Insurance

This week, the Center on Health Equity and Access covers news related to AI integration, disparities in pediatric hospitalizations, new advancements presented at the 2024 CMS Health Equity Conference, and an expert discussion on the cardiovascular field.

Presenters from CMS and the CDC explored the importance of standardizing health equity data collection at the 2024 CMS Health Equity Conference.

There has been a lack of visible progress from RECOVER, the $1.6 billion initiative launched by the National Institutes of Health to research long COVID; the CDC has detected a third human case of bird flu linked to sick dairy cows; small businesses and their workers are struggling to receive weight-loss drug insurance coverage.

A new program from Optum Rx would offer greater predictability by using a guarantee-based pricing model.

Patients struggle to afford glucagon-like peptide-1 (GLP-1) medications for diabetes; doctors see potential and pitfalls in new ChatGPT model’s humanlike conversations; Medicare payment reform efforts focus on inflation adjustments and payment model overhauls.

The results of T1International’s 2022 Out-of-Pocket Expenses survey highlight many huge inequities in the US and around the world relating to insulin and diabetes care supplies.

The US Senate hosted a panel addressing physician and health care shortages and efforts to increase minority representation in the medical field. An expert discussed initiatives to prevent senior homelessness. Advocates called for the repeal of the Comstock Act. Regulatory reforms are called for to improve rural cancer patients' access to pharmacies. Research reveals the impact of denials on patient access to immunology treatments.

Concerns arise over primary care shortages; women struggle with coverage for effective nonhormonal treatments; FLiRT variants drive concerns amidst waning surveillance and immunity

Other findings from the latest Kaiser Family Foundation Health Tracking Poll shed light on public awareness, use, and opinions on Medicare coverage of glucagon-like peptide-1 (GLP-1) drugs.

Covering antiobesity medications like semaglutide could save Medicare around $500 million annually; preliminary CDC data showed a 3% decline in the number of US overdose deaths last year; the Biden administration recently announced the first national maternal mental health strategy.

At the spring conference of the New Jersey Health Care Quality Institute, speakers discussed how health policy, affordability, and transparency may play a role in voters’ decisions.

The senate hearing held by the US Senate Committee on Health, Education, Labor, and Pensions, led by Sen. Bernie Sanders (I, Vermont), chairman of the committee, and ranking member Sen. Bill Cassidy, MD, (R, Louisiana), addressed the critical issue of physician and health care worker shortages, as well as the maternal health crisis, in the US.

A new study highlights significant disparity in reimbursement rates across states between hospitals and Medicare; the first patient to receive a genetically modified pig kidney has died; research examines outcomes of over 500 patients receiving medication abortion pills by mail.

The CEO of SCAN Health Plan discusses its first-ever Environmental, Social, and Governance Report.

This week's topics include frameworks for improving health equity nationwide, addressing social determinants of health, discussing CMS's Medicare rules, investigating breast cancer treatment refusal, and exploring HIV and major depressive disorder in underrepresented groups.

Results featured at the Academy of Managed Care Pharmacy 2024 annual meeting revealed a pattern of prior authorization rejections that could delay necessary therapeutic treatments for various patient groups.

Gaps in the delivery and coverage of behavioral health care can be addressed through continued advocacy for better policies and financial incentives surrounding treatment.

Ascension Health was hit with a cyberattack; a new federal policy is aimed at integrating Medicare and Medicaid coverage; the CDC is planning to post data on influenza A found in wastewater in a public dashboard.

Fifty percent of US rural hospitals are facing financial problems; US lawmakers have called out the corporate spending of 3 large nursing home companies; hospice patients under Medicare Advantage are now facing uncertainty after the government ended its pilot program.

Rising Medicare Advantage enrollment occurred alongside declines in enrollment in traditional Medicare with employer-sponsored supplemental coverage and traditional Medicare without supplemental coverage.

The Senate Finance Committee has introduced bipartisan legislation that proposes using Medicaid and Medicare programs to help prevent and reduce generic drug shortages; US indicators for COVID-19, flu, and respiratory syncytial virus (RSV) declined further last week; findings from a recent study reveal growing disparities in child death rates across racial and ethnic groups.

This week, the Center on Health Equity and Access highlights a variety of gaps that exist in health care, spanning women's health, the rising rate of metabolic disease, and policy for LGBTQ+ and immigrant populations. The consensus among featured experts points to comprehensive care models.

Leaders at 49 accountable care organizations (ACOs) shared their perspectives on the Medicare Shared Savings Program, as well as a range of strategies for success and ongoing challenges.

A new federal rule will enable thousands of immigrants in the Deferred Action for Childhood Arrivals (DACA) program to obtain health care through the Affordable Care Act; a forthcoming CMS rule is expected to lower home-based care wait times and raise caregiver wages; the HHS Office for Civil Rights has finalized 2 rules that strengthen the ACA’s health care discrimination ban.

About 5000 leaders in health economics and outcomes research will gather for the 2024 meeting, which has the theme, "HEOR: A Transformative Force for Whole Health.”

In a presentation at the Greater Philadelphia Business Coalition on Health Women’s Health Summit, Shelly Lanning, cofounder and president of Visana Health, addressed the need for comprehensive approaches in women’s health care and their coverage options.

Joanne Mizell shares insurer strategies in addressing the escalating rates of metabolic diseases, highlighting the importance of holistic treatment methods like lifestyle modification programs, which integrate nutrition, physical activity, and community engagement.

When the same product comes to market with additional indications, irrational pricing decisions result in ever-increasing prices instead of volume translating to lower costs, said Jon Mahrt, MBA, of OptumRX.

Researchers also estimated that more than 700,000 Americans with diabetes could lose insurance coverage if these proposed retractions are put into place, with some new policies already in effect.

Makers of medical tests will have about 4 years to show the FDA that their new offerings deliver accurate results; after previously decreasing for 27 years, US tuberculosis (TB) cases increased every year since 2020; a US district judge rejected a challenge by Bristol Myers Squibb and Johnson & Johnson to the Medicare drug price negotiation program.