Payers

The Medicare Shared Savings Program (MSSP) has seen its growth slow, but CMS has an opportunity to act on proposals that would address benchmarking and more fairly allocate savings to accountable care organizations in the program.

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.

Psychographics is a way of categorizing someone based on their everyday behaviors using data that are collected every time they go to the store or post on social media, said Robert Groves, MD, executive vice president and chief medical officer at Banner | Aetna. In health care, psychographics can be used to positively influence someone to their benefit.

Migraines plague some 35 million Americans, the majority of them women in their 30s and 40s, and disabling pain and symptoms are linked to lost productivity at work, school, and home. On this episode of Managed Care Cast, we bring you an excerpt of an interview with a headache specialist about the extra challenges for patients and providers during the pandemic.

The Oncology Care Model (OCM) was a great program that led to practice transformation and improved patient care, but there needs to be a way to address the high cost of cancer therapies, said Marcus Neubauer, MD, chief medical officer of the US Oncology Network.

Anemia, fevers, dehydration, and other side effects from cancer treatment are all candidates for targeting with predictive analytics in an effort to care for patients are home instead of the hospital, said Elizabeth Kwo, MD, MBA, MPH, the deputy chief clinical officer at Anthem BCBS, and a speaker at the 10th anniversary of Patient-Centered Oncology Care® conference.

For patients with heart failure and cardiovascular disease, high intensity interval training has a greater positive effect on cardiorespiratory fitness than moderate intensity continuous training.

With the Oncology Care Model (OCM) slated to end in 2022, the successor model is still not in place. According to panelists, there is likely going to be a gap after OCM ends and the new model begins, but more importantly, practices should prepare for the new model to be mandatory.

The Oncology Care Model (OCM) is scheduled to end in just a few months, but with no new model in place to succeed it and practices still struggling during the pandemic, OCM should continue in its current form, said Kashyap Patel, MD, CEO of Carolina Blood and Cancer Care Associations, current president of the Community Oncology Alliance, and co-chair of Patient-Centered Oncology Care®.

In the opening sessions at the Patient-Centered Oncology Care® conference, held September 23-24 both virtually and in Nashville, Tennessee, speakers focused on addressing disparities by getting involved and engaged with the community.

Having the option of receiving care in their community instead of a large hospital located hours away is not only a benefit for many patients, but research is showing community oncology practices are a low-cost, high-quality provider of care, explained Jeff Patton, MD, executive chairman of Tennessee Oncology and CEO of OneOncology.

On the opening day of Patient-Centered Oncology Care, Robert Groves, MD, of Banner | Aetna, discussed the use of psychographics to predict health behavior in local populations.

Remote patient monitoring includes urgent care uses, long-term monitoring to help keep patients with cancer out of the hospital by monitoring the effects of oncology treatment at home, and even voice monitoring to check for altered mental status, said Elizabeth Kwo, MD, MBA, MPH, the deputy chief clinical officer at Anthem BCBS, and a speaker at the 10th anniversary of Patient-Centered Oncology Care® conference.

On this episode of Managed Care Cast, we address how delays in routine care and other aspects of the pandemic are affecting payer organizations today, and how technology innovations like natural language processing can work to empower key initiatives in population health and beyond.

New data from the CREDENCE trial shows that the sodium glucose co-transporter 2 (SGLT2) inhibitor canagliflozin may reduce hyperkalemia risk in people with type 2 diabetes and chronic kidney disease who are using RAAS inhibitors.

Considering the personal, societal, and economic toll of treatment-resistant depression, we must make it easier to access medicines and care that provide value, both for the patient and for the health care system.

The advisory committee voted against COVID-19 vaccine booster shots for individuals 16 years and older, but unanimously voted for booster shots for people 65 years and older or who are at high risk of severe COVID-19.

At the 10th anniversary meeting of Patient-Centered Oncology Care®, sessions will cover reducing disparities in cancer care, bringing clinical trials closer to the community, and expanding the scope of what the term "precision medicine" means in cancer care.

Innovative therapies for rare diseases such as spinal muscular atrophy (SMA), when paid for by public budgets in the European Union and elsewhere, are often managed by agreements between payers and drug companies, but details can be hard to discern.

An emphasis on transitions of care should ensure the highest level of care for patients and provide support to physicians.

David J. Reeves, PharmD, BCOP, of Butler University discusses encouraging results from a recent trial, along with safety questions about the types of patients who weren't studied but are likely to have small cell lung cancer.

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 this episode of Managed Care Cast, we speak with one of the authors of a recent book looking at the erosion of trust in health care, the factors that influence trust, and what can be done to restore trust.

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.

The chief of medical oncology and hematology at Bryn Mawr Hospital and associate principal investigator for Main Line Health's NCI Community Oncology Research Program discusses therapeutic advances along with ongoing challenges in enrolling patients with small cell lung cancer (SCLC) in clinical trials.