Insurance

Amy Laughlin, MD, MSHP, of Orlando Health commented on at-home cancer care costs and shared her predictions on how at-home cancer care will evolve.

Gaps exist between self-reported and claims-based estimates of postpartum care among individuals who were covered by Medicaid for their delivery care, according to one study.

The most popular reimbursement content of 2023 included coverage of the shift from the Oncology Care Model to the Enhancing Oncology Model, reactions to the 2024 Medicare Physician Fee Schedule, and concerns around denial of services in Medicare Advantage plans.

Employers, recognized as pivotal contributors to health equity, are urged to prioritize equitable benefits, address the complexity of health plans, and engage in education, data-driven interventions, and systematic measurements to comprehensively improve outcomes for diverse employee populations.

As many as 116 million patients were impacted by large health data breaches this year; grassroots groups have begun leading the push to re-enroll patients denied Medicare coverage for bureaucratic reasons; a nationwide shortage of primary care clinicians is causing more distrust in the health care system.

More than 15.3 million Americans enrolled in health insurance under the Affordable Care Act for 2024, which is a 33% increase from last year; emergency contraception sales in the United States may spike by around 10% in the new year; top Biden administration officials met with prominent civil rights and public health leaders on Tuesday amid the decision to delay the menthol cigarette ban.

This article examines how CMS’ adjustment for social risk factors affects the Medicare Advantage Star Ratings and the type of contracts affected by the adjustment.

These findings suggest that addressing socioeconomic disparities and inequities that impact access to health care and services may help improve survival outcomes across racial/ethnic groups of male patients with early breast cancer.

"From a health benefit standpoint, specifically, the employees have to be able to access care, they have to be able to afford the care that they are going to receive, and the benefits also have to be relevant to employees," Bruce Sherman, MD explains.

A vaccine is showing promising results in treating melanoma; the Biden administration will implement inflation penalties on dozens of drugmakers to reduce out-of-pocket costs for Medicare recipients; the CDC issued an alert urging health care providers to increase immunization coverage for influenza, COVID-19, and respiratory syncytial virus (RSV).

A new report from AHIP shows that Medicare Advantage outperformed traditional Medicare on several clinical quality measures, including preventive screenings. However, debate continues over these plans’ cost efficiency and impact on the financial sustainability of rural hospitals.

The US Preventive Services Task Force (USPSTF) recommended that children with obesity receive intensive counseling at age 6 to promote healthy diet and exercise habits; a new survey found that the majority of American patients are wary of their doctors using artificial intelligence (AI); a class-action lawsuit was filed Tuesday against health insurer Humana for using an AI algorithm that systemically denies seniors rehabilitation care recommended by their doctors.

The commercial market got slightly less competitive while the Medicare Advantage market got a little more competitive, but both markets remain highly concentrated.

The Biden administration proposed new efforts that it says will promote competition, transparency, and affordability in the health care industry.

The Biden administration recently met with manufacturers of respiratory syncytial virus (RSV) immunizations to encourage them to increase access to the vaccine; since the Dobbs v Jackson decision, many patients have been seeking more permanent reproductive health care solutions; a Mathematica analysis showed that Medicare prescription drug price negotiations could have cut seniors’ out-of-pocket costs by nearly a quarter had the program been in effect in 2021.

Increased options and strong demand resulted in record-breaking 2024 enrollment.

Data analysis showed that 40% of patients who filled a prescription for Wegovy in 2021 or 2022 were still taking it a year later; both Democrats and reproductive rights organizations are pressuring the Biden administration to ensure health insurers fully cover contraception; CMS implemented Medicare changes in March that limited access to blood tests that help transplant recipients ensure their organs remain healthy.

Allowing nurse practitioners to serve as attribution-eligible providers for Medicare Shared Savings Program accountable care organizations leads to no change in hierarchical condition category risk scores and modest growth in attributed beneficiaries.

The sustained, collaborative effort to expand Medicaid will improve the lives of working North Carolinians who, prior to enactment, earned too much to qualify for Medicaid, but not enough to afford insurance on the marketplace.

Safety-net programs need to not only be budgeted for but also aimed at the right people to ensure receipt of proper health care.

If finalized, these proposals will generally take effect on January 1, 2025, unless otherwise noted.

Jeffrey Sippel, MD, MPH, addresses the increasing denial of insurance claims for non-invasive ventilators (NIV) in Medicare Advantage plans, particularly impacting ALS patients, emphasizing the time crunch on patients, and criticizing the financial focus over patients' well-being.

Health plan type highly influences the likelihood of biosimilar uptake, with low-flexibility insurance plans more likely to have patients who either switched to a biosimilar or were initiated on a biosimilar.

Jeffrey Sippel, MD, MPH, discusses the trend of insurance claim denials related to non-invasive ventilators for patients with ALS.

Due to the frequent rejection of claims for noninvasive ventilators by Medicare Advantage plans, individuals with amyotrophic lateral sclerosis (ALS) are experiencing disproportionately high rates of hospital admissions.

A class action lawsuit was filed against UnitedHealth Group and a subsidiary for allegedly using an algorithm to deny rehabilitation coverage for seriously ill patients; US and China officials are finalizing an agreement to crack down on fentanyl; a study published Tuesday projected global heat deaths to increase by 370% if no action is taken against global warming.

This qualitative study elucidates therapists’ perspectives on barriers to and facilitators of access to telemental health among Medicaid-enrolled youth served by a large safety-net organization.

Investigators propose potential payment models for gene therapies that consider equitable patient access and payer reimbursement.

This 2022 survey of Medicare accountable care organizations (ACOs) shows significant growth in non-Medicare value-based contracts and in contracts with downside risk.

Formulary restrictions can create treatment barriers for patients with atrial fibrillation, including unnecessary delays in treatment and prescription abandonment, with vulnerable populations at greater risk.