Insurance

With the Medicare Access and CHIP Reauthorization Act (MACRA) set to take effect January 1, 2017, The American Journal of Managed Care has created a resource center, the MACRA Compendium, where payers and providers can find updates on the transition to value-based care.

Wide price variation in hospital prices for the care that they render-up to a 2.7-fold difference-is driven by the hospital's market leverage, according to a new report by the New York State Health Foundation (NYSHealth).

On the day of the approval, top FDA and CMS officials write in JAMA of the need to share data for better healthcare delivery.

The findings come as CMS targets cardiac procedures in both its hospital readmission reduction program and in a bundled payment model set to take effect July 1, 2017.

The findings confirm other studies that show differences in the practice patterns between male and female physicians.

The elderly population in the United States is growing significantly. People who are 80 years and older most likely need long-term care due to severe disabilities.

CMS must learn from implementation of new quality measure sets as it refines and expands the Core Quality Measure Collaborative, Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

After widespread criticism from healthcare providers, drug companies, and lawmakers, CMS has announced that it will not go forward with its proposed Medicare Part B payment program. The experimental reimbursement model was intended to reduce outpatient drug spending, but oncologists worried it would have unfairly slashed their Part B payments.

A new accountable care organization (ACO) model announced by CMS aims to improve care and lower costs by allowing beneficiaries enrolled in both Medicare and Medicaid to be covered under a Medicare Shared Savings Program ACO.

The Rx Price Watch report from the Public Policy Institute of the American Association of Retired Persons (AARP) has found that retail prices of widely used brand name prescription drugs rose at a significantly faster rate than general inflation over the past decade.

The American Journal of Managed Care and the American Association of Diabetes Educators have collaborated on a special joint issue of Evidence-Based Diabetes Management, which focuses on the growing evidence for payer coverage of Diabetes Self-Management Education and Support and the Diabetes Prevention Program.

Since insurers began pulling out of the individual market in many states, CMS has vowed to crack down on practices that drive up costs.

A recent report from the Government Accountability Office mostly concurs with CMS on a dispute over problems with the Medicare competitive bidding program, following an explosive study in Diabetes Care that found beneficiaries lost access to key supplies.

Diabetes educators are well-positioned to help accountable care organizations meet their business, healthcare, and financial goals. The emphasis on primary care in treating chronic disease calls for an increased emphasis on diabetes educators to achieve better healthcare outcomes in a cost-effective manner.

The American Association of Diabetes Educators has offered extensive comments to CMS on how Medicare reimbursement of the Diabetes Prevention Program should occur, so that community groups offering the program financially thrive.

The 2015 joint statement of the American Association of Diabetes Educators, the American Diabetes Association, and the Academy of Nutrition and Dietetics called for diabetes self-management education and support at 4 distinct points: at diagnosis, at annual assessments, when complications arise, and at transitions.

Though there are many unknowns regarding how the Trump administration will affect policy, there is bipartisan support for lowering costs and increasing quality. The Medicare Access & CHIP Reauthorization Act of 2015 is a separate law that was passed with 92% bi-partisan support in 2015. Read on for tips on creating a strategy that will set you up for success under advanced alternate payment models.

What we’re reading, December 12, 2016: veterans with dementia who used both the Department of Veterans Affairs healthcare system and Medicare were more likely to be prescribed potentially unsafe medications; HHS will begin to conduct on-site privacy compliance audits in 2017; study finds that women with strong social connections have better breast cancer outcomes.

The report confirms what CMS made clear in the final rule for the Medicare Access and CHIP Reauthorization Act: many small and rural providers were not ready for a shift away from fee-for-service.

Retaining seniors in the Diabetes Prevention Program will be important for community groups offering it through Medicare, because the proposal calls for payment to be based on performance.

One-third of seniors say a family member coordinates their care, but another one-third say no one does.

Value-based insurance design (VBID) is one of just a few areas that has bipartisan support, and now the concept of VBID is being brought to TRICARE, the healthcare program of the United States Department of Defense Military Health System.

An analysis of per capita Medicare spending among beneficiaries with 6 or more chronic conditions reveals wide geographic variations in costs across the US, with similar spending levels often seen in counties neighboring one another.

The group that represents 5000 hospitals outlined a policy agenda that calls for regulatory reform but also seeks some certainty that patients who gained coverage under the Affordable Care Act will be able to retain it in the future.

Prescription drug spending didn't rise as much as it did in 2014, but it still outpaced all other categories.

The physicians said the American Medical Association abandoned a core mission of protecting patients by endorsing a nominee who wants to roll back Medicaid expansion and privatize Medicare.

There has been increased bipartisan support around the expanded role of value-based insurance design.

A nationally representative study among patients enrolled in Medicare, who were diagnosed with cancer, found that out-of-pocket costs averaged at 23.7% of their household income. A majority of these costs could be attributed to hospitalization.

The proposal from CMS may make it difficult for groups that have been providing the DPP to take part in Medicare reimbursement.

What we're reading, November 28, 2016: The GOP is considering reforms to Medicare and Democrats are gearing up for a fight; the IRS will send letters to try to sign more people up for Obamacare; and the abortion rate reaches the lowest level in decades.