February 5th 2023
In this column, a health insurance executive discusses 2 ways to address rising inflation, including moving past the traditional fee-for-service payment model.
HDHPs Deter Women From Additional Testing After Abnormal Mammogram, Study Says
November 29th 2022The groups who told researchers they would be more likely to skip additional testing had lower levels of income or education and were more likely to be on Medicaid or be uninsured, among other factors.
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Panel Addresses How Payers, Providers Can Optimally Use Real-World Evidence to Advance Cancer Care
November 10th 2022Utilizing real-world evidence that applies to the specific care needs of certain patient populations can promote timely decision-making among payers and providers on the use of effective cancer therapies available on the market, said panelists at the 2022 Patient-Centered Oncology Care® (PCOC) meeting.
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The Department of Veterans Affairs (VA) will give cancer claims priority when a new law takes effect in January 2023; Pfizer is looking to use its COVID-19 profits to grow other blockbusters; the probable loss of Medicaid coverage for millions next year is setting off debate.
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A poster presented at the Academy of Managed Care Pharmacy Nexus 2022 showed that patients with recurrent Clostridioides difficile infection (rCDI), who had Medicare Advantage Part D coverage or were enrolled in a commercial health plan were associated with significantly greater health care resource utilization, including emergency department and inpatient visits, compared with those without rCDI.
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Hidradenitis Suppurativa ED Readmission Linked to Opioid Prescribing, Medicaid Insurance
November 1st 2022Emergency department (ED) readmission was more common than dermatology follow-up among patients with hidradenitis suppurativa (HS) within 30 and 180 days of initially presenting to the ED, with patients with Medicaid coverage and those who had an opioid prescribed were more likely to return.
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Dr Joseph Alvarnas Explains Cancer Care Equity Act for Medi-Cal Beneficiaries
October 29th 2022Joseph Alvarnas, MD, vice president of government affairs at City of Hope and chief clinical adviser of AccessHope in Duarte, California, discusses the recently passed Cancer Care Equity Act in California that provides access to clinical trials and advanced care for Medi-Cal beneficiaries.
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New ICD-10 Code Aims to Provide More Insight Into Hepatic Encephalopathy
October 26th 2022In an interview, the section chief of hepatology at Rush University Medical Center discussed why the addition of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code K76.82 is necessary.
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AMA Report Evaluates PBM Competition and Vertical Integration With Insurers
October 14th 2022While a majority of national lives are covered by vertically integrated insurers, the proportion varies widely at the state level from as low as 6% to as high as 97% of covered lives, according to a new American Medical Association (AMA) report about competition in the pharmacy benefit manager (PBM) sector and insurance.
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Implementation and Cost Validation of a Real-time Benefit Tool
This study evaluates impact of a real-time benefit tool on medication access and physician and pharmacy workflows at a large academic medical center.
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The Impact of HDHPs on Service Use and Spending for Substance Use Disorders
Offering a high-deductible health plan (HDHP) led to a 6.6% reduction in the probability of using substance use disorder services and a shift in spending from the plan to the enrollee.
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Insurers Negotiate Lower Hospital Prices for HIX Than for Commercial Groups
September 15th 2022Hospital price transparency data suggest that health insurance exchange (HIX) plans get lower negotiated rates than commercial group plans and higher negotiated rates than Medicare Advantage plans.
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Sex Differences in Medicare Beneficiaries’ Experiences by Low-Income Status
Only low-income male Medicare beneficiaries had worse patient experience than their female counterparts. The authors discuss opportunities to improve experiences for all patients.
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Implementing Multistate Behavioral Health Pay-for-Performance Initiatives in Medicaid Managed Care
The authors describe a pay-for-performance initiative targeting behavioral health providers, which was introduced by a large Medicaid managed care organization across multiple states.
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Race, Insurance Type Among Predictors of Depressive Symptoms in Atopic Dermatitis
August 10th 2022Most patients with atopic dermatitis had flunctuating levels of depressive symptoms, with having public or no insurance, more severe itch, and skin pain cited as additional predictors of adverse mental health outcomes.
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Premium Tax Credits in the American Rescue Plan and Off-Marketplace Enrollees
We estimate that the median 2021 premium tax credit for off-marketplace enrollees in California would be $311 if they switched to marketplace plans, with wide variation by age and plan size.
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Formulary Restrictions and Stroke Risk in Patients With Atrial Fibrillation
August 4th 2022Limiting access to non–vitamin K antagonist oral anticoagulants through step therapy and prior authorization may exacerbate current underuse of anticoagulants and increase the risk of stroke in patients with newly diagnosed atrial fibrillation.
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Incidence, Mortality, Costs Increased Among Medicaid Patients With NVHAP
August 3rd 2022A recent study calculated the incidence and mortality rates for patients with Medicaid coverage who had nonventilator hospital-acquired pneumonia (NVHAP) and found possible associations between greater health care costs and NVHAP diagnosis.
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