Insurance

Even experienced providers say prescribing has become too complex and time consuming with Medicare Part D plans, which differ in formularies and prior authorization processes.

Predictive modeling can be used to identify disabled Medicaid beneficiaries at high risk of future hospitalizations who could benefit from appropriate interventions.

Manesh Patel, MD, an interventional cardiologist at Duke University began by presenting a talk entitled, Appropriate Use Criteria: The Reasons, Methods, Intended, and Unintended Consequences. He first pointed out that Medicare expenditures on imaging have doubled between 2000 and 2006.

The cost-saving potential of specialty or disease-specific ACOs can be huge...but it is unclear whether these specialty services are more efficiently provided through their own ACO or as ancillary to the burgeoning primary care ACO marketplace.

As a side effect of national sequester cuts, many cancer clinics have been forced to turn away Medicare patients.

Could two years really have made the difference? While some healthcare reforms proposals have called for raising Medicare eligibility from age 65 to 67 to address cost concerns associated with the Affordable Care Act, President Obama has made it clear that he would not consider increasing the age limit as a way to aid the national deficit.

For the second time in 6 months, the Centers for Medicare & Medicaid Services officials have revised readmission penalties for hospitals. In doing so, approximately 1200 hospitals are now subject to lesser penalties.

A new study published online today in The American Journal of Managed Care found that in Medicare Part D, generic drug coverage was cost-saving compared to no coverage in bipolar disorder and schizophrenia, while also improving health outcomes. Researchers from the University of Pittsburgh School of Medicine, the Pitt Graduate School of Public Health, and Western Psychiatric Institute and Clinic of UPMC note that policymakers and insurers should consider generic-only coverage, rather than no gap coverage, to both conserve healthcare resources and improve health.