Medicare

Under preferred pharmacy networks, unsubsidized Part D beneficiaries faced substantial incentives and moderately switched toward preferred pharmacies, whereas subsidized beneficiaries were insulated and demonstrated little switching.

A health system transformational leadership framework and management system made visible and eliminated defects in value and was associated with reduced annual Medicare expenditures and increased quality between 2017 and 2020.

Health plans use data to decide on quality improvement initiatives. Having a dashboard that characterizes how equitably plans are serving their enrollees would promote health equity.

Over the next 18 to 24 months, Humana is exiting the commercial health plan business to focus on government-funded programs, like Medicare Advantage, and specialty businesses.

Coverage from the Institute for Value-Based Medicine® session with Astera Cancer Care in Edison, New Jersey, held November 3, 2022.

Improved outcomes associated with fidaxomicin compared with vancomycin suggest benefits from its greater use in Medicare patients, although uptake remains low despite its recommended use.

A panel discussion at the 70th Annual Roy A. Bowers Pharmaceutical Conference addressed recent care delivery initiatives in New Jersey that aim to address health inequities and other population health concerns.

Medication risk scores analyze an individual’s medication regimen to look for the potential for simultaneous, multi-drug interactions, which can cause adverse drug events and other medication-related harms.

Medication adherence is not the only area to focus on for older adults who have Medicare coverage. Optimizing treatment and medication access are also important.

This study attempts to identify the sources of the significant 2.5-fold variation found in home health expenditures, a possible indicator of inefficiency and waste.

Four large Medicare Advantage insurers manage access to expensive physician-administered drugs with a combination of prior authorization, step therapy, and Part D formulary design.

Social determinants of health present many health-related challenges for Medicare Advantage (MA) plan members, something these plans are looking to overcome by diversifying their service offerings.

Simplified treatments and patient-specific and systemic interventions can reduce nonadherence in patients.

Today, CMS unveiled its plan for a successor to the Oncology Care Model (OCM), its ambitious foray into value-based care delivery that has been credited with changing the landscape for patients with cancer, even if it received mixed reviews on achieving savings in its early years.

Oncologist and health tech veteran Bobby Green, MD, who practiced for 17 years in Florida and was previously with Flatiron, is now Thyme Care’s president and chief medical officer. He has relocated to Nashville, Tennessee, to launch Thyme Care.

Community engagement, investment, and quality metrics were spotlighted as potential solutions to address health inequities affecting marginalized communities nationwide.

A new report from the Office of Inspector General (OIG) of HHS suggests the accuracy of Medicare’s race and ethnicity data will only diminish over time, unless changes are implemented.

The Supreme Court has ruled that HHS' decision to lower reimbursement rates to hospitals so that those in the 340B program received reduced rates because they received discounted drugs was unlawful.

Influenza vaccine uptake improved among Medicare Advantage enrollees when influenza vaccination was introduced as a performance metric in Medicare star ratings and accompanying bonus payments.

The analysis of adults with low income enrolled in Medicare Advantage (MA) or traditional Medicare (TM) indicates that increasing enrollment in MA may not advance health equity in the Medicare program.

The Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model provides the next great opportunity in moving a health care payment system toward paying for value and rewarding preventive care and keeping patients healthy.

Investigators in Spain tested whether the tool would work in elderly patients in the primary care setting.

It is still unknown whether the relationship between polypharmacy and malnutrition is bidirectional and authors could not determine causation.

The tools we need to achieve long-term stability for community providers and ensure better outcomes for rural Americans are available, and CMS can help us utilize them.

Results of a secondary analysis of a randomized controlled trial emphasize the risks of polypharmacy with regard to prescription and nonprescription medications.

The report details totals paid to hospitals by private insurers and providers and compares the sums with a Medicare benchmark.

President Joe Biden announces plans to improve baby formula shortages; Massachusetts reaches settlement with veterans who contracted COVID-19 in long-term care facility; a quarter of Medicare beneficiaries were harmed from hospital stays in 2018.

UPMC Health Plan, RxAnte, and Mosaic Pharmacy Services outlined how they are operating a value-based pharmacy care management program within Community HealthChoices, Pennsylvania’s managed Medicaid long-term services and supports (LTSS) program, at a recent conference.