Insurance

As the nation's largest pharmacy benefit managers leave more therapies off formularies, some ask: are patients harmed? A new review in The American Journal of Managed Care, covering 26 studies about drug exclusions, found that most policies saved money without fallout for patients-but there were some exceptions.

The authors review empirical evaluations of drug exclusion policies to examine their impact on patients and on healthcare costs.

More than 3500 sites offer diabetes self-management education, and speakers at the annual meeting of the American Association of Diabetes Educators discussed how this system could be engaged to bring the Diabetes Prevention Program to all 50 states.

The transition to a value-based payment system may ultimately reward diabetes educators, but right now these professionals see challenges on the front lines.

CMS unveiled the results of its new star rating system for hospitals amid great controversy. Here are 5 things to know about the new Medicare stars rating program for hospitals.

Adding more states and conditions to the Medicare Advantage value-based insurance design model will allow CMS to reach a more diverse group of plans and patients, in both rural and urban settings.

The step comes in the wake of reports from Pro Publica, which found 47 incidents since 2012, and signs the problem was getting worse.

Healthcare may not be the leading focus in the 2016 presidential race, but the candidates agree that there are issues that need to be addressed. This infographic breaks the difference between health policy proposals from Donald Trump and Hillary Clinton.

What we're reading, August 8, 2016: a new Medicare law would require hospitals to notify patients about loopholes in nursing home coverage; e-cigarette makers flooded the market ahead of new regulation implementation; and California bill on nurse-midwife independents causes controversy.

The 2016 presidential race has been mostly about the candidates' personal qualities and less about their policies. But that doesn't mean Donald Trump and Hillary Clinton don't have debate-worthy ideas in their healthcare platforms.

In an attempt to appease the Department of Justice and save their proposed merger, Aetna and Humana make deals to sell certain Medicare Advantage assets to Molina Healthcare.

Both Express Scripts and CVS Health said they were taking aim at prescription drug prices that keep going up even when competitors are available.

What we're reading, August 3, 2016: Medicare penalties for hospital readmissions reach a new high; the importance of down-ballot races this election; and Virginia's Bureau of Insurance comes out against the Anthem-Cigna merger.

With Medicare preparing to reimburse for the Diabetes Prevention Program in January 2018, companies are forming or expanding to make this evidence-based program scalable to reach 86 million people with prediabetes.

What we're reading, August 2, 2016: co-ops in New Mexico and Massachusetts sue the government over the risk-adjustment formula and why hospital ratings should be viewed with a bit of skepticism.

Using longitudinal Medicare claims data, this study quantified the association of the Medicare Part D coverage gap with medication adherence among beneficiaries with chronic obstructive pulmonary disease.

The successor to an earlier value-based effort in primary care could reach 5000 practices and 3.5 million patients. The original model showed transformation but had not yet shown savings after 2 years.

Two consultants who help stakeholders in value-based transitions say CMS is serious about an aggressive pace for payment reform.

World Lung Cancer Day is a grassroots effort conceived by a lung cancer survivor. Here are a few updates on ways to prevent the disease and manage treatment.

The most recent pattern of healthcare spending among Americans appears to show a divergence of expenditures trends for the wealthy, middle class, and poor, which suggests a redistribution of care toward wealthier Americans.

This week, the top stories in managed care included the release of Medicare's Star ratings for hospital quality, a new proposal from CMS to require bundled payments for cardiac care, and an FDA panel recommended approving a continuous glucose monitoring system for dosing insulin.

What we're reading, July 28, 2016: CMS released first hospital quality ratings; Anthem is prepared to fight the government over Cigna purchase; and regulations are falling behind stem cell clinics.

The report found that in-person coaching and digital formats with human coaching were both effective and delivered value. ICER's review comes as Medicare is creating reimbursement standards to take effect in January 2018.

What we're reading, July 27, 2016: UnitedHealth and Aetna are looking to join California's Medicaid program; the World Health Organization is considering removing transgender identity from list of mental disorders; and medical schools rethink how to treat addiction.

A new review of Medicare prescription drug plans suggests that these plans need incentives that will push them to consider long-term outcomes and costs because they tend to consider only short-term clinical outcomes and costs related only to the pharmacy benefit.

Presented by The Atlantic at the Democratic National Convention, the forum saw members of Congress, a scientist, and a patient all call for more prevention and early intervention in a disease that could swamp the federal budget by 2050.

Critics of the Hospital Compare "Star" ratings ask whether the failure to take patient wealth into account unfairly penalizes hospitals that care for larger numbers of poor patients.

This would be the second group of procedures targeted for bundled payments in Medicare. Rules for hip and knee replacements went into effect in April in 67 markets.

What We’re Reading, July 25, 2016: Keeping dementia at bay in the elderly; PhRMA spends more and insurers spend less on lobbying, so far in 2016; and a record-breaking fraud case in Florida.

In a conference call the morning after a landmark vote, Dexcom's president and CEO said the company will not wait for final FDA approval to start talks with CMS.