Payers

The American Journal of Managed Care and the American Association of Diabetes Educators have collaborated on a special joint issue of Evidence-Based Diabetes Management, which focuses on the growing evidence for payer coverage of Diabetes Self-Management Education and Support and the Diabetes Prevention Program.

The 2015 joint statement of the American Association of Diabetes Educators, the American Diabetes Association, and the Academy of Nutrition and Dietetics called for diabetes self-management education and support at 4 distinct points: at diagnosis, at annual assessments, when complications arise, and at transitions.

At the 5th annual meeting of Patient-Centered Oncology Care®, hosted by The American Journal of Managed Care, November 17-18 in Baltimore, Maryland, experts with diverse experiences and backgrounds discussed the contradiction presented by immuno-oncology agents in the world of precision medicine.

Many payers are incorporating Fitbit technology into healthcare plans as part of both prevention and clinical treatment programs, hoping that it can help members become healthier and more active, according to Ben Sommers, MBA, vice president of North America Business Development at Fitbit Wellness.

Last month, the healthcare payment network InstaMed announced that it was the first in the industry to achieve point-to-point encryption (P2PE) v2.0 validation. How important is this level of encryption for healthcare? What will this mean for those who seek better protection of their payment card data?

Coupons seem like a good deal for consumers, but they mask the true costs of drugs and force up premiums for everyone.

In the year since New Jersey regulators approved OMNIA, the state's health insurance market has experienced the same upheaval seen elsewhere: the number of options on the exchanges has shrunk from 5 to 2.

Professor R. Keith Campbell, MBA, BPharm, CDE, now retired from Washington State University College of Pharmacy, highlights the clinical advantages of Afrezza based on the evidence as well as his personal perspective.

Democratic lawmakers who signed a letter to Mylan this week say that the practice of offering coupons masks the high drug prices that are paid by commercial health plans. The practice is not allowed in Medicare or Medicaid.

While Mylan has steadily increased the price of EpiPens since 2007, the uproar from consumers is more recent. This suggests that for several years, payers masked the cost of the product, but that has changed with the popularity of high deductible plans.

Payers are making investments in care coordination to halt the overuse of services and medication. Certified diabetes educators (CDEs) are ideal candidates for this role, since so much of high healthcare spending is due to chronic disease.

There are signs that smaller providers, in particular, are not moving toward value-based reimbursement at the same pace as larger healthcare stakeholders.

A statewide all-payer claims database would permit more insight into what’s happening with cost and quality of providers, and possibly transform healthcare payment, explained Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition.

According to Kelly J. Clark, MD, MBA, president elect of the American Society of Addiction Medicine, payers and pharmacy benefit managers can aid in patient access to the medication they need to treat addictive disease by ensuring an evidence-based prior authorization protocol, just as they would for a patient with a chronic disease.

Coverage from Patient-Centered Diabetes Care, April 7-8, 2016. Presented by The American Journal of Managed Care and Joslin Diabetes Center.

Spurred by the migration to new payment methodologies and a rapidly evolving competitive landscape, many managed care companies have launched venture and innovation programs. This article provides a high-level evaluation of the universe of model options accessible to payers who are interested in such programs.

The growth of clinical pathways in cancer care brings opportunities to improve quality and control cost, but there are frustrations, too. Physicians want to retain some freedom and are pushing back against the administrative jungle from multiple payers, according to a special issue of Evidence-Based Oncology, a publication of The American Journal of Managed Care.

On the first day of The Community Oncology Conference: Innovation in Cancer Care, held in Orlando, Florida, April 13-15, 2016, oncologists discussed how their practices are coping with the transition toward quality- and value-based reimbursement.

Did MannKind misjudge consumer demand, or are barriers from payers to blame for Afrezza's woes? A feature outlining the misfortunes and future plans for the only inhaled insulin on the market.

GAO found that the first challenge to improving hospital safety can be getting good data about one's own institution.

Mann spent $1 billion of his own money to bring Afrezza to market. The Los Angeles Times reported he died in Las Vegas.

The study, while small, suggests a scalable solution that would allow payers address diabetes prevention and health disparities.

Researchers found that physicians often seized the "opportunity" to start dialysis if patients were in the hospital for other illnesses.

The new rule has been issued just as states are cracking down on the practice of balance billing patients who take steps to use in-network hospitals, only to be balanced billed anyway if they are seen by a provider not on their health plan.

Sessions on obesity and the role of technology in disease management will be part of the annual gathering of stakeholders, presented by The American Journal of Managed Care, April 7-8, 2016, at the Teaneck Marriott at Glenpointe in Teaneck, New Jersey.