This week CMS released their third round of annual data, the value-based topics of the American Society of Clinical Oncology gained new ground, and The American Journal of Managed Care will travel to their 75th session of the American Diabetes Association in Boston.
CMS released their third round of annual data, detailing how exactly hospitals spent $62 billion in 2013 as well as the $90 billion paid to providers and supplies. For the first time in the report’s history, CMS released information regarding which prescription medications were the most popular in the Medicare Part D program.
CMS acting administrator, Andy Slavitt, additionally announced a plan to allow entrepreneur’s access to Medicare acclaims data. Until this recent change in regulation, all Medicare acclaims data was off-limits for any for-profit venture as the data can be used to create products and software for value-based billing systems.
The American Society of Clinical Oncology (ASCO) held its annual meeting last weekend in Chicago, IL. In ASCO’s year long value initiative, topics ranging from defining value in cancer care to the promise of new biomarkers in immuno-oncology gained new ground. Many patient concerns with costs include co-payments, the cost of travel, and whether insurance will cover the best drugs available.
In clinical news, Luis A. Diaz, Jr, MD, associate professor of oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center reported on patients with high mutational burden with mismatched repair who responded to checkpoint inhibition to PD-1.
This is the first year insurers have full claims data for new enrollees under the ACA.
The cost of specialty medications along with the rise of claims form the newly insured is being cited around the country as payers seek great increases for 2016. Blue Cross Blue Shield will file for hikes of 20% or more in several states, although many expect regulators to refute those requests. Some health insurers price themselves below the competition and now need to implement rate hikes to cover the cost they see coming in through claims, according to Cathy Murphy-Barren, vice president, American Academy of Actuaries.
The American Journal of Managed Care travels to Boston, MA for their 75 Scientific Sessions of the American Diabetes Association. Coverage of the meeting begins this weekend, which will include highlights from the Tiques trial, an important case study for every therapy in the DPP4 class.
Managed Care Minute Weekly Poll Results:
CMS' new proposal for Medicaid managed care includes rules to make it easier to find specialists in areas like pediatrics and dentistry. Which will do the most to help Medicaid clients find specialists:
California Aims for Equity by Redefining Cancer Care
December 8th 2023Authors highlight key aspects of the California Cancer Care Equity Act, including its focus on Medi-Cal beneficiaries, the requirement for managed care plans to contract with specialized cancer centers, and the definition of complex cancers.
Read More
Oncology Onward: A Conversation With Thyme Care CEO and Cofounder Robin Shah
October 2nd 2023Robin Shah, CEO of Thyme Care, which he founded in 2020 with Bobby Green, MD, president and chief medical officer, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, to discuss his evolution as an entrepreneur in oncology care innovation and his goal of positively changing how patients experience the cancer system.
Listen
What We’re Reading: RSV Vaccine Demand; Permanent Contraception; Drug Negotiation Impact
December 8th 2023The Biden administration recently met with manufacturers of respiratory syncytial virus (RSV) immunizations to encourage them to increase access to the vaccine; since the Dobbs v Jackson decision, many patients have been seeking more permanent reproductive health care solutions; a Mathematica analysis showed that Medicare prescription drug price negotiations could have cut seniors’ out-of-pocket costs by nearly a quarter had the program been in effect in 2021.
Read More
Insufficient Data, Disparities Plague Lung Cancer Risk Factor Documentation
September 24th 2023On this episode of Managed Care Cast, we speak with the senior author of a study published in the September 2023 issue of The American Journal of Managed Care® on the importance of adequate and effective lung cancer risk factor documentation to determine a patient's eligibility for screening.
Listen
New Insights on Breast Cancer Outcomes Among Sexual, Gender Minorities
December 7th 2023Despite there being a great demand for data collection on sexual orientation and gender identity in the cancer space, individuals who identify as a sexual and gender minority remain poorly represented.
Read More
Research Reveals the Role of Structural Racism in Lung Cancer Risk
December 7th 2023Spanning 22 studies, the analysis illuminated housing disparities, occupational hazards, unequal health care access, economic inequality, and discriminatory industry practices and how they collectively contribute to heightened lung cancer risks.
Read More