Insurance

This week, the top managed care stories included CMS outlining a plan to encourage Medicare accountable care organizations to take on more risk, faster; a study found substantial growth in Medicaid managed care enrollment; an analysis showed nearly 1 in 5 inpatient hospital stays includes a claim from an out-of-network provider.

The first in a series of articles that identifies CMS' goals in updating the Medicare Shared Savings Program and how well the proposals make taking on more risk appealing for accountable care organizations.

Following CMS’ announcement of a proposed rule to overhaul the Medicare Shared Savings Program, the National Association of ACOs (NAACOS) released a statement, saying the move will “upend the ACO [accountable care organization] movement by creating havoc with a significant overhaul introducing many untested and troubling policies.”

The share of Medicare Advantage (MA) beneficiaries in the nursing home (NH) population has been steadily rising, while MA plans appear to be increasingly concentrating beneficiaries in select NHs with better performance on quality measures.

A new rule in the Medicare Access and CHIP Reauthorization Act’s 2019 Quality Payment Program and the proposed 2019 Medicare Physician Fee Schedule could negatively affect the quality of cancer care for Medicare beneficiaries, according to the American Society of Clinical Oncology.

An optimized hepatitis C virus screening and linkage-to-care process reduces the number of patients lost to follow-up and improves linkage to care for Medicare, Medicaid, and commercially insured patients.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

CMS is proposing an overhaul for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program by reducing the amount of time an ACO can stay in a 1-sided risk arrangement to 2 years. CMS said it expects to save about $2.24 billion over 10 years even as the number of ACOs drop. CMS is renaming the program "Pathways to Success."

Senator Bernie Sanders, I-Vermont, has claimed his Medicare-for-all plan will cut healthcare spending by $2 trillion, but fact checking shows that's unlikely; CVS' CEO defends its pharmacy benefit manager against claims rebates are driving up drug prices; researchers have found that immigrants have healthcare costs that are half to two-thirds of the costs of people born in the United States.

LifeScan, the diabetes division that Johnson & Johnson shed after ending US sales of its Animas insulin pump, will be the sole preferred provider of meters and testing strips for Express Scripts members in 2019.

Despite the presumption that larger practices that have more resources and are therefore better at providing care and improving outcomes, new research shows that they spend more on and have higher readmission rates for Medicare beneficiaries than smaller practices.

If patients want to be empowered to control their healthcare and if the United States wants healthcare to be economically efficient, then interoperability is critical, said Don Rucker, MD, the National Coordinator for Health Information Technology (IT), during the Office of the National Coordinator for Health IT’s 2nd Interoperability Forum. He was followed by CMS Administrator Seema Verma, who disparaged the current technological situation and painted a future where health data followed the patient and can be shared at the press of a button.

One of the reasons why hospital readmissions for the elderly are remaining high may be posthospital syndrome; priority review vouchers, which can be awarded by the FDA to 1 company and sold for a hefty price to another, are commanding a lower price than in past years; almost 8 months after Amazon, JP Morgan Chase, and Berkshire Hathaway announced their joint healthcare venture, there is little public information about it.

A new study found hospital participation in 5 common medical bundles under the Bundled Payments for Care Improvement initiative was not associated with significant changes in Medicare payments, clinical complexity, length of stay, emergency department use, hospital readmission, or mortality.

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.

If Medicare was allowed to negotiate drug prices, the Medicare Part D program could save $2.8 billion in 1 year on the 20 most commonly prescribed drugs alone, according to a new report from Senator Claire McCaskill, D-Missouri, the top-ranking Democrat on the Senate Homeland Security and Governmental Affairs Committee.

This week, the top managed care stories included a report that found quality issues and fraud in Medicare’s hospice program; the Trump administration expanded short-term health plans; cancer screening rates are falling short of targets.

Two days after a critical report into the quality and care of hospices caring for Medicare beneficiaries, CMS released a final payment rule for 2019, giving providers an increase of $340 million, and said it will update the information on its Hospice Compare website.

Researchers have found that transitional care management (TCM) services are associated with reductions in mortality and total Medicare costs; however, adoption of these services has remained low since the implementation of TCM payment codes in 2013.

For the second year in a row, the average basic premium for a Medicare Part D plan will decline; a series of charts in The Wall Street Journal highlights what is driving US healthcare spending; taking a break from exercising can have metabolic consequences that linger for some people even after they return to their normal levels of exercise.

A report from the Office of Inspector General (OIG) at HHS synthesized 10 years of research about the Medicare Hospice Program and found deficiencies in patient care, inappropriate billing, and even fraud. Patients went without pain medicine, hospices did not always provide the right level of care or provided poor quality care, billed for unnecessary care, enrolled people who were not eligible for care, or billed for services that were never provided.

We've rounded up the top 5 articles of July, including changes being touted for the 340B program and a global report urging countries to think seriously about planning for high quality care.

The Community Oncology Alliance (COA) announced their support of CMS’ 2019 Outpatient Prospective Payment System (OPPS) Proposed Rule.

Medicare has lowered its star ratings for staffing levels in 1 out of 11 nursing homes; the Pharmaceutical Research and Manufacturers of America has donated to a lobbying group running a "dark money" campaign in favor of repealing and replacing the Affordable Care Act; a libertarian policy center funded by the conservative Koch brothers found that Senator Bernie Sanders's Medicare for All plan would cost $32.6 trillion over 10 years.

The cost of food insecurity in excess healthcare costs has been listed at $77 billion a year. Implementing meal delivery programs to improve health outcomes and lower costs has gained traction nationwide. Here are 5 things to know.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

Close to 200 organizations wrote to CMS and HHS this week to express concerns with the Trump administration’s plans to cut millions of dollars from the Affordable Care Act’s marketing and outreach budget, saying that they are “frustrated by CMS’ assertions that the need for these services has decreased as the number of uninsured or underinsured Americans continues to grow.”

CMS announced a raft of proposed changes, including expanding its site-neutral payments between what Medicare pays for at physicians’ offices and off-campus hospital clinics, where rates are higher because of added hospital facility fees. The agency is also extending 340B drug discounts to off-site hospital clinics.

The Trump administration is proposing to pay doctors who take Medicare basically the same amount for office visits regardless of reason; the pending sale of Mission Health to HCA Healthcare reflects a national trend as hospitals consolidate at an accelerating pace and the cost of healthcare continues to rise; a closer look at 5 ideas in President Trump's plan to lower drug prices.

For a set of common physician services, employer-sponsored Medicare Advantage plans are found to pay prices that are similar to traditional Medicare rates.