Policy

As the healthcare industry continues its transition towards alternative payment models (APMs), some providers might feel apprehensive about keeping up with new requirements like those in the Medicare Access and CHIP Reauthorization Act (MACRA) final rule. However, these providers can use healthcare information technology (IT), data analysis tools, and other resources to adapt to these changes, according to Suzanne Travis, vice president of regulatory strategy at McKesson.

Among the measures on the ballot for Californians this Election Day is Proposition 61, the Drug Price Standards Initiative. The measure, which would restrict the amount state agencies pay for drugs, has a multitude of supporters and opponents who have amassed a combined $125.84 million in contributions as of Monday.

Medicaid programs provide hepatitis C treatments to needy patients despite the high price, said Matt Salo, executive director of the National Association of Medicaid Directors. He is optimistic that having more manufacturers in the market will bring costs down and make treatment more accessible for all.

When transitioning towards value-based oncology, large employers should look to value-based models that have worked for other conditions, said Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition. These successful payment models include patient-centered medical homes, bundled payments, and accountable care organizations.

Employers face tough decisions about rising costs, high-quality care, coordination of benefits, and workplace accommodations when employees are diagnosed with cancer, but they will always want to support those employees as best they can, according to Marianne Fazen, PhD, president and CEO of the Texas Business Group on Health.

A home-based palliative care (HBPC) program tested within an accountable care organization (ACO) demonstrated substantial cost savings and reduced hospital admissions for patients near the end of life, according to a Journal of Palliative Medicine study.

Many institutions and researchers responded to the PAN Challenge call for papers last year, and even more are expected this year, said Daniel J. Klein, president and CEO of the Patient Access Network Foundation. He emphasized that this year’s Challenge is especially important because it can help reduce the financial hardships that many cancer patients often face.

The rate of inmates infected with the hepatitis C virus is estimated at 17.4% across the United States, and can reach as high as 40% in some states. However, many inmates in state prisons are not permitted to receive the the newest and most expensive treatments for the virus.

“Healthy Steps for Older Adults,” the Pennsylvania Department of Aging’s falls prevention program, resulted in savings of $718 to $840 per person.

Nineteen percent of bills for out-of-network visits were negotiated, and of these negotiated bills, individuals were successful in lowering their costs approximately half the time.

The cost of an intravenous drug used to treat lead poisoning has skyrocketed after a 2700% price increase by Valeant Pharmaceuticals. Experts worry that its high price and the lack of alternatives will place it out of reach for hospitals that need it. This is not the first time Valeant has been criticized for its price-raising practices.

The authors aimed to examine whether participation in Medicare managed care, compared with fee-for-service, has any effects on racial/ethnic disparities in diabetes care and healthcare expenditures among older adults.

Researchers at the University of Chicago have developed a clinically relevant patient-centered tool that can measure a patient’s risk for financial stress.

The PAN Challenge is seeking long-term sustainable strategies to expand affordable access to care, which will benefit seriously ill patients the most, according to Daniel J. Klein, president and CEO of the Patient Access Network (PAN) Foundation.

Hospital consolidation has resulted in fewer choices for physicians and higher costs for patients, insurers, and taxpayers, according to Paul B. Ginsburg, PhD, the Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution and a professor of health policy at the University of Southern California.

Digital health programs like telehealth have already made progress in fields like mental health by expanding access and lowering costs, but there are opportunities to achieve much more in the future, according to Susan Dentzer, president and CEO of The Network for Excellence in Health Innovation.

Compared with Japan, the United States has substantially less geographic variation in surgical outcomes, but it has higher variation in cost.

Outpatient surgeries in the United States account for roughly 7% of annual healthcare expenditures. To exploit substantial opportunities to improve the value of outpatient surgical care, the authors composed an evidence-based care delivery composite for national discussion and pilot testing.

Scott Breidbart, MD, MBA, chief clinical officer of EmblemHealth, explained that paying patients for adherence could be efficient when the payment initiatives are targeted towards members who have not shown to be adherent; however, he added that there are several limitations in paying for adherence, including the sustainability of the system and whether it will incentivize patients who are adherent to stop taking their medications.

In the August issue of Evidence-Based Oncology, The Samfund's Samantha Watson, MBA, and Michelle Landwehr, MPH, outline how young adult cancer survivors are disproportionately affected by treatment costs. This infographic breaks down the vicious cycle these patients get stuck in.

Although team-based care improved cardiovascular disease risk factors, it had a negative financial impact on a primary care practice.

The authors surveyed physicians regarding “Choosing Wisely” and hypothesized drivers of overuse, finding high reported prevalence of hypothesized drivers of overuse and widespread support for cost-consciousness.

Biosimilars in the United States may demonstrate higher discounts and cost reduction than current estimates.

This paper estimates the costs and benefits of over-the-counter (OTC) statins using data on statin use and cardiovascular risk, clinical studies of statin safety and efficacy, and an OTC statin use trial.

The authors examine real-world hepatitis C virus cure rates with direct-acting antivirals among patients coinfected with HIV.