A review of our peer-reviewed research in the healthcare and mainstream press.
RevenueCycle Intelligence included a June study from The American Journal of Managed Care (AJMC) in its recent story, “Key Ways to Succeed Under MACRA’s Quality Payment Program.” The AJMC study, “Risk Contracting and Operational Capabilities in Large Medical Groups During National Healthcare Reform,” found that only one-third of providers have linked at least 50% of revenue to a risk-based alternate payment model. This slow pace of reform has limited the pace of progress in value-based care, even though CMS has set aggressive goals for Medicare.
A new study in AJMC showing the value of nonclinical benefits for patients with chronic diseases, such as increased productivity and “peace of mind,” received attention this week in news outlets, including Yahoo Finance. Diseases like multiple sclerosis (MS) cause patients fatigue and memory problems, which can limit productivity. Payers that cover newer therapies for MS create value for society, but these benefits often go unrecognized, the study asserted.
The Supreme Court seems likely to reject a challenge to the abortion pill mifepristone; the FDA is inspecting far fewer pharmaceutical companies conducting clinical research; AstraZeneca has sued to block an Arkansas law that it said would unlawfully expand the 340B program to include for profit-pharmacy chains.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
Covered Preventive Services at Risk: V-BID Summit Breaks Down the Braidwood v Becerra Case
March 20th 2024For more than a decade, certain high-value preventive care services have been covered at no cost to patients under the Affordable Care Act, but a current legal challenge has the coverage at risk.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
Fragmented Payer System, Vulnerable Supply Chain Among Threats to Accessing Essential Medicines
March 13th 2024During a session of the 2024 V-BID Summit, panelists Stacie Dusetzina, PhD, and Inma Hernandez, PharmD, PhD, discussed how access to essential medications is curtailed not just by the longstanding complexities of insurance design but also by emerging threats such as supply chain weaknesses and cyberattacks.
Read More
Most private health insurers have yet to publish criteria for when they will cover postpartum depression drug, zuranolone; state lawmakers are increasingly opposing health care mergers that they believe do not serve the public interest; Medicaid extensions made in 2021 led to a 40% decline in postpartum lack of insurance.
Read More