Insurance

The annual wellness visit is beneficial for patients, providers, and payers with an emphasis on preventive care for early intervention.

The high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.

On this episode of Managed Care Cast, we speak with the author of a study published in the January 2025 issue of The American Journal of Managed Care® to examine the association between quantitative network adequacy standards and mental health care access among adult Medicaid enrollees.

President Donald Trump's initial executive orders target previous efforts to reduce health care costs, pandemic preparedness, and international partnerships, showing a stark contrast to the Biden administration.

Experts suggest that most Americans will not experience immediate changes in their out-of-pocket health care expenses.

Insurer-pharmacy benefit manager (PBM) firms control most of the Medicare Part D market, steering patients to their pharmacies through network exclusions and targeted marketing.

Semaglutide (Ozempic) is 1 of 15 medications that will be included in yearly price negotiations between Medicare and manufacturers.

Including a telephone component in Medicare Consumer Assessment of Healthcare Providers and Systems survey administration continues to be valuable because telephone responses comprise a substantial portion of responses for several underserved groups.

There is limited awareness and utilization of supplemental benefits among Medicare Advantage beneficiaries, with cost-sharing and out-of-pocket spending playing key roles, a new study has found.

Altruism values for treatments of rare, severe pediatric diseases have not been estimated. This study found the altruism value for a hypothetical new Duchenne muscular dystrophy treatment to be $80 per year.

Jessica Tracy, head of Growth and Partnerships at Enthea, shares how employers and unions can support mental health and address access barriers to evidence-based ketamine treatments.

ACA enrollment rate hits a milestone, though IRA subsidies may not extend beyond 2025; network adequacy standards fail to translate into efficient access to mental health care for Medicaid enrollees; research examines racial disparities in postpartum hypertension and vaccine uptake.

The authors used medical loss ratio forms to assess trends in premiums, medical claims, administrative costs, quality improvement, and margins in the large group insurer market.

Record numbers have enrolled in Affordable Care Act (ACA) coverage as open enrollment continues through January 15, 2025.

Quantitative Medicaid managed care network adequacy standards were not associated with improved mental health (MH) care access among adults and those with MH conditions.

Opioid use disorder (OUD) can cause serious maternal complications, but data on the burden of OUD in pregnancy is severely lacking and more evidence-based solutions are needed.

Cochair of our recent Institute for Value-Based Medicine® event hosted with NYU Langone Health, Oscar B. Lahoud, MD, speaks on his hoped-for top health care priorities under the incoming administration.

The health care provisions include key reforms targeting pharmacy benefit managers, extensions of Medicare telehealth flexibilities, and measures aimed at combating the opioid crisis and preparing for future pandemics.

A new report from The Commonwealth Fund compares trends in health plan spending and employee costs for 2014 through 2023 between small and large businesses, taking into account plan premiums, employee contributions, and deductibles. It also highlights that although small firms do not even have to offer health benefits, large firms are required to do so by the Affordable Care Act.

This study found widespread instances of disconnect in online provider directories between information needed by patients and data availability.

Among commercial and Medicare supplemental beneficiaries with cost sharing, higher out-of-pocket spending for the first cardiac rehabilitation session was associated with lower program adherence.

Older adults in the United States are disproportionately affected by health care costs compared with their counterparts in other wealthy nations.

While the Medicare Competitive Bidding Program reduced spending, it did not significantly impact supplemental oxygen use or clinical outcomes among patients with chronic obstructive pulmonary disease (COPD).

The Wellness Way facility was designed to improve access to comprehensive outpatient care and address social determinants of health for a diverse patient population.