Health Care Delivery

A new study shows only a small share of patients with private insurance who were newly diagnosed with diabetes in 2011-2012 enrolled in self-management training, raising questions about how well managed care could address both long-term health and cost control for this important group. These patients are a target for special attention under the ACA.

After last year's disastrous start, the first day of open enrollment in year 2 of the Affordable Care Act had fewer hiccups. HHS Secretary Sylvia Mathew Burwell was reporting success from this weekend.

Following the Supreme Court's decision to hear an appeal for the ACA subsidy lawsuit King v Burwell, a DC appeals court has halted work on a similar case it was reviewing.

Although open enrollment for the Affordable Care Act's insurance Marketplaces is almost here, a 10-question survey from Kaiser Family Foundation found that the health law's target audience still struggles with understanding insurance coverage.

More than a year after its disastrous debut, the federal website HealthCare.gov reopened last night, giving shoppers a few days to browse ahead of the November 15 start date for open enrollment, when consumers will have 60 days to make changes or, for some, select first-time coverage under the Affordable Care Act.

Amidst discussions on liver care, transplants, and infections was a session on Value-Based Medicine in Hepatology, on the third day at The Liver Meeting 2014, an annual event by the American Association for the Study of Liver Disease, held in Boston, Massachusetts, from November 7 to 11, 2014. Presenters saw a huge turnout for the session, a sign of increased interest in value-based care.

Based on data from 17 states and the District of Columbia, premium increases for 2015 are expected to be low, according to a report from The Urban Institute.

On the heels of a major Republican victory in the midterm elections, the Supreme Court has decided to review the latest challenge to the Affordable Care Act.

Three days after the Republican Party gained control of the US Senate and rose to 250 seats in the House of Representatives, the airwaves are filled with bluster aimed at respective bases over what will become of the Affordable Care Act (ACA). While experts from both sides of the aisle agree that a full repeal is unlikely, 1 item has shown up on almost every early list of elements unlikely to survive the next Congress: the medical device tax.

Large employer health plans will now be required to cover in-patient hospitalization services, according to a notice from the Treasury Department and HHS on Tuesday morning. The final regulation will be issued next year.

At this time, the Supreme Court of the United States has declined to hear an appeal of one of the cases challenging the legality of making subsidies under the Affordable Care Act available to consumers on the federally run health insurance exchanges.

The Affordable Care Act expanded healthcare coverage to many low-income Americans, but this same demographic has a low health literacy that makes it difficult for them to navigate program eligibility systems, according to a study from The Urban Institute.

The toughest topics in cancer care will be on tap November 13-14, 2014, in Baltimore, Maryland, when AJMCLive presents Patient-Centered Oncology Care. If you've followed the discussion among pharmaceutical leaders, oncologists, and payers over access to care, you'll want to join stakeholders to discuss how to ensure patients get what they need while controlling costs.

The war of words between managed care and pharmaceutical manufacturers, which began when Gilead set the price for its drug to treat the hepatitis C virus (HCV), has taken off in October with the reclassification of a trio of cancer drugs from Genentech. Growth in the "specialty pharma" sector, where prices are rising much faster than drug prices generally, has drawn concern from payers and the umbrella group that represents them, while the trade group that represents drugmakers is pushing back against critics, saying that it faces challenges in bringing life-saving therapies to market.

US Health and Human Services Secretary Sylvia M. Burwell announces new progams and financial incentives to help accountable care organizations (ACOs) and professional medical associations make the transition from fee-for-service to value-based healthcare delivery.

A provision of the Affordable Care Act, the Sunshine Act provides for increased transparency in the healthcare realm.

Ending the subsidies offered under the Affordable Care Act would sharply increase costs for consumers, according to a study from the RAND Corporation. Furthermore, without the subsidies, more than 11 million Americans will lose their health insurance.

An article in the Journal of the American Medical Association outlines what both CMS and the Pioneer ACOs have learned in the early years of the program, such as the importance of engaging primary care physicians, not growing too quickly, and the need to find better ways to count which patients are in the ACO.

The Institute of Medicine announced yesterday that A. Mark Fendrick, MD, co-editor-in-chief of The American Journal of Managed Care and a national leader in efforts to reform healthcare reimbursement strategies, is among 70 new members elected to the prestigious body.

Congressional candidates may be still be talking about the Affordable Care Act, but a majority of the uninsured are still unaware of main components of the law, according to a poll from the Kaiser Family Foundation.

As accountable care organizations, or ACOs, proliferate across the United States, a question arises for both veteran healthcare leaders and consumers: is the ACO something new, or just a relabeling of managed care vehicles created during the last wave of healthcare reform? A well-run ACO offers something better than the managed care of prior years, according to presenters at the gathering of the ACO and Emerging Healthcare Coalition, which took place October 16-17, 2014, in Miami, Florida.

Providers and insurers across the country are partnering to launch narrow-network plans even as controversy continues over whether these plans offer adequate provider access for consumers.

Despite continued Republican opposition to the Affordable Care Act, sentiment is shifting from repeal to replace. Still, the fact that open enrollment on HealthCare.gov begins after the midterm elections does not seem like a coincidence to the GOP.

A majority of Americans covered by the Affordable Care Act are expecting to change plans for 2015, which may be a smart move, according to industry experts. People who simply re-enroll may not realize they are no longer among the lowest costing plans, which will affect how much their subsidies pay for.