Health Care Delivery

This week in managed care, the top stories included House Republicans' new plan to repeal and replace the Affordable Care Act, new funding from HHS to help small practices follow the Medicare Access and CHIP Reauthorization Act, and the Supreme Court rules on a patent lawsuit that impacts pharmaceutical companies.

Despite recommendations and the passage of legislation, there is little evidence that the quality of behavioral health has improved significantly over the last 10 years in the United States.

What we're reading, June 24, 2016: Britain's decision to leave the European Union will impact drug regulation; Supreme Court decision derails California proposal to allow illegal immigrants to buy health insurance; and lawmakers look to reduce exclusivity period for biologics.

An appellate panel found that a group of hospitals could not have information that Horizon withheld during discovery in 2 breach of contract suits related to its OMNIA tiered health plan. An attorney for 1 group of those hospitals said it will appeal because consumers and providers need to know how the tiered health network was created.

House Speaker Paul Ryan said the policy outline represents the first consensus among his conference to replace "Obamacare," which the document says has not worked because it has limited choice, increased consumer costs, and created new regulatory burdens for employers.

Addressing the unmet social needs of patients requires additional investment on the part of the healthcare industry, but provides a tangible return on investment.

What we're reading, June 22, 2016: Obama administration targets young individuals for Affordable Care Act enrollment; Boeing is directly contracting with a major California health system to provide employee benefits; growing interest in the use of value-based insurance design.

An expert panel at The Community Oncology Conference: Innovation in Cancer Care, held in Orlando, Florida, April 13-15, 2016, provided insight on current transitions in healthcare reform, and their predictions for the future.

Since the implementation of the ACA, health plans have been moving towards more managed, narrower plans. In addition, Erica Hutchins Coe, partner and co-leader of Center for US Health System Reform at McKinsey & Company, said that she has seen a progression of younger, healthier adults moving into the marketplace.

Study’s findings add to concerns about health plans’ incentives not to comply with their legal obligation under the law to provide mental health benefits on par with medical and surgical benefits.

If the announcement by the Swiss pharmaceutical giant Novartis holds true, biosimilars that the company plans to launch over the next 4 years could create a significant dent in the sales of 5 blockbuster molecules in the oncology and immunology space.

The Affordable Care Act has helped many Americans gain access to health coverage, and a recent analysis from HHS discovered that rural America in particular has benefited.

The Affordable Care Act and additional legislation that has mandated extending mental health parity coverage are contributing to an increased demand for mental health services that the United States is not meeting.

This week, the top stories in managed care included study results presented at the 76th Scientific Sessions of the American Diabetes Association from the SWITCH and LEADER trials, a recommendation for a smarter way to screen for prostate cancer, and researchers found physicians underutilize medications to treat opioid addiction.

Growing antibiotic resistance is a significant global problem. But steps are being taken to apply brakes on the rise of "superbugs."

Delivering the results of complex genetic tests to at-risk patients over the telephone may be an effective way to reduce burdens and costs for patients with cancer or at risk for cancer and would not cause patients added stress, a study found.

CancerLinQ is a big data platform developed by the American Society of Clinical Oncology (ASCO) that aggregates clinical data from electronic health records for quality benchmarking and hypothesis generation. Such observational data can complement traditional evidence but must be used with caution.

Scottsdale Health Partners helps patients with social needs through a complex care coordination program and working with community resources like adult protective services or other city government branches, James Whitfill, MD, chief medical officer, explained at the National Association of ACOs Spring 2016 Conference.

Medicaid payments to hospitals comprise a large portion of a hospital’s finances; however, policy changes occurring under the Affordable Care Act may have several implications on the way hospitals receive payments from Medicaid.

While there are FDA-approved medications proven to help curb opioid addiction, not many physicians are taking full advantage of it.

Fears that insurers would sell cheaper, “bare bones” plans to attract healthy enrollees away from the Affordable Care Act (ACA)’s marketplaces and shift sicker, more costly enrollees into the ACA plans have been unfounded.

Health plans are recognizing the importance of behavioral healthcare. In addition to meeting parity requirements, plans are proactively engaging with consumers who need behavioral healthcare, coordinating their care across the continuum, and working with them to find community-based support services they may need.

What we're reading, June 10, 2016: Carolinas HealthCare System faces antitrust lawsuit; Alaska looks to bail out its Obamacare marketplace; and Pfizer increases drug prices in the US for the second time this year.

Healthcare leaders and experts will come together to discuss disruptors, consumer engagement, digital health, and more at the AHIP Institute & Expo, being held June 15-17 in Las Vegas.

A new analysis from The Commonwealth Fund has found that the Cadillac tax will likely be more progressive than initially thought.

What we're reading, June 9, 2016: Philadelphia is poised to become the first major city to pass a soda tax; California raises its smoking age to 21; and the Obama administration looks to limit short-term health plans.

Even in a state with relatively few Medicaid restrictions on hepatitis C virus medications, a low number of patients requested treatment.

With only 3 medications FDA-approved to treat opioid addiction, patient access to these treatment options can be difficult, and each medication presents its own challenges, said Kelly J. Clark, MD, MBA, president elect of the American Society of Addiction Medicine.

There is a significant variation in quality of urgent healthcare provided during virtual visits, according to a new study published in JAMA Internal Medicine.

Since the implementation of ACA, Florida Blue’s enrollment plans have changed in that plan has expanded its outreach platforms and had to educate a larger audience of consumers, explained Anne Jessup, senior director of digital channels at Florida Blue.