Health Care Cost

The authors updated a diagnosis list to identify low-acuity emergency department visits by veterans and applied it to examine trends and predictors of veterans’ low-acuity utilization.

Patty Taddei-Allen, PharmD, MBA, warns that co-pay accumulators and maximizers may lower plan costs but increase patient burden and disrupt medication adherence.

Adam Colburn, JD, highlights 3 federal bills to expand value-based care, digital therapeutics, and pharmacist reimbursement across Medicare and Medicaid.

Complex Medicaid patients randomly assigned to receive outpatient social worker care coordination services experienced increased hospitalizations but no differences in emergency department visits or costs.

The increased costs of premiums after the expiration of enhanced subsidies have led to an increased percentage of those not able to make their payments.

Rapid advances in precision oncology are exposing gaps in testing, treatment access, and care delivery, challenging managed care to keep pace.

John Barkett, MBA, discusses recent regulatory proposals to make massive health plan price files more usable.

Esketamine's monotherapy approval and new real-world data are forcing a reckoning for managed care.

A cost model shows anti-VEGF savings only when high injection burden offsets device fees and reading time in AI home OCT vs clinic OCT.

Why Medicaid-covered kids struggle to see pediatricians: low reimbursement and practice deserts in low-income ZIP codes create real barriers to care.

Major health plans cut millions of preapproval hurdles, add 90-day continuity protections, and push real-time e-authorization to speed care access.

Manufacturer-sponsored biologic coupons have decreased since 2018, with rising per-claim values, impacting patient costs and formulary incentives.

Social determinants of health can delay access to NGS, limiting targeted therapy use and survival outcomes in advanced cancers.

ACIP changes threaten vaccine coverage and raise costs, according to a roundtable of experts warning of widening disparities and long-term public health risks.

From teledermatology billing to rural outreach and transplant advances, new studies and presentations reveal shifts in access, equity, and patient outcomes.

Findings from a randomized controlled trial on reducing information barriers for consumers selecting primary care clinics in a tiered network design demonstrate limited marginal effect of the intervention.

Inpatient encounters for Medicare patients 65 years and older are associated with higher coding intensity compared with commercially insured, Medicaid, or self-pay hospitalizations for those same individuals prior to age 65 years.

This retrospective analysis examines employees with obesity and reports on glucagon-like peptide-1 receptor agonist use, comorbidities, and work outcomes over time.

Federal pharmacy benefit manager transparency reforms must contend with concentrated pharmaceutical markets that lack competitive conditions. Learnings from transparency will shape future drug pricing reforms.

Using price transparency data to select high-value providers will require improving the quality of the data, presenting the data intuitively, and making it easier to act on the information.

Employers can use price transparency data to reconsider their choice of carriers or plans, negotiate prices with their carriers, and steer employees toward high-quality, reasonably priced providers.

Outpatient electronic health records at an academic medical center showed that only 1% of visits by tobacco users were associated with a bill for cessation counseling.

Half of working-age Medicaid enrollees face disenrollment under national work requirements, despite having greater functional impairment than those who would comply.

TrumpRx launched in early February with the aim to offer lower-priced drugs to those without insurance or those who would like to pay in cash. The results are more complicated.

Experts reflect on opioid policy impacts, IRA reforms and insulin caps impact drug access, and oncology leaders advance more equitable, integrated cancer care.