Health Care Delivery

What we're reading, November 2, 2016: Donald Trump attacks Obamacare while drug makers pour funding into Republican candidates, and Anthem considers reducing Affordable Care Act participation and is under fire in California for auto-renewals.

A total of 27 million Americans under the age of 65 remain uninsured, and 43% of them are eligible for financial assistance through the Affordable Care Act either by enrolling in Medicaid or through subsidies for purchasing coverage.

What we're reading, November 1, 2016: despite law, women in California still struggle to access birth control; Americans mostly believe obesity can be fixed through willpower; and Facebook is going after pharmaceutical advertisements.

The Affordable Care Act has helped reduce uninsurance, but has replaced it with underinsurance. Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and director of the Healthcare Markets and Regulation Lab in the Department of Health Care Policy at Harvard Medical School, explains how to address this new problem

Various stakeholders in the healthcare industry are trying to determine value in healthcare, and speakers representing the pharmaceutical industry, research, and the patient perspective discussed the topic during the VBID Summit.

A new report looks at how Medicaid in states that expanded the program are pursuing alternative payment models in order to better respond to the complex health and social needs of beneficiaries.

What we’re reading, October 31, 2016: a CDC survey found that although almost 4 in 5 physicians have electronic health record (EHR) systems in place, only one-third use them; Community Health Options, an ACA Marketplace exchange in Maine, will no longer cover elective abortions; CMS improves its Dialysis Facility Compare website and adds patient ratings.

Karin VanZant, executive director of Life Services at CareSource, said that social needs are inherently interconnected and by focusing on 1 particular area, the various other factors are bound to be addressed as well.

Underinsurance is a byproduct of the many changes being brought to the healthcare system, said Robert W. Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council, during a session at the VBID Summit.

A new study by Avalere Health identified the key challenges facing health insurance exchanges created by the Affordable Care Act (ACA) and considers a range of potential policy options that could be combined to improve the sustainability of the market into the future.

This week, the top stories in managed care included an announcement that premiums on Obamacare plans are set to increase by 25% on average, a discussion of Medicare Advantage growth at America's Health Insurance Plans' National Conference on Medicare, and recommendations for success with the Oncology Care Model.

Frustration with high prescription drug prices remains an issue that cuts across party lines. Majorities of Democrats, Republicans, and independents want the government to protect access to high-cost treatments for those with chronic conditions.

At the fall live meeting of the ACO & Emerging Healthcare Delivery Coalition in Philadelphia, Pennsylvania, attendees heard presentations and participated in workshops that discussed care management, value-driven payment systems, and the future of healthcare.

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

What we're reading, October 27, 2016: the number of counties with just 1 Obamacare insurer will skyrocket in 2017; Teva and IBM partner for 2 projects; and the United States may never be able to rid itself of the Zika virus.

Challenges outlined by healthcare experts back in 2010 are coming to pass, as young adults do not see the current penalties for going without coverage as enough incentive to become insured.

What we’re reading, October 26, 2016: AAP advises that parents take measures to reduce the risk of SIDS; Republican presidential nominee Donald Trump reacts to ACA premium hikes announced by HHS; patients with ALS volunteer for an accelerated study on the effects of a dietary supplement.

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.