Insurance

Karmanos Cancer Institute, in Detroit, Michigan, established a specialty pharmacy to help alleviate the financial burden many patients face when paying for their oral novel therapeutics.

Results from Avalere Health show that once Medicare patients get through the experience and expense of CAR T-cell therapy, they do well and costs drop significantly.

Reimbursement for CAR-T therapy has progressed to where commercially insured patients obtain coverage regularly, but issues remain for patients with Medicare, said John Sweetenham, MD, professor in the Department of Internal Medicine at UT Southwestern Medical Center and the Associate Director for Clinical Affairs at UTSW’s Harold C. Simmons Comprehensive Cancer Center.

One delivery system’s healthcare utilization in its Medicare Advantage product was notably less than in its Pioneer accountable care organization or in a traditional Medicare comparison group.

Accountable care organizations (ACOs) have saved Medicare a total of $3.53 billion from 2013 to 2017, or $755 million after shared savings were paid out, according to a new report from the National Association of ACOs (NAACOS).

Kaiser Permanente chairman and chief executive officer Bernard J. Tyson dies at 60; vitamin E acetate is linked as a potential cause of vaping-related lung injuries; Medicare’s outpatient premium cost is rising.

The Committee for a Responsible Federal Budget released a detailed report on potential finance options for implementing "Medicare for All"; employers beginning to lessen dependence on high-deductible health plans; Juul to cut nearly 500 jobs by end of 2019.

We learn most when we have benchmarking and we can examine our own processes of care, explained Michael Kolodziej, MD, vice president and chief innovation officer at ADVI Health, Inc.

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 news included an effort by the Trump administration to bolster Medicare Advantage; an abortion case from Louisiana reached the Supreme Court; the study of adapting to changing oxygen levels wins the Nobel Prize.

Value-based models continue to enter the healthcare system, affecting a variety of fields, including primary care. And while success stories have been shared by payers and CMS touts these models as a way to “save” primary care, that's not the current reality, said Theresa Hush, chief executive officer of Roji Health Intelligence, LLC, during a session on population health management at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum, held October 10-11 in Las Vegas, Nevada.