Health Care Cost

A new study published by the American Cancer Society found that younger colorectal cancer survivors end up spending over $8500 annually in medical expenses and they also experience significantly greater loss of productivity compared with individuals without cancer.

The rising cost of drugs was in the spotlight in 2015, and the manuscripts in The American Journal of Pharmacy Benefits highlights the growing concerns of the healthcare industry in regards to rising expenditures.

As the healthcare system moves to an environment of value-based payment, bundled payments could become the next step in healthcare transformation. However, there are both opportunities and risks in this form of value-based payment, explained Michael Ciarametaro, MBA, director of research at the National Pharmaceutical Council, at the ISPOR 20th Annual International Meeting.

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

Most physicians consider telehealth a promising tool in improving patient access to primary care services, but only 15% use it in their practice.

HIMSS is working to determine the readiness of providers to participate in the types of value-based payment models that CMS is moving toward.

The effort comes at a key time: CMS is moving ahead at full steam to require more use of alternate payment models in reimbursement.

The 17% decline in hospital-acquired conditions from 2010 to 2014 is the result of a decades long campaign and means lives saved, the avoidance of pain and suffering, and less costly care, said David Blumenthal, MD, MPP, president of The Commonwealth Fund.

The current dialogue occurring between payers and providers is critical in today's healthcare environment, and it's an interaction that certainly was not happening just 5 or 6 years ago, according to Ted Okon, executive director of the Community Oncology Alliance.

Initial adoption of clinical pathways grew from payers mandating their use with individual providers, but there is now greater interest from accountable care organizations and others to use pathways to reduce variation and cost while improving outcomes, explained Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.

Oncology, like primary care, is ripe for delivery reform, but it has remained stuck in a fee-for-service mindset, said Kavita Patel, MD, fellow in economic studies and managing director at Brookings Institution.

A new study suggests that financial incentives shared by both doctors and patients work best at improving medication compliance among patients.

The top stories in managed care were discussions of value-based care at the NAMCP Fall Managed Care Forum, hospitals are suing over Horizon Blue Cross Blue Shield of New Jersey's OMNIA plan, and CMS finalizes its bundled payments for joint replacement.

The HHS Pharmaceutical Forum brought together a diverse set of stakeholders to share ideas on delivering affordable but high-quality care, improving outcomes, and continuing to lead in innovation. Here are 5 things that came out of the daylong meeting.

CMS has finalized a rule for a bundled payment test for hip and knee replacements that will be mandatory for nearly all hospitals in 67 geographical areas across the country.

The Medicare Shared Savings Program is the perfect way for primary care physicians to get involved with alternative payments as Medicare moves to replace fee-for-service, explained Hymin Zucker, MD, chief medical officer of the Triple Aim Development Group.

As the healthcare industry positions itself for the change to value-based care, there needs to be a widespread change in terms of collaboration between physicians, hospitals, and payers.

According to the CDC, while smoking rates are seeing a steady decline, rates for uninsured and adults on Medicaid are more than twice those for adults with private health insurance.

A forced closing of Health Republic Insurance of New York has left many in need of immediate coverage.

Heterogeneity in quality of care and cancer patient survival based on insurance coverage are the highlight of a report by researchers at the Institute for Population Health Improvement at the University of California Davis.

When accountable care organizations first started forming, the country thought it would be easier than it has been, but finding the right partner is crucial, said Pam Halvorson, regional vice president of clinic operations with Trinity Pioneer ACO.

What we're reading, November 3, 2015: off-label drug use is associated with a higher risk of adverse drug events; CMS finalizes its rule for advanced care planning for end-of-life care; and Californians send measure to cut drug prices to the vote.

The Community Oncology Alliance (COA) created its Payer Exchange Summit to get payers who are thinking about getting involved in oncology payment reform or want to know what to do exposed to successful pilots, explained Ted Okon, MBA, executive director of COA.

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