Medicare

People aging with HIV have more drug–drug interactions compared with those without HIV, according to results of an observational study.

The authors of this study examined expense reports to understand how participants in Medicare’s Accountable Care Organization Investment Model spent to achieve program goals.

It’s right to acknowledge that dental, hearing, and vision are important for total health care for Medicare beneficiaries, said Melissa Andel, MPP, vice president of health policy at CommonHealth Solutions.

The announcement of a "strategic refresh" for payment models under the Center for Medicare and Medicaid Innovation offered no details on what practices should expect when the Oncology Care Model (OCM) expires in 2022.

A report from the Centers for Medicare and Medicaid Innovation confirmed that practices within the US Oncology Network and Tennessee Oncology participating in the Oncology Care Model (OCM) program have contributed significant savings to the agency.

To guide its growth and its forays into home-based care, SCAN Group recently announced a Diversification Advisory Council, a group of 6 leaders from inside and outside health care with expertise in health care technology, reimbursement, and consumer engagement.

Appeals court affirms decision to place a hold on the Biden administration's COVID-19 vaccine mandate for large employers; rising Medicare premiums linked with controversial Alzheimer drug; 3 states expand COVID-19 booster shot eligibility to all adults.

COVID-19 prompted CMS to make major adjustments to the Medicare Advantage (MA) Star Ratings System, resulting in better-than-average performance for nearly all plans. However, these changes were temporary, and MA plans will have to reset their strategies for 2023 and beyond.

Michael E. Chernew, PhD, co-editor-in-chief of The American Journal of Managed Care®, discussed cost and sustainability issues specific to commercial insurance, Medicare, and Medicaid at the National Alliance 2021 Annual Forum held in a hybrid format in Washington, DC.

The share of patients meeting the definition of polypharmacy for the condition of overactive bladder declined from 2006 to 2017, but the phenomenon was still prevalent in women and patients in nursing homes, according to a recent study.

On this episode of Managed Care Cast, we speak with one of the coauthors of a study that illustrates the changing outpatient trends in a primary care provider’s (PCP) panel of Medicare patients and how that translates to an increased workload for primary care doctors.

Multiple comorbidities and medications are prevalent in older cancer populations, who may benefit from structured medication reviews by specialist geriatricians.

The annual report, from the American Cancer Society, National Cancer Institute, the CDC, and the North American Association of Central Cancer Registries, details US cancer trends.

Physician and health policy advocates praised the emphasis on streamlining models and ending silos, but practices that invested in the Oncology Care Model (OCM) await key details.

Medicare Advantage enrollees, particularly those with lower out-of-network benefits, may have restricted access to top-ranked hospitals for complex cancer care compared with traditional Medicare enrollees.

Ahead of Medicare open enrollment, which starts October 15, CMS released its annual report of which Medicare Advantage (MA) and Part D drug plans achieved 5-star ratings.

The 2022 performance year’s Star Ratings require Medicare Advantage plans to take a more significant role in preventing readmissions.

The Congressional Budget Office (CBO) estimated that adding dental, vision, and hearing benefits would increase Medicare’s direct spending, but the American Dental Association (ADA) is claiming reimbursement will not be enough to cover these costs

One company received approximately $3.7 billion while enrolling only 22% of Medicare Advantage customers.

The current study found that those prescribed potentially inappropriate medications were actually less likely to revisit the emergency department within 30 days, in contrast to prior work.

The study found that BPCI Model 3, which held postacute facilities accountable for costs of care, was not associated with payment reductions or changes in other quality and selection metrics among skilled nursing facilities.

The administration said it would make the results of its drug price negotiations with manufacturers, as well as its approach to value-based care models, open to a variety of payers.

On January 1, CMS implemented the Hospital Price Transparency final rule, but by July, it was clear that many hospitals were noncompliant. Even with a proposed rule for penalties, requirements still only fall on certain parts of the health care industry.

Polypharmacy may be raising the risk of inappropriate medication use, and avoiding this is crucial.

The use of potentially inappropriate medications (PIMs) by older adults appeared to be linked to a greater risk of frailty, although the researchers said further work is needed.