Health Care Cost

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.

A new analysis projects that millions will lose Medicaid expansion coverage—including many who are working, exempt, or have serious health needs.

Analysis of billing codes before and after implementation of a care process for weight-focused visits revealed increased primary care revenue for these encounters.

Population data reveal serious infections drive CLL hospital costs, clarifying morbidity and mortality in the hematologic cancer and its true economic consequences.

John Barkett, MBA, discusses how health care price transparency can affect both patient out-of-pocket costs and overall health care spending.

New studies show 2024 IRA Medicare drug caps and expanded subsidies cut cost-related nonadherence, especially for those with chronic disease.

An intensive outpatient clinic model significantly reduced health care spending, hospital admissions, and emergency department visits among complex Medicaid patients over a 2-year period.

Making health care prices public was supposed to cut costs. The reality is more complicated.

Oncology has never had more to offer, and yet it is straining under the weight of its own progress.

Industry payments to cardiologists are linked to higher Medicare spending, with $10,000 in payments tied to $14.10 more per beneficiary.