Health Care Delivery

This week, the nation turned its attention to the split rulings of 2 state federal court of appeals.

As healthcare reform advances, experts say, dermatologists face mounting pressure to prove their mettle to insurance exchanges and accountable care organizations (ACOs).

To better align the care of beneficiaries insured under both the Medicaid and Medicare programs, CMS invited states to participate in a 3-year demonstration project. However, it seems that many beneficiaries have opted out of these care coordination programs that are offered across the country.

A federal rule requiring health insurers to spend a minimum percentage of premium dollars on medical care led to more than $332 million in rebates last year, according to HHS.

On the second day of "Patient-Centered Diabetes Care: Putting Theory Into Practice," Jan Berger, MD, MJ, president of Health Intelligence Partners, moderated the panel discussion "Measuring the Impact of Pharmacists in Diabetes Patient Care."

Joyce furthered the discussion on the role of pharmacists in patient-care started by Haydon-Greatting by providing case studies that stemmed out of a CMS-funded research grant.

Obamacare got taken for a roller-coaster ride on Tuesday when two different appeals courts took completely different takes on the latest challenges to the law.

A federal appeals court panel ruling in Washington, DC, if upheld, could majorly impact the Affordable Care Act.

The Obama administration and state insurance regulators are developing stricter standards to address the concerns of consumers who say that many health plans under the Affordable Care Act have unduly limited their choices of doctors and hospitals, leaving them with unexpected medical bills.

When it comes to value-based decision making, several factors can influence physician behavior. Although many organizations rely on financial incentives, the Commonwealth Fund argued in a report released Tuesday that healthcare leaders should think beyond the dollars and dimes.

The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, hosted a recent Web-based session that featured three presentations on aspects of the transition to value-based care: why barriers to change persist, what steps one ACO is taking to drive better health, and why a "patient-centered" method of picking a doctor makes sense.

House Republicans took the initial step on Thursday to sue President Barack Obama over the administration's decision to delay the employer mandate of the healthcare law.

While much attention has focused on expanded coverage and online insurance bazaars, policymakers' bigger challenge is improving Americans' health while putting a brake on the cost of their care. The keys to that puzzle, CareFirst and many others are deciding, are the internists and general practitioners who have largely been left behind by health care's financial boom.

Federal agencies remain committed to increase patients' access to affordable, high quality, and comprehensive healthcare.

HHS Secretary Sylvia Mathews Burwell announced today the availability of $100 million from the Affordable Care Act to support an estimated 150 new health center sites across the country in 2015.

The Affordable Care Act (ACA) prohibits insurance companies from rejecting new customers based on their pre-existing health conditions. Yet, a recent report alleged that 4 Florida-based payers may have structured their prescription drug benefit plans in a way which does just that.

Over the past few decades, 38 states and the District of Columbia have switched their Medicaid plans to some form of managed care for at least part of their government programs.

Consumers thinking about becoming enrolled in health insurance exchange plans may gain access to a new low-premium, high-deductible option: the copper plan. However, these plans have many patient advocate groups and policy experts concerned about their "bare-bone" offerings.

Specialty pharmaceuticals are changing the lives of patients with cancer and chronic conditions, but their high cost and increased used has drawn the scrutiny of payers. A review in this month's issue of The American Journal of Managed Care, which examined studies involving therapies for rheumatoid arthritis, multiple sclerosis, and breast cancer, found that when these drugs are used with the right patients, the value for patients is high.

A proposed Centers for Medicare & Medicaid Services ruling would make it easier for consumers to automatically re-enroll in their plans from the healthcare insurance exchanges if they liked them.

Medicaid expansion continues to vary in popularity. Twenty-six states and the District of Columbia plan to expand Medicaid, while 4 are actively considering it and 20 have no plans to do so.

Increasingly, pharmacy benefit managers (PBMs) are refusing to purchase high-cost drugs from manufacturers or include them in their formularies - the lists of drugs that a health plan will cover.

Physician groups are lobbying hard to extend an Obamacare provision that requires state Medicaid programs to pay primary-care physicians at higher Medicare rates to improve access for Medicaid patients. But to persuade congressional Republicans to go along, they are downplaying the fact that the pay bump is part of the Patient Protection and Affordable Care Act.

The American Journal of Managed Care followed up the first meeting of its ACO and Emerging Healthcare Delivery Coalition with its first interactive conference call, which was open to all members. Anthony Slonim, MD, DrPH, a Coalition co-chair who on July 1 will become president and CEO at Renown Health in Reno, Nev., moderated the roundtable discussion.