Insurance

In Most of the US, Self-insured Employers Lack Power at the Bargaining Table With Hospitals

July 20th 2021, 9:25pm

Podcast

In this episode of Managed Care Cast, the lead author of an article in the July issue of The American Journal of Managed Care describes the latest research that looks at the power of self-insured employers to negotiate hospital prices and the relationship between employer market power and hospital prices.

MA Primary Care Payment Models Influenced Telemedicine Usage During the Pandemic, Research Shows

July 16th 2021, 3:00pm

Article

Larger primary care practices in downside risk–only payment models and capitation saw the highest telemedicine utilization rates by their patients enrolled in Medicare Advantage (MA) plans.

How Biogen’s Aduhelm Approval Marks a Precipitous Turning Point for the FDA

July 14th 2021, 6:03pm

Article

A string of controversies surrounding the approval of Biogen's Alzheimer disease drug aducanumab (Aduhelm) has not only called into question the independent nature of the FDA, but puts both providers and patients in a challenging position when it comes to deciding whether or not to prescribe or take the treatment.

Is Private Health Insurance Really Superior to Public Programs?

July 13th 2021, 5:26pm

Podcast

On this episode of Managed Care Cast, Charlie Wray, DO, MS, an assistant professor of medicine at the University of California San Francisco, outlines the findings of a paper he coauthored which assessed Americans' experiences with their insurance providers.

Contributor: MACRA Has Not Lived Up to Its Promise

July 5th 2021, 7:45pm

Article

The Medicare Access and CHIP Reauthorization Act (MACRA) needs to be reimagined get back on track and to live up to its promise to incentivize value-based care.

Contributor: 3 Technologies to Support Health Plans Post COVID-19

July 5th 2021, 1:00pm

Article

Health insurance companies are anticipating a swell in pent-up demand for delayed or forgone health services in 2020, as well as increased costs associated with distributing COVID-19 vaccines to millions of Americans. To offset the potentially precarious business impact caused by these converging factors, insurers are turning to technology for help.

US Releases First Rule to Protect Against Surprise Medical Bills

July 1st 2021, 10:26pm

Article

The measure is designed to end surprise medical billing and balance billing, taking the first step to implement the so-called No Surprises Act that passed Congress at the end of last year.

Senator, Health Care Executives Discuss What’s Next in Payment, Access Issues

June 24th 2021, 8:15pm

Article

The head of AHIP sat down with a senator and 3 health care executives for a conversation about payment and access issues at the organization's 2021 Institute and Expo Online.

Commercial and Medicare Advantage Payment for Anesthesiology Services

June 16th 2021, 1:00pm

Article

Mean in-network commercial allowed amounts and charges per anesthesia conversion factor are 314% and 659% of traditional Medicare rates, respectively. Medicare Advantage payments align with traditional Medicare prices.

Pandemic Factors Driving Predictions for 2022 Medical Cost Trends

June 15th 2021, 10:00pm

Podcast

On this episode of Managed Care Cast, we speak with the author of the annual PwC Behind the Numbers report, which looks ahead at medical cost trends in the United States.