Policy

Expanding coverage and access to glucagon-like peptide-1 (GLP-1) medication can be beneficial for all with the cooperation of multiple parties in health care.

This investigation analyzes public data on adult patients from the 2017 National Health Interview Survey, including how often they were treated with respect and could see health care providers who shared their cultural views.

Andrew S. Oseran, MD, MBA, MSc, hypothesizes that higher Medicare Advantage (MA) risk scores may result from either a more accurate capture of beneficiaries' comorbidities or inappropriate "upcoding" of conditions.

The Braidwood Management v Becerra decision could require payers to step up to continue covering preventive services, depending on the decision, according to Richard Hughes IV, JD, MPH.

The excess payments Medicare Advantage plans receive for higher risk scores may be more influenced by differences in coding practices rather than actual differences in disease burden between MA and fee-for-service Medicare beneficiaries, according to Andrew, S. Oseran, MD, MBA, MSc, of Beth Israel Deaconess Medical Center.

Medicare beneficiaries treated by physicians with high levels of Medicare Advantage risk exposure had higher care quality and efficiency outcomes compared with those treated by other physicians.

The Republican bill for the congressional budget narrowly passes the House of Representatives, advancing to the Senate floor.

Medicare Advantage (MA) plans, with fixed payments based on medical complexity, incentivize aggressive coding of comorbidities, potentially inflating costs for the federal government, according to Andrew S. Oseran, MD, MBA, MSc, of Beth Israel Deaconess Medical Center.

Delays in receiving coverage for essential medications like insulin and albuterol can worsen symptoms, increase costs, and add stress for patients.

Of the surveyed physicians, 93% reported that prior authorization delays patient care, and 89% said it contributes to burnout.

These findings support the claim that Medicare Advantage (MA) payments may be driven more by diagnosis and coding practices rather than differences in disease burden between MA and fee-for-service (FFS) Medicare beneficiaries.

Health care institutions with large numbers of Medicare and Medicaid patients may be constrained from offering cancer therapies made available under the accelerated approval pathway.

The rising frequency of natural disasters due to climate change could make health plans more susceptible to significant negative effects, according to Maria DeYoreo, PhD, of RAND Corporation.

The Trump administration argues that HHS Secretary Robert F. Kennedy Jr can overrule the US Preventive Services Task Force to determine the preventive services covered under the Affordable Care Act.

The study found no evidence that geographically limited disasters significantly reduced annual quality performance scores, highlighting the resilience of these programs.

President Donald J. Trump pushed for significant health care changes during his first month back in office, through executive orders affecting managed care, drug pricing, and clinical trial diversity guidance.

The House budget includes cutting $880 billion from programs under the House Energy and Commerce Committee's jurisdiction, which include Medicaid.

Comparing plans with similar characteristics, such as size, geographic location, or demographics served, allows for more meaningful insights and improvement opportunities.

While Republican state-led efforts aim to increase restrictions to abortion care and access to mifepristone and misoprostol in 2025, JAMA authors join the conversation with their published research and commentary.

The upcoming Supreme Court hearing on Braidwood Management v Becerra could affect how preventive services are covered by both public and private insurance.

As enrollment shifts to the Affordable Care Act (ACA) marketplace following the unwinding of Medicaid and the Trump administration begins to implement health policy changes, Molly Dean, MSW, Siftwell's policy advisor, shares insight on how to adapt.

The executive order calls for recommendations on how to expand access and reduce costs for in vitro fertilization (IVF) treatment.

The study aimed to assess the effect of localized disasters on health plan quality performance scores, according to lead investigator Maria DeYoreo, PhD, of RAND Corporation.