Health Care Delivery

With specialty pharmaceuticals carrying extremely high-and rising-costs, nonadherence and discontinuation of therapy is becoming even more commonplace. The value-based insurance design (V-BID) model, so termed by A. Mark Fendrick, MD, Dean Smith, PhD, and Michael Chernew, MD, promotes personalized patient care by easing access to specialty medications while reducing the number of prescribed treatments of lesser value as a replacement.

The Patient Protection and Affordable Care Act (ACA) will likely improve insurance coverage for most young adults, but subsets of young adults in the United States will face significant premium increases in the individual market. We examined the association between insurance status and cancer-specific outcomes among young adults.

The federal government may reimburse doctors for talking to Medicare patients and their families about advance care planning, including living wills and end-of-life treatment options potentially rekindling one of the fiercest storms in the Affordable Care Act debate.

With 36 states utilizing Healthcare.gov, and with at least 2 additional states considering enrollment, the concept of a national healthcare insurance exchange (HIE) may quickly become a reality.

The second day at the 50th annual meeting of the American Society of Clinical Oncology ended with a session entitled "Health Care in America in 2014: Current and Future Implications of the Patient Protection and Affordable Care Act" (PPACA). The presenters provided an overview of the recent and anticipated changes related to the PPACA as well as its timeline.

Although they're not expanding Medicaid under the Affordable Care Act, Texas, Florida and other states are expanding managed care, bringing insurers opportunities as well as challenges, including competition from provider-based health plans.

There are rumblings that federal lawmakers may be willing to repeal Medicare's burdensome rule requiring physicians in critical access hospitals to make an educated guess that the patients they're admitting will be either discharged or transferred in less than four days.

One of the biggest beneficiaries of the health law's expansion of coverage to more than 13 million people this year has been the nation's safety-net hospitals, which treat a disproportionate share of poor and uninsured people and therefore face billions of dollars in unpaid bills.

Advocates for a single-payer Medicare for all health system are fanning out across Capitol Hill this week, lobbying members of Congress.

A change to provisions in the Affordable Care Act (ACA) would allow insurers to receive federal funding for any financial losses they endured due to the health law.

Amid strong lobbying by business groups, support is growing to end the Affordable Care Act's employer mandate, a change that would see millions more Americans buying their health insurance through exchanges.

American College of Cardiology 2014

Parents in low-income families were less likely to delay asthma care for their children or avoid taking their children to see a doctor is they had lower vs. higher levels of health insurance cost-sharing.

Few states could claim Obamacare's first enrollment period was smooth-whatever the final numbers-but most will approach their insurance exchanges the same way for the 2015 window. None has asked the Obama administration to take over its marketplace or elected to abandon HealthCare.gov in favor of running its own.

The CMS on Friday issued its final rule for exchange and insurance market standards for 2015 and beyond, a potpourri of policies that address consumer notices, quality reporting and enrollee satisfaction surveys, the Small Business Health Options Program (SHOP), standards for navigators and other consumer assisters, and policies regarding the premium stabilization programs, among others.

Using mystery shoppers looking for access to health care, Public Health Seattle & King County has found troubling indications that access to primary-care providers may not be as advertised.

NCCN Guidelines Updates

Avik Roy, senior fellow, Manhattan Institute, says that the problem with the community rating provision is that age bands can make insurance costly for young patients.

The American Journal of Managed Care will host the first gathering of its ACO and Emerging Healthcare Delivery Coalition this week in Baltimore, Md. The ACO Coalition aims to share best practices for setting up successful ACOs.

Many state legislators remain wary of the costs associated with expanding their Medicaid programs under the Affordable Care Act (ACA). However, a new report from the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) that details the budgetary effects of the ACA said differently.

A left-leaning think tank whose research is often taken seriously by backers of the health-care overhaul has published a paper suggesting the administration should scrap the health law's requirement that employers offer coverage or pay a penalty.

Enrollees in some of the health law's most popular plans will face high cost-sharing requirements that the pharmaceutical industry says could keep patients from getting the drugs they need.

Roger Kathol, MD, president of Cartesian Solutions, Inc, and professor of internal medicine and psychiatry at the University of Minnesota, says that health reform presents several opportunities for psychiatrists.