Health Care Delivery

Two Viewpoint articles JAMA highlight continuing healthcare deficiencies and inequalities in the United States and present a call to action for bold new strategies to direct resources toward improvements in support of population health.

What we're reading, October 3, 2016: President Barack Obama's Affordable Care Act will have to change to survive; pharmacy benefit managers getting blamed for rising drug prices; and veterans could go without health insurance because states won't expand Medicaid.

While working for Horizon Healthcare Innovations, Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute, gained insights on how best to transition to a pay-for-outcomes system and was able to actively work with healthcare stakeholders who were engaging in these models.

CareSource is helping to bridge the gap in a patient’s care by working within that space to pull together the various stakeholders and put the patient’s care needs at the forefront of the conversation, said Karin VanZant, executive director of Life Services at CareSource.

After 2 years of extraordinary gains in Medicaid coverage due to expansion under the Affordable Care Act, coverage in the program has steadied. Private managed care covers nearly three-fourths of enrolled lives.

What we're reading, September 30, 2016: HHS prioritized payments to Obamacare insurers over the Treasury; the CDC is concerned flu vaccinations may be down; and UnitedHealth Group and University of California come together for new partnership.

Research has shown that care provided through teledermatology is comparable to that delivered in face-to-face appointments, and future dermatologists are being taught to deliver care this way to improve patient access to expert dermatological care, said Nellie Konnikov, MD, professor and chief of dermatology at the Boston Department of Veterans Affairs.

Data show that the biggest factor affecting distribution of uninsured rates was whether a state expanded Medicaid. Even with that limitation, uninsured rates have reached historic lows. The trouble is, only about one-fourth of Americans know this, and more have moved on to issues that affect them personally, such as the cost of premiums or high deductibles.

The effort to reach young adults will allow them to shop for coverage entirely on mobile digital technology. But an economist interviewed earlier this month says it might not be enough.

What we're reading, September 27, 2016: a panel of experts recommends expanding preventive services for women with no cost sharing; BlueCross BlueShield of Tennessee is exiting 3 Obamacare exchanges; and Pfizer will not split into 2 companies.

Analysis of prescription transaction data provided insight into reduced out-of-pocket spending and increased medical fill rates for people who gained coverage under the Affordable Care Act and had at least 1 chronic condition.

Patience and compromise will be key to healing political rifts caused by Medicaid expansion, explained Matt Salo, executive director of the National Association of Medicaid Directors.

Under the Affordable Care Act, health centers received federal funding to provide comprehensive primary care to patients in underserved communities. An analysis of Medicaid claims data in 13 states has found that these health centers reduced spending by 24% per Medicaid patient.

Readmission rates for both safety net hospitals and other hospitals have decreased since Medicare’s Hospital Readmissions Reduction Program went into effect in 2013. However, disparate rates of improvement could show that these hospitals in low-income areas are still at a disadvantage.

About half of people involved with the justice system are newly eligible for health insurance through the Affordable Care Act. While coverage is rising, one-third still lack insurance.

What we're reading, September 23, 2016: California's insurance commissioner wants to try a public option; Valeant avoids double-digit price hikes with 9.9% increases; maker of Suboxone being sued by 35 states and the District of Columbia for keeping generics off the market.

The integration of behavioral healthcare into a medical setting is being delayed by resistance from those benefiting from the current payment model, said Roger Kathol, MD, president of Cartesian Solutions, Inc., and adjunct professor of psychiatry at the University of Minnesota.

People who visit the emergency department (ED) for mental health care are transferred to another facility at a rate 6 times higher than people who visit EDs for non-psychiatric conditions, and they wait hours longer, as well

Ideally, the healthcare industry needs to be more consumer driven, so that solutions and programs are built with the patient in mind, said Jay Sheehy, senior vice president of product innovation at EmblemHealth.

Since the implementation of the Affordable Care Act, more and more individuals are gaining access to insurance. Therefore, part of the New Jersey Health Care Quality Institute's responsibility is to make the complexities of the healthcare industry more easily understandable for members, according to Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute

This week, the top managed care stories included news that Risa Lavizzo-Mourey, MD, MBA, will be leaving the Robert Wood Johnson Foundation, a report that obesity rate in the military are also on the rise, and CMS denied Ohio's proposal to charge fees for Medicaid.

Massachusetts achieved near-universal insurance coverage after enacting its own healthcare reform 10 years ago, but gains in improved access to and affordability of care faded over time.

The American Journal of Managed Care reached out to Daniel F. Hayes, MD, FASCO, 2016-2017 president of the American Society of Clinical Oncology (ASCO), to understand his perception of how the recommendations of the Cancer Moonshot initiative's Blue Ribbon Panel would impact cancer care in the United States.

Gaining access to Afrezza can mean battling with an insurer to cover it. Sometimes the first hurdle is getting a doctor to write a prescription, according to those who've been through the process.

Understanding patients’ capability for self-management is a key part of understanding the risk of health declines and avoidable utilization, researchers determine.