Insurance

Basit Chaudhry, MD, PhD, founder of Tuple Health, discussed the feedback he's heard from practices about the Oncology Care Model and how these opinions could be used to guide potential changes.

Will bundled payments be implemented quickly or slowly? Will they be voluntary or mandatory? There's disagreement about what the ongoing movement toward accountable care should look like.

Medicare Part A is an automatic entitlement that older Americans start receiving when they begin receiving their Social Security check, but the other parts of Medicare can be more difficult to enroll in. Mandi Bishop, CEO of Aloha Knows, interviewed 2 intelligent individuals who went through a 5-month process to get a mistake fixed for enrollment in Medicare Part B.

A new study published in JAMA Internal Medicine finds that adding Medicare fee schedules to hospitals’ electronic health record systems did not significantly impact the number of laboratory tests ordered by physicians.

High-cost patients are only modestly concentrated in specific hospitals and healthcare markets.

The authors found great variation in wellness visits by location, along with socioeconomic disparities.

The American Society of Clinical Oncology (ASCO) has raised concerns that utilization management strategies, especially for high-cost prescription drugs, could reduce patient access.

The Be The Match Registry has seen phenomenal success with bone marrow and umbilical cord transplants. After having overcome donor availability, it is now important for CMS to create standardized reimbursement policies for the procedure.

During this year's Patient Access Network Foundation Challenge, research submitted by Kai Yeung, PharmD, PhD, of the Kaiser Permanente Washington Health Research Institute, was chosen as the paper winner. The main topic of the challenge this year had been Sustainable Strategies for Providing Access to Critical Medications.

Policies across federal programs vary, with those serving active military and veterans having fewer barriers than Medicare.

Full recognition is key as the provider of the Diabetes Prevention Program awaits rules for Medicare reimbursement. CMS will offer the program to Medicare beneficiaries in 2018.

Shantanu Agrawal, MD, MPhil, comes to the quality measurement organization as Congress weighs whether to continue a relationship with HHS to develop measures used in federal health programs.

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 new radiology guidelines for early-stage breast cancer; 4 continuing healthcare challenges for President Donald Trump; and Medicare coverage for Dexcom's continuous glucose monitor.

The report finds that being part of an ACO allows clinicians to be rated as a group for a key measure to determine Medicare reimbursement.

Dexcom's G5 Mobile is the only continuous glucose monitoring system that meets Medicare criteria for coverage. However, details of the coverage rules released this week state that people with diabetes who want coverage cannot use the system with a smartphone app.

The results are consistent with prior surveys by the American Association of Diabetes Educators. The group said CMS has put its 2019 round of bidding on hold, a move it "applauds."

A value-based formulary was implemented that used cost-effectiveness analysis to inform medication co-payments. Diabetes cohort expenditures decreased by $9 per member per month.

An innovative housing model for seniors that incorporates healthcare within the residential environment contributed to lowered rates of both inpatient hospitalizations and readmissions, according to a recent study.

The delay is partly due to the Inauguration Day executive order than delayed implementing new regulations. But it may also signal a shift in thinking on CMS' approach to bundled payments and who should drive them-doctors or health systems.

Partnering with local nonprofits with expertise in various areas, such as food support, vocational services, and mental health case management, Hennepin Health has been able to successful manage the health of a complex population, explained Ross Owen, health strategy director of Hennepin County.

Home visits by teams led by registered nurses or lay health workers can reduce costs and utilization of services, such as emergency department visits and hospitalizations, according to a paper published in Health Affairs.

Medicare claims analyses offer insight into how proposed policy changes would affect out-of-pocket prescription costs for Part D beneficiaries requiring specialty drugs.

The increased emphasis that the Affordable Care Act and Medicare accountable care organizations (ACOs) placed on prevention is important in reducing the high cost of older patients, especially as the baby boomer generation reached retirement age, explained Mariétou Ouayogodé, PhD, post-doctoral fellow at The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth.