Payers

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.

Depending on one's point of view, the 340B prescription drug program keeps safety net hospitals afloat or serves as a profit center at the expensive of community providers. Three leading voices-Rena M. Conti, PhD; Peter B. Bach, MD, MAPP; and Michael Kolodziej, MD; recommend reforms in the new issue of Evidence-Based Oncology, a publication of The American Journal of Managed Care.

At the first annual conference of the Institute for Clinical Immuno-Oncology on October 1, 2015, in Philadelphia, the discussion revolved around integrating immuno-oncology into clinical practice and programs that assist with patient access to these treatments.

Providers and payers came together to discuss challenges and share success stories as they adapt to the changing healthcare realm.

Payer—provider teams presented updates on their cost-saving pilot projects and looked to the future of these models in oncology care.

With various healthcare stakeholders having different wants and needs from the healthcare system, meetings that bring all parties together in one room are important, according to Suzanne F. Delbanco, executive director of Catalyst for Payment Reform, and keynote speaker at the spring live meeting of the ACO and Emerging Healthcare Delivery Coalition.

New resources are being directed toward precision medicine, particularly in cancer care. With that in mind, Evidence-Based Oncology, a publication of The American Journal of Managed Care, devotes its current issue to articles and commentaries on this growing field.

The recent mergers between healthcare payers continue the trend of consolidation that has swept the healthcare industry since passage of the ACA.

In oncology, the shift from a "companion diagnostic" to a "companion therapeutic" paradigm is in high gear. While the noise and confusion is leading many payers to avoid coverage, they can benefit by proactively taking steps to integrate precision oncology to better manage quality, access, and cost of cancer care.

The link between getting patients to take medication correctly and keeping down healthcare costs is strong enough that adherence is being tied to reimbursement for healthcare providers. A study published recently in The American Journal of Managed Care examines connections at the health plan level between good plan-level adherence, lower rates of disease complications, and lower medical spending.

Jennifer Malin, MD, medical director for oncology at Anthem, explains how both physicians and payers struggle with the high cost of some cancer treatment drugs.

The report found a 6.5% increase in the compound annual growth rate during the 5-year period leading up to 2014.

The suits are on behalf of providers and health insurance customers and involve some famous plaintiffs' attorneys.

The implementation of the Affordable Care Act and its resulting market turbulence has not created the operation challenges for payers that was expected, according to a report from athenahealth, Inc.

This week The American Journal of Managed Care launched its new Managed Markets News Network, featuring the top stories in managed care and interviews with industry experts.

The guidance comes after advocacy groups and members of Congress complained of widespread violations of the Affordable Care Act's requirement that all forms of birth control be covered without a co-payment, not just the low-cost methods. The action also responds to recent reports that payers have balked at requests for BRCA testing even when indicated.

Since the introduction of the Oncology Care Model, oncologists have raised numerous questions as they weigh whether to apply for participation.

The pharmaceutical industry has learnt its lesson from the pushback that Gilead faced over the price of its hepatitis C drug, Sovaldi. The lack of a price discussion prior to the introduction of the regimen washed-out the excitement over a "cure" for the disease.

A general session at the Community Oncology Conference, Community Oncology 2.0, Moving Forward on Payment Reform, was a panel discussion that saw participation by 2 providers and a payer.

With a focus on improving quality while maintaining the cost of care, providers and payers are evaluating various payment models that could improve patient outcomes using evidence-based treatment at lower costs to the healthcare system.

As patents on some of the most lucrative medicines began to expire, many companies shifted money to rare-disease drugs, knowing that those medicines cost less to develop and will face limited competition.

When the first National Comprehensive Cancer Network Guidelines were developed 20 years ago, even the participating members who were there at the beginning were skeptical they would be able to come to an agreement and build something lasting.

A new analysis published by the RAND Corporation suggests strategies that the pharmaceutical industry could offer payers as they try to cover the front-loaded cost of newer breakthrough drugs.

Starting with a contract that works for both parties involved is the best way to ensure payers and providers will work together, said Craig Thiele, MD, chief medical officer of CareSource.