Insurance

Laurie Wesolowicz, PharmD, director, pharmacy services clinical, Blue Cross Blue Shield of Michigan (BCBSM), says that clinical evidence and other factors can drive formulary decision-making. Evidence can influence the value and coverage recommendations for drugs covered under the pharmacy (formulary) and medical benefits.

A pharmacist-led Medicare Medication Therapy Management program can improve clinical outcomes in Medicare beneficiaries without an increase in medication costs.

CMS intends to implement a 1.9% rate reduction in payment rates for Medicare Advantage plans in 2015. Some payers fear that number may increase as fees associated with the Affordable Care Act (ACA), as well as other policy changes, also begin to impact physician reimbursement.

In a rare display of bipartisanship, key committees of both houses of Congress are backing legislation that would permanently erase the sustainable growth-rate formula, a poorly thought out payment reform measure that for more than a decade dictated sharp cuts in Medicare physician pay.

Medicare is proposing a small cut in Medicare Advantage rates for 2015, less than half of what private insurers were expecting from the federal agency. The final rule will be released April 7.

Decreased out-of-pocket spending on prescription drugs accounts for reduced financial burden of care to patients, and is consistent with improved access to care.

The CMS will offer end-to-end testing of Medicare claims using the ICD-10 diagnostic and procedure codes, an attempt to deliver much sought-after assurances that its contractors will be prepared for the Oct. 1 implementation date.

How Can Molecular Diagnostic Companies Show Value if Insurers Won't Pay?

To improve care, policy analysts and health leaders recommend there be fewer and narrower quality measures.

In response to a request for comment issued by the Centers for Medicare & Medicaid Services on its proposed Quality Strategy, the American Hospital Association is calling for more significant alignment of its quality measurement activities in order to reduce the burden on hospitals and providers.

Oncology clinical pathways have helped health plans deliver quality care while keeping an eye on costs. The lack of standardization in pathways can be cumbersome on a busy oncology practice. If Medicare adopts a pathways model, it could offer a framework for broader use.

Current reform efforts seek to tie providers' pay with performance, yet a recent finding suggests that less than 15% of internal medicine residency programs provide education that focuses on such training.

The American Medical Association pledged its full support for legislation repealing the Medicare sustainable growth-rate physician payment formula.

Susan Fox, director, business and product development, US Script, Inc, says the prescription benefit provides a unique opportunity to attract, attain, serve, and retain members in exchange insurance plans

Earning Too Little for Health-Law Subsidies but Ineligible for Benefits Under Existing Medicaid Programs

The CMS is extending the deadline for physicians and other eligible professionals to attest to meaningful use for the Medicare EHR incentive program for the 2013 reporting year and is offering some hospitals a second chance at receiving payment-as well as possible relief from the program's 2015 penalties for failing to comply in 2013.

With hospitals vehemently opposed to more Medicare cuts to fund the bipartisan legislation unveiled Thursday that would permanently end the annual charade around physician pay cuts, Congress may have to enact some form of payment or tax reform if it expects to get the job done this year.

A bipartisan agreement has been reached regarding the sustainable growth rate (SGR) and Medicare reimbursement model.

As out-of-pocket medical costs grow for many Americans, the insurance industry is offering a way to help and, at the same time, expand its business: by selling supplemental policies that may fill the gaps for consumers.

Healthcare providers say Medicare is going to short-change them on patients who spend fewer than two nights in the hospital, and delaying implementation of a new payment policy until October won't change that.

The Obama administration on Thursday reported what it called encouraging results from efforts to reduce healthcare costs and improve the quality of care for more than 5 million Medicare beneficiaries under Obamacare

Nearly half of the organizations in the CMS' largest test of accountable care slowed Medicare spending, but just 29 of 114 ACOs saved enough to receive bonus payments, the agency said.

It sounds like an oxymoron -- semi-permanent repeal -- but some former Medicare administrators are suggesting it as a solution to permanently repealing Medicare's much-hated sustainable growth rate (SGR) payment formula.

There is a radical and bipartisan bill making its way to Congress that could change the future of Medicare.