Health Care Cost

Targeted therapies have improved outcomes for patients with lung cancer, but the goal needs to be tailoring the right therapy to the right patient, said Ticiana Leal, MD, associate professor, director of the Thoracic Medical Oncology Program, Department of Hematology and Medical Oncology, Emory University School of Medicine.

As health care shifts reimbursement models from fee-for-service to value-based care, new terms and phrases have been surfacing across the industry. Two of the terms emerging with increased usage are “patient engagement” and an “active patient.” But what do they mean? And why are they important?

On this episode of Managed Care Cast, we speak with 2 authors of an article in the September issue of The American Journal of Managed Care®, which focused on the results of their evaluation of an intensive, community-based care management program for dual-eligible Medicaid ACO high-risk patients.

With 6 pegfilgrastim biosimilars approved, and multiple administration options, a patient-centric model of pegfilgrastim administration should be possible for patients with cancer who require prophylaxis of febrile neutropenia.

Streamlining the prior authorization process can improve care accuracy and patient access to care, writes Siva Namasivayam, CEO of Cohere Health.

A recent study found that 1 in 5 households were strapped with medical debt; hospitals and hospital systems in North Carolina proposed a way to expand Medicaid to hundreds of thousands of adults; the CDC reported that more adults sought mental health treatment in 2021 compared with 2019.

Nearly 30% of youths are affected with worsening mental health by the end of adolescence, with anxiety typically presenting in childhood and depression during the teenage years, but the problem is even more acute for Black and Latinx youth.

The retrospective claims database analysis looked at patients in the United States, where it is estimated that costs related to asthma are more than $80 billion annually.

Despite $2.5 million placeholder price tags, the Institute for Clinical and Economic Review draft evidence report considers gene therapy cost-effective versus comparators in both hemophilia A and B.

Being able to use minimal residual disease (MRD) negativity to make treatment decisions, such as stopping maintenance therapy, can have savings related to cost and quality of life (QOL) for patients, said Ajay Nooka, MD, MPH, FACP, associate professor, Winship Cancer Institute.

Patients with diabetes and chronic obstructive pulmonary disease (COPD) have worse outcomes when hospitalized and appear to be more vulnerable to respiratory and nonrespiratory complications after a COPD exacerbation, which highlights the need for targeted interventions in this population.

The authors modeled costs associated with a pedometer-based, web-mediated physical activity intervention compared with a pedometer alone for chronic obstructive pulmonary disease (COPD) management. The intervention was cost-saving.

In the health spending debate, what policy makers need most is an honest, realistic, and evidence-based discussion. Unfortunately, many studies in the public arena fall far short.

While commercial payers have been engaged with the shift to biosimilars, they all have their own preferred biosimilar, which makes it challenging for practices, explained Lalan Wilfong, MD, vice president of payer relations & practice transformation at The US Oncology Network.

Using systemic corticosteroids (SCS) to treat chronic rhinosinusitis with nasal polyps (CRSwNP) has been linked to adverse outcomes among patients, prompting these study investigators to compare their health care resource utilization with that of patients who have CRSwNP but don’t use SCS.

On September 7, a trio of panels from Avalere Health addressed steps that will follow approval of the Inflation Reduction Act, implementing the Enhancing Oncology Model (EOM) in 2023, and addressing health care disparities.

In 2021, the specialty drug trend rebounded from the pandemic, and it is expected to stay strong with more specialty drugs coming. Increased availability of biosimilars could shift this trend.

Medication-at-home pharmacy is an innovative method of medication management that is vital to the success of the health care system.

Lack of state funding and understaffing are threatening the vaccination campaign for novel Omicron-specific booster shots; experts explore the differences between subcutaneous and intradermal delivery of monkeypox vaccines; HHS’ Office for Civil Rights is struggling to manage rising cases of cyberattacks on US health care organizations.

Do-it-yourself (DIY) automated insulin delivery systems have gained rapid uptake, yielding self-reported improvements in glycemic control and quality of life for patients, but creating unique challenges for health care providers (HCPs).

Findings from this multicenter randomized controlled trial showed that the transition bundle was associated with a lower risk of 7-day and 30-day hospital readmission from chronic obstructive pulmonary disease (COPD).

As Medicare Advantage increasingly becomes the dominant form of Medicare coverage, Congress must improve transparency of programmatic costs and benefits to promote beneficiary choice.

The results suggest that dipeptidyl peptidase-4 (DDP-4) inhibitors, which are widely prescribed in Germany, are not a cost-effective option despite lower drug pricing compared with empagliflozin.

On this episode of Managed Care Cast, we speak with the author of an article in the August issue of The American Journal of Managed Care® about the premium tax credits for health insurance purchased through the health care marketplace, which were recently extended for another 2 years with the signing of the Inflation Reduction Act.