Health Care Delivery

What we're reading, August 29, 2016: Audit finds Medicare Advantage plans overcharged the government; enrollment on the Affordable Care Act's exchanges less than half of initial prediction; and California bill to protect consumers from surprise medical bills divides physicians.

Despite coverage gains since the implementation of the Affordable Care Act, groups at risk of being uninsured before the law continue to have higher uninsured rates.

This week in managed care, the top stories included new reports on a 10-year experiment in payment reform, more results from the early years of the Affordable Care Act, and findings on employee wellness programs.

Healthcare as we have known it doesn’t work cooperatively, which is one reason it costs way too much, according to Donald M. Berwick, MD, MPP, president emeritus and senior fellow of the Institute for Healthcare Improvement and co-originator of the term the Triple Aim. Berwick spoke with The American Journal of Managed Care as it publishes reports on Aligning Forces for Quality, funded by the Robert Wood Johnson Foundation.

Advances in genetic technologies have a great potential to be used to advance treatments, especially through personalized medicine. However, there are concerns that disadvantaged groups do not have access to these advances.

As health insurers reduce their involvement in the Affordable Care Act (ACA)’s insurance exchanges and states approve sharp premium increases for 2017, HHS is trying to assuage fears that coverage under the ACA will be unaffordable for consumers next year.

In 2006, the Robert Wood Johnson Foundation launched Aligning Forces for Quality, which sought to improve the quality of healthcare using a regional approach. Findings on this massive undertaking, introduced by Donald M. Berwick, MD, MPP, former CMS administrator, reaffirm both the importance and challenge of implementing healthcare reform.

What we're reading, August 24, 2016: Tennessee signed off on high premium hikes as its exchange is close to collapse; 5 states sue the Obama administration over a transgender healthcare policy; and a new non—travel-related Zika case is identified in Tampa Bay.

Governor Phil Bryant's opposition to expansion contrasts with his public support for other healthcare initiatives, such as a new diabetes research center and telehealth research.

It’s a hotly debated question about healthcare reform: How does Medicaid expansion impact emergency department usage?

Researchers from Tufts Medical Center analyzed findings from 26 studies to determine how drug exclusion policies affect patients and healthcare costs.

Factors such as insurance status and being married are significant determinants of survival compared with race/ethnicity, in patients with multiple myeloma who are less than 65 years of age.

What we're reading, August 22, 2016: freestanding emergency clinics come under increased scrutiny; hospitals are being more open about medical mistakes; and regulations to blame for rising generic drug prices.

While Joe Antos, PhD, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, believes that the ACO model is here to stay, he said that the way these organizations operate are likely to change.

A new report by the American College of Physicians sheds light on the harsh truth that being underinsured is as big a challenge as being uninsured. Cost sharing, in particular deductibles, has caused patients to forgo or delay care, including medically necessary services.

This week, the top stories in managed care included Aetna's announcement that it was pulling back its participation on the Affordable Care Act exchanges, the annual meeting of the American Association of Diabetes Educators outlined how existing sites can help roll out the Diabetes Prevention Program nationwide, and hospital leaders gave their opinions on CMS' hospital readmission program.

Since 2005, American Cancer Society has sponsored the Health Insurance Assistance Service, a unique initiative to help cancer patients navigate the private coverage system and to educate policy makers about how coverage works for patients with this serious and chronic condition.

When it comes to health coverage, most Americans face an unnerving reality-they have no idea what is covered under their health insurance policy until after they are affected by illness or disease.

Questions about hospitals or their foundations paying for premiums of sick patients to keep them out of Medicaid are as old as the exchanges themselves.

What we're reading, August 19, 2016: CMS is investigating if patients are being steered away from Medicaid and Medicare to private plans; Medicare Part D paid 17% more for drugs in 2014 than in 2013; and 5 things to know about HIPAA today.

What we're reading, August 17, 2016: Walgreens looks to gamify medication adherence; Aetna warned the Department of Justice that if its merger wasn't approved, it would pull back from exchange participation; and the controversy behind numbers of medication error deaths.

Many accountable care organizations are beginning to adopt various programs or strategies into their framework to increase patient access to behavioral health care, but several challenges remain.

Another large insurer says it can't sustain losses from people who were sicker than anyone imagined. Leaving unprofitable markets doesn't answer the question of how to pay for their care.

What we're reading, August 16, 2016: hospitals are partnering with ride-hailing services to get patients to their appointments; Democrats look to repeal a ban on federal funding for abortion; and Colorado will vote on a right-to-die bill this fall.

This week, the top stories in managed care include news on how Medicaid expansion improved health outcomes of low-income individuals, a report on how physical activity lowers risk of 5 common chronic conditions, and findings on how insurance type impacts health outcomes in cancer.