We've rounded up the top 5 articles of July, including changes being touted for the 340B program and a global report urging countries to think seriously about planning for high quality care.
July saw a slew of policy and quality of care headlines, with changes being touted for the 340B program, halts to risk adjustment payments, and a global report urging countries to think seriously about planning for high quality care.
The American Journal of Managed Care® has rounded up our top 5 most read news stories of the month:
Novo Nordisk Funds Obesity Fellows Program to Address Gaps in Physician Education
With rising obesity rates worldwide, physician education has struggled to keep pace. To address this gap, Novo Nordisk announced this month that it will work with the Obesity Society and the Obesity Medicine Association to create the Obesity Medicine Fellowship Development Program.
The program will bring the number of fellowship programs in the country to 20, up from just 5 that exist currently. Novo Nordisk noted the importance of educating a new generation of young physicians to treat obesity itself and not just the complications that arise from the condition.
Read more about the program here.
Azar Tells 340B Meeting “Change Is Coming” After Trump Tweets About Drug Prices
Early in the month, HHS Secretary Alex Azar gave a keynote speech about drug prices at the 340B Coalition Summer Conference, where he also discussed changes to the program. Shortly before he was set to speak, President Trump tweeted out about drug prices, singling out Pfizer about their price hikes.
During his speech, Azar highlighted 2 reforms he said are needed for 340B: more transparency about how discounts are being used and reducing the gap between discounted prices and the reimbursement provided, particularly by government programs.
Read more about the speech here.
340B Health Says Changing Hospital Eligibility Will Slash Program
A day after Azar gave his speech, 340B health released a report showing that more than half of disproportionate share hospitals (DSHs) would lose eligibility under a Congressional proposal on the program. The analysis found that 573 of the 1115 DSHs currently in the program would be dropped from 340B and would no longer be eligible for the drug price discounts provided by the program.
In 5 states—Idaho, North Dakota, South Dakota, Utah, and Vermont—all DSHs in the program would lose their eligibility.
See more findings from the report here.
Pause in Risk Adjustment Payments Announced, CMS Blames District Court’s Decision
Blaming a recent decision by the US District Court for the District of New Mexico, CMS announced that it had halted collections or payments under the risk adjustment program, including amounts for the 2017 benefit year.
The program was finalized in 2013 by CMS and includes the use of a statewide average premium in order to maintain a budget neutral program. The provision created a “risk pool” by participating health insurers in order to help balance the costs of insurers who have high-risk enrollees.
The adjustment payments have since been reinstated.
Read more about the decision here.
Global Report Calls for Urgent Interventions to Improve Healthcare Quality
The Organisation for Economic Co-operation and Development, the World Health Organization, and the Work Bank released a report this month urging governments around the globe to think about planning for high quality care, noting that poor quality health services are holding back progress in countries of all income levels.
Findings in the report include: around 15% of hospital expenditures in high-income countries are due to mistakes in care or patients becoming infected while in hospitals, and suboptimal care is common in both private and public primary care healthcare facilities in several low- and middle-income countries.
See more of the report’s findings here.
CMS released a final rule to help patients obtain Children’s Health Insurance Program (CHIP) coverage and issued a proposed rule to update Medicare payment policies and rates for inpatient rehabilitation facilities; debate over if gift card incentives are acceptable in health care marketing.
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Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
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A global AIDS program that was in limbo for months got temporary relief after congressional negotiators agreed to a 1-year renewal in the next government funding package; the outcome of the November presidential election could determine the state of fetal tissue research in the US; federal officials and industry executives failed to make improvements that stop hacking attacks.
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Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
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Fragmented Payer System, Vulnerable Supply Chain Among Threats to Accessing Essential Medicines
March 13th 2024During a session of the 2024 V-BID Summit, panelists Stacie Dusetzina, PhD, and Inma Hernandez, PharmD, PhD, discussed how access to essential medications is curtailed not just by the longstanding complexities of insurance design but also by emerging threats such as supply chain weaknesses and cyberattacks.
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Most private health insurers have yet to publish criteria for when they will cover postpartum depression drug, zuranolone; state lawmakers are increasingly opposing health care mergers that they believe do not serve the public interest; Medicaid extensions made in 2021 led to a 40% decline in postpartum lack of insurance.
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