July 24th 2025
This article examines the prevalence of pay-for-performance incentives to promote human papillomavirus vaccination and other quality metrics as reported by frontline clinical staff.
What We're Reading: 1000 Counties Will Have Just One ACA Insurer
October 27th 2016What we're reading, October 27, 2016: the number of counties with just 1 Obamacare insurer will skyrocket in 2017; Teva and IBM partner for 2 projects; and the United States may never be able to rid itself of the Zika virus.
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What We're Reading: AAP Issues Sleep Safety Recommendations for Infants
October 26th 2016What we’re reading, October 26, 2016: AAP advises that parents take measures to reduce the risk of SIDS; Republican presidential nominee Donald Trump reacts to ACA premium hikes announced by HHS; patients with ALS volunteer for an accelerated study on the effects of a dietary supplement.
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A Year After Horizon's OMNIA Rollout, Premium Hikes Are One-Fourth National Average
October 25th 2016A year after its high-profile arrival in New Jersey, Horizon's OMNIA plan will give most enrollees premium increases of 5% to 6%-far less than the 25% average increase announced in a report from HHS.
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Politics and Health Policy After the Presidential Election
October 25th 2016Working under the assumption that the outcome of the presidential race is pretty set, Avik S. A. Roy and John E. McDonough, DrPH, MPA, pondered the potential health policy changes during a Hillary Clinton presidency with a Republican-controlled Congress.
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What We're Reading: ACA Deadline Extended for Consumers With Discontinued Plans
October 25th 2016What we're reading, October 25, 2016: individuals with discontinued Obamacare plans will have a special enrollment period; Arizona governor orders limits on opioid prescriptions; and the FDA aims to speed up generic drug reviews.
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MA Enjoyed Great Success, but Faces Greater Challenges, CMS' Cavanaugh Says
October 24th 2016The Affordable Care Act’s changes in payment and reduction in benchmarks in Medicare Advantage raised questions about the future of the program that ended up being unfounded, said Sean Cavanaugh, deputy administrator and director of the Center for Medicare at CMS, during the opening keynote at America’s Health Insurance Plans’ National Conference on Medicare, held October 24-25 in Washington, DC.
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Andrei Gonzales Advocates for Experimenting With New Payment Models
October 23rd 2016One of the positive effects of the Affordable Care Act’s shift to value-based care is that providers and payers are experimenting with a number of new models, so the successful ones are being implemented on a larger scale, according to Andrei Gonzales, director of value-based reimbursement initiatives at McKesson Health Solutions.
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ACO Coalition Meeting Explores What's Next for Medicare, Payment Reform, and the ACA
October 22nd 2016Despite progress, tying healthcare payments to value has proved easier in theory than in practice, according to speakers at this fall’s meeting of the ACO & Emerging Healthcare Delivery Coalition. Experts convened October 20-21, 2016, by The American Journal of Managed Care looked ahead at the challenges the next president will face with the future of the Affordable Care Act.
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Freestanding Children's Hospitals Face Large Financial Losses for Medicaid Patients
October 22nd 2016Freestanding children’s hospitals had the largest financial losses for pediatric inpatients covered by Medicaid, and may be unable to offset reductions in federal Disproportionate Share Hospital payments because of the expansion of health insurance coverage under the Affordable Care Act.
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Burwell Sees 9% Hike in ACA Enrollment for 2017
October 20th 2016The assessment comes after HHS has put months of effort into attracting young, uninsured adults, including those who have previously paid a penalty for not being insured and those who are likely eligible for financial assistance.
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What We're Reading: CDC Changes Recommendations to Encourage HPV Vaccination
October 20th 2016What we're reading, October 20, 2016: CDC recommends fewer doses of the HPV vaccine; HHS expects an enrollment to increase by 1 million in the upcoming season; and HIPAA violations result in a multimillion fine for St. Joseph's Health.
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What We're Reading: DC Considering Right-to-Die Legislation
October 19th 2016What we're reading, October 19, 2016: the District of Columbia will vote on right-to-die legislation; huge premium increases for Obamacare plans; and why primary care physicians haven't gotten involved in the opioid epidemic.
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Using Medicaid to Cover Supportive Housing, Improve Health
October 18th 2016Supportive housing targets individuals who have experienced homelessness with chronic disease, disabilities, mental health issues, or substance use disorders. And with the expansion of Medicaid under the Affordable Care Act, the program can help address supportive housing needs.
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Inconsistent Treatment for Prisoners With Hepatitis C Provokes Lawsuits
October 17th 2016The rate of inmates infected with the hepatitis C virus is estimated at 17.4% across the United States, and can reach as high as 40% in some states. However, many inmates in state prisons are not permitted to receive the the newest and most expensive treatments for the virus.
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What We're Reading: Insurer Troubles Mean ACA Coverage Could Shrink in 2017
October 17th 2016What we're reading, October 17, 2016: more than 1 million Americans will lose their current Obamacare plan; physicians grow increasingly frustrated over insurance trends; and how overactive bladder disorder could benefit from less drug treatments.
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Health Insurance "Churning" No Worse After ACA Passage, but Still a Problem
October 16th 2016Almost one-fourth of low-income adults in 3 states (Arkansas, Kentucky, and Texas) have experienced changes in health insurance coverage, known as “churning,” since the passage of the Affordable Care Act.
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What We're Reading: Bernie Sanders Supports California's Drug Price Control Measure
October 14th 2016What we’re reading, October 14, 2016: Senator Bernie Sanders will speak in support of a California bill that would require the state to pay less for prescription drugs; HHS reaches out to consumers ahead of open enrollment period; and CDC warns that contaminated heart surgery devices could cause severe infections.
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OOP Expenses Remain a Problem in Medicare, Especially for Beneficiaries Taking Specialty Drugs
October 11th 2016Medicare beneficiaries still face huge out-of-pocket expenses because of uncapped cost sharing in the catastrophic coverage phase. This is especially true for beneficiaries who take specialty drugs.
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What We're Reading: Tying Medical Organization Recommendations to Insurance Coverage
October 11th 2016What we're reading, October 11, 2016: USPSTF recommendations maybe shouldn't be tied to insurance coverage; growing dispute over homeopathy research; and the harm of pharmaceutical companies' copay assistant programs.
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ACA One of Many Points of Contention During Second Clinton-Trump Debate
October 10th 2016The second presidential debate, which took place Sunday night at Washington University in St. Louis, Missouri, allowed candidates Donald Trump and Hillary Clinton to spar over a multitude of issues, including the future of healthcare in America.
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Payment Tied to Patient Experience Improvement Benefits Hospitals Serving Minority Patients
October 8th 2016Although hospitals in Medicare’s Value-Based Purchasing program already receive patient experience points based on achievement, improvement, and consistency, placing more emphasis on improvement points could benefit hospitals serving minority patients
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This Week in Managed Care: October 7, 2016
October 7th 2016This week, the top managed care stories included conference coverage from the Academy of Managed Care Pharmacy's 2016 Nexus, Bill Clinton courted controversy when discussing the Affordable Care Act, and research finds fear of a job loss can increase the risk of diabetes.
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