Insurance

With most accountable care organizations (ACOs) continuing to participate in the upside-only track, the Medicare Shared Savings Program has not netted the savings that the Congressional Budget Office estimated in 2010. But some findings indicate the program will see greater savings as more ACOs transition to the downside-risk tracks and gain more years of experience.

Condition-specific readmissions measures for heart failure, pneumonia, and heart attack may not accurately or fairly reflect hospital quality, according to a study published this week in the Annals of Internal Medicine. The study found significant differences in hospitals' performance when readmissions were assessed for non-Medicare patients and for conditions other than those currently reported, showing that when these additional factors are taken into account, half of the hospitals would be subject to a change in their financial penalty status.

Dan Klein, President and CEO, Patient Access Network Foundation, discusses how the lack of a limit on cost sharing in Medicare affects patient outcomes and disease states that PAN Foundation is keeping an eye on.

Getting patients, especially in the Medicare population, to adhere to taking prescribed medications is key to preventing future complications. One health plan used personalized outreach to call Medicare beneficiaries to educate them about adherence and find out more about what barriers might exist to taking medications as prescribed by a healthcare provider.

In 2014, Maryland and CMS entered a 5-year agreement employing the All-Payer Hospital Model in the state to cut costs while improving quality. According to the year 3 performance data, Maryland has met or is on track to meet all model requirements, saving hundreds of millions of dollars as it lowers hospital readmissions and steers the state away from a volume-based system.

The report finds a connection between payment reform and hospital use patterns, but that connection may add to the debate that cardiologists have raised over the effect on patients.

The burden of high drug costs is something that everyone with health insurance coverage is facing, explained Leigh Purvis, director, Health Services Research, AARP Public Policy Institute.

Coverage of the 67th Scientific Session of the American College of Cardiology.

Healthcare reform pledged to do better for patients with heart failure, creating the incentives and team-based approaches these fragile patients need. In some cases, this has happened, but there have also been unintended consequences, according to a panel appearing Sunday at the 67th Scientific Session of the American College of Cardiology, being held in Orlando, Florida.

Savings hospitals had lower baseline spending than nonsavings hospitals during the first year of the Comprehensive Care for Joint Replacement (CJR) program, according to a Research Letter in JAMA.

In a keynote address at the 2018 National Health Policy Conference of America’s Health Insurance Plans (AHIP) in Washington, DC, HHS Secretary Alex Azar asked his audience to consider 4 areas that he said are key to “accelerating value-based transformation, and creating a true market for healthcare” through means of some sort of federal intervention that puts patients in control of their own health records.

Experts from healthcare policy organizations and advocacy groups that cater to Medicare enrollees exchanged best practices and proposed policies to help alleviate access issues during the Cost-Sharing Roundtable, co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care®, on February 23, 2018, at the Barbara Jordan Conference Center in Washington, DC.

Leaders from charitable organizations that provide the safety net so patients can meet their healthcare costs and access their required medical treatment have concerns with the widening gap between patient financial needs and available resources. They were speaking at the Cost-Sharing Roundtable in Washington, DC, co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care®.

The first results of the Oncology Care Model (OCM), a 5-year bundled payment demonstration from CMS, were released recently, and at a session at the National Community Oncology Dispensing Association Spring Forum 2018, Mike Fazio of Archway Health discussed the reconciliation statements from the first performance period of OCM, and where practices can look to make improvements going forward.

Patients with cancer, many who are older and on Medicare, are finding their medications are becoming unaffordable, Michele McCourt, senior director of the CancerCare Co-Payment Assistance Foundation, explained at the Cost-Sharing Roundtable, co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care®.

Coverage from the National Community Oncology Dispensing Association Spring Forum 2018.

Since 2000, the number of patients undergoing gender-affirming surgery who identified as self-payers decreased. From 2012-2013 to 2014, coverage by Medicare and Medicaid of gender-affirming surgeries increased 3-fold.

In a joint letter, several organizations urged CMS Administrator Seema Verma to allow certain accountable care organizations to continue in the Medicare Shared Savings Program (MSSP) Track 1 for a third agreement period, warning that these ACOs are not ready to take on a 2-sided risk.

State variations in chronic obstructive pulmonary disease (COPD) outcomes suggest that the condition is more common in large rural areas compared with metropolitan areas, according to the Morbidity and Mortality Weekly Report from CDC.

New research has found that allogeneic hematopoietic stem cell transplantation is just as effective in patients with non-Hodgkin lymphoma who are age 65 and older as it is in patients between the ages of 55 and 64.

Coverage of value updates from Patient-Centered Oncology Care, November 16-17, 2018.

A symposium at Seton Hall Law School examined the role of care coordination and transitions in helping those with substance use disorder find success in treatment. Some experts say that managed care has not supported care coodination despite evidence that it works and ultimately saves money for health systems.

With formal integration initiatives, such as accountable care organizations, having modest effects, researchers analyzed the impact of informal clinical integration on cardiac surgery payments and found that patients who were treated in health systems with higher informal integration had greater savings.

A liberal think tank released a universal healthcare plan modeled on Medicare that would also preserve employer-based insurance coverage as an option for those who are satisfied with their current plans. The Center for American Progress (CAP) is calling its program “Medicare Extra for All” and said it would be available to everyone regardless of income, health status, age, or insurance status.

CAR T- cell therapies are among the most expensive ever invented. For now, there’s a lot of uncertainty, as both government and commercial insurers, and a handful of the nation’s leading cancer centers, navigate a reimbursement structure that truly has no precedent.

Driven by an aging US population and other economic and demographic factors, national health spending is projected to climb to 19.7% of the economy over the next 8 years, up from 17.9% in 2016, according to new estimates released Wednesday from CMS and published online in Health Affairs.

The Department of Justice is moving forward with a $1 billion lawsuit against UnitedHealth Group over Medicare claims; Oregon's legislature is considering adding healthcare as a right to the state's constitution; another trial for an Alzheimer disease drug is stopped.

From 2013 to 2016, Medicare Shared Savings Program accountable care organizations (ACOs) improved quality. Continued infrastructure development funding, better relationships with postacute care facilities, and shared learnings among diverse ACOs would maximize quality improvement.

The proposed budget released Monday would have winners and losers in Medicare; President Donald Trump's budget, a messaging statement, contains healthcare cuts; veterans in California risk eviction from veterans homes if they intend to use an aid-in-dying law.