Insurance

Along with weight loss, exercise, and nutrition, employers now target sleep improvements in employees; a Republican member of the FTC supports Medicare drug price negotiations; sepsis is likely responsible for 20% of deaths worldwide.

US Census data show the segment of the population over age 65 is growing faster than the group under age 65, highlighting the need for new healthcare delivery solutions.

Accountable care organization (ACO) participation in the Medicare Shared Savings Program (MSSP) remained flat this year, according to a press release from the National Association of Accountable Care Organizations issued Friday, January 10.

Avalere Health broadcasted its annual Healthcare Industry Outlook for 2020 on January 9. The hour-long discussion included insights on some of the top healthcare topics predicted to have an impact in 2020. Although Medicare and drug pricing took center stage, artificial intelligence, the future of the Affordable Care Act, and 2020 presidential campaign platforms were among the subjects discussed.

From linguistic dissonances of medical terminology to the generation of new care pathways for Medicare patients, the top 5 most-read articles of The American Journal of Accountable Care® spanned topics relevant to both patients and providers in 2019.

Patients with breast cancer who have government insurance face a higher risk of death, according to a retrospective study presented at the 2019 San Antonio Breast Cancer Symposium on December 13.

An article Schleicher co-wrote in JAMA Oncology, which appeared the day before the announcement of Oncology Care First, offered insights into the need for changes to the original OCM.

Kashyap Patel, MD, the chief executive officer of Carolina Blood and Cancer Care Associates—a leading OCM practice—and associate editor of Evidence-Based Oncology™ (EBO), said he’s optimistic about Oncology Care First.

The availability of biosimilars introduces competition based on price, offering a lower-cost alternative in the short term and helping to restrict—or even reverse—longer-term price growth.

A senior vice president of Archway Health discusses challenges and opportunities of the proposed Oncology Care First model.

Karmanos Cancer Institute, in Detroit, Michigan, established a specialty pharmacy to help alleviate the financial burden many patients face when paying for their oral novel therapeutics.

Results from Avalere Health show that once Medicare patients get through the experience and expense of CAR T-cell therapy, they do well and costs drop significantly.

Reimbursement for CAR-T therapy has progressed to where commercially insured patients obtain coverage regularly, but issues remain for patients with Medicare, said John Sweetenham, MD, professor in the Department of Internal Medicine at UT Southwestern Medical Center and the Associate Director for Clinical Affairs at UTSW’s Harold C. Simmons Comprehensive Cancer Center.

One delivery system’s healthcare utilization in its Medicare Advantage product was notably less than in its Pioneer accountable care organization or in a traditional Medicare comparison group.

Accountable care organizations (ACOs) have saved Medicare a total of $3.53 billion from 2013 to 2017, or $755 million after shared savings were paid out, according to a new report from the National Association of ACOs (NAACOS).

Kaiser Permanente chairman and chief executive officer Bernard J. Tyson dies at 60; vitamin E acetate is linked as a potential cause of vaping-related lung injuries; Medicare’s outpatient premium cost is rising.

The Committee for a Responsible Federal Budget released a detailed report on potential finance options for implementing "Medicare for All"; employers beginning to lessen dependence on high-deductible health plans; Juul to cut nearly 500 jobs by end of 2019.

We learn most when we have benchmarking and we can examine our own processes of care, explained Michael Kolodziej, MD, vice president and chief innovation officer at ADVI Health, Inc.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included an effort by the Trump administration to bolster Medicare Advantage; an abortion case from Louisiana reached the Supreme Court; the study of adapting to changing oxygen levels wins the Nobel Prize.

Value-based models continue to enter the healthcare system, affecting a variety of fields, including primary care. And while success stories have been shared by payers and CMS touts these models as a way to “save” primary care, that's not the current reality, said Theresa Hush, chief executive officer of Roji Health Intelligence, LLC, during a session on population health management at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum, held October 10-11 in Las Vegas, Nevada.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Unraveling the possible causes and triggers of agitation in people with dementia is worthy of detective work, according to a recent presentation.

This week, the top managed care news included Medicare cuts hospital payments over readmissions; a second-generation chimeric antigen receptor T-cell therapy shows promise; a diabetes drug is approved to prevent kidney failure for the first time.