Policy

The first part of the session titled Innovation in Transition: Models, Global Trends, Regulatory Challenges, and Funding Opportunities started with a presentation from John B. Simpson, MD, PhD, chief executive officer at Avinger, Inc, called Individual-Based Innovation. Dr Simpson briefly described the lumivascular approach to treatment of cardiovascular disease, which is image-guided atherectomy.

The disastrous rollout of HealthCare.gov may have another serious problem: A CBS News analysis shows that in many of the 15 state-based health insurance exchanges more people are enrolling in Medicaid rather than buying private health insurance.

Implementation of ICD-10, or the International Statistical Classification of Diseases and Related Health Problems, 10th revision, is on the horizon. This significant, next-generation change in the health information technology field will be used for everything from billing and measuring quality to managing population health.

Many physicians around the country are getting notices from Advantage plans that they are being cut from private insurers' networks. In addition, some insurers have announced they are reducing their Advantage plan offerings in some states, trimming extra benefits and increasing patient cost sharing.

Hospitals will face growing pressure to reduce costs and improve outcomes as transparency programs reveal comparative performance.

This study identified inefficiencies in drug and medical service utilization related to pain management among Medicare members with osteoarthritis and chronic low back pain.

Seniors need to examine insurance plans carefully to avoid devastating financial surprises. It's not easy, though, as insurance becomes increasingly complex with sometimes widely disparate rules for various scenarios.

Health plans are sending hundreds of thousands of cancellation letters to people who buy their own coverage, frustrating some consumers who want to keep what they have and forcing others to buy more costly policies.

Benefits consultant Aon Hewitt predicted that healthcare premium costs for large U.S. employers would rise about 6 percent in 2013, but when it tallied up its numbers for the year, the increase was only about 3.3 percent.

Dual eligibles-the class of Americans that qualify for both Medicaid and Medicare coverage-are mostly older adults with low incomes and tend to be the sickest beneficiaries covered by either Medicaid or Medicare.

The dynamic landscape of healthcare and managed care pharmacy will be deeply impacted by new and emerging specialty medications. The ever-spiraling costs of specialty medications have led many experts to question whether these treatments translate into true improvements in health outcomes or patients' quality of life.

Not surprisingly, Thomas Merrill, lead researcher, Center for Accountable Care Intelligence, Leavitt Partners, LLC, said that cost is a major work flow challenge associated with Accountable Care Organizations.

In this interview, Curtis Triplitt, PharmD, associate professor and assistant dean of research, Texas Tech University Health Sciences Center, Permian Basin, explains why diabetes should be treated with a patient-centered approach.

Physicians' access to a health information exchange saved more than $1 million in emergency care costs over a one-year period, according to a study released Monday by the American College of Emergency Physicians,

Community health centers will pay a steep price for states' decisions not to expand Medicaid under the federal health law.

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.