Medicare

Future Medicare Part D models should consider alternative strategies to improve cost-related non-adherence.

Larger primary care practices in downside risk–only payment models and capitation saw the highest telemedicine utilization rates by their patients enrolled in Medicare Advantage (MA) plans.

High-tier generic drug placement in Medicare Part D has increased over time, but it may be related to a drug’s clinical profile and availability of substitutes rather than preferred brand-name drug coverage.

A string of controversies surrounding the approval of Biogen's Alzheimer disease drug aducanumab (Aduhelm) has not only called into question the independent nature of the FDA, but puts both providers and patients in a challenging position when it comes to deciding whether or not to prescribe or take the treatment.

On this episode of Managed Care Cast, Charlie Wray, DO, MS, an assistant professor of medicine at the University of California San Francisco, outlines the findings of a paper he coauthored which assessed Americans' experiences with their insurance providers.

Medicare Advantage plans may deliver care more efficiently to food-insecure beneficiaries than traditional Medicare, but they are not better at reducing food insecurity.

PBMs keep copays higher on the same generic drugs.

The Medicare Access and CHIP Reauthorization Act (MACRA) needs to be reimagined get back on track and to live up to its promise to incentivize value-based care.

Abstracts cover the cost of cancer-related diarrhea, 30-day readmission rates, and how perceptions of the likelihood of survival affect end-of-life care.

A pharmacist-led collaborative medication management service reduced problems associated with polypharmacy in older adults with chronic kidney disease (CKD).

The head of AHIP sat down with a senator and 3 health care executives for a conversation about payment and access issues at the organization's 2021 Institute and Expo Online.

The Medicare Payment Advisory Commission (MedPAC) suggested several changes to Medicare Advantage (MA) plan benchmark calculations, with the intent to generate yield savings for Medicare, and urged CMS to streamline alternative payment model (APMs) where it can.

In a 7 to 2 decision, the Supreme Court ruled Thursday that the Affordable Care Act (ACA) will stand, as plaintiffs seeking to declare the law unconstitutional did not have standing.

The researchers created a model that simulated what would happen when health systems and providers began working together in Medicare accountable care organizations (ACOs) in arrangements that did not extend to outright mergers or acquisitions.

Davey Daniel, MD, hematology/medical oncology specialist, Tennessee Oncology, discusses findings of an abstract presented at ASCO 2021 showing a lower total cost of care paid by Medicare for episodes of care for patients in the Oncology Care Model (OCM) enrolled in clinical trials vs those receiving routine care.

Although most Medicare Part D plans cover guideline-recommended outpatient chronic obstructive pulmonary disease (COPD) inhalers, the utilization controls applied to these therapies vary by plan type.

In a review of literature published since the Affordable Care Act’s passage, more than half of analyses find that Medicare Advantage outperforms traditional Medicare on quality, health, and cost outcomes.

To be sustainable and successful, Medicare alternative payment models (APMs) have to attract and retain high and low performers. That requires a different approach to pricing and evaluation.

During her opening plenary at the NAACOS Spring 2021 Conference, Liz Fowler, PhD, JD, deputy administrator and director of the Center of Medicare and Medicaid Innovation, highlighted how the center is taking a pause to reassess its models and what is coming next.

Patients enrolled in Medicare Advantage had better outcomes and lower cost following skilled nursing facility (SNF) discharge than patients enrolled in traditional fee-for-service Medicare.

In the debate of administrative expenses for public and private Medicare, we show incompatibility and extend the analysis to income, benefits, and loss ratio comparisons.

Medicare Advantage plans have a clear opportunity to improve quality by delivering more comprehensive, timely medication reconciliation services to recently discharged members.