In theory, this approach could help untangle some knotty cost and quality concerns about medications as they move from clinical trials and into clinical use. But there's a credibility issue: The perception that much of t...In theory, this approach could help untangle some knotty cost and quality concerns about medications as they move from clinical trials and into clinical use. But there's a credibility issue: The perception that much of the research is biased and that the studies are designed so the results serve the interests of the sponsors.
The insurer's vice president of provider alignment solutions says: "We're going to start to signal to providers that if you are going to stay an upside-only arrangement, we're not going to give you free money forever in...The insurer's vice president of provider alignment solutions says: "We're going to start to signal to providers that if you are going to stay an upside-only arrangement, we're not going to give you free money forever in the form of the care-coordination fees that we've been paying out. They're not an entitlement."
Building on a similar effort in California, Catalyst for Payment Reform is proposing a standardized set of 50 ACO measures. A timely development. In the first quarter of last year, an estimated 19.1 million lives were co...Building on a similar effort in California, Catalyst for Payment Reform is proposing a standardized set of 50 ACO measures. A timely development. In the first quarter of last year, an estimated 19.1 million lives were covered by 715 commercial ACOs, compared with 17.2 million lives a year earlier.
Physicians and their charges have different ideas about what makes for good cancer care. Patient surveys help, but they need to be handled right.Physicians and their charges have different ideas about what makes for good cancer care. Patient surveys help, but they need to be handled right.
Medicare's new bundled payments program is expected to be popular, despite unanswered questions about the target prices for the episodes, risk adjustment, and use of quality data. Until CMS releases more detail on pricin...Medicare's new bundled payments program is expected to be popular, despite unanswered questions about the target prices for the episodes, risk adjustment, and use of quality data. Until CMS releases more detail on pricing targets and other not-so-trivial nuances, providers who jump in may be taking a leap of faith.
The 40-year-old vice president of regional markets for eastern Massachusetts wants enrollees and, especially, employers to know that there will continue to be a lot of public policy change as the ACA evolves. His course?...The 40-year-old vice president of regional markets for eastern Massachusetts wants enrollees and, especially, employers to know that there will continue to be a lot of public policy change as the ACA evolves. His course? Keep strengthening ties with providers.
Taylor DC, Abel JL, Bancroft T
… +4 more, Buzinec P, Goolsby Hunter A, Carson RT, Martin C
Manag Care
· 2018 Feb · PMID 29451468
As expected, pharmacy costs increased with the introduction of this new treatment in a market dominated by over-the-counter and generic treatments. On the other hand, outpatient GI-related and irritable bowel disease hea...As expected, pharmacy costs increased with the introduction of this new treatment in a market dominated by over-the-counter and generic treatments. On the other hand, outpatient GI-related and irritable bowel disease health care resource use and costs substantially decreased among commercial and Medicare patients following linaclotide treatment initiation.
Hemlibra demonstrates how far antibody science has progressed. Genentech's drug, approved late last year, connects two clotting factors to prevent the devastating bleeds in hemophilia patients with inhibitors. The high p...Hemlibra demonstrates how far antibody science has progressed. Genentech's drug, approved late last year, connects two clotting factors to prevent the devastating bleeds in hemophilia patients with inhibitors. The high price may be offset by avoided costs in patients with factor VIII inhibitors.
Women are a key focus segment for health care organizations both because of the medical services they utilize as individuals and the influence they have on the health care of others. In one survey, 59% of women and 94% o...Women are a key focus segment for health care organizations both because of the medical services they utilize as individuals and the influence they have on the health care of others. In one survey, 59% of women and 94% of working moms reported making or heavily influencing health care decisions for their entire families.
This old standby's ultimate demise will likely take place when cervical cancer incidence declines as the HPV vaccine starts to take effect at a population level. New guidelines are being written, but insurers could have...This old standby's ultimate demise will likely take place when cervical cancer incidence declines as the HPV vaccine starts to take effect at a population level. New guidelines are being written, but insurers could have a major influence on how closely those guidelines are followed. So far, though, they haven't waded very far into the Pap-HPV debate.
