Payers

Minimal residual disease (MRD) is being used more frequently in clinical trials and to identify the best treatment course for patients, but unknowns remain about the optimal use of MRD testing.

Xavier Becerra, California's attorney general, will become the next secretary of HHS after the Senate voted 50-49, split by party lines.

The study examined the cost to Medicare when patients with end-stage renal disease switched from their employer-based health insurance to Medicare between 2007 and 2017 before the end of the 30-month coordination period.

This article describes a recently finalized CMS rule addressing the permissibility of co-pay accumulator adjustment programs (CAAPs) when no generic is available.

A panel of experts provided consumer insights into value-based insurance design (VBID) and how the COVID-19 pandemic may have changed consumer behaviors in a way that VBID may be able to address as the country emerges from the pandemic.

A desire to remove barriers to high-value care and provide services that would improve health and quality of life drove early adopters of value-based insurance design (VBID).

On this episode of Managed Care Cast, we speak with the chief medical officer for Virginia’s Medicaid program about 4 ways payers can make sure that those with opioid use disorder get the treatment they need; the strategies are outlined in the March issue of The American Journal of Managed Care.

Whole-genome sequencing (WGS) is at least as accurate as conventional tests when it comes to genomic profiling in patients with acute myeloid leukemia and myelodysplastic syndromes.

This article documents a 100% increase in privately insured outpatient knee replacement surgeries following Medicare’s decision to remove knee replacements from its Inpatient Only list.

The $1.9 trillion spending package aimed at providing COVID-19 relief for those with low and middle incomes also represents the biggest investment in the exchange marketplaces created by the Affordable Care Act (ACA) since the landmark law was passed 11 years ago.

Investigators sought to better understand increasing price trends, including those seen among disease-modifying drugs to treat multiple sclerosis (MS) and other neurological diseases.

A review of evidence finds that oxygen therapy may be beneficial for all patients with pulmonary arterial hypertension, not just those who develop severe hypoxemia.

Direct inpatient and outpatient costs are significantly higher for patients with untreated spinal muscular atrophy (SMA) compared with matched controls.

The specialization program will teach fundamentals and offer real-world examples of value-based care through an online program.

Medicare Advantage enrollees are more likely to be treated with metformin and sulfonylureas and less likely to receive costly newer medications than those in traditional Medicare.

Kavita Patel, MD, MS, FACP, a fellow at the Brookings Institution Center for Health Policy, touched on key topics in health care at the ACCC 47th Annual Meeting and Cancer Center Business Summit.

Jeffrey Hogan, Northeast regional manager of the Rogers Benefit Group and member of the Board of Directors for the Connecticut Business Group on Health, discussed how his organization helped providers navigate some of the challenges posed by the pandemic.

Use of a specialty pharmacy to take over the management of prior authorization (PA) requests for a dermatology practice significantly reduced the time to a decision and also decreased the time it took to fill the medication.

From 1999 to 2015, permanent disability claims for patients with rheumatoid arthritis (RA) spiked during periods of economic recessions, suggesting that the COVID-19 pandemic may create a similar effect in the near future.

Donald M. Berwick, MD, MPP, the former CMS administrator who is president emeritus and senior fellow at the Institute for Healthcare Improvement, discusses cost variation in cancer care found through the digital classification system the COTA Nodal Address.

The coronavirus disease 2019 (COVID-19) pandemic has led to sharp declines in US life expectancy; a new CMS administrator nominee is selected; Biden administration announces funds to combat virus variants.

During a 2021 AcademyHealth National Health Policy Conference session, members of The Commonwealth Fund Task Force on Payment and Delivery System Reform discussed policy recommendations aimed at preparing the United States for future pandemics and addressing care inequities brought to light by the coronavirus disease 2019 crisis.

Sachin Jain, MD, MBA, FACP, president and CEO at SCAN Group and SCAN Health Plan, discusses how data can help ensure that vulnerable populations aren't harmed by value-based payment models.

In a panel at the 2021 AcademyHealth National Health Policy Conference, representatives from 3 community health plans across the United States discussed how payers are driving telehealth access and utilization in the wake of the coronavirus disease 2019 pandemic.

Former HHS secretary Kathleen Sebelius and Sachin Jain, MD, MBA, CEO of SCAN Group and Health Plan, took time to reflect on the advent of the Affordable Care Act (ACA) and examine the Biden administration’s opportunity to enact influential health policy on the first day of the 2021 AcademyHealth National Health Policy Conference.