Payers

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.

Intravenous diuretic treatment of patients with decompensated heart failure can increase urine output, promote weight loss, and improve dyspnea.

During a webinar, experts discussed where health care has improved life expectancy and the relationship between cost and relative contribution that each area makes to life improvement and expectancy.

To mark the 25th anniversary of The American Journal of Managed Care®, each issue in 2020 will include a special feature: an interview with a thought leader in the world of health care and medicine. The November issue features a conversation with William H. Shrank, MD, MSHS, chief medical officer of Humana.

The patients must always come first, emphasized Milena Murray, PharmD, MSc, BCIDP, AAHIVP, associate professor at Midwestern University College of Pharmacy, who practices at the Northwestern Medicine Infectious Disease Center in Chicago.

Study results demonstrate the multimillion-dollar savings achieved among patients with heart failure with reduced ejection fraction (HFrEF) following treatment initiation with sacubitril and valsartan.

Pharmacists have an important role to play in the success of value-based payment models, according to panelists who discussed their health plan’s value initiatives at the Academy of Managed Care Pharmacy Nexus 2020 meeting.

In a panel discussion at the Academy of Managed Care Pharmacy Nexus 2020 meeting, experts discussed driving factors of and barriers to the use of real-world evidence by payers in oncology decision-making.

As the coronavirus disease 2019 (COVID-19) pandemic threatens to worsen the opioid crisis, payers must rapidly deploy policies to ensure care for individuals with opioid use disorder.

The authors, from RxCrossroads by McKesson, discuss the impact of copay accumulator and maximizer programs.

A new national study is highlighting disparities in morbidity and barriers to care that face patients with chronic obstructive pulmonary disease (COPD) living in in rural areas.

Natera’s Signatera ctDNA test will determine study eligibility and treatment effectiveness in HR-positive, HER2-negative breast cancer patients.

More Humana doctors are taking on full global risk under Medicare Advantage than are still using traditional fee-for-service.

The relatively few examples of commercially funded condition-specific bundled payments provide insights into how to spread this alternative payment model further in the private insurance market.

More biosimilars are hitting the US market, but marketplace dynamics have made it difficult to take advantage of these therapies.

Pediatric patients who had a referral from their pediatric rheumatologist and continued insurance coverage saw decreased delays when transitioning to an adult rheumatology clinic.