Policy

Since 2010, the growth and proliferation of accountable care organizations (ACOs) has increased, and the rise of this collaborative care model is not without reason. Lack of consumer engagement, lack of competition, and misaligned incentives have made care less affordable.

Suzanne Tschida, PharmD, vice president, specialty benefits & outcomes, OptumRx, said that at UnitedHealth Group a tiering system is used for the management of specialty medications with a cost-share or copay structure.

Expansion or not, it is obvious that states must consider how to make their Medicaid programs more sustainable.

Most Americans don't want the government to decide if medical treatments are economical before letting patients use them, a new survey suggests.

In the past few years, efforts to lower costs and improve care have proliferated.

Clinical trials and treatment in multiple sclerosis (MS) place an unwelcome economic burden upon countries with MS prevalence. With rising costs and a growing interest in MS clinical trials from emerging countries, new studies are needed to evaluate the significance of these factors.

Melanie Bella, director, Medicare-Medicaid Coordination Office, Centers for Medicare & Medicaid Services, says the sole focus of the Medicare-Medicaid Coordination Office is to increase coordination and access to services from many fronts.

The Obama administration on Wednesday released a long-awaited report on premiums in Obamacare's federal insurance exchanges - the first look at the rates that will apply in the vast majority of states.

Jan Berger, MD, MJ, president & CEO, Health Intelligence Partners, and editor-in-chief of The American Journal of Pharmacy Benefits, says that historically medication adherence, when it pertained to PBMs, was really just about selling pills-it was an isolated, siloed issue.

It is up to physicians to seek education and training on genetics. Panelists agree that it is important for patients to speak with a genetic counselor even if it is over the phone.

MedPAC, the Congressional advisory committee on Medicare, discussed how to get patients more involved in their health decisions.

Health Information Technology (HIT) is expected to make patients' medical information not only more accessible, but easier to share among providers. Yet, despite the promising capabilities of HIT, providers are not entirely convinced about the costs that come with health technology.

A new study suggests that primary care providers participating in an accountable care organization (ACO) and having greater engagement with patients transparency into the cost of services and procedures have the ability to bend the healthcare cost curve by an 8 to 1 margin in terms of return on investment (ROI).

Panelists all agree that there needs to be evidence and guidelines for both payers and providers. There are not enough resources to try every drug on every patient. Although it will be costly, there needs to be evidence on putting these drugs together as combinations.

Two new studies have put a price tag on healthcare services considered of little benefit to patients. In both reports, researchers raised questions about the role that healthcare providers play in delivering potentially unnecessary care.

Hospitals and healthcare systems nationwide are increasingly buying more physician practices as health reform requires care delivery to move toward a more quality-based care model instead of a fee-for-service one. The reactions are mixed.

Bargaining leverage, not the cost of providing complex care, is the main reason why some hospitals can demand prices twice as high as their competitors' and still get contracts to treat privately insured patients, according to a new study.

A study estimates that total annual costs for five major health care-associated infections (HAIs) were $9.8 billion, with surgical site infections contributing the most to overall costs, according to a report.

Premium rates for health plan policies in the health insurance exchange (HIE) are expected to vary nationally, but they aren't likely to skyrocket - at least according to one research group.

Accountable care organizations (ACOs) and other coordinated care models present opportunities for improving quality as well as offering incentives that will drive lower-cost decision making among providers

As healthcare costs rise in Florida, insurers and hospitals vested in the success of the Affordable Care Act, are coming up with new ways to cut costs from buying services in bulk and piloting programs to lowering hospital readmission rates and limiting the number of doctors within a plan's network.

The nation as a whole is facing a physician shortage. The Association of American Medical Colleges estimates that the United States will have a shortfall of 90,000 physicians within the next decade.

The most important piece of legislation in Michigan, and perhaps the country, remains idle on the floor of the Michigan Senate.

While the employer mandate delay and other stalls in the implementation of the Affordable Care Act have raised a few eyebrows, a recent report from the Kaiser Family Foundation brings forth some encouraging news.

Opinions rage about whether health insurance costs will rise or fall with implementation of the Affordable Care Act, commonly known as Obamacare.