The Centers for Medicare and Medicaid Services wants hospitals to find ways to keep patients from returning to the hospital, and the agency has created rewards and punishments in pursuit of this goal. A study in The American Journal of Managed Care is just one of a pair of recent clinical trials that finds readmissions may be beyond some hospitals' control, and policymakers might need to rethink their approach.
With a shortage of primary care physicians and the costs that come with a trip to the emergency room, can retail clinics fill the gap? A study published today in The American Journal of Managed Care finds they can, offering care that is just as good or better for common ailments like ear infections or strep throat.
Immuno-oncology, in which the patient's own immune system is engaged to fight cancer, has shown potential but also presents challenges, including the cost of treatment. Last month, The American Journal of Managed Care convened an expert panel to discuss the value of current therapies and how payers make policy calls
Fictional teens with cancer may be suddenly popular in film and TV, but they are hard to find in the one place where they are most needed: in clinical trials to find drugs to save their lives. A story in the new issue of Evidence-Based Oncology, a publication of The American Journal of Managed Care, examines this problem.
Both Medicare and commercial insurers have raised the bar for molecular diagnostic companies, requiring them to show clinical utility to receive reimbursement for cellular tests designed to guide treatment in cancer, rheumatoid arthritis, and other diseases. An important new article in The American Journal of Managed Care reviews cases from a top Medicare contractor and outlines how to build the evidence to meet today's standards.
The accountable care organization, or ACO, can be a mechanism for employers to achieve healthcare savings, according to a just-published article in The American Journal of Accountable Care, the publication of The American Journal of Managed Care dedicated to healthcare reform.
The American Journal of Managed Care brings the next meeting of its ACO and Emerging Healthcare Delivery Coalition to the Miami Marriott Biscayne Bay October 16-17, 2014, where participants can learn and share best practices in an effort to improve overall patient outcomes.
For most of the spring, news on the Affordable Care Act was all about the numbers, and to much surprise enrollment surpassed the magical 7 million mark. Now, Patricia Salber, MD, and Christobel Selecky report in The American Journal of Accountable Care what having coverage means, whether it makes a difference, and what are the unanswered questions.
Putting various branded drugs in "non-preferred" tiers and charging higher copays for them has been used for a number of years to steer consumers to use less costly medicines by giving them "skin in the game." But authors writing for The American Journal of Managed Care are alarmed by the policies of some insurers that now have designated entire classes of widely used generic drugs "non-preferred," leaving many patients without any low-cost treatment options for their diseases.
With flu vaccination season upon us, the question arises, shot or nasal spray? For children, a nasal spray might be an easier option, and a new study just published in The American Journal of Pharmacy Benefits shows that if a moderate to harsh flu season is expected, it's a cost-effective choice, too.
Of the many elements in healthcare reform, one essential has been overlooked: helping patients pick the doctor who is right for them. In an commentary appearing in Evidence-Based Oncology, a publication of The American Journal of Managed Care, Brian W. Powers and Sachin H. Jain, MD, MBA, outline a framework for accountable physician selection, noting that the higher the stakes, the more important this process.
Status in the States, the series in The American Journal of Managed Care's news publication, Evidence-Based Oncology, took a look at cancer care in New Jersey two years after a high-profile reorganization of the state's higher education system. The overhaul has improved collaboration within research units and with nearby pharmaceutical giants, and a new medical school reports a bumper crop of applicants.
Balancing health care tailored to the individual with a modern reimbursement scheme based on population health is the challenge that awaits the nation's healthcare system. Based on a study in The American Journal of Managed Care, it can be done, even among patients like seniors who use more healthcare than most.
Evidence-Based Oncology, a news publication of The American Journal of Managed Care, this week published coverage from the 50th Annual Meeting of the American Society of Clinical Oncology. The regular issue of Evidence-Based Oncology, published with the ASCO special issue, features a statement on ASCO's value initiative from Chief Medical Officer Richard L. Schilsky, MD.
While the problem of childhood obesity has received attention, the connections among childhood obesity and hypertension, and their associated costs, have received less scrutiny. A new study in The American Journal of Managed Care estimates healthcare costs related to high blood pressure and body mass index in children and teens.
The American Journal of Managed Care's ACO Coalition, now at 100 members, gives healthcare leaders a way to share ideas for improving population health. A recent Web-based exchange involving Mount Sinai ACO's diabetes strategy showed how the initiative is working to spread good ideas across the country.
