Hospital outpatient prices for standard blood tests, cancer screening and other services varied widely and were sharply higher, on average, than prices charged by ambulatory clinics and independent doctors, an analysis of autoworker health-plan spending across 18 cities has found.
Terri Bernacchi, strategic consultant, audit and risk assessment, CIS, identified value-based contracting (VBC) as a forward-thinking approach for pricing and market needs. She discussed how VBC can improve formulary access, how it can impact the healthcare insurance exchanges, and how it can influence provider/payer reimbursement models.
What is value and how do we define it? In a panel discussion led by moderator Jean-Paul Gagnon, former senior director, Sanofi-Aventis, participants were asked to analyze the ways in which healthcare can shift from a fee-for-service model to one that focuses on value.
The Senate introduced legislation this week that would require Medicare to consider patients' finances when deciding whether to punish a hospital for readmission numbers.
Jeffrey Albright, director national accounts, Jazz Pharmaceuticals, said that many patients' access to specialty pharmaceutical products can be limited as health plans struggle to control costs. He provided important insight into pharmaceutical manufacturers' strategies, which aim to optimize appropriate patient access to the medications and products they need through various services that can provide reimbursement support.
While the fee-for-service reimbursement model has long been accepted as the standard model in healthcare, it must shift to one that focuses on value. Value-based reimbursement will encourage stakeholders to achieve the triple aim: improve patient experience, better manage population health, and reduce per-capita costs of healthcare so that patients receive more for the dollar spent, said Dan Sontupe, executive vice president, payer marketing & market access, The Cement Bloc.
Once strictly the domain of research labs, gene-sequencing tests increasingly are being used to help understand the genetic causes of rare disease, putting insurance companies in the position of deciding whether to pay the $5,000 to $17,000 for the tests.
Initiation of guideline-preferred first-line antiretroviral therapy (ART) was associated with better ART adherence and persistence and similar total healthcare expenditures among Medicaid-insured HIV patients.
This study examines whether patients treated with specialty pharmaceuticals have improved outcomes compared with patients treated with conventional therapies, and evaluates costs associated with these treatments.
As the bill for providing healthcare in the United States continues to grow, hospitals are finding that many of their expenses can be chalked up to patients with chronic illnesses such as diabetes and heart failure taking avoidable trips to the emergency room (ER).
Despite reform and shifts in health policy, the United States healthcare system ranked last in quality compared with 10 other industrialized counties-just as it did in 2010, 2007, 2006, and 2004.
Trimming the costs of diabetes to the healthcare system will take multiple strategies, but there's a lack of consensus on precisely how each will work. Are the new recommendations on statins worth the cost?
Negotiating cash payments with medical providers outside the managed-care realm can save a bundle.
Autism exacts a heavy toll on families across the country, but what is the financial cost of the disorder?
Patients who want to compare prices for prostate-cancer surgery may find it rough going: a study has found a 13-fold difference in prices quoted by 100 hospitals across the United States. Moreover, most provided little more than broad estimates, and only three gave a hard copy of the charges.
Cleveland Clinic CEO Dr. Toby Cosgrove will not take over the scandal-ridden Veterans Affairs Department and will remain in his current job.
The White House is considering Toby Cosgrove, MD, president and CEO, Cleveland Clinic, to be the next secretary of the Department of Veterans Affairs.
Toby Cosgrove, MD, president and CEO, the Cleveland Clinic, says that because smoking is such a major contributor to our nation's healthcare woes, the Clinic has encouraged college campuses to go smoke-free. This, he believes, will help reduce the large percentage of smokers who adopt the habit while in school.
The American Society of Clinical Oncology's algorithm to help oncologists evaluate the clinical benefits, side effects and costs of a cancer drug or therapy will be fine-tuned over the summer and should be available for public comment by the fall, said Dr. Lowell Schnipper, chair of the society's Value in Cancer Care Task Force.
For oncologists and other cancer care specialists, value-based care is essential.
The health services research poster session held in the afternoon on the penultimate day of the 50th annual meeting of the American Society of Clinical Oncology (ASCO) presented different perspectives on issues that determine patient care decisions. This is an important discussion, especially in light of the recent report by The Wall Street Journal on WellPoint's effort to promote oncologist adherence to standardized treatment guidelines.
The discussion on value in cancer care was rekindled today at the 50th annual meeting of the American Society of Clinical Oncology, but this time on a global scale. The session, "ASCO/European CanCer Organisation (ECCO) Joint Session: Value and Cancer Care," saw participation from physicians and economists from around the world, with individual perspectives on defining value and the programs being developed to address the issue.
"The Value of Cancer Care and the Professional and Ethical Obligations of the Practicing Oncologist: A Debate" delved into the ethical issues raised by the economic reality of the rising costs of cancer care for the practicing oncologist.
Specialty pharmaceuticals are currently the object of payer focus as one of the major drivers of increased pharmacy spending in 2014 and beyond.
Beginning July 1, health providers can expect to receive incentives for prescribing specific cancer treatments backed by the insurance company WellPoint. The WellPoint's innovative program will pay providers $350 per patient per month each time they choose 1 of the insurer's "preferred" cancer treatment options.