Insurance

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 CMS unveiling a new voluntary bundled payment model; coverage from the JP Morgan Healthcare Conference, including immunotherapy's impact on HIV treatment and biosimilars; and news that 2 key diabetes devices will be covered by Medicare.

The Medicare Payment Advisory Commission (MedPAC) conducted a formal vote that recommend repealing and replacing CMS’ Merit-based Incentive Payment System (MIPS).

Brenda Schmidt, CEO of Solera Health, discusses the historic launch of the Medicare Diabetes Prevention Program scheduled for this April and how her company is helping providers and other stakeholders get ready.

The announcement comes after CMS canceled an Obama-era proposal for mandatory bundled payments in cardiac care, as well as a mandatory expansion of a program in joint replacements.

The announcement comes after CMS canceled an Obama-era proposal for mandatory bundled payments in cardiac care, as well as a mandatory expansion of a program in joint replacements.

Cross-sectoral partnerships between Area Agencies on Aging (AAA) and healthcare and non-healthcare organizations are an effective way of addressing determinants of health among older adults, according to a recent study published in Health Affairs.

The factory-calibrated continuous glucose monitoring (CGM) system is being touted as less expensive, and a spokeswoman said it will not require bundling with a meter, which is required for a competitor.

What's in store for the 2018 healthcare landscape? The buzzwords for the year include flexibility, innovation, and data across a number of areas.

Dexcom Executive Vice President and Chief Commercial Officer RIck Doubleday visited The American Journal of Managed Care® to discuss Medicare reimbursement for the Dexcom G5 and a new partnership with Fitbit.

Rick Doubleday is the executive vice president, and chief commercial officer at Dexcom. He is responsible for the sales, marketing and customer service functions. Previously, Doubleday led all sales and marketing functions for the company, driving the acceleration of worldwide awareness and adoption of Dexcom continuous glucose monitoring (CGM). Doubleday visited The American Journal of Managed Care® this fall to discuss bringing the Dexcom G5 to Medicare beneficiaries.

To drive real innovation in Medicare Advantage—improvements that will result in better health outcomes and reduce costs—CMS should start with doctors.

Patients cared for by physicians in their first year as hospitalists have worse 30-day and hospital mortality when compared with more experienced hospitalists.

More than 700 hospitals were penalized for having the highest rates of patient injuries; the Physician-focused Payment Technical Advisory Committee backed 2 new alternative payment models; and experts outline the biggest challenges of implementing and maintaining electronic health records going into the new year.

Coverage from the Community Oncology Alliance (COA)’s Payer Exchange Summit on Oncology Payment Reform, held October 23-24 in Tysons Corner, Virginia.

A least one US payer, CareMore, has a program to combat loneliness in seniors to prevent chronic disease and other health problems.

A group of 7 organizations wrote to CMS Administrator Seema Verma, urging the agency to support independent physicians and practices in the move to value-based care.

"The Oncology Drug Marketplace: Trends in Discounting and Site of Care," commissioned by the Community Onoclogy Alliance and conducted by Berkley Research Group, found that 340B hospitals have a clear financial incentive to expand oncology services; 340B hospitals receive over one-third of all Part B oncology drug reimbursement; a disproportionate share of the shift in site of care is attributable to 340B hospitals; and between 2010 and 2015, statutory discounts and rebates paid by manufacturers have almost tripled and put upward pricing pressure on drugs.

Medicare is alleging laboratories improperly billed the government for improper tests; time is running out for children receiving healthcare from CHIP; the AMA extends its diabetes prevention model to Maryland and other states.

Commonwealth Fund researchers said Medicare Advantage plans will need enhanced incentives to make sure that high-quality care is provided at lower cost, as the number of beneficiaries in these plans is expected to climb by 2027.

A report from the Urban Institute traces CMS' evolving approach to compensating primary care physicians to treat those with multiple chronic conditions.

Is transfusion dependence a barrier to hospice utilization among older patients with leukemia who are enrolled in Medicare?

CMS' update to the Medicare Advantave Value-Based Insurance Design Model, demonstrate CMS’ continued commitment to expanding the demonstration and allowing participating plans more flexibility for customized benefit designs.

Diagnosis-related group coding determines eligibility for many Medicare bundled payment initiatives. This approach excluded many patients with chronic obstructive pulmonary disease likely to benefit while including others without the disease.