Policy

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.

For this retrospective study, the authors examined data on more than 3 million screening mammographies for more than 1 million female patients; of the screenings, 23.6% had abnormal results and only 6.7% were recommended for biopsy.

On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.

Regina Barragan-Carrillo, MD, a postdoctoral fellow at City of Hope Comprehensive Cancer Center, discussed findings that show 76% of renal cell carcinoma trials take place in wealthy countries, amid news that clinical trial access for the world's poor may become even more challenging.

The Senate voted 52-48 to confirm Robert F. Kennedy Jr as secretary of HHS, setting up the vaccine skeptic to carry out major changes in pursuit of his Make America Healthy Again agenda.