Insurance

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

Another organization has announced a plan for making health coverage affordable, following a spate of similar proposals like “Medicare for All” and “Medicare Extra for All” and in the wake of continued efforts by the Trump administration to nibble away at the Affordable Care Act (ACA).

A telephonic transitional care program at a rural hospital reduced postdischarge Medicare spending by 31% and reduced inpatient spending for Medicare fee-for-service beneficiaries.

Unlike commercial plans, Medicare beneficiaries run the risk hitting the donut hole, which causes their costs to go up dramatically, said Paul Billings, senior vice president advocacy for the American Lung Association.

Since its inception, the Center for Medicare and Medicaid Innovation (CMMI) has implemented 37 models testing healthcare delivery and payment reform. A new Goverment Accountability Office assessment found that CMMI has partially met goals for performance targets.

Patients who get care at a hospital often receive bills that are bigger than they were expecting. In the case of Medicare, this can happen when a beneficiary receives care at a hospital for several days but was never formally admitted to the hospital.