Reimbursement

The top content published in The American Journal of Accountable Care® (AJAC) covered redesigning health care, value-based care, and novel payment models, like the ACO REACH model.

The most-read articles related to our Strategic Alliance Partnership (SAP) program focused on behavioral health, oncology care, and partner news.

The combined resources of CareOregon and SCAN Group’s health plan and care delivery subsidiaries, operating under the HealthRight umbrella, will have revenues of $6.8 billion and will serve nearly 800,000 health plan members.

Coverage from the first day of the inaugural OneOncology Physician Leadership Conference, held November 11-13, 2022, in Nashville, Tennessee.

Coverage from the Community Oncology Alliance Payer Exchange Summit, held in Tyson's Corner, Virginia, October 24-25, 2022.

A national survey demonstrated differences in organizational capacity between hospitals participating in Medicare bundled payment programs and those coparticipating in both Medicare and commercial bundled payment programs.

Impending cuts to Medicare physician services could have an overwhelmingly negative impact on millions of older patients and individuals with disabilities across the country.

In a recent study, it was found that individuals with public health insurance had worse health competence beliefs, reducing transition goals, expectations, and beliefs.

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

The groups who told researchers they would be more likely to skip additional testing had lower levels of income or education and were more likely to be on Medicaid or be uninsured, among other factors.

A survey conducted by the Health Care Payment Learning and Action Network found that “more plans are using incentives in value-based care arrangements to improve health equity.”

While those with Medicaid insurance were more likely to have an insurance transition before or after giving birth, those with private insurance were also found to have insurance changes.

The 2023 Physician Fee Schedule final rule was released and swiftly drew condemnations from physician leaders because of a 4.5% cut to reimbursement.

Joseph Alvarnas, MD, vice president of government affairs at City of Hope and chief clinical adviser of AccessHope in Duarte, California, discusses the recently passed Cancer Care Equity Act in California that provides access to clinical trials and advanced care for Medi-Cal beneficiaries.

The quest to deliver better cancer care—with better outcomes and patient experience—is not a one-size-fits-all journey, as seen in panels during the Community Oncology Alliance (COA) Payer Exchange Summit, held in Tyson’s Corner, Virginia.

The new law will expand access for Medi-Cal patients who receive a complex cancer diagnosis and represents a critical first step in fulfilling the promise of the California Cancer Patients Bill of Rights, a resolution adopted by the legislature in 2021.

Coverage from the Minnesota meeting of the Institute for Value-Based Medicine, chaired by Rajini Katipamula-Malisetti, MD, vice president of medical oncology at Minnesota Oncology.

While a majority of national lives are covered by vertically integrated insurers, the proportion varies widely at the state level from as low as 6% to as high as 97% of covered lives, according to a new American Medical Association (AMA) report about competition in the pharmacy benefit manager (PBM) sector and insurance.

In a recent opinion published in JAMA, health policy researchers reviewed the advantages and disadvantages of prior authorization in Medicare Advantage (MA) to identify key areas that need improvement.

Enrollees who join Medicare Advantage undergo significant turnover in the years following enrollment.

The Enhancing Oncology Model (EOM) will be the successor to the Oncology Care Model.

The topline results showed the phase 3 trial met both the primary endpoint and all secondary endpoints.

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

"No matter where you go, there you are." Buckaroo Banzai

Survey responses of 320 US hospitals highlight the dire consequences of the COVID-19 pandemic on facilities and point to a future of ongoing financial and staffing challenges.