Medicare

Constrained optimization empirically derived social risk weights that gave equal influence to subgroup performance by dual eligibility and disability in overall contract scores.

This study links county-level social vulnerability to variation in Medicare Advantage prior authorization policies.

A July AJMC study found metastatic cancer diagnoses significantly increase Medicaid spending, highlighting the potential budget benefits of earlier detection.

New cancer drugs reached patients fastest, but overall access timelines remained lengthy across the US, France, Germany, and Switzerland.

CMS value-based payment models underrepresent Black, Hispanic, dual-eligible, and disadvantaged Medicare beneficiaries compared with the broader population.

Dermatologists spend 13 hours weekly on prior authorization as health plans tout an 11% reduction in requests.

Many rural and urban areas lack preferred pharmacies. Where preferred pharmacies were available, distances were generally minimal relative to the cost savings; however, rural-urban disparities persist.

CMS proposes major Medicare reforms to ACOs, physician pay, and MIPS reporting, aiming to reward outcomes over service volume by 2029.

Existing rebates and manufacturers' gaming risk may limit these gains.

This study examines how key players in managed care drive postacute home health referrals, identifying tensions, limited patient involvement, and barriers to care coordination.

Medicare Advantage (MA) beneficiaries had similar optimal cancer treatment use and treatment timing as traditional Medicare (TM), with lower anticipated costs.

Robert Kratzke, MD, discusses how biomarker testing mandates and faster sequencing can improve access to precision lung cancer care.

Stefanie Houseknecht, PharmD, discusses patient education, financial barriers, and pharmacy's expanding role in precision lung cancer care.

COVID-19-related Medicare spending and health care use declined after acute infection, with minimal excess costs by weeks 13 to 40 after diagnosis.

Expanded FDA indications and Medicare coverage of semaglutide for cardiovascular risk prevention were associated with increased Wegovy utilization, most notably through Medicare Part D.

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.