Hospice has long been seen as a solution to achieving both quality of care and cost control at the end of life. The arrival of Medicare Part D has raised concerns that some drugs are paid for twice, but efforts to fix the problem will shift some burdens on to Part D plans, according to The American Journal of Pharmacy Benefits.
Bringing stakeholders together is the mission of AJMCLive, the meeting series of The American Journal of Managed Care. It's reflected in the two keynote speakers for Patient-Centered Oncology Care on Nov. 14: a leader of physicians, Peter Yu, MD, the current president of ASCO; and a leader among payers, Burton VanderLaan, MD, FACP, medical director of Priority Health.
A study just published in The American Journal of Managed Care examined how benefit design differences affected seniors who received prescription coverage through Medicare Advantage compared with a stand-alone Medicare drug plan. The review showed that integrating drug coverage with medical care resulted in fewer barriers to name-brand drugs, with lower copayments.
Not every patient responds the same way to the same treatment, yet healthcare is moving toward a system based on population health. How can researchers, health plans, and providers respond? This month in The American Journal of Managed Care, Jennifer S. Graff, PharmD, and co-authors call for an approach that identifies when differences in patient responses are mostly like to matter, and offering greater flexibility when the patient's health is most at stake.
Dr. Michael Bell, previously announced as the keynote speaker for the September 25-26 live meeting hosted by The American Journal of Managed Care, this weekend discussed his role in overhauling lab safety at the Centers for Disease Control and Prevention in Atlanta. Attendees at AJMCLive's Atlanta conference, "Value-Based Decision-Making in Infectious Disease," will have the chance to hear Dr. Bell discuss the prevention of hospital-acquired infections.
A study in The American Journal of Managed Care finds Medicaid prior authorization requirements for newer antipsychotic drugs are associated with an increased likelihood that individuals with schizophrenia will be incarcerated for nonviolent drug offenses. The study comes amid media scrutiny over whether cutbacks in mental health actually save money, when other costs are taken into account.
The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, hosted a recent Web-based session that featured three presentations on aspects of the transition to value-based care: why barriers to change persist, what steps one ACO is taking to drive better health, and why a "patient-centered" method of picking a doctor makes sense.
Clinical care pathways in oncology have gained notice with WellPoint's announcement of a $350 per patient, per month incentive. As WellPoint's effort starts this week, The American Journal of Managed Care convened a panel with the insurer's medical director for oncology care, ASCO President Peter Paul Yu, MD, and two other voices from the payer and provider realms to discuss how pathways are changing cancer care.
Specialty pharmaceuticals are changing the lives of patients with cancer and chronic conditions, but their high cost and increased used has drawn the scrutiny of payers. A review in this month's issue of The American Journal of Managed Care, which examined studies involving therapies for rheumatoid arthritis, multiple sclerosis, and breast cancer, found that when these drugs are used with the right patients, the value for patients is high.
The American Journal of Managed Care will host a two-day event September 25-26, 2014, in Atlanta taking on some of healthcare's biggest challenges in infectious disease, including HIV, MERS and how to pay for new therapies for hepatitis C. Giving the keynote address will be Michael Bell, MD, deputy director of the Centers for Disease Control and Prevention's Division of Healthcare Quality Promotion.
Geisinger Health System's use of a diabetes care system among high-risk patients produced lower risks of myocardial infarction, stroke and retinopathy over a three-year period, according to a study in The American Journal of Managed Care. Best of all, most of the benefit accrued in the first year of care.
The June issue of The American Journal of Accountable Care discusses the potential of "connected care," to improve access and cut costs, and proves how what patients say will matter when measuring quality. The publication, from The American Journal of Managed Care, is devoted to research and commentary on healthcare reform.
The American Journal of Managed Care followed up the first meeting of its ACO and Emerging Healthcare Delivery Coalition with its first interactive conference call, which was open to all members. Anthony Slonim, MD, DrPH, a Coalition co-chair who on July 1 will become president and CEO at Renown Health in Reno, Nev., moderated the roundtable discussion.
The American Journal of Managed Care will host a two-day event September 25-26, 2014, to take on some of healthcare's biggest challenges: Treatments that cure hepatitis C are making news but upending balance sheets. A recent recommendation seeks preventive therapy to stop new cases of HIV. Hospitals and public health officials are grappling with how to prevent the spread of MERS. Only AJMC will bring payers, clinicians, policy leaders, and pharmaceutical representatives together to share ideas.
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