Health Care Delivery

A 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.

Working 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.

What 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.

For millions, the Affordable Care Act promised relief from the expenses of contraception. So why are many still not feeling it?

The 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.

One 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.

Despite 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.

Freestanding 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.

The 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.

What 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.

Implementation of the Affordable Care Act’s contraceptive mandate in 2012 was associated with more consistent use of generic oral contraceptives, according to a new study.

What 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.

For millions, the Affordable Care Act promised relief from the expenses of contraception. So why are many still not feeling it?

Supportive 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.

The findings of a poll of emergency department physicians were presented at American College of Emergency Physicians' annual Scientific Assembly, which is meeting in Las Vegas.

As we enter a time of extraordinary advances in cancer care, some of the optimism over these advances has been tem­pered by the growing realization of the challenges of delivering these cancer care solutions.

The 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.

What 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.

Almost 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.

What 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.

The partnership is expected to improve the quality of care and the overall care experience for Aetna members who seek care at Regional Cancer Care Associates (RCCA) clinics in New Jersey and Maryland.

Medicare 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.

What 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.

The 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.

Although 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

This 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.

Nationally, nongroup marketplace premiums are 10% lower than the average employer-sponsored insurance premiums, according to an analysis by the Urban Institute.

What we're reading, October, 6, 2016: UnitedHealth is sued for allegedly overcharging on prescription drugs; the Obama administration could point consumers to remaining insurance options as insurers leave the Affordable Care Act exchanges; and human life spans may have it a ceiling.

The former president said that Obama's signature law works well for those who are enrolled in Medicaid or who qualify for subsidies, but others have seen premium increases with lower benefits. The White House noted that Hillary Clinton supports improvements to the law.

Data released by HHS today revealed that up to 2.5 million Americans currently purchasing health insurance through an off-Marketplace plan could qualify for ACA tax credit assistance if they switch to a Marketplace plan for 2017.