Insurance

The Justice Department said that Healogics, a Florida-based wound care chain, agreed to pay up to $22.51 million to settle allegations that it violated the False Claims Act by knowingly causing wound care centers to bill Medicare for medically unnecessary and unreasonable hyperbaric oxygen (HBO) therapy.

If you heard of a drug with a 387 percent return on investment, wouldn’t you want in? That was the result of a voluntary program in Maine that provided proper meals to high-risk Medicare patients leaving the hospital. Managed Care Cast explores results that appear in the current issue ofThe American Journal of Managed Care®.

Physicians participating in the Oncology Care Model now provider care for approximately 21% of Medicare patients with cancer. An analysis from Avalere Health found that those doctors treat some types of cancers more than others.

The Trump administration is proposing to halt the public disclosure of hospital infections on the CMS Hospital Compare website; the American Medical Association (AMA) is opposing the proposed merger between CVS Health and Aetna after an analysis of the impact; and health experts are warning about the short- and long-term health impacts of the current zero tolerance immigration policy.

Health insurer Humana and pharmacy chain Walgreens announced Tuesday they are opening joint primary care clinics for senior citizens in Kansas City, Missouri. Separately, a report from America’s Health Insurance Plans (AHIP) found that Medicare Advantage populations continue to be more diverse and represent a larger share of low-income seniors than traditional fee-for-service (FFS) Medicare beneficiaries.

Authors from Foundation Medicine explain the regulatory path that led to approval of FoundationOne CDx.

Health plans are under scrutiny to address social determinants of health, which include food insecurity and poor housing.

This week, the top managed care stories include the CDC says the suicide rate is rising; lawmakers ask when drug prices will start falling; and a policy change will allow people in Medicare to use their smartphone to manage diabetes.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

This article reports that an integrated medication management program in a Pioneer Accountable Care Organization was associated with decreases in all-cause hospitalization and Medicare costs.

The ban on letting people in Medicare connect their continuous glucose monitor (CGM) to a smartphone drew ire from patients, advocates, and even the Government Accountability Office.

Researchers from the University of Maryland at Baltimore tracked how quickly drugs in eight therapeutic classes made it onto formulary across hundreds of Medicare Part D plans over five years, and found that while plan differences mattered, drug characteristics mattered more in decisions.

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 include Medicare Part A will run out earlier than predicted; healthcare costs for families continue to rise; and thousands of women with a common form of early breast cancer can forgo chemotherapy.

Telehealth, a universal term for the use of digital information and communication technologies to remotely access healthcare services, is improving availability of healthcare services, particularly for patients in rural areas.

There is significant heterogeneity in formulary placement and restrictions on new drug approvals in the Part D marketplace.

A study of baseline characteristics and spending of hospitals participating in Medicare's voluntary and mandatory orthopedic bundled programs found that there were few differences, indicating that mandatory programs could engage more hospitals that otherwise would not have participated in voluntary programs.

While utilization management in general is a pain point for everyone, it’s a necessary evil in the United States, where we spend 18% of our gross domestic product on healthcare, explained Debra Patt, MD, MPH, MBA, vice president, policy and strategy, Texas Oncology; medical director, analytics, McKesson Specialty Health, during a session at the 2018 American Society of Clinical Oncology Annual Meeting in Chicago, Illinois.

CMS reported that 91% of all clinicians eligible for the Merit-based Incentive Payment System (MIPS) participated in the first year of the Quality Payment Program (QPP), surpassing the agency’s goal of 90%.

The top status comes as digital providers, such as Omada Health, are trying to convince CMS to include them in the Medicare National Diabetes Prevention Program program.

A retrospective analysis conducted by researchers at the University of Louisville has found that less than 2% of the more than 7.5 million eligible smokers were screened for lung cancer in 2016 despite recommendations by the United States Preventive Services Task Force (USPSTF). These results will be presented at the 2018 American Society of Clinical Oncology Annual Meeting, June 1-5, Chicago, Illinois.

An analysis of the 4 years of the Comprehensive Primary Care Initiative found slowed growth in emergency department visits, but no significant changes in Medicare spending or claims-based quality of care.

A new rule from CMS for 2019 would allow for more flexibility in benefit design for Medicare Advantage enrollees with specified chronic conditions.

As part of a settlement with the Department of Justice, Pfizer will pay the government nearly $24 million to resolve kickback allegations; both blue and red states worry association health plans could become targets for scam artists; a prototype of a swallowable sensor that can send results to a smartphone app will provide a peek into the digestive system.

The American Diabetes Association (ADA) released a set of policy recommendations designed to spotlight the increasing difficulties patients with diabetes have affording insulin or gaining access to the life-saving medication. The recommendations follow the findings of a working group about the issue, the findings of which were presented to the Special Senate Committee on Aging earlier this month.

The American Diabetes Association (ADA) released a set of policy recommendations designed to spotlight the increasing difficulties patients with diabetes have affording insulin or gaining access to the life-saving medication. The recommendations follow the findings of a working group about the issue, the findings of which were presented to the Special Senate Committee on Aging earlier this month.

Successful initiatives using private sector data can provide insight into what is needed to power the paradigm shift to price transparency.

The number of Medicare Part D enrollees reaching catastrophic coverage increased by more than 50% from 2013 to 2016, according to an analysis form Avalere Health

So far, the move to accountable care has been promising, but more needs to be done to encourage providers into risk, said panelists at The American Journal of Managed Care®’s Accountable Care Delivery Congress.

In a survey released by Community Oncology Alliance (COA), the majority of physicians reported concern over proposals to reform the Medicare Part B program