Insurance

As the country increases the pace of shifting to value-based payments, a significant question remains: how can independent primary care doctors operate in this new environment?

The technology was approved by FDA in June and unveiled at the Scientific Sessions of the American Diabetes Association.

Although CMS has introduced a strict timeline to move to value-based payments, its new Oncology Care Model is partially relying on fee-for-service, and that's a good thing in the case of oncology, said Ira Klein, MD, MBA, senior director of quality, Strategic Customer Group at The Janssen Pharmaceutical Companies of Johnson & Johnson.

Medicare beneficiaries undergoing dialysis who reach the Part D coverage gap have increased out-of-pocket spending, increased medical service utilization and costs, and increased mortality, according to a new study.

Healthcare groups and members of the Senate Judiciary Committee have weighed in with concerns about decreased competition and harm to consumers if the Aetna-Humana and Anthem-Cigna transactions are approved.

Public outrage over the 5000% price increase for Daraprim, a 62-year-old drug purchased by Turing Pharmaceuticals in August, prompted the company to promise it would lower the drug's cost. This is not the first time such an incidence has occurred.

Hillary Clinton unveiled a plan in Iowa that features a $250 per month cap on drug costs for patients with chronic conditions. This comes 2 weeks after her chief rival for the Democratic nomination, US Senator Bernie Sanders of Vermont, introduced a bill aimed at reining in drug costs. In the summer, The American Journal of Managed Care said polling showed that rising drug costs were poised to become a major issue in the 2016 campaign.

Today's report is a successor to the groundbreaking report, "To Err is Human," which launched the movement to make healthcare quality part of the nation's policy agenda. Until now, however, not enough attention has been paid to an essential element: getting the diagnosis correct and getting it quickly.

As enrollment in Medicare Advantage is expected to increase to a new all-time high for the sixth year in a row, CMS announced that Medicare Advantage premiums will remain stable in 2016.

Meaningful use stage 3 is not scheduled to start until 2017, but 41 medical societies are calling to delay the start of stage 3, especially given recent changes to Medicare.

The top stories in managed care include the nomination for the next FDA commissioner, a report reveals cancer drugs are driving growth in the 340B program more than initially thought, and nearly half a billion in ACA funds are made available to health centers.

When prices of the first 2 entrants of this new class of cholesterol-lowering drugs came in well above expectations, leading PBMs announced plans to limit who could gain access and sent a clear message to the drug makers: get ready to negotiate.

Initial medication filling during the first 2 to 4 months following initiation of a statin strongly predicted adherence patterns during the following year.

As CMS moves to value-based payments, having good measures of value that payers and providers trust will be critical, explained Stuart Guterman, senior scholar in residence AcademyHealth.

Evidence-Based Diabetes Management gained exclusive access to the Comprehensive Weight Management Program for a view of what "behavioral change" really means for patients overcoming obesity and for the clinicians managing their care.

Women bear greater costs related to Alzheimer's disease (AD) compared with men for 2 reasons: they are at greater risk of developing the AD and cost Medicare and Medicaid more, and they are more likely to provide informal, unpaid care to family members with AD.

The company's Prevent program is approved by CDC as meeting standards for obesity prevention counseling as required of payers by the US Prevention Services Task Force.

The American Journal of Managed Care spoke with Bruce J. Gould, MD, medical director of Northwest Georgia Oncology Centers on the impact of the 340B drug pricing program on private oncology practices.

Unaccounted for social and clinical characteristics of a hospital's patient population explain nearly half of the difference in readmission rates between the best and the worst performing hospitals when it comes to Medicare penalties for hospital readmission rates.

Healthcare policy experts gathered in Washington, DC, to discuss access, cost, and the definition of value in oncology care.

The top stories in managed care this week include value-based pricing of the new PCSK9 inhibitors, CMS unveiled a new health equity plan for Medicare, and the American Medical Association released analyses on proposed health insurance mergers.

Although a new report from The Commonwealth Fund raised concerns about the competition of Medicare Advantage (MA) programs available across the country, a new analysis from Avalere Health found that there has been a growing number of MA plan options for consumers.

As CMS pushes healthcare systems to move away from fee-for-service, the state's largest insurer makes a major move toward value-based payment.

At the end of CMS' comment period, the American Society of Clinical Oncology submitted its comments and recommendations for the proposed changes.

The California Public Employees' Retirement System saved $7 million on screening colonoscopies during a 2-year period following implementation of reference pricing.