Payers

The pandemic has shown a spotlight on how critically important respiratory care is to Americans who struggle to breathe on their own. Yet, Medicare policy must be updated to ensure that access to lifesaving equipment will never be disrupted.

Schizophrenia, chronic pain, and multiple medical diagnoses at enrollment into a large managed Medicaid system are associated with long-term high health care utilization.

Late July brings a 64% enrollment increase; owner charged with fraudulently billing Medicare over $784 million; COVID-19 hot spots lose nurses due to burnout.

In the June Matters in Managed Care webinar, experts from Blue Cross and Blue Shield of North Carolina, Duke-Margolis Center for Health Policy, UNC Center for the Business of Health, and WakeMed discussed how they are working together to address some of the state’s unique primary care needs.

In the June Matters in Managed Care webinar, experts from Blue Cross and Blue Shield of North Carolina, Duke-Margolis Center for Health Policy, UNC Center for the Business of Health, and WakeMed discussed how they are working together to address some of the state’s unique primary care needs.

In the June Matters in Managed Care webinar, experts from Blue Cross and Blue Shield of North Carolina, Duke-Margolis Center for Health Policy, UNC Center for the Business of Health, and WakeMed discussed how they are working together to address some of the state’s unique primary care needs.

In the June Matters in Managed Care webinar, experts from Blue Cross and Blue Shield of North Carolina, Duke-Margolis Center for Health Policy, UNC Center for the Business of Health, and WakeMed discussed how they are working together to address some of the state’s unique primary care needs.

In the June Matters in Managed Care webinar, experts from Blue Cross and Blue Shield of North Carolina, Duke-Margolis Center for Health Policy, UNC Center for the Business of Health, and WakeMed discussed how they are working together to address some of the state’s unique primary care needs.

In the June Matters in Managed Care webinar, experts from Blue Cross and Blue Shield of North Carolina, Duke-Margolis Center for Health Policy, UNC Center for the Business of Health, and WakeMed discussed how they are working together to address some of the state’s unique primary care needs.

In the June Matters in Managed Care webinar, experts from Blue Cross and Blue Shield of North Carolina, Duke-Margolis Center for Health Policy, UNC Center for the Business of Health, and WakeMed discussed how they are working together to address some of the state’s unique primary care needs.

In the June Matters in Managed Care webinar, experts from Blue Cross and Blue Shield of North Carolina, Duke-Margolis Center for Health Policy, UNC Center for the Business of Health, and WakeMed discussed how they are working together to address some of the state’s unique primary care needs.

Speakers at the Advanced Topics for Oncology Pharmacy Professionals Summit discussed financial toxicity in health care, how it particularly impacts patients with cancer, and how to address the issue with patients and the health system.

The federal government requires insurers to cover PrEP; Johnson & Johnson (J&J) and pharmaceutical wholesalers agree to settle opioid crisis lawsuits; NYC health care workers will be required to receive a vaccine or weekly tests for COVID-19.

Members covered by an integrated pharmacy benefit (as opposed to a pharmacy carve-out) experienced slower growth in medical spending.

In this episode of Managed Care Cast, the lead author of an article in the July issue of The American Journal of Managed Care describes the latest research that looks at the power of self-insured employers to negotiate hospital prices and the relationship between employer market power and hospital prices.

Larger primary care practices in downside risk–only payment models and capitation saw the highest telemedicine utilization rates by their patients enrolled in Medicare Advantage (MA) plans.

A string of controversies surrounding the approval of Biogen's Alzheimer disease drug aducanumab (Aduhelm) has not only called into question the independent nature of the FDA, but puts both providers and patients in a challenging position when it comes to deciding whether or not to prescribe or take the treatment.

This study examines the ability of self-insured employers to negotiate hospital prices and the relationship between hospital prices and employer market power in the United States.

PBMs keep copays higher on the same generic drugs.

Robin Gelburd, JD, details the dip in telehealth claims observed during April 2021.

The Medicare Access and CHIP Reauthorization Act (MACRA) needs to be reimagined get back on track and to live up to its promise to incentivize value-based care.

Data from IMpower 130, IMpower 132, and IMpower 150 confirm that combining atezolizumab with chemotherapy is the best first-line treatment in advanced NSCLC when anti-PD-L1 therapy is indicated.

Abstracts cover the cost of cancer-related diarrhea, 30-day readmission rates, and how perceptions of the likelihood of survival affect end-of-life care.

The proposed changes to the payment model for end stage renal disease (ESRD) would make it the first payment model under the CMS Innovation Center to directly address health equity by incentivizing increased rates of home dialysis and kidney transplants.

The measure is designed to end surprise medical billing and balance billing, taking the first step to implement the so-called No Surprises Act that passed Congress at the end of last year.