Mary K. Caffrey

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.

A Republican legislative leader who was a top negotiator in creating Arkansas' private option will be the new governor's chief of staff. The pick is viewed by some as a sign that the private option may have a defender in the incoming administration. Meanwhile, Arkansas' hospitals are highlighting the difference the private option has made in reducing the ranks of uninsured seeking treatment.

Diabetes advocates are pressing for a bill that would compel Medicare to cover CGM technology. They cite a study in The American Journal of Managed Care, which found it costs $17,564 every time a person with diabetes goes to the emergency department with hypoglycemia.

The managed care wars of the 1990s, when patients complained that health plans would not pay for them to see the doctor of their choice, seem almost quaint in light of today's battles. With the rise of narrow networks, there are new fights about access to doctors, of course. But the more troublesome battles, which are sometimes literally life-threatening, involve access to drugs.

More than a year after its disastrous debut, the federal website HealthCare.gov reopened last night, giving shoppers a few days to browse ahead of the November 15 start date for open enrollment, when consumers will have 60 days to make changes or, for some, select first-time coverage under the Affordable Care Act.

Three days after the Republican Party gained control of the US Senate and rose to 250 seats in the House of Representatives, the airwaves are filled with bluster aimed at respective bases over what will become of the Affordable Care Act (ACA). While experts from both sides of the aisle agree that a full repeal is unlikely, 1 item has shown up on almost every early list of elements unlikely to survive the next Congress: the medical device tax.

The so-called "Mediterranean diet" has long been recommended as a way to control weight and prevent diabetes. Now, the American Heart Association and the American Stroke Association have issued new guidelines that say the diet should be encouraged to reduce a person's risk of first-time stroke.

A special report on what the historic election of Republicans in races for the Senate, US House of Representatives, and governor means for the future of the Affordable Care Act, Medicaid expansion, and managed care, and reports on important healthcare ballot measures from around the country.

Their role is essential and growing as the nation's elderly population increases, and many older persons seek to stay in their homes. But with pay and benefits only a rung above fast food workers, home health aides are a little seen and often unheard part of the managed care continuum. That changed one September morning in Ohio, when a rally brought their plight literally into the sunshine.

Starting in January, primary care physicians will be paid to coordinate care for Medicare patients and can be reimbursed for telehealth visits for wellness and behavioral health, according to a published report.

From Medicaid providers that are regulated as insurers alongside managed care organizations, as happens in Mississippi, to "enhanced medical homes," which are found in Colorado, the variety that exists in healthcare delivery across the states has adapted to reflect the shift to accountable care, according to an author writing for the American Journal of Public Health.

From the youngest patients to the oldest, the Affordable Care Act's promise that care will be provided despite pre-existing conditions is bumping against the challenge of keeping costs in check. From around the country come reports of pushback, which evoke the 1990s stories of managed care's debut: limited choice.

A crackdown to ensure that Medicaid beneficiaries get accurate information about provider networks is coming in January, CMS officials vowed yesterday, according to published reports. New regulations for Medicaid managed care to be unveiled in early 2015 will ensure that consumers get timely access to care and better integration of services.

The war of words between managed care and pharmaceutical manufacturers, which began when Gilead set the price for its drug to treat the hepatitis C virus (HCV), has taken off in October with the reclassification of a trio of cancer drugs from Genentech. Growth in the "specialty pharma" sector, where prices are rising much faster than drug prices generally, has drawn concern from payers and the umbrella group that represents them, while the trade group that represents drugmakers is pushing back against critics, saying that it faces challenges in bringing life-saving therapies to market.

Trials to learn the safety of vaccines to prevent the spread of the Ebola virus are moving as fast as possible in the United States and in Great Britain, as public health officials on both sides of the Atlantic scramble to contain the worst-ever outbreak of the disease.

US Health and Human Services Secretary Sylvia M. Burwell announces new progams and financial incentives to help accountable care organizations (ACOs) and professional medical associations make the transition from fee-for-service to value-based healthcare delivery.

More than 53,000 managed care clients in 6 western New York counties will not have to find a new insurer, thanks to an emerging partnership that caused the area's BlueCross BlueShield carrier to reverse its decision to exit the health plans.

An article in the Journal of the American Medical Association outlines what both CMS and the Pioneer ACOs have learned in the early years of the program, such as the importance of engaging primary care physicians, not growing too quickly, and the need to find better ways to count which patients are in the ACO.

The Institute of Medicine announced yesterday that A. Mark Fendrick, MD, co-editor-in-chief of The American Journal of Managed Care and a national leader in efforts to reform healthcare reimbursement strategies, is among 70 new members elected to the prestigious body.

As accountable care organizations, or ACOs, proliferate across the United States, a question arises for both veteran healthcare leaders and consumers: is the ACO something new, or just a relabeling of managed care vehicles created during the last wave of healthcare reform? A well-run ACO offers something better than the managed care of prior years, according to presenters at the gathering of the ACO and Emerging Healthcare Coalition, which took place October 16-17, 2014, in Miami, Florida.

Myriad Genetics, Inc., announced today that the Medicare Administrative Contractor (MAC) that has jurisdiction over most molecular diagnostic tests has issued its draft notice on how Medicare will provide reimbursement for Prolaris, a test that Myriad has developed to guide treatment decisions in prostate cancer.