Insurance

Despite an official policy since early 2017 that calls for Medicare to cover CGM for certain beneficiaries with diabetes, an attorney who won a landmark case prior to the policy change reports that beneficiaries are still being denied coverage.

Replacing the Merit-based Incentive Payment System (MIPS) with a voluntary program should encourage providers to move quicker into more risk-based payment models, according to Travis Broome, vice president for policy at Aledade.

Four telehealth bills could be signed into law over the next year by Congress; President Donald Trump mentioned "right-to-try" legislation in a favorable light in his State of the Union speech; the House Energy and Commerce Committee will hold legislation hearings on the opioid crisis February 26.

As a result of the Medicare Outpatient Prospective Payment System rule that took effect on January 1, 85% of 340B hospitals will see net payment increases in 2018. Rural hospitals will reap the largest benefits, according to an analysis conducted by Avalere and commissioned by Community Oncology Alliance.

Although it’s difficult to generalize the impact of social determinants of health, addressing them is fundamental to improving overall healthcare quality for member populations.

Officials at Omada Health said the PREDICTS trial was planned long before CMS decided not to include virtual providers in this spring's launch of the Medicare Diabetes Prevention Program. But a spokesperson said the company hopes the growing body of evidence in support of virtual programs will "assuage any concerns."

For many people on traditional Medicare plans, healthcare costs are a rising burden and are expected to consume a larger share of total income by 2030, according to an analysis from the Kaiser Family Foundation.

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.

Medicare's refusal to expand physician education funding will exacerbate the staffing shortage that is growing as baby boomers retire.

This week, the top managed care news included Senate confirming Alex Azar as the new HHS Secretary; a report found that healthcare prices rose in 2016; the accountable care organization movement continued to expand.

High cost sharing is associated with reduced and/or delayed access to targeted therapies under Medicare Part D for patients with metastatic renal cell carcinoma, suggesting that financial barriers play a significant role in treatment decisions, according to a study published in Cancer Medicine.

Patients dually enrolled in Medicare and Medicaid have higher levels of Medicare spending compared to other beneficiaries, and it can impact hospitals' performance on a Medicare cost measure, according to a study published in Health Affairs.

Patients dually enrolled in Medicare and Medicaid have higher levels of Medicare spending compared to other beneficiaries, and it can impact hospitals' performance on a Medicare cost measure, according to a study published in Health Affairs.

Placing seniors on observation status appears to be a tactic to avoid adding to a hosptial's readmission rate, but it hurts seniors financially.

The pairing will give employers and health plans "holistic" solutions for chronic disease management, according to CEOs of the companies.

CMS Administrator Seema Verma said the administration will review the so-called Stark Law, which was enacted to prevent independent physicians from referring Medicare patients to facilities where they have a financial benefit.

Hospital participation in Meaningful Use was associated with reduced disparities in 30-day readmissions for African American Medicare beneficiaries.

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 included CMS unveiling a new voluntary bundled payment model; coverage from the JP Morgan Healthcare Conference, including immunotherapy's impact on HIV treatment and biosimilars; and news that 2 key diabetes devices will be covered by Medicare.

The Medicare Payment Advisory Commission (MedPAC) conducted a formal vote that recommend repealing and replacing CMS’ Merit-based Incentive Payment System (MIPS).

Brenda Schmidt, CEO of Solera Health, discusses the historic launch of the Medicare Diabetes Prevention Program scheduled for this April and how her company is helping providers and other stakeholders get ready.

The announcement comes after CMS canceled an Obama-era proposal for mandatory bundled payments in cardiac care, as well as a mandatory expansion of a program in joint replacements.

The announcement comes after CMS canceled an Obama-era proposal for mandatory bundled payments in cardiac care, as well as a mandatory expansion of a program in joint replacements.

Cross-sectoral partnerships between Area Agencies on Aging (AAA) and healthcare and non-healthcare organizations are an effective way of addressing determinants of health among older adults, according to a recent study published in Health Affairs.