Medicare

The authors used Medicaid claims data to quantify program spending, use of services, and enrollment patterns among Medicaid beneficiaries newly diagnosed with a metastatic vs a nonmetastatic cancer.

This study evaluated whether adherence to a hypertension quality measure correlates with actual blood pressure control. Findings reveal misalignment between adherence metrics and clinical outcomes.

The House passed HR 5347 to extend flexible Medicare ACO quality reporting and support smaller practices transitioning to digital measures.

Senate Democrats introduced a bill to cap out-of-pocket costs at $5000 for traditional Medicare beneficiaries and expand low-income assistance.

Cardinal Health hires ex-FCS leader Nathan Walcker to drive The Specialty Alliance's growth, including managed services in gastroenterology and urology.

Broader cancer care networks were not consistently associated with lower Medicare Advantage disenrollment after cancer diagnosis.

A CMS proposed rule would make the Medicare Drug Price Negotiation Program permanent, covering up to 20 drugs per year starting in 2029.

On paper, the OCM cost Medicare millions. A decade later, physicians say its lessons are priceless.

Cancer trauma, drug pricing claims, abortion cost gaps, insurance denials affecting 1 in 5, and food insecurity's economic toll top this week's roundup.

During a White House briefing, Mehmet Oz, MD, discussed the expansion of Trump Rx and crackdowns on duplicate ACA enrollment and fraudulent hospice programs.

The problem is not that price transparency itself has failed, but rather that policy makers have focused their efforts on the wrong place.

The authors describe Medicare Advantage plans that screen for and provide supplemental benefits addressing social needs and explore how these benefits meet communities’ social needs.

Medicare FFS beneficiaries with metastatic cancer received broad genomic profiling more often than MA patients.

Beneficiaries in socially vulnerable communities received higher-quality, more-efficient care under value-based care (at-risk Medicare Advantage) compared with those in fee-for-service Medicare payment arrangements.

Claims data linked eviction protection rollbacks to higher psychotropic prescription and SMI visits, revealing housing security’s mental health toll.

This study evaluated differences in racial and ethnic disparities in surgical outcomes between Medicare Advantage and traditional Medicare beneficiaries, finding consistent but nonuniform smaller disparities within Medicare Advantage.

Food insecurity identification modeling for Medicare can establish a reliable method of prioritizing members at risk of food insecurity for identification and program enrollment.

Evidence suggests that adoption of oncology biosimilars in Medicare value-based payment models has produced substantial cost savings and improved provider financial performance.

OCM showed no increased likelihood of starting systemic therapy in patients with newly diagnosed cancers, despite gains in poor-prognosis cases.

A lengthy Ways and Means Committee hearing revealed extensive Medicare system exploitation and ignited partisan debates on fixing it.

The 2018 permanent authorization of dual-eligible special needs plans marked a significant long-term commitment by policy makers and coincided with substantial growth in plan offerings and enrollment.

KFF Health Tracking Poll finds prior authorization tops patient hassles; Drew Altman, PhD, warns complexity delays care, hitting chronic patients hardest.

Two posters presented at AMCP 2026 found low dry eye disease (DED) treatment uptake and frequent discontinuation among Medicare patients, whereas comorbid DED did not affect glaucoma adherence.

Major health plans cut millions of preapproval hurdles, add 90-day continuity protections, and push real-time e-authorization to speed care access.

The cap cut quarterly spending by the hundreds and lowered A1c levels but failed to expand the pool of insulin users.