Policy

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

Health system leaders, policy makers, payers, and consumer advocates should use multiple synergistic levers to reduce the use of care that does not provide clinical benefit.

Despite the presumption that larger practices that have more resources and are therefore better at providing care and improving outcomes, new research shows that they spend more on and have higher readmission rates for Medicare beneficiaries than smaller practices.

Researchers have found that transitional care management (TCM) services are associated with reductions in mortality and total Medicare costs; however, adoption of these services has remained low since the implementation of TCM payment codes in 2013.

Individuals, families, and local, state, and federal government all have incurred costs as a result of the opioid epidemic, explained Dennis P. Scanlon, PhD, professor, Health Policy and Administration, and director, Center for Health Care and Policy Research, Pennsylvania State University.

Care strategies updates from the American Society of Clinical Oncology's Annual Meeting, held June 2018.

Critics of healthcare consolidation have cited higher costs of chemotherapy administration as an example of how mergers drive up costs. A new study in The American Journal of Managed Care®finds that while drug administration costs in hospitals are higher, chemotherapy drug spending among Medicare patients is lower, driven by less frequent use of therapy.

Adherence to newly initiated biologic therapy for rheumatoid arthritis is important for long-term adherence.

Two years after initiating a high-touch customer model to better serve their members, WEA Trust has achieved a 31% reduction in readmission rates, resulting in savings of $1.9 million, as well as a 7.1% reduction in emergency room use, translating to $2.4 million in savings.

The American Medical Group Association has endorsed a set of 14 value measurements to streamline the reporting process and reduce costs while also improving care by offering a standard set of measures for value-based contracts with payers.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

Cancer patients are agreeing to treatment plans lacking a fundamental understanding of the impacts on their finances, explained Ellen Miller Sonet, MBA, JD, chief strategy and policy officer, CancerCare.

Advances in medicine have produced breakthroughs in the treatment of a number of rare diseases, but these advances often come at a high cost. A multi-stakeholder panel at the International Society for Pharmacoeconomics and Outcomes Research 23rd Annual International Meeting, in Baltimore, Maryland, addressed the question of how to define value in the always evolving and ever more expensive treatment landscape.

In a Monday panel convened at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 23rd Annual International Meeting in Baltimore, Maryland, stakeholders grappled with the role that value assessments play—or should play—in US private payer coverage and formulary decisions.

While incentives and penalties are effective at getting people to complete health risk assessments, the assessments do not lower costs or increase wellness.

At the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting, experts addressed the cost of treating patients with hemophilia and the importance of care coordination to ensure a more holistic approach toward caring for these patients.

Reimbursement models, novel gene therapy–based treatments, and price transparency: these were some of the topics covered by presenters and panelists at the annual meeting of the Community Oncology Alliance.

How are community practices coping with administering chimeric antigen receptor (CAR)-T treatments? At the 2018 Community Oncology Conference hosted by the Community Oncology Alliance, Houston Holmes, MD, MBA, FACP, Texas Oncology, shared his experience with administering CAR T-cells in a community cancer center–based setting.

CVS has announced the launch of CVS Pharmacy Rx Savings Finder, which will provide its 30,000 pharmacists the ability to find less expensive alternatives for their patients.

Nine in 10 people with non-group health insurance will continue buying coverage despite the repeal of the individual mandate and express worry over future availability and price of health coverage, according to a health tracking poll from Kaiser Family Foundation. The poll also found that for the uninsured, the main reason for not purchasing coverage is that it is too expensive.

The second day of the National Comprehensive Cancer Network (NCCN) 23rd Annual Conference in Orlando, Florida, opened with a dual keynote presentation on transforming cancer care in the United States.

Prior authorizations delay care, have a significant negative impact on clinical outcomes, and place a high burden on providers, according to a physician survey conducted by the American Medical Association (AMA).

In 2014, Maryland and CMS entered a 5-year agreement employing the All-Payer Hospital Model in the state to cut costs while improving quality. According to the year 3 performance data, Maryland has met or is on track to meet all model requirements, saving hundreds of millions of dollars as it lowers hospital readmissions and steers the state away from a volume-based system.

Currently, the FDA is evaluating 2 investigational drugs, both of which treat the underlying pathophysiology of hereditary transthyretin amyloidosis.