Healthcare Cost

Specialty Drug Spending After State-Mandated Out-of-Pocket Caps

August 06, 2020


Despite concerns, legislation to cap out-of-pocket payments for specialty drugs has not been shown to shift costs to health plans, thereby increasing insurance premiums, according to a study published in New England Journal of Medicine.

Experts Highlight COVID-19 Vaccine Developments and Remaining Challenges

August 04, 2020


The coronavirus disease 2019 (COVID-19) vaccines that are leading the pack are utilizing a new vaccine technology that has never been approved for human use by the FDA. As a result, there are a lot of unknowns.

Hospitals Vow to Fight Court of Appeals 340B Ruling

August 03, 2020


The ruling reversed a lower court ruling regarding the drug discount program for hospitals that serve patients covered by Medicaid.

CMS Seeks Incentives for At-Home Dialysis in Wake of COVID-19

July 07, 2020


End-stage renal disease has long been one of the most expensive and debilitating conditions that affects Medicare beneficiaries. Not only does dialysis cost $90,000 a year—those awaiting a kidney transplant automatically qualify for Medicare—but the need to travel to a dialysis center multiple times a week disrupts employment and home life.

COVID-19 Adds New Wrinkle in Shift to 2-Sided Risk in Oncology Care

April 23, 2020


Oncology practices could use more time to become accustomed to 2-sided risk even without a global pandemic, but the current crisis makes the need more urgent, say payment reform leaders at the Community Oncology Alliance virtual conference.

Dr Howard Burris: Lessons Learned From a Crisis Could Assist Future of Clinical Trials

April 20, 2020


At the 2020 Community Oncology Conference, hosted by the Community Oncology Alliance, Howard "Skip" Burris III, MD, FACP, FASCO, president, chief medical officer, and executive director of drug development for Sarah Cannon Research Institute, will discuss "The Now and Future of Clinical Trials in the Community Oncology Setting." The American Journal of Managed Care® recently spoke with Burris, who is wrapping up his term as president of the American Society of Clinical Oncology, about how the coronavirus disease 2019 pandemic is affecting clinical trials as well as other aspects of the future of patient care in community oncology settings.

As Kidney Week Ends, Providers Are Urged to Join New Care Models

November 12, 2019


As Kidney Week closed, nephrologists gathered to hear policy updates and information about forthcoming payment models from CMS and seemed pleased with what they heard.

Current Value-Based Care Models Need Greater Emphasis on Specialty Care

September 18, 2019


This article provides an overview of the impact of specialty care and the opportunity for it to leapfrog primary care as a lead focus for accountable care.

Implementation Variation in Natural Experiments of State Health Policy Initiatives

September 17, 2019


This paper presents a method to characterize policy implementation across states to enable more nuanced impact assessments of federal healthcare delivery system and payment reforms.

Physician-Initiated Payment Reform: A New Path Toward Value

September 10, 2019


Physician groups have begun designing alternative payment models for their own specialties, proposing that CMS include financial risk, funding for new technologies, and legal waivers.