Medicare

Many oncologists oppose white bagging because they prefer to be able to adjust doses during a visit based on lab reports taken that day.

Conversations are ongoing between CMS and patient advocates on how accountable care organizations (ACOs) and similar programs can better interface with beneficiaries.

The accountable care organizations (ACOs) participating in the new ACO REACH model will have a health equity benchmark adjustment and need to collect more data to help better understand the populations being cared for and serve those from underserved communities, said Michael Chernew, PhD.

The Global and Professional Direct Contracting model is going to be replaced with a new accountable care organization (ACO) model, which addresses some of the pushback there had been on the direct contracting model, said Michael Chernew, PhD.

On this episode of Managed Care Cast, Lori Timmins, PhD, and Eugene Rich, MD, discuss the findings of their interim analysis of data from the first 3 years of the Comprehensive Primary Care Plus Initiative, a large-scale effort of primary care redesign meant to improve care fragmentation among Medicare fee-for-service beneficiaries.

Medicare advantage beneficiaries who received care from providers in 2-sided risk payment models had lower rates of acute care use, according to new study findings.

Medicare Advantage plan members could save $12 billion if enrolled in fee-for-service (FFS) plans instead; Black patients were classified as low priority for intensive care unit (ICU) triage twice as often as other patients; Moderna and Pfizer face lawsuits over potential COVID-19 vaccine patent infringement.

The authors found an association between Medicare’s wage index adjustment and the differential use of labor-intensive surgical procedures and medical device–intensive minimally invasive clinical procedures across the United States.

Medicare beneficiaries attributed to small practices in accountable care organizations (ACOs) achieve greater savings than beneficiaries attributed to large practices in ACOs.

This article examines the association between a large-scale primary care redesign—the Comprehensive Primary Care Plus Initiative—and ambulatory care patterns of Medicare beneficiaries with highly fragmented care.

On this episode of Managed Care Cast, we speak with Tim Gronniger, the CEO of Caravan Health, about what to look for as accountable care organizations (ACOs) and policy makers try to encourage more providers to join value-based care arrangements.

Polypharmacy was associated with a nearly doubled increase in health care expenditures and a tripled increase in pharmacy expenditures among older patients with cardiovascular diseases (CVD).

Natalie Dickson, MD, president and chief strategy officer of Tennessee Oncology, discusses Tennessee Oncology's role in the discussion to reform 340B.

A bill to provide late-fee warnings to Medicare beneficiaries was introduced; Pfizer is expected to provide 10 million COVID-19 antiviral pills to low- and middle-income nations; a Texas judge halts an investigation into a 16-year-old girl receiving gender-affirming treatment.

A new metric may help improve polypharmacy rates in older adults through identification of low-value prescribing practices.

During an AHIP webinar, Mark Hamelburg, senior vice president of federal programs at AHIP, explained the shifts coming to Medicare and Medicaid when the public health emergency finally ends.

The redesigned accountable care organization (ACO) model is called the Realizing Equity, Access, and Community Health model and is scheduled to begin in 2023.

Stephen Schleicher, MD, MBA, chief medical officer of Tennessee Oncology, discusses the practice's plans to continue providing quality oncology care to its patients after the end of the Oncology Care Model (OCM).

A woman is now the third person in the world to be cured of HIV; CDC data suggest vaccinating women against COVID-19 during pregnancy may protect infants after birth; provider groups push to keep Direct Contracting payment model.

By making diligent compliance efforts a priority in the years ahead, health plans can shore up existing processes to achieve financial success and ensure risk adjustment as regulatory bodies take aim at organizational missteps.

The FDA delays its decision on Pfizer/BioNTech’s COVID-19 vaccine in young children; the Federal Trade Commission (FTC) will vote on whether to investigate pharmacy benefit managers (PBMs); nearly half of high-volume antibiotic prescribers are located in Southern states.

How Value-based Care Is Changing Radiation Oncology for the Better

The changes come as Tennessee Oncology must now plan for a gap between the Oncology Care Model and a future alternative payment model from CMS.

Natalie Dickson, MD, president and chief strategy officer of Tennessee Oncology, discusses challenges for Tennessee Oncology and community oncology in general.

This study compares the impact of the 3 different out-of-pocket maximums proposed in Congress and by the Medicare Payment Advisory Commission.