Health Care Delivery

The Obama administration and state insurance regulators are developing stricter standards to address the concerns of consumers who say that many health plans under the Affordable Care Act have unduly limited their choices of doctors and hospitals, leaving them with unexpected medical bills.

When it comes to value-based decision making, several factors can influence physician behavior. Although many organizations rely on financial incentives, the Commonwealth Fund argued in a report released Tuesday that healthcare leaders should think beyond the dollars and dimes.

The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, hosted a recent Web-based session that featured three presentations on aspects of the transition to value-based care: why barriers to change persist, what steps one ACO is taking to drive better health, and why a "patient-centered" method of picking a doctor makes sense.

House Republicans took the initial step on Thursday to sue President Barack Obama over the administration's decision to delay the employer mandate of the healthcare law.

While much attention has focused on expanded coverage and online insurance bazaars, policymakers' bigger challenge is improving Americans' health while putting a brake on the cost of their care. The keys to that puzzle, CareFirst and many others are deciding, are the internists and general practitioners who have largely been left behind by health care's financial boom.

Federal agencies remain committed to increase patients' access to affordable, high quality, and comprehensive healthcare.

HHS Secretary Sylvia Mathews Burwell announced today the availability of $100 million from the Affordable Care Act to support an estimated 150 new health center sites across the country in 2015.

The Affordable Care Act (ACA) prohibits insurance companies from rejecting new customers based on their pre-existing health conditions. Yet, a recent report alleged that 4 Florida-based payers may have structured their prescription drug benefit plans in a way which does just that.

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.