Episode payments for maternity care, however, are particularly challenging for many reasons, including the fact that a full course of care starts with one patient and usually ends with at least two. Something needs to be...Episode payments for maternity care, however, are particularly challenging for many reasons, including the fact that a full course of care starts with one patient and usually ends with at least two. Something needs to be done, because pregnancy, labor, and birth account for seven of the top 20 most expensive hospitalized conditions.
There's no question that sexual harassment-and worse-is common at the country's hospitals, clinics, research labs, and doctor's offices. Health care's gender imbalances create situations that are ripe for abuse: Women ma...There's no question that sexual harassment-and worse-is common at the country's hospitals, clinics, research labs, and doctor's offices. Health care's gender imbalances create situations that are ripe for abuse: Women make up the majority of the workforce in health care but men still dominate positions of authority.
A MedPage Today blog post suggested that they do. A torrent of online comments followed. Most were somewhere on the spectrum of outraged. For their part, industry veterans said that they're unaware of bonuses for denials...A MedPage Today blog post suggested that they do. A torrent of online comments followed. Most were somewhere on the spectrum of outraged. For their part, industry veterans said that they're unaware of bonuses for denials but agree that prior authorization processes should be more transparent.
The defendants and plaintiffs have changed sides in the latest courtroom drama surrounding the ACA requirement that health plans cover women's contraception. Where once the plaintiffs took exception on religious and mora...The defendants and plaintiffs have changed sides in the latest courtroom drama surrounding the ACA requirement that health plans cover women's contraception. Where once the plaintiffs took exception on religious and moral grounds, it's now states and reproductive rights groups who support the requirements that are bringing the legal challenges.
PURPOSE: Electronic health records (EHRs), now used by hundreds of thousands of providers and encouraged by federal policy, have the potential to improve quality and decrease costs in health care. But interoperability, a...PURPOSE: Electronic health records (EHRs), now used by hundreds of thousands of providers and encouraged by federal policy, have the potential to improve quality and decrease costs in health care. But interoperability, although technically feasible among different EHR systems, is the weak link in the chain of logic. Interoperability is inhibited by poor understanding, by suboptimal implementation, and at times by a disinclination to dilute market share or patient base on the part of vendors or providers, respectively. The intent of this project has been to develop a series of practicable recommendations that, if followed by EHR vendors and users, can promote and enhance interoperability, helping EHRs reach their potential. METHODOLOGY: A group of 11 physicians, one nurse, and one health policy consultant, practicing from California to Massachusetts, has developed a document titled "Feature and Function Recommendations To Optimize Clinician Usability of Direct Interoperability To Enhance Patient Care" that offers recommendations from the clinician point of view. This report introduces some of these recommendations and suggests their implications for policy and the "virtualization" of EHRs. CONCLUSION: Widespread adoption of even a few of these recommendations by designers and vendors would enable a major advance toward the "Triple Aim" of improving the patient experience, improving the health of populations, and reducing per capita costs.
Ingrezza and Austedo were approved last year. ICER calculations raise questions about their price.Ingrezza and Austedo were approved last year. ICER calculations raise questions about their price.
Palliative care would fill a need and could save health care dollars in the process. But providers often need to patch together CPT codes to get paid for it.Palliative care would fill a need and could save health care dollars in the process. But providers often need to patch together CPT codes to get paid for it.
Because physicians and health plan members both value choice, the current weak market for Inflectra and Renflexis could be a passing phase.Because physicians and health plan members both value choice, the current weak market for Inflectra and Renflexis could be a passing phase.
Insurers are playing "small ball" and not showing leadership, says the former congressman. And some "spin-dry" inpatient providers are doing more harm than good in combating the opioid epidemic. Meanwhile, Kennedy, who c...Insurers are playing "small ball" and not showing leadership, says the former congressman. And some "spin-dry" inpatient providers are doing more harm than good in combating the opioid epidemic. Meanwhile, Kennedy, who chronicled his own harrowing mental health and addiction struggles in a 2015 memoir, says he has been sober for more than six years.