Insurance

What We're Reading, July 12, 2016: Oregon's Health CO-OP to close down by the end of July; experts discuss fairer ways to decide on drug pricing; and gender bias in physician salaries at academic institutions.

The National Cancer Institute (NCI) estimates that the aging US population will contribute to a substantial increase in the number of older cancer survivors over the next 25 years.

The president predicts that in 20 years, the nation will look back on "Obamacare" as a moment of courage that has improved people's lives.

The proposal to fund the collaborative care model is part of a broader effort to direct $900 million into primary care, mental health, and care coordination.

Details of how Medicare will deliver the Diabetes Prevention Program include efforts to prevent fraud, ensure patient privacy, and tie payment to value-based principles.

Yesterday's announcement featured several steps to combat opioid addiction, including expanded access to buprenorphine, steps to educate physicians, and controls on prescription programs through the Department of Defense and the Indian Health Service.

The New Jersey insurer said its fraud fighting efforts included both detective work and analytics. Nationwide, fraud prevention relies increasingly on predictive modeling to keep suspicious payments from ever going out the door.

The last 6 months have been considered by many as a historic moment for interventions that focus on the social needs of patients, explained Rocco Perla, president of Health Leads.

How does a state with almost no money launch Medicaid expansion? Louisiana health officials used data they already had, and in doing so have created a model that could be used elsewhere.

CMS has announced that the Oncology Care Model (OCM) developed by the Center for Medicare and Medicaid Innovation has 196 practices and 17 payers enrolled for participation.

What we're reading, June 29, 2016: CMS is considering changes to the proposed Medicare Part B demonstration; Senate Democrats block the GOP's Zika funding bill; and a Bloomberg analysis shines light on the pricing practices of the pharmaceutical industry.

Prescription drug spending between 2014 and 2015 increased at a much higher rate among health exchange plans compared with commercial plans, Medicare, and Medicaid plans. Express Scripts highlighted 3 select trends that are having the biggest impact on plans.

This week in managed care, the top stories included House Republicans' new plan to repeal and replace the Affordable Care Act, new funding from HHS to help small practices follow the Medicare Access and CHIP Reauthorization Act, and the Supreme Court rules on a patent lawsuit that impacts pharmaceutical companies.

This week's takedown shows that the fraud prevention and enforcement efforts that began nearly a decade ago are bearing fruit, including the change to predictive modeling to spot suspicious billing in Medicare.

HHS and the Department of Justice announced a nationwide sweep led by the Medicare Fraud Strike Force resulting in charges against 301 individuals for their alleged participation in healthcare fraud schemes involving $900 million in false billings.