Insurance

Since the introduction of the Oncology Care Model, oncologists have raised numerous questions as they weigh whether to apply for participation.

An independent review of Medicare payments reveals that 42% of the healthcare dollars Medicare paid to providers in its fee-for-service program in 2013 were designed to boost the value of care patients receive.

A study conducted at the University of Maryland School of Public Health, published in the journal Health Affairs, evaluated the results of an intervention to connect low-income uninsured and Medicaid patients to a reliable source of primary healthcare.

When 5% of Medicaid recipients account for 54% of spending, cost is just the beginning of the problem.

CMS' decision to pay primary care physicians to coordinate for seniors with multiple chronic conditions cannot soon enough, if a study in Clinical Diabetes is any sign.

The Pioneer ACO Model successfully reported smaller increases in total Medicare expenditures and reductions in health service utilization, for savings of approximately $385 million during the first 2 years compared with general Medicare fee-for-service.

As accountable care organizations work to deliver population health, patient satisfaction, and cost savings, the need to engage patients as partners in their own healthcare has never been more essential. The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, gathered this week at the historic Hotel del Coronado in San Diego, California, to explore ways to make patients the starting points of healthcare, not just its recipients.

Patients at hospitals with high rates of skilled nursing facility discharge usually have poorer outcomes and higher downstream spending, according to researchers from Massachusetts Institute of Technology and Vanderbilt University.

The federal government popped the cap off drug spending on Thursday, detailing doctor-by-doctor and drug-by-drug how Medicare and its beneficiaries spent $103 billion on pharmaceuticals in 2013.

Today's call for Medicare to cover the Diabetes Prevention Program is part of a broader effort by advocacy groups and the AMA to identify those with prediabetes and intervene before people develop full-blown diabetes.

Medigap, the Medicare supplement coverage that helps fee-for-service beneficiaries fill gaps in their benefits, continues to be important for low-income beneficiaries and especially those living in rural areas, according to America's Health Insurance Plans.

Nearly 40% of healthcare providers treating Medicare patients will have their payments docked 1.5% this year because they didn't submit data on patients' health to the government, CMS said.

A new report from the Government Accountability Office found that CMS could use electronically readable cards in Medicare for a number of different purposes.

The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, will host its first meeting on the West Coast April 30-May 1, 2015, at the Hotel del Coronado in San Diego, California. An outstanding group of faculty will take part as this multistakeholder group meets for the first time since the announcement of the ACO "Next Generation" initiative.

CMS wasted nearly $251 million in taxpayer dollars on infusion drugs in just 18 months by using outdated drug pricing estimates, which drove up the cost of prescription injectable drugs for an aging baby boomer population.

One of the challenges providers will face in the new Oncology Care Model that CMS announced earlier this year is measuring quality and meeting quality standards under, according to Patti Forest, MD, MBA, senior medical director of network quality and performance at Blue Cross Blue Shield of North Carolina.