Policy

Health plans use data to decide on quality improvement initiatives. Having a dashboard that characterizes how equitably plans are serving their enrollees would promote health equity.

Cyber attacks on health care are raising cyber insurance costs; Democrats and Republicans clash over what constitutes a cut vs a reform; rural hospitals begin conversion under a new federal payment program.

Medicaid expansion deal proposed in North Carolina; FDA gains new leverage over quick drug approvals; Walgreens announces it will not dispense abortion pills in several states where it’s legal.

The FDA approved the first drug for the rare disease Friedreich’s ataxia; House Republicans seek information from pharmacy benefit managers (PBMs); FDA panel narrowly supports respiratory syncytial virus (RSV) vaccine for older adults.

A new investigation blames the COVID-19 pandemic on a leak from a laboratory in China; Colorado proposes co-pay limits for EpiPens; the first at-home flu and COVID-19 test maker, Lucira Health, declares bankruptcy.

Court decision could ban abortion pill, mifepristone, nationwide; Illinois gears up to fight mental health crisis among children; CMS rejects expanded coverage for Alzheimer drug, Leqembi.

Senators concerned over health care worker shortages; Medicaid beneficiaries left unaware of renewal deadline; Ohio to open health clinic after toxic train derailment.

The Biden administration sends medical experts to the site of the derailed train carrying hazardous materials in Ohio; senators push for pharmacy benefit manager (PBM) reforms; Kentucky Supreme Court proceeds with near-total abortion ban.

High patient experience scores were associated with the collection and use of any clinician performance information, especially with whether the practice shared this information internally to compare.

Social Security and Medicare spending could double by 2023; FDA panel experts want naloxone to be available over the counter after the drug information is revised; Moderna announced its COVID-19 vaccines will stay free, and the Biden administration might keep tests and treatments free for the uninsured.

Using data from 632 primary care practices, the authors show that the CMS Practice Assessment Tool has adequate predictive validity for participation in alternative payment models.

On this episode of Managed Care Cast, we speak with Inland Empire Health Plan, a managed care plan serving more than 1.4 million residents on Medi-Cal in California, about a new maternal mental health program aimed at supporting new mothers, both before they give birth and afterward.

HHS wants to require nursing homes to disclose more ownership and management information; privacy advocates warn that mental health data can legally be sold from certain platforms not covered by the Health Insurance Portability and Accountability Act; the FDA won’t review Soligenix’s cancer drug proposal because of an insufficient application.

Congress has no solution for out-of-network ambulance rides; teenagers going to an emergency department in a mental health crisis don't receive necessary follow-up care; Medicaid explores nutritional benefits of food as medicine spending in some states.

Overall survival and recurrence-free survival showed substantial improvement when physicians more closely followed quality recommendations for non–small cell lung cancer (NSCLC).

Rates of preventive oral health services among pediatric medical visits in Florida were similar whether visits were paid via Medicaid comprehensive managed care or fee for service.

CDC recommends adults and children get routine COVID-19 shots; single dose of antibiotic during labor reduces risk of mothers developing sepsis; suicide rates increase after 2-year decline.

The Biden administration released 2 sets of guidance documents for pharmaceutical manufacturers about how it plans to implement the new Medicare Prescription Drug Inflation Rebate Program as required under the Inflation Reduction Act, and said some beneficiaries could see lower coinsurance for some Part B drugs as soon as April 1.

Some of the nation’s strictest provider network regulations have led to neither high rates of provider directory accuracy nor timely access to mental health care.

A pediatric shot for respiratory syncytial virus (RSV) may not be covered as a free routine vaccine; hospitals fail to comply with payment transparency rules; the fate of abortion pills is in the hands of conservative judges

CDC warns against EzriCare Artificial Tears, which were recalled by the manufacturer; certain weight loss drugs not covered by most payers; Mississippi's Republican governor denies being privately in support of Medicaid expansion.

With the public health emergency soon coming to an end, people covered by Medicaid will encounter new barriers, discusses Dennis Scanlon, PhD, professor of health policy and administration, Penn State University.

The government is allowing Medicare Advantage (MA) plans to delay returning hundreds of millions of dollars or more in government overpayments; a proposed new extension of the Affordable Care Act (ACA) might make birth control coverage more accessible for certain private insurance plans; a study found that students lost around 33% of their school year because of the pandemic’s educational barriers and are struggling to regain that lost time.