Health Care Delivery

Patients enrolled in plans on the public health insurance exchange filled more prescriptions than commercial members during the first year of enrollment under Affordable Care Act, according to a report from Prime Therapeutics.

The authors investigated multi-sectoral healthcare alliance responses to the ACA and whether these responses differed between states supportive and unsupportive of health reform.

The authors analyzed the association of insurance coverage and likelihood of an ED visit being nonurgent or primary care—sensitive based on an ED classification algorithm.

Keeping afloat by understanding the Affordable Care Act, managed care, consumerism, and transparency from the perspective of purchasers, providers, and consumers.

The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, launched a little over a year ago to give stakeholders focused on accountable care opportunities to share ideas on how to move from volume- to value-based models. The Coalition's most recent Web-based session shows how meetings have evolved to highly detailed discussions of how organizations are making those transitions.

Although Republicans have been considering a repeal and replace approach to fixing the Affordable Care Act (ACA), Avik Roy, senior fellow at the Manhattan Institute, has his own plan.

Since open enrollment began in October 2013, 14.1 million adults have signed up for health insurance with an additional 2.3 million gaining coverage through the provision covering young adults.

Cardiologists treat patients who are older, sicker, and more reliant on Medicare. That means they must pay attention to new payment models from CMS that reduce reliance on fee-for-service and increase the presence of accountable care organizations.

The biggest battle in healthcare these days-besides the ongoing fight over Obamacare-is over the price of expensive life-saving medications.

Despite claims by the Obama administration that the Affordable Care Act will reduce health insurance companies' spending on overhead, insurers' financial filings show the law had no impact.

Although HHS Secretary Sylvia M. Burwell touted the success of this past open enrollment period and the affordability of quality health plans, she declined to comment on King v. Burwell during her keynote speech at America's Health Insurance Plans (AHIP)'s National Health Policy Conference.

Obamacare's tenuous toehold in Montana appears to be growing no firmer. Despite a hearing crowded with supporters of the Democratic governor's Medicaid expansion bill, Republican legislators have dealt the measure a likely death blow.

As The American Journal of Managed Care marks its 20th year of publication, the editors invited Margaret O'Kane, the founding and current president of the National Committee on Quality Assurance, to address today's retail environment for healthcare consumers. In 2015, NCQA marks its 25th year of improving healthcare quality through measurement, transparency, and accountability.

Young adults appear to have changed their use of the emergency department since the implementation of the Affordable Care Act to reflect a more efficient use of medical care, according to a new report in the Annals of Emergency Medicine.

Commissioned by The Leukemia and Lymphoma Society, the results of the study help make the case for placing limits on out-of-pocket costs for patients that would relieve their financial burden without a significant impact to insurers.

New Hampshire's waiver features premium assistance to shop on the HealthCare.gov exchange and includes a work-referral requirement. CMS resisted linking a waiver to work-related requirements more than a year ago when granting Pennsylvania's waiver.

A one-minute look at managed care news during the week of March 2, 2015, including oral arguments for King v. Burwell and the approval of the first biosimilar in the United States.

The second open enrollment period for the Affordable Care Act went much smoother for consumers signing up for health plans through HealthCare.gov; however, CMS still has much work to do, according to a new report from the Government Accountability Office.

Twitter can be used as a real-time measurement of public sentiment for the Affordable Care Act (ACA) and the positivity and negativity of tweets could be used to determine state-level marketplace enrollment, according to researchers.

The Supreme Court's liberal wing grilled the petitioner's attorney on whether today's argument squared with what he said in the 2012 challenge to the Affordable Care Act. Justice Kennedy asked how states could be forced to set up exchanges or see their residents lose tax credits.

Although the decision in King v. Burwell will not directly affect states that have set up their own health insurance exchanges, they could see some benefits, according to David Blumenthal, MD, chief executive officer of The Commonwealth Fund.

On March 4, The American Journal of Managed Care will be live-reporting the news from the Supreme Court oral arguments in the case of King v. Burwell. In the meantime, here is a recap of the news leading up to the lawsuit's day in court.

On March 4 the Supreme Court will hear arguments in the case of King v. Burwell, which determines the fate of subsidies in the 34 federally facilitated marketplaces, and David Blumenthal, MD, chief executive officer of The Commonwealth Fund, outlined the potentially catastrophic effects if the Court were to side with the plaintiffs.

Under the Affordable Care Act, CMS is charged with evaluating how well accepted quality measures are working to help meet a National Quality Strategy.

Suzanne F. Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform, will be the keynote speaker at the spring meeting of the ACO and Emerging Healthcare Delivery Coalition, to be held April 30 and May 1, 2015, in San Diego, California. The ACO Coalition, an initiative of The American Journal of Managed Care, brings together stakeholders from across the healthcare spectrum interested in sharing best practices relative to the changing delivery and payment models.

The list of situations that trigger a special, 60-day enrollment period will get longer in April, when a new rule issued by HHS takes effect.

Budget cuts mean county health clinics will be unable to fill hundreds of jobs, leaving smaller staffs to serve low-income people in state that declined to expand Medicaid despite pleas from its hospitals and business leaders.