Insurance

This week's topics include frameworks for improving health equity nationwide, addressing social determinants of health, discussing CMS's Medicare rules, investigating breast cancer treatment refusal, and exploring HIV and major depressive disorder in underrepresented groups.

Results featured at the Academy of Managed Care Pharmacy 2024 annual meeting revealed a pattern of prior authorization rejections that could delay necessary therapeutic treatments for various patient groups.

Gaps in the delivery and coverage of behavioral health care can be addressed through continued advocacy for better policies and financial incentives surrounding treatment.

Ascension Health was hit with a cyberattack; a new federal policy is aimed at integrating Medicare and Medicaid coverage; the CDC is planning to post data on influenza A found in wastewater in a public dashboard.

On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.

Fifty percent of US rural hospitals are facing financial problems; US lawmakers have called out the corporate spending of 3 large nursing home companies; hospice patients under Medicare Advantage are now facing uncertainty after the government ended its pilot program.

Rising Medicare Advantage enrollment occurred alongside declines in enrollment in traditional Medicare with employer-sponsored supplemental coverage and traditional Medicare without supplemental coverage.

Neil Goldfarb, president and chief executive officer of the Greater Philadelphia Business Coalition on Health (GPBCH), shared insight into the themes and sessions at the upcoming GPBCH Annual Conference taking place June 6, 2024.

With more therapies available in bladder, kidney, and prostate cancers, collaboration among health care providers can help ensure patients are getting the most appropriate care for their type and stage of cancer, said Mary Dunn, MSN, NP-C, OCN, RN, of University of North Carolina.

Inma Hernandez, PharmD, PhD, professor at the University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, discussed the potential sources of savings associated with the Medicare Drug Price Negotiation Program.

The Senate Finance Committee has introduced bipartisan legislation that proposes using Medicaid and Medicare programs to help prevent and reduce generic drug shortages; US indicators for COVID-19, flu, and respiratory syncytial virus (RSV) declined further last week; findings from a recent study reveal growing disparities in child death rates across racial and ethnic groups.

This week, the Center on Health Equity and Access highlights a variety of gaps that exist in health care, spanning women's health, the rising rate of metabolic disease, and policy for LGBTQ+ and immigrant populations. The consensus among featured experts points to comprehensive care models.

Leaders at 49 accountable care organizations (ACOs) shared their perspectives on the Medicare Shared Savings Program, as well as a range of strategies for success and ongoing challenges.

A new federal rule will enable thousands of immigrants in the Deferred Action for Childhood Arrivals (DACA) program to obtain health care through the Affordable Care Act; a forthcoming CMS rule is expected to lower home-based care wait times and raise caregiver wages; the HHS Office for Civil Rights has finalized 2 rules that strengthen the ACA’s health care discrimination ban.

About 5000 leaders in health economics and outcomes research will gather for the 2024 meeting, which has the theme, "HEOR: A Transformative Force for Whole Health.”

In a presentation at the Greater Philadelphia Business Coalition on Health Women’s Health Summit, Shelly Lanning, cofounder and president of Visana Health, addressed the need for comprehensive approaches in women’s health care and their coverage options.

Joanne Mizell shares insurer strategies in addressing the escalating rates of metabolic diseases, highlighting the importance of holistic treatment methods like lifestyle modification programs, which integrate nutrition, physical activity, and community engagement.

When the same product comes to market with additional indications, irrational pricing decisions result in ever-increasing prices instead of volume translating to lower costs, said Jon Mahrt, MBA, of OptumRX.

Researchers also estimated that more than 700,000 Americans with diabetes could lose insurance coverage if these proposed retractions are put into place, with some new policies already in effect.

Makers of medical tests will have about 4 years to show the FDA that their new offerings deliver accurate results; after previously decreasing for 27 years, US tuberculosis (TB) cases increased every year since 2020; a US district judge rejected a challenge by Bristol Myers Squibb and Johnson & Johnson to the Medicare drug price negotiation program.

Researchers addressed the impact of long-term coverage of telemedicine, following concerns that it will increase spending and hurt health care quality.

Prices for care at hospital trauma centers vary across hospitals; drug shortages reached a record high during the first quarter of 2024; although 3 of the biggest makers of asthma inhalers pledged to cap out-of-pocket costs for some US patients at $35, these do not apply to daily inhalers used by the youngest kids with asthma.

Using 25 health system performance indicators, the Commonwealth Fund 2024 State Health Disparities Report evaluated racial and ethnic disparities in health care and health outcomes both within and across US states and highlighted the urgent need for equitable health care policies and practices in the US.

The Biden administration recently launched the Global Health Security Strategy, a new effort to combat the spread of infectious diseases; lawmakers zeroed in on the risks of massive consolidation in health care during the first congressional hearing on the Change Healthcare hack; the FDA recently announced the recall of a pair of heart devices linked to numerous deaths and injuries.

Large insurance sales agency call centers are accused of enrolling individuals in plans without consent; more young adults are choosing permanent contraception procedures; widespread frustration with prior authorization requirements hints at potential future measures.