Medicare

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.

Coverage, equity, and value-based payments are critical areas of focus for the Biden administration’s health care agenda leading up to the midterm elections, according to 3 experts from Avalere.

Alexis Garcia, PharmD, senior director of business development at Tabula Rasa HealthCare, explains the importance of up-to-date data when implementing medication therapy management programs.

The opening plenary of the Spring 2022 National Association of Accountable Care Organizations conference focused on addressing health equity and improving synergy between CMS and ACOs.

Investigators have found that Medicare Advantage plans were denying care that should be covered for tens of thousands of people; Anthony Fauci, MD, claimed that the United States is in the transition phase of the pandemic; measles cases rose by 79% in 2022.

Alexis Garcia, PharmD, senior director of business development at Tabula Rasa HealthCare, outlines how cytochrome P450 enzymes can impact medication efficacy in patients taking multiple drugs.

Addressing the opioid crisis will require a strong, multifaceted approach that includes efforts to prevent addiction before it begins. By passing the NOPAIN Act, Congress can seize the win-win opportunity to reduce unnecessary exposure to opioids, while protecting—and expanding—a patient’s right to choose their own care.

Coverage from the Association of Community Cancer Centers 2022 Annual Meeting and Cancer Center Business Summit, held in Washington, DC, March 2-4.

In Medicaid, delivering care needs to address the lack of resources and other socioeconomic factors that impact patients, said Steve Evans, MD, chief medical officer of SilverSummit at Centene.

Researchers investigated polypharmacy incidence in one of the fastest-aging regions in Spain.

Stephen Schleicher, MD, MBA, chief medical officer of Tennessee Oncology, talks about lessons learned from the Oncology Care Model (OCM) and Medicare that are being used to innovate toward value-based care.

Panelists touted the ability to pay for items and repairs to keep Medicare beneficiaries healthier at home, avoiding potentially costly hospitalizations and complications.

Without addressing rising costs, the problem of underinsurance in health care coverage will remain, said panelists at the 2022 V-BID Summit, discussing some of the smaller steps that are being proposed or are already in place to try to ease the financial burden.

At the 2022 V-BID Summit, hosted by the Center for Value-Based Insurance Design at the University of Michigan, representatives of CMS and the Commonwealth Fund gave an update on the efforts to monitor, evaluate, and improve health equity in the United States.

Many of the accountable care organization (ACO) models are being tested to find changes to make to the Medicare Shared Savings Program, but there is a general problem with short-lived models ending and being replaced by new ones, said Michael Chernew, PhD.

Mitigating the high cost of prescription drugs is a win-win to address the complex, multipronged problem of getting patients to take their medications as advised.

New research published in Health Affairs details the rates of specialty medication noninitiation among Medicare Part D beneficiaries.

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.