Insurance

Thy N. Huynh, MD, FAAD, Bruce A. Brod, MHCI, MD, FAAD, and Melissa Piliang, MD, FAAD, discussed expanding access to pediatric dermatology, dermatology data aggregation, and advocacy for Medicare physician payment reform, respectively.

Information on health equity was removed by the federal government for both the Children’s Health Insurance Program and Medicaid.

Enhanced premium tax credits (PTCs) have made marketplace health insurance more affordable, and eliminating them could have sweeping impacts on consumers and the health care industry, according to a new report.

In this qualitative investigation, leaders of Medicaid managed care plans were interviewed to identify facilitators of and barriers to electronic consultation for specialty care delivery.

Expanding coverage and access to glucagon-like peptide-1 (GLP-1) medication can be beneficial for all with the cooperation of multiple parties in health care.

Tiffany Meng, PharmD, an oncology pharmacist, UCSF Health, shares how pharmacists can collaborate with physicians to find the most effective and affordable therapies for patients.

Andrew S. Oseran, MD, MBA, MSc, hypothesizes that higher Medicare Advantage (MA) risk scores may result from either a more accurate capture of beneficiaries' comorbidities or inappropriate "upcoding" of conditions.

The Braidwood Management v Becerra decision could require payers to step up to continue covering preventive services, depending on the decision, according to Richard Hughes IV, JD, MPH.

The Health Insurance Disparities Index allows stakeholders to assess progress in addressing health care disparities using publicly available, validated, reported health plan quality metrics results.

The excess payments Medicare Advantage plans receive for higher risk scores may be more influenced by differences in coding practices rather than actual differences in disease burden between MA and fee-for-service Medicare beneficiaries, according to Andrew, S. Oseran, MD, MBA, MSc, of Beth Israel Deaconess Medical Center.

Medicare Advantage (MA) plans, with fixed payments based on medical complexity, incentivize aggressive coding of comorbidities, potentially inflating costs for the federal government, according to Andrew S. Oseran, MD, MBA, MSc, of Beth Israel Deaconess Medical Center.

Delays in receiving coverage for essential medications like insulin and albuterol can worsen symptoms, increase costs, and add stress for patients.

Building trust with patients who are dually eligible for Medicaid and Medicare can help to improve their lives as they navigate receiving care to address their clinical and behavioral health needs.

Of the surveyed physicians, 93% reported that prior authorization delays patient care, and 89% said it contributes to burnout.

These findings support the claim that Medicare Advantage (MA) payments may be driven more by diagnosis and coding practices rather than differences in disease burden between MA and fee-for-service (FFS) Medicare beneficiaries.

Higher telemedicine adoption among Medicare beneficiaries was associated with a slight increase in total visits but a reduction in certain low-value tests and related spending.

The rising frequency of natural disasters due to climate change could make health plans more susceptible to significant negative effects, according to Maria DeYoreo, PhD, of RAND Corporation.

The Trump administration argues that HHS Secretary Robert F. Kennedy Jr can overrule the US Preventive Services Task Force to determine the preventive services covered under the Affordable Care Act.

The study found no evidence that geographically limited disasters significantly reduced annual quality performance scores, highlighting the resilience of these programs.

Among hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.

President Donald J. Trump pushed for significant health care changes during his first month back in office, through executive orders affecting managed care, drug pricing, and clinical trial diversity guidance.

The House budget includes cutting $880 billion from programs under the House Energy and Commerce Committee's jurisdiction, which include Medicaid.

Comparing plans with similar characteristics, such as size, geographic location, or demographics served, allows for more meaningful insights and improvement opportunities.

The upcoming Supreme Court hearing on Braidwood Management v Becerra could affect how preventive services are covered by both public and private insurance.

The study aimed to assess the effect of localized disasters on health plan quality performance scores, according to lead investigator Maria DeYoreo, PhD, of RAND Corporation.

For this retrospective study, the authors examined data on more than 3 million screening mammographies for more than 1 million female patients; of the screenings, 23.6% had abnormal results and only 6.7% were recommended for biopsy.

The number of psychiatrists submitting more than 10 claims to Medicare Part B decreased by 16.8% from 2014 to 2022.

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

During the unwinding of continuous Medicaid provisions, 8.7% of pediatric patients at community-based health organizations became uninsured, with higher rates among older children, females, and those with chronic medical conditions.

Relying on veteran survey responses and novel actuarial data, the authors examine the relationship between benefit value and reliance on the Veterans Health Administration.