Health Care Delivery

Over the past few decades, 38 states and the District of Columbia have switched their Medicaid plans to some form of managed care for at least part of their government programs.

Consumers thinking about becoming enrolled in health insurance exchange plans may gain access to a new low-premium, high-deductible option: the copper plan. However, these plans have many patient advocate groups and policy experts concerned about their "bare-bone" offerings.

Specialty pharmaceuticals are changing the lives of patients with cancer and chronic conditions, but their high cost and increased used has drawn the scrutiny of payers. A review in this month's issue of The American Journal of Managed Care, which examined studies involving therapies for rheumatoid arthritis, multiple sclerosis, and breast cancer, found that when these drugs are used with the right patients, the value for patients is high.

A proposed Centers for Medicare & Medicaid Services ruling would make it easier for consumers to automatically re-enroll in their plans from the healthcare insurance exchanges if they liked them.

Medicaid expansion continues to vary in popularity. Twenty-six states and the District of Columbia plan to expand Medicaid, while 4 are actively considering it and 20 have no plans to do so.

Increasingly, pharmacy benefit managers (PBMs) are refusing to purchase high-cost drugs from manufacturers or include them in their formularies - the lists of drugs that a health plan will cover.

Physician groups are lobbying hard to extend an Obamacare provision that requires state Medicaid programs to pay primary-care physicians at higher Medicare rates to improve access for Medicaid patients. But to persuade congressional Republicans to go along, they are downplaying the fact that the pay bump is part of the Patient Protection and Affordable Care Act.

The American Journal of Managed Care followed up the first meeting of its ACO and Emerging Healthcare Delivery Coalition with its first interactive conference call, which was open to all members. Anthony Slonim, MD, DrPH, a Coalition co-chair who on July 1 will become president and CEO at Renown Health in Reno, Nev., moderated the roundtable discussion.

The Affordable Care Act (ACA) granted millions of uninsured Americans access to healthcare plans on the federal and state exchanges. Utilizing consumer research, Pamela Morris, director, Syndicated Research, Zitter Health Insights, described how both consumers and healthcare professionals are navigating these innovative insurance marketplaces.

Virginia Gov. Terry McAuliffe vowed Friday to bypass the General Assembly and expand Medicaid eligibility for about 400,000 low-income residents on his own.

I'll say it: I think most states, if not all, will be on the Federal exchange by the end of the decade.

A panel asks: "Due to the ACA, who is now presenting with cancer? Who is walking through the door and is there a difference between patients since the ACA implementation?"

The American Journal of Managed Care will host a two-day event September 25-26, 2014, to take on some of healthcare's biggest challenges: Treatments that cure hepatitis C are making news but upending balance sheets. A recent recommendation seeks preventive therapy to stop new cases of HIV. Hospitals and public health officials are grappling with how to prevent the spread of MERS. Only AJMC will bring payers, clinicians, policy leaders, and pharmaceutical representatives together to share ideas.

This study examines whether patients treated with specialty pharmaceuticals have improved outcomes compared with patients treated with conventional therapies, and evaluates costs associated with these treatments.

Officials from HHS released new data detailing the profile of consumers who enrolled in federal health insurance exchange plans, and the data show that more than 8 million people signed up for coverage.

Two measures of the evolving health insurance market show that change is happening more quickly than anticipated.

The drug industry scored a victory last month against the Obama administration's plans to give hospitals millions of dollars in discounts through the 340B program on orphan drugs. But HHS is sticking to its position that the Patient Protection and Affordable Care Act promises breaks on the expensive drugs when they're used for non-orphan indications.

An analysis examining Medicare data found that the number of elderly beneficiaries receiving narcotic painkillers and anti-anxiety medications drastically increased from 2007 to 2012.

Personal health information may be key to reducing the costs of care. To work most efficiently, patient participation and compliance will be necessary.

Kathleen Sebelius handed leadership of the Health and Human Services Department to her successor on Monday and wished new Secretary Sylvia Matthews Burwell the best of luck.

From coast to coast, people say that their health coverage and care are too expensive.

The federal health-care law was intended to create a uniform standard of health coverage across the U.S. But the law also is creating opportunities for states to pursue their own solutions.

With specialty pharmaceuticals carrying extremely high-and rising-costs, nonadherence and discontinuation of therapy is becoming even more commonplace. The value-based insurance design (V-BID) model, so termed by A. Mark Fendrick, MD, Dean Smith, PhD, and Michael Chernew, MD, promotes personalized patient care by easing access to specialty medications while reducing the number of prescribed treatments of lesser value as a replacement.

The Patient Protection and Affordable Care Act (ACA) will likely improve insurance coverage for most young adults, but subsets of young adults in the United States will face significant premium increases in the individual market. We examined the association between insurance status and cancer-specific outcomes among young adults.

The federal government may reimburse doctors for talking to Medicare patients and their families about advance care planning, including living wills and end-of-life treatment options potentially rekindling one of the fiercest storms in the Affordable Care Act debate.

With 36 states utilizing Healthcare.gov, and with at least 2 additional states considering enrollment, the concept of a national healthcare insurance exchange (HIE) may quickly become a reality.

The second day at the 50th annual meeting of the American Society of Clinical Oncology ended with a session entitled "Health Care in America in 2014: Current and Future Implications of the Patient Protection and Affordable Care Act" (PPACA). The presenters provided an overview of the recent and anticipated changes related to the PPACA as well as its timeline.

Although they're not expanding Medicaid under the Affordable Care Act, Texas, Florida and other states are expanding managed care, bringing insurers opportunities as well as challenges, including competition from provider-based health plans.

There are rumblings that federal lawmakers may be willing to repeal Medicare's burdensome rule requiring physicians in critical access hospitals to make an educated guess that the patients they're admitting will be either discharged or transferred in less than four days.

One of the biggest beneficiaries of the health law's expansion of coverage to more than 13 million people this year has been the nation's safety-net hospitals, which treat a disproportionate share of poor and uninsured people and therefore face billions of dollars in unpaid bills.