Health Care Delivery

Panel members provide their own perspective on what clinical pathways encompass.

After beWellnm lost a major state insurer, the exchange changed its enrollment strategy and traveled throughout New Mexico to discuss the change in the market and remind the population about the assistance available, explained Amy Dowd, CEO of beWellnm.

What we're reading, April 25, 2016: Marilyn Tavenner predicts steep Obamacare insurance premium hikes in 2017; the World Health Organization formally begins looking for its new leader; and the life expectancy between rich and poor young Americans narrows.

This week, the top stories in managed care included the news that UnitedHealth will be exiting most Obamacare exchanges in 2017, and coverage from both the annual meeting of the Academy of Managed Care Pharmacy and the Community Oncology Conference.

The state's first-in-the-nation waiver to Medicaid seemed endangered in late 2014, but Governor Asa Hutchinson decided keeping people insured was worth it.

According to Avalere Health, physicians who prescribe lower cost drugs would be reimbursed at a higher rate than those who use more expensive drugs, under the proposed Medicare Part B demo model.

What we're reading, April 21, 2016: Congress keeps things moving on the fight against the opioid epidemic; new paper from the National Bureau of Economic Research finds Medicaid expansion has a broader societal impact; and Novartis faces stiff competition from generic version of Gleevec.

Coverage of sessions held at Cancerscape, the Association of Community Cancer Center’s 42nd annual meeting on policy, value, and quality, held March 2-4, 2016, in Washington, DC.

As healthcare moves to value-based arrangements and delivery models like accountable care organizations (ACOs), the benefit of incorporating a pharmacist can be overlooked. Tina Joseph, PharmD, BCACP, and Reena Jones, PharmD, CPh, both from Nova Southeastern University, outlined how pharmacists can be integrated into ACOs in order to improve care and patient satisfaction, while reducing cost.

A cost-economic analysis by researchers at the Yale School of Public Health has found that switching to Gardasil-9, which protects against 9 oncogenic serotypes of the human papillomavirus, would provide improved health benefits at the same or lower societal cost.

UnitedHealth Group started the year in 34 insurance exchanges, but that number will be a lot less come 2017. CEO Stephen Hemsley announced that the company will only participate in a "handful" of Affordable Care Act exchanges next year.

What we're reading, April 18, 2016: medical experts ask the Joint Commission to revisit its standards of pain management; study determines low-cost generics just as effective at treating hepatitis C as brand name drugs; and UnitedHealth also pulling out of Michigan Obamacare exchange.

An overview of the oncology clinical pathways development program at the UPMC CancerCenter and how it led to the creation of Via Oncology, a clinical pathways vendor.

What we're reading, April 15, 2016: troubling disparities in access to preventive care remain; new test to choose the right hepatitis C medication could save money; and upcoming loss of exclusivity for some drugs could mean big savings for the healthcare system.

Patients encountering high deductibles regarding medication in their Affordable Care Act plans can seek assistance from drug manufacturers by using copay programs, said Daniel J. Klein, president and CEO of the Patient Access Network Foundation.

Representatives from 3 clinics that successfully participated in the Commission on Cancer accreditation process for the Oncology Medical Home model participated in a panel discussion on the first day of The Community Oncology Conference: Innovation in Cancer Care.

On the first day of The Community Oncology Conference: Innovation in Cancer Care, held in Orlando, Florida, April 13-15, 2016, oncologists discussed how their practices are coping with the transition toward quality- and value-based reimbursement.

What we're reading, April 14, 2016: House passes bill to speed up approval for Zika virus vaccines; spending on prescription brand name drugs grew just 2.8% in 2015; and Maine Senate passes measure to expand Medicaid.

The rise in employee cost-sharing for healthcare predates Obamacare but has taken off since the law passed in 2010. Higher deductibles have been accompanied by stagnant wages, ensuring that the higher payments are deeply felt.

In preparation for the Spring Live Meeting of the ACO & Emerging Healthcare Delivery Coalition, 2 speakers who will be at the meeting will participate in 2 30-minute tweetchats.

We offer recommendations for the development and design of clinical pathways in an effort to establish a set of normative criteria that creates trust and transparency.

Potential modifications to the risk-adjustment model used for the Affordable Care Act commercial plans could improve the model and appropriately compensate plans that enroll sicker enrollees.

Changes with insurance products have led to more costs being shifted to consumers and they are having very mixed emotions when faced with high-deductible health plans, explained Niteesh Choudhry, MD, PhD, associate professor of medicine at Harvard Medical School.

Policy decisions can influence whether communities are supportive of or detrimental to community health and well-being. Such housing policies can also play important roles in reducing or even preventing diseases.

Clinical pathways have been emphasized as a means to deliver efficient, quality care and to ensure better outcomes at lower costs. The Oncology Medical Home takes this to the next, more comprehensive, step of quantifying and improving quality and value in cancer care while lowering overall costs.

What we're reading, April 11, 2016: UnitedHealth calls it quits for 2 Obamacare state exchanges; study finds disparities across country in lifespans of low-income people; and Hillary Clinton and PhRMA agree on one proposal to curb drug costs.

Hurricane Katrina revealed the gaps in public health services in New Orleans, especially for those living in poverty, said Charlotte Parent, director of health of the New Orleans Health Department.

States can greatly improve access to behavioral health services for residents by expanding Medicaid through the Affordable Care Act, HHS reported.

A preliminary briefing document expresses concerns over clinical benefit over existing treatments, safety, and overall risk-benefit of the drug for the subset of lung cancer patients for whom the drug has been developed.

What we're reading, April 7, 2016: hospitals will help Louisiana pay for Medicaid expansion; Pfizer considers splitting the company after deal with Allergan falls through; and Pfizer gets 300 lawsuits dismissed.