Policy

What we're reading, January 8, 2016: HHS releases report with full Obamacare enrollment information for all 50 states and the District of Columbia; the expansion of the biosimilars in 2016; and promising Ebola treatment found not effective.

The 3 core measures of acute myocardial infarction, congestive heart failure, and pneumonia are the leading causes of hospital admissions and expenditures. Our study sets the benchmark foundation for outcome evaluations of CMS’s value-based purchasing program and the Affordable Care Act.

The most read articles in The American Journal of Managed Care's Evidence-Based Oncology ranged from personal narratives to healthcare policy issues that impact the broader population.

Patients with higher out-of-pocket visit costs, such as co-payments and deductibles, initiated provider contact by e-mail more often. Patients report that e-mailing changed their care-seeking behaviors and improved overall health.

Disease management programs for diabetes care based on bundled payment did not slow down the cost growth. Multimorbid adult patients with diabetes had largest cost growth.

What we're reading, October 15, 2015: federal prosecutors subpoena Valeant Pharmaceuticals over how the company prices drugs, Atul Gawande, MD, makes the case for better coordinated care, and proposed biosimilar reimbursement sparks outrage.

A white paper released by QuantiaMD has identified a lack of awareness and education about biosimilars among prescribing physicians.

Many patients with cancer desire cost discussions with doctors, but those discussions are rare. Nevertheless, cost discussions may lower patient costs-usually without altering treatment.

To provide guidance for successful partnerships, the authors identify common themes from their experience with successful health plan/medical group partnerships programs.

Novartis has announced that Zarxio will be available at 15% of the cost of its reference product Neupogen.

With 1 biosimilar already approved in the US, the FDA has finally released draft guidelines for naming these new products.

The Biosimilars Council wants CMS to hold back on Medicare Part B reimbursement for biosimilars.

Assessment of prevalence and specific costs associated with discrete multimorbid mental health disease clusters in adults with diabetes.

Mitigating cost increases through preemptive care and clinical efficacy to reduce the disease burden of clinically at-risk patients.

The potential of nurse practitioners is not being fully realized in primary care medical practices. Consequently, cost and quality gains are not being achieved.

Zarxio (filgrastim-sndz), manufactured by Sandoz as a biosimilar to Amgen's Neupogen, has finally received marketing approval from a federal appeals court.

Two new changes to CMS' ACO Investment Model will help practices in rural areas gain more access to the benefits of accountable care organizations.

Researchers of The Commonwealth Fund discovered that 95% of individuals with Medicaid coverage over the past year had a regular doctor and 55% of this population reported receiving excellent or very good care.

Quality of care and relative resource use for patients with diabetes are not necessarily positively related. Further, the relationship varies by year, plan type, and region.

Focusing on quality and quality measurements has the potential to reduce costs, increase quality, and deliver more value to patients, consumers, and customers.

Newly announced fraud charges against 243 individuals involved schemes of approximately $712 million worth in false billings, according to an announcement by HHS. CMS also suspended a number of providers.

A systematic review of insurance benefit designs with differential cost sharing for substitute prescription drugs.