Payers

Leaders from several different accountable care organizations (ACOs) describe their experience of creating programs to care for Medicare beneficiaries using the skilled nursing facility (SNF) waiver process.

Compared with use of originator products, use of biosimilars in the United States is apparently still not a priority of commercial health plans, according to the results of a recent JAMA study.

The International Olympic Committee postpones the 2020 games slated for this summer; the American Society of Clinical Oncology (ASCO) urges Congress for increased protection and support for medical practices; AHIP will allow its member payers to transfer patients with coronavirus disease 2019 (COVID-19) from hospitals to other clinical settings, if appropriate, without prior authorization.

"We want to make sure practices have time to learn, understand, adapt, and modify, to a new Oncology Care Model," said Michael Diaz, MD, president of Community Oncology Alliance.

There are shortcomings in the ways we have approached value assessment to date, writes the executive director of the Innovation and Value Initiative.

It's time for curated, customer-centric thinking to come to healthcare, writes healthcare industry executives.

Financial barriers and perceived implicit biases were both barriers that families of children with acute leukemia raised regarding access to care issues that might have delayed diagnosis, said Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco.

On this episode of the podcast, we speak with Peter Bonis, MD, chief medical officer, Clinical Effectiveness, Wolters Kluwer Health, which recently released the survey, Mending HealthCare in America 2020: Consumers & Cost.

While efforts to abate surprise medical billing, such as the kind that come from out-of-network emergency department visits, are currently being debated in Washington, DC, the kind of billing discussed here occurs when patients struggle to understand the difference between preventive health services, which are covered at no cost under the Affordable Care Act, and billing for services at a doctor’s visit for an illness, condition, or injury.

Amy Ellis, director of quality and value-based care at Northwest Medical Specialties, and Amanda Hodges, director of implementation for ReVital Cancer Rehabilitation, who acts as a bridge between the oncology world and the rehabilitation world, discuss overcoming barriers in practices to help patients with cancer get the rehab care they need, how patients with cancer can benefit from rehab, and defining value.

Patients with mantle cell lymphoma (MCL) face a substantial economic burden and susceptibility to adverse events (AEs) in the real world, according to an abstract presented at the 61st American Society of Hematology Annual Meeting and Exposition.

Accountable care organizations (ACOs) have saved Medicare a total of $3.53 billion from 2013 to 2017, or $755 million after shared savings were paid out, according to a new report from the National Association of ACOs (NAACOS).

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Prescriptive analytics, not just predictive analytics, will make a difference in patient outcomes, said John Frownfelter, MD, FACP, chief medical officer of Jvion.

This week, the top managed care news included research that may hold the key to slowing progression of multiple sclerosis; Humana says it is saving billions of dollars through value-based care; the challenges of rural healthcare delivery.

Here are the top 5 articles for the month of November.

The industry does not do a very good job of letting providers know there are ways to cover risk or protect against it. Better educating physicians on this would help improve uptake of value-based care models, said Mike Fazio, senior vice president of client services, Archway Health.

While there is an increased interest in using real-world evidence (RWE) to design, test, and review rare disease treatments, payers may not be as receptive to using RWE when making reimbursement and formulary decisions, according to a new report from Syneos Health.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included research that shows stents may offer no more value than drugs for some heart patients; a ban on flavored tobacco products gains momentum; a survey finds most American families struggle with social factors that impact health.

Healthcare needs to learn to adapt faster to changes, said John Frownfelter, MD, FACP, chief medical officer of Jvion.

The FDA has approved a new treatment for adult patients with acute hepatic porphyria (AHP) a rare genetic disorder. Givlaari is an RNA interference therapeutic targeting aminolevulinic acid synthase 1. Simultaneously, Alnylam Pharmaceuticals announced a new framework for value-based agreements to help patients gain access to the treatment.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and Wake Forest Baptist Health announced an agreement that could reduce Affordable Care Act (ACA) rates for small business customers with 1 to 50 eligible employees by up to 15%.

Two new rules from CMS will take steps to increase price transparency for the purpose of empowering patients and increasing competition in the market.