Insurance

As Americans continue to struggle to afford their medical bills, and some newly insured under the Affordable Care Act find they can’t afford to use the coverage they purchased, finding the “right” health insurance plan is important.

During the 5-year value-based insurance design demonstration in Medicare Advantage, the hope is that the models will show that lower cost-sharing for high-value services and providers meets the triple aim, explained A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

The characteristics of the patients a hospital serves play a huge role in determining the readmission fines, according to a study.

What we're reading, December 8, 2015: Cigna remains committed to participation in Obamacare exchanges; Puerto Rico demands the US fix healthcare funding disparities; and fewer Americans struggle to pay medical bills.

After 5 years of low growth, CMS reports that national health spending grew 5.3% in 2014, which is still slower than most years prior to the implementation of the Affordable Care Act.

At the annual meeting of the American Society of Hematology, providers brooded over implications of quality measures and how they will influence clinical practice in the coming years.

Study looks at how cost-effective 2 drugs that prevent stroke are from a patient's viewpoint.

The 17% decline in hospital-acquired conditions from 2010 to 2014 is the result of a decades long campaign and means lives saved, the avoidance of pain and suffering, and less costly care, said David Blumenthal, MD, MPP, president of The Commonwealth Fund.

Targets for savings needed to cover retirees' healthcare expenses are rising.

Relaxed direct-to-consumer advertising restrictions for drugs by the FDA in 1997 has precipitated an increase in prescription drug utilization, not just among Medicare enrollees, but also among non-elderly users.

This week in managed care, CMS proposed changes to the health insurance marketplaces for 2017, AJMC highlights 5 takeaways from the HHS Pharmaceutical Forum, CVS chose to cover just 1 PCSK9, and industry reacts to FDA regulating diagnostic tests.

Diabetes is a growing epidemic in the United States and new research has indicated that half of healthy 45-year-olds will develop pre-diabetes and one-third will develop diabetes at some point.

The American College of Physicians has published a paper in the Annals of Internal Medicine that advices clinicians to prescribe generic drugs whenever possible.

The top stories in managed care were discussions of value-based care at the NAMCP Fall Managed Care Forum, hospitals are suing over Horizon Blue Cross Blue Shield of New Jersey's OMNIA plan, and CMS finalizes its bundled payments for joint replacement.

The findings suggest that addressing heart patients' social needs is the first step toward getting them to exercise more.

The HHS Pharmaceutical Forum brought together a diverse set of stakeholders to share ideas on delivering affordable but high-quality care, improving outcomes, and continuing to lead in innovation. Here are 5 things that came out of the daylong meeting.

Julie M. Vose, MD, MBA, FASCO, president of the American Society of Clinical Oncology (ASCO), and keynote speaker at this year's Patient-Centered Oncology Care meeting, discusses addressing cost of care, using value calculators, and the Medicare Access and CHIP Reauthorization Act.

What we're reading, November 20, 2015: CMS wants to penalize doctors for ordering routine prostate-cancer screening tests; lawmakers, patients, and advocates call for head of Drug Enforcement Agency to be fired; and specialty drug costs exceed household incomes.

The American Society of Clinical Oncology has made public its detailed guidance to CMS, supporting implementation of physician-focused and other alternative payment models under MACRA.

What we're reading, November 17, 2015: misunderstanding of antibiotics has fueled the rise of drug-resistant superbugs; healthcare leaders overwhelmingly support government intervention to curb rising cost of drugs; and the FDA wants more regulation on laboratory-developed tests.

CMS has finalized a rule for a bundled payment test for hip and knee replacements that will be mandatory for nearly all hospitals in 67 geographical areas across the country.

What we're reading, November 16, 2015: consumers face sticker shock on Affordable Care Act plans when they get sick and face high deductibles; Medicare spending on hepatitis C drugs nearly doubled in 2015; and US maternal mortality has worsened since 1990.

The Medicare Shared Savings Program is the perfect way for primary care physicians to get involved with alternative payments as Medicare moves to replace fee-for-service, explained Hymin Zucker, MD, chief medical officer of the Triple Aim Development Group.

This week in managed care the top stories include pivotal results from the SPRINT study on blood pressure, an analysis on how states successfully enrolled consumers in the insurance marketplace, and experts discuss value-based care.

Expanding and more representative participation in Medicare's Bundled Payments for Care Improvement initiative suggests potential for large impact, pending the results of risk-bearing participants.