Insurance

Reimbursement policy has been a driver of change in the way hospitals handle heart failure patients.

Following the transition year and ahead of the full implementation in year 3, CMS made provisions to the Quality Payment Program to make it easier for clinicians to participate in the program, reduce burden, and to get clincians ready for full implementation.

CMS officials addressed a key concern that groups offering the Diabetes Prevention Program would bear too much financial risk, but they were unmoved on requests to let beneficiaries try the program more than once in a lifetime.

The reform will adjust payment for drugs purchased through the program, relieve some burden for rural hospitals, and exempt rural sole community hospitals, certain cancer hospitals, and children's hospitals.

CMS just released 2016 data on the Medicare Shared Savings Program and the information proves that patience pays off, savings don't have to happen at the expense of quality, and that physician-led accountable care organizations are more successful.

Despite its clinical success the Diabetes Prevention Program has only reached a fraction of those who need it. That could change once Medicare starts paying for the program next year.

With confusion surrounding the meaning of “savings” with regard to ACO programs, authors writing in Health Affairs outlined 3 different types of savings.

A session at the Academy of Managed Care Pharmacy (AMCP) 2017 Nexus meeting discussed the implications of recent legislative and regulatory changes in healthcare at the federal and state levels.

The hospital formulary system is an ongoing process that evaluates and selects the safest, most effective, and most economical care for hospitalized patients. As healthcare continues to change, so will the formulary management process.

The authors used Medicare claims data to examine trends in hospital–physician integration in high-volume specialties, including medical oncology.

With the clinical and financial implications of high-cost medications, and their impact on health system revenue, it is of utmost importance for all key stakeholders to be engaged in the complex revenue cycle.

The findings generated data on 19 specific clinical variables that could help physicians and patients made personalized decisions about diabetes prevention.

Specialized Medicare Advantage plans called chronic condition special needs plans (C-SNPs), may demonstrate greater improvement in outcomes and utilization of care for the beneficiaries when compared to non-SNP Medicare plans, according to a new analysis from Avalere Health.

Scaling behavioral change and reducing diabetes at the population level were major themes of the meeting.

CMS’ decision to exclude digital health from its proposal for the Medicare Diabetes Prevention Program (DPP) has caused a controversy, explained Paul Chew, MD, chief medical officer of Omada Health.

A GAO report faults CMS policy on durable medical equipment, and the diaTribe Foundation convenes a daylong session to guide the FDA on how future drugs and devices should be evaluated for measures beyond A1C.

Medicare formularies were inconsistent in increasing restrictiveness to drugs that received FDA black box warnings for death and/or cardiovascular risk with safer available drug alternatives.

As obesity rates increase, health systems will have to take charge of finding places to discharge the largest patients to avoid penalties from Medicare, authors of a new study find.

While little seems certain about the current healthcare reform debate in Congress, the transition to value-based care is well underway. We are beginning to see that when providers are paid to deliver better care at lower costs, they can have a real impact on both.

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 stories included a new direction for the Center for Medicare and Medicaid Innovation; a bipartisan group of governors spoke out against the latest effort to repeal the Affordable Care Act; and the World Health Organization warned that antibiotics currently being developed were not enough to fight antibiotic-resistant infections.

While the ongoing healthcare debate in Congress creating a lot of uncertainty among the healthcare industry, there are areas of certainty and optimism, said Dan Todd, JD, principal at Todd Strategy.

The chief medical officer of Omada Health discusses a transition from one of the world's largest pharmaceutical companies to a digital health provider, and from treating chronic disease to preventing it.

CMS has issued an informal request for information seeking input on a new direction promoting patient-centered care and market-driven reforms for the CMS Innovation Center.

Truck drivers were identified in a Gallup survey as the profession most at risk for type 2 diabetes.

This study examined the early impacts of closing the donut hole in Medicare Part D.

Amanda Forys, MSPH, director of Xcenda’s Reimbursement Policy Insights consulting team, discusses how Medicare will address and possibly change its biosimilar policies as the FDA offers more guidance and as biosimilars become more prevalent in the market.

Just hours apart, 2 groups of senators unveiled health reform proposals that each take a drastically different approach to redefining the government’s role in healthcare.

A group that represents both community-based and virtual providers finds many issues with CMS' proposal for Medicare's Diabetes Prevention Program.