Payers

This article explores the impact of payment models (fee for service vs salary based) on practice patterns, including wait times and care for patients with chronic diseases.

Survey results demonstrate an opportunity to incorporate good practices for high-deductible health plans that can help enrollees maximize value and better navigate their benefits and treatment options.

On this episode of Managed Care Cast, Marcelina Jasmine Silva, DO, discusses her recent work on prolonged cessation of chronic opioid analgesic therapy among patients with chronic noncancer pain.

An editorial in response to the editor-in-chief’s December 2021 letter describes how a payer continues to push the limits of innovation through shared learnings and collaboration.

The economic burden of rare diseases based on direct, indirect, and mortality-related costs is 10 times greater than the burden for mass market diseases, such as diabetes and cardiovascular disease, and this burden increases when no treatment is available.

A new lawsuit aims to block a $13 billion health insurance acquisition; the CDC is expected to release updated mask guidelines; the European Medicines Agency supports boosters among teenagers for COVID-19.

During an AHIP webinar, Mark Hamelburg, senior vice president of federal programs at AHIP, explained the shifts coming to Medicare and Medicaid when the public health emergency finally ends.

The redesigned accountable care organization (ACO) model is called the Realizing Equity, Access, and Community Health model and is scheduled to begin in 2023.

Jacob Sands, MD, who leads the small cell lung cancer research program at Dana-Farber Cancer Institute, speaks with The American Journal of Managed Care (AJMC®) about the need for more patients who meet the criteria for lung screening to catch cancer before it reaches an advanced stage.

AHIP released a report looking at the price markups for 10 drugs that can be delivered more affordably through specialty pharmacies, including 3 drugs with multiple biosimilars available.

The president’s aim is a 50% reduction in age-adjusted cancer deaths by 2047. This goal seems audacious, but it is likely achievable.

AHIP has released a new set of privacy principles that reaffirm the health insurance provider industry’s commitment to developing privacy, confidentiality, and cybersecurity practices to protect personal health information.

By making diligent compliance efforts a priority in the years ahead, health plans can shore up existing processes to achieve financial success and ensure risk adjustment as regulatory bodies take aim at organizational missteps.

Lessons from the early days of chimeric antigen receptor (CAR) T-cell therapy remain fresh as Kite Pharma prepares for the FDA to act on its supplemental biologics license application for use of axi-cel as second-line therapy in relapsed or refractory large B-cell lymphoma. A target action date is set for April 1, 2022.

Geoffrey Boyce, CEO of Array Behavioral Care, explains how behavioral health care differs between in-person and telehealth care.

Leadership from the Innovation & Value Initiative, along with experts in mental health and a representative from employer purchasing group, discuss strategies for creating value-based decisions in mental health coverage.

Leadership from the Innovation & Value Initiative, along with experts in mental health and a representative from employer purchasing group, discuss strategies for creating value-based decisions in mental health coverage.

Leadership from the Innovation & Value Initiative, along with experts in mental health and a representative from employer purchasing group, discuss strategies for creating value-based decisions in mental health coverage.

Leadership from the Innovation & Value Initiative, along with experts in mental health and a representative from employer purchasing group, discuss strategies for creating value-based decisions in mental health coverage.

Cardinal Health's report, “2022 Biosimilars Report: The U.S. Journey and Path Ahead,” outlines how biosimilars will move beyond their comfort zones in oncology and rheumatology and more boldly into therapeutic areas such as ophthalmology and diabetes care.

This study compares the impact of the 3 different out-of-pocket maximums proposed in Congress and by the Medicare Payment Advisory Commission.

This retrospective study using administrative claims data examining health care resource utilization (HCRU) found that in the months before a diagnosis of eosinophilic esophagitis (EoE), other diseases were more commonly diagnosed.

Medicaid managed care utilization review data for mental health services were analyzed for the calendar years 2017 and 2018. These data indicate low rates of utilization review denials for both inpatient and outpatient mental health services.

The rise in popularity of genetic testing brings along a myriad of challenges ranging from concerns on data privacy to insurance coverage, but, when utilized correctly, it could mark a step forward for significant advancements in individual and population health.