan Center for Value-Based Insurance Design’s (V-BID) annual V-BID Summit on March 14.

Patients with acute myeloid leukemia (AML) who were treated at a National Cancer Institute-designated cancer center had a 53% lower risk of early mortality, according to a study published in Cancer.

Panelists Kavita Patel, MD, Brookings Institute; Michael E. Chernew, PhD, Harvard Medical School; and Katy Spangler, Spangler Strategies discussed implementing the value-based insurance design concept in health policy and payment models, challenges with quality measurements, the role of employers in value-based care, and more at the VBID Summit, held March 14 by the University of Michigan Center for Value-Based Insurance Design.

Rural counties in the United States have experienced a decline in the availability of hospital-based obstetric services, dropping from 55% of counties having these services in 2004 to 46% in 2014. This loss can “exacerbate maternal health challenges” in rural areas, according to a study in JAMA.

As hospitals are increasingly held accountable for what happens outside the hospital walls, they need access to better claims data. In a recent study published in the November issue of The American Journal of Managed Care®, researchers with the Michigan Value Collaborative found that it is possible to derive episode-level utilization from claims data and it provides a level of postdischarge care precision that is superior to medical records that hospitals have access to.

Idaho tested the Trump administration's willingness to provide flexibility to states on the health insurance options they offer. CMS has ruled that Idaho cannot sell health plans that do not meet the requirements of the Affordable Care Act (ACA).

Elected officials and others who affect policy know that cost-sharing and out-of-pocket costs are issues in healthcare, but they don’t truly understand the issues, said panelists during a policy discussion on ways to improve access and reduce financial hardship during the Cost-Sharing Roundtable.

Patients with chronic obstructive pulmonary disease (COPD) who were trained on appropriate inhaler use and who were checked on their use were significantly more likely to be adherent, study found.

The first results of the Oncology Care Model (OCM), a 5-year bundled payment demonstration from CMS, were released recently, and at a session at the National Community Oncology Dispensing Association Spring Forum 2018, Mike Fazio of Archway Health discussed the reconciliation statements from the first performance period of OCM, and where practices can look to make improvements going forward.

As cancer treatments improve and death rates decline, more patients survive who are at risk of becoming addicted to pain medications they were prescribed to treat their cancer-related pain, explained Merrill Norton, PharmD, NCAC II, CCS, CCDP-D, of the University of Georgia.

Positive quality interventions are part of a nationwide effort to standardize and improve oncology dispensing practices. They are best practices that are meant to be highly specific to a drug and help pharmacies and clinicians ensure that a patient-centric model exists, explained speakers during a workshop at National Community Oncology Dispensing Association (NCODA) Spring Forum 2018.

Being proactive about identifying potential financial burdens and preparing patients who have a disease for the costs of their treatment helps to ensure that patients will be adherent to their medication and have the best possible outcomes, according to a panel of providers at the Cost-Sharing Roundtable, co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care®.

Coverage from the National Community Oncology Dispensing Association Spring Forum 2018.

Since 2000, the number of patients undergoing gender-affirming surgery who identified as self-payers decreased. From 2012-2013 to 2014, coverage by Medicare and Medicaid of gender-affirming surgeries increased 3-fold.

State variations in chronic obstructive pulmonary disease (COPD) outcomes suggest that the condition is more common in large rural areas compared with metropolitan areas, according to the Morbidity and Mortality Weekly Report from CDC.

New research has found that allogeneic hematopoietic stem cell transplantation is just as effective in patients with non-Hodgkin lymphoma who are age 65 and older as it is in patients between the ages of 55 and 64.

Clinical and policy decisions made using early trial results could be misguided, according to a study that found early results in chronic disease trials are often exaggerated compared with findings in subsequent trials.

Patients with chronic myeloid leukemia (CML) who have a sustained deep molecular response can maintain treatment-free remission for at least 48 weeks after using second-line nilotinib, according to a new study published in Annals of Internal Medicine.

Long-term use of inhaled corticosteroids, which are widely used to treat chronic obstructive pulmonary disease, are associated with an increased risk of fractures, according to a new study in CHEST.

A new National Bureau of Economic Research working paper identified potential hospital cost shifting and that hospitals penalized by the Hospital Readmission Reduction Program and the Hospital Value-Based Purchasing Program actually had an increase in average payments of 1.5%.