Insurance

Carol R. Regueiro, MD, MSc, of Allegheny Health Network, highlights how the Physician Partners of Western PA practice support model has successfully engaged specialty practices to enhance patient connections and promote a population health perspective.

This week’s Center on Health Equity & Access highlights emphasize the role of social determinants of health in policy-making and underscore the importance of addressing rising costs and challenges employers face.

Carol R. Regueiro, MD, MSc, of Allegheny Health Network (AHN), explains how AHN's congestive heart failure bundle has enhanced collaboration between cardiology and primary care.

In the wake of the Inflation Reduction Act and other regulatory changes, Medicare Advantage plans have braced for significant cuts that are forcing them to take a hard look at their product offering.

Report reveals growing divide between subsidized and unsubsidized enrollees.

Program yields largest savings in its history of more than $2.1 billion in 2023.

The US should consider reducing or eliminating employer-sponsored insurance. Here are some ways to do it efficiently.

Carol R. Regueiro, MD, MSc, of Allegheny Health Network, described how AHN's Physician Partners of Western PA practice support model and shadow bundle distribution model enhanced collaboration between primary and specialty care to improve patient outcomes.

Cost avoidance varied by clinical setting, with the largest savings occurring in hematology clinics ($73,773), followed by rheumatology ($45,330) and pediatric gastrointestinal/irritable bowel syndrome ($16,519).

The Medicaid budget survey for fiscal years 2024 and 2025 revealed state predictions are expecting a decline in Medicaid enrollment and an increase in spending next year due to the end of pandemic-era policies and federal funding.

On this episode of Managed Care Cast, we're talking with the author of a study published in the October 2024 issue of The American Journal of Managed Care® that explored prior authorization decisions in cancer care by race and ethnicity for commercially insured patients.

Medicaid expansion is associated with improved care and increased survival rates for patients with certain breast cancers, but future studies should focus on whether Medicaid expansion mitigates the disparities between Black and non-White patients.

Medicaid, Medicare, and private insurance programs all showed significant variability in expenditures based on social and nonclinical factors.

Among near-poor Black and Hispanic individuals, Medicare Advantage was associated with increased vision care and some, although not uniform, reductions in access disparities vs traditional Medicare.

Groundbreaking proposal to expand contraception coverage under the ACA marks the most significant update in over 10 years.

Many women remain unaware that the Affordable Care Act (ACA) mandates cost-free preventive services; however, ongoing legal challenges threaten the future of this coverage.

The Wellth smartphone app significantly increased medication adherence and lowered unnecessary health care utilization and costs over 9 months among Medicaid beneficiaries who were self-managing chronic conditions.

Co-pay accumulators and maximizers are 2 programs that insurers have started implementing to help them redirect financial assistance from the patient, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.

As a result of vertical integration, health plans may have 2 different coverage policies on the medical benefit side and the pharmacy benefit side for the same drug.

The prior authorization process for patients with cancer demonstrates fewer days until submission and lower denial rates for Asian patients relative to White patients.

According to KFF’s annual Employer Health Benefits Survey, the average premium for family coverage now stands at $25,572, with workers contributing an average of $6296 annually.

This article explores the congruence between payer patient assignment and quality performance and the implications for incentive payments in alternative payment models.

Hereditary breast cancers are caused by germline mutations, which are genetic mutations inherited at conception and so called because they originate in germ cells, those that develop into reproductive cells and become eggs in female individuals and sperm in male individuals.

The company announced layoffs due to business challenges and regulatory pressures.

Average Medicare drug premiums for older Americans will drop next year for those enrolled in traditional Medicare plans or who have coverage through Medicare Advantage, with opinions divided along party lines on the economic implications.