Payers

A 9% year-over-year increase was observed in the number of US Medicare beneficiaries who enrolled in a Medicare Advantage health plan in 2020, with the increase in enrollment influenced by the coronavirus disease 2019 pandemic and its related effects.

The Biden administration will reopen the health exchanges created by the Affordable Care Act (ACA); direct HHS and other agencies to reexamine other health policies, including Medicaid work requirements; and reverse the so-called global gag rule while affirming support for reproductive health.

Collaboration between a clinical laboratory and a managed care organization improved prenatal care and outcomes through real-time, actionable, laboratory-derived insights and care coordination.

President Joe Biden reportedly will take executive action to reopen federal marketplaces selling Affordable Care Act (ACA) health plans; Moderna investigating booster shot designed to be more effective against emerging variants of coronavirus disease 2019 (COVID-19); Brazil coronavirus variant is found in Minnesota.

Pharmacy-led telehealth strategies will position Special Needs Plans (SNPs) for Star Ratings success during the pandemic and for years to come.

Health plan pharmacists are in the perfect position to see overprescribing as it happens.

The statement is aimed at drug companies, policymakers, pharmacy benefit managers, employers, and others, and calls to attention soaring insulin costs, which were the subject of several Congressional hearings in 2019.

On this episode of Managed Care Cast, we speak with the new chief financial officer of Strive Health, a value-based kidney care company that works with payers and providers to create an integrated care delivery system for chronic kidney disease and end-stage renal disease (ESRD). We discuss the changes coming to nephrology practices, as well as new ways of looking at the whole patient to halt the slide to irreversible ESRD.

Telehealth services have saw a spike in October as COVID-19 cases continued to rise, as seen in claims tracked by FAIR Health.

Addressing the social health needs of those ill with coronavirus disease 2019 (COVID-19) is a challenge for providers and health care systems. On this episode of Managed Care Cast, we speak with Bechara Choucair, MD, senior vice president and chief health officer for Kaiser Permanente, who discusses the organization's guide that walks clinicians through considerations to keep in mind when screening patients in order to improve health outcomes as well as reduce community transmission.

Feedback from the field is incredibly important when participating in new payment models like the Oncology Care Model, said Basit Chaudhry, MD, PhD, founder of Tuple Health.

Coronavirus disease 2019 (COVID-19) dominated 2020. This is a look back at how the pandemic evolved and progressed through the year, which closed with the arrival of vaccines, but also continued challenges.

Kashyap Patel, MD, associate editor of Evidence-Based Oncology, a publication of The American Journal of Managed Care, will serve a 1-year term beginning in January.

Insurance status can influence an individual’s ability to access care, stated Milena Murray, PharmD, MSc, BCIDP, AAHIVP, associate professor at Midwestern University College of Pharmacy.

The authors wrote that in states that expanded Medicaid health insurance coverage in 2014, there was an increase of early-stage colon cancer diagnoses compared with states that did not implement expansion.

Patients with COVID-19 and end-stage renal disease were 11 times more likely to be admitted to the hospital than patients without kidney disease.

We must rethink our one-size-fits-all approach to social determinants of health interventions and instead target patients who truly need and would benefit from these interventions.

During a period of rapid fluctuation in the intravenous iron market, there was increased use of a more expensive drug that afforded providers additional revenue.

Incorporating data from functional status assessments, we developed a Medicaid payment model for long-term services and supports in a community-dwelling population of older adults.

This case report of a novel methodology for the analytic development of bundled payments addresses statistical analysis, data visualization, and clinical consultation.

This study compared beneficiary characteristics and Medicare per capita expenditures among seriously ill Medicare accountable care organization (ACO) populations defined using prospective and retrospective claims-based attribution methods.

Relative readmission rates, a measure of care coordination, did not change over time for beneficiaries enrolled in Medicare Advantage and traditional Medicare.

COVID-19 created a striking rise in telehealth services over the past year, as seen in claims tracked by FAIR Health.

Although half of US rheumatologists have patients for which nonmedical switching has been suggested, only 35% were likely to switch patients with rheumatoid arthritis doing well on a reference product to a biosimilar.