Health Care Delivery

As The American Journal of Managed Care marks its 20th year of publication, the editors invited Margaret O'Kane, the founding and current president of the National Committee on Quality Assurance, to address today's retail environment for healthcare consumers. In 2015, NCQA marks its 25th year of improving healthcare quality through measurement, transparency, and accountability.

Young adults appear to have changed their use of the emergency department since the implementation of the Affordable Care Act to reflect a more efficient use of medical care, according to a new report in the Annals of Emergency Medicine.

Commissioned by The Leukemia and Lymphoma Society, the results of the study help make the case for placing limits on out-of-pocket costs for patients that would relieve their financial burden without a significant impact to insurers.

New Hampshire's waiver features premium assistance to shop on the HealthCare.gov exchange and includes a work-referral requirement. CMS resisted linking a waiver to work-related requirements more than a year ago when granting Pennsylvania's waiver.

A one-minute look at managed care news during the week of March 2, 2015, including oral arguments for King v. Burwell and the approval of the first biosimilar in the United States.

The second open enrollment period for the Affordable Care Act went much smoother for consumers signing up for health plans through HealthCare.gov; however, CMS still has much work to do, according to a new report from the Government Accountability Office.

Twitter can be used as a real-time measurement of public sentiment for the Affordable Care Act (ACA) and the positivity and negativity of tweets could be used to determine state-level marketplace enrollment, according to researchers.

The Supreme Court's liberal wing grilled the petitioner's attorney on whether today's argument squared with what he said in the 2012 challenge to the Affordable Care Act. Justice Kennedy asked how states could be forced to set up exchanges or see their residents lose tax credits.

Although the decision in King v. Burwell will not directly affect states that have set up their own health insurance exchanges, they could see some benefits, according to David Blumenthal, MD, chief executive officer of The Commonwealth Fund.

On March 4, The American Journal of Managed Care will be live-reporting the news from the Supreme Court oral arguments in the case of King v. Burwell. In the meantime, here is a recap of the news leading up to the lawsuit's day in court.

On March 4 the Supreme Court will hear arguments in the case of King v. Burwell, which determines the fate of subsidies in the 34 federally facilitated marketplaces, and David Blumenthal, MD, chief executive officer of The Commonwealth Fund, outlined the potentially catastrophic effects if the Court were to side with the plaintiffs.

Under the Affordable Care Act, CMS is charged with evaluating how well accepted quality measures are working to help meet a National Quality Strategy.

Suzanne F. Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform, will be the keynote speaker at the spring meeting of the ACO and Emerging Healthcare Delivery Coalition, to be held April 30 and May 1, 2015, in San Diego, California. The ACO Coalition, an initiative of The American Journal of Managed Care, brings together stakeholders from across the healthcare spectrum interested in sharing best practices relative to the changing delivery and payment models.

The list of situations that trigger a special, 60-day enrollment period will get longer in April, when a new rule issued by HHS takes effect.

Budget cuts mean county health clinics will be unable to fill hundreds of jobs, leaving smaller staffs to serve low-income people in state that declined to expand Medicaid despite pleas from its hospitals and business leaders.

A lengthy report published by the Kaiser Family Foundation predicts widespread market disruption if ACA premium subsidies are lost under King vs. Burwell. Adverse selection, insurers exiting markets, and higher rates are just some of the possibilities.

Project to research better way to treat neutropenia is 1 of 5 to get latest funding from Patient-Centered Outcomes Research Institute.

H&R Block, the largest consumer tax preparer, said those who underestimated their 2014 income must repay an average of $530. Those who failed to get coverage at all must pay an average penalty of $172.

The difference in uninsured rates in states that have embraced the Affordable Care Act and those that have not became even starker in 2014, according to new results from the Gallup-Healthways Well-Being Index.

The federal government sent incorrect tax information to about 800,000 people who purchased health insurance last year through HealthCare.gov and asked them to delay filing their returns, Obama administration officials said Friday.

According to a healthcare consultant, hospitals that handle high patient volume tend to receive lower patient satisfaction scores than the smaller, specialty hospitals. The discrepancy in the patient demographic and the kind of procedures being conducted need to be considered when evaluating hospitals, experts think.

Governors in states without their own exchanges admit they have no fallback option if the Supreme Court takes away subsidies from an estimated 8 million consumers.

Why Medicaid expansion represents an opportunity to improve the welfare of the poorest Americans, who are still recovering from the Great Recession.

A one-minute look at managed care news during the week of February 16, 2015, including extended open enrollment under the Affordable Care Act and shared decision-making for cancer treatments.

Facing high costs but smaller budgets, some states are struggling to find financially and politically sustainable ways to keep their health exchanges running.

Consumers would have to show they only learned about the tax penalty when they went to file their tax returns, according to CMS' Andrew Slavitt. Under the Affordable Care Act, penalties for not having coverage for 2015 are $325 or 2% of household income.

Despite opposition from Republicans, Florida has surpassed California to become the state with the highest number of consumers enrolling in health insurance coverage through the Affordable Care Act's exchanges.