Health Care Delivery

A new study published by the IMS Institute for Healthcare Informatics finds that reimbursement approaches based on cost-per-quality-adjusted-life-year measures rather than drug effectiveness may limit access to innovative cancer treatments.

A provision of the ACA that calls for the federal government to cover a higher share of Texas' administrative costs will help cover $102 million of a $338 million shortfall in Medicaid costs.

A one-minute look at managed care news during the week of March 23, 2015, including the 5-year anniversary of the Affordable Care Act and another step toward value-based payments.

Although the Supreme Court's decision on King v. Burwell could remove subsidies from the federal marketplace, Americans prefer HealthCare.gov over the state-run exchanges, according to poll results from right-wing advocacy group Foundation for Government Accountability.

The Health Care Payment Learning and Action Network kicked off with its inaugural meeting bringing together public and private sector actors to discuss efforts to move healthcare toward a system that pays based on quality rather than quantity.

With the Affordable Care Act's requirement that most nongroup health insurance plans offer minimum coverage standards, concerns arose about plan cancellations affecting those who already had insurance coverage. However, recent data found cancellations were uncommon.

A deadline for the loss of federal aid for hospitals that serve the uninsured has reignited talk of expansion, and a key CMS leader said this week that the agency is willing to be "flexible."

The most common reasons for repayments or refunds are changes in income or family size. The law allows consumers to report these changes to the Marketplace throughout the year, but with the law being so new, most 2014 reconciliations will happen during tax filing.

The study, conducted by the national laboratory Quest Diagnostics, found that in states that expanded Medicaid, he number of Medicaid enrollees with newly identified diabetes rose by 23%, to 18,020 in the first 6 months of 2014, from 14,625 in the same period in 2013.

On the 5th anniversary of the enactment of the Affordable Care Act, Susan Dentzer, senior policy advisor at the Robert Wood Johnson Foundaiton, looks back at what has been accomplished and looks ahead at what is left to do.

There has been much hand wringing over the health law requirement that large employers this year offer insurance to workers who put in 30 or more hours a week or face penalties for not doing so. A new study found that so far there's little cause for concern.

Opinion on the Affordable Care Act still breaks sharply along partisan lines, making the prospects for even technical fixes unlikely, much less a major change that might be needed in the wake of a ruling in King v. Burwell that would take away premium subsidies in states without their own exchanges.

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.