The growing need for primary care providers has opened the door for nurse practitioners to fill the void. Nursing students are rushing to get nurse practitioner degrees, and researchers are working to keep pace with stud...The growing need for primary care providers has opened the door for nurse practitioners to fill the void. Nursing students are rushing to get nurse practitioner degrees, and researchers are working to keep pace with studies. Most of the results provide evidence for expanded use of nurse practitioners in a variety of settings.
To take just one example: A 2017 meta-analysis published in the Cochrane Database of Systematic Reviews found that interventions with financial incentives-typically small vouchers ($50 monthly or less) for retail items l...To take just one example: A 2017 meta-analysis published in the Cochrane Database of Systematic Reviews found that interventions with financial incentives-typically small vouchers ($50 monthly or less) for retail items like groceries-increased smoking cessation rates during pregnancy.
Bundled payments work for hip and knee replacements for several reasons. The surgeries themselves are now fairly routine. For most patients, the recovery is usually predictable. There are also some golden opportunities f...Bundled payments work for hip and knee replacements for several reasons. The surgeries themselves are now fairly routine. For most patients, the recovery is usually predictable. There are also some golden opportunities for reducing expenditures that don't compromise care.
Direct-acting antiviral drugs have revolutionized the treatment of hepatitis C and have some enthusiastic experts even go so far as to talk about eradicating the disease. The dark cloud in this otherwise rosy picture has...Direct-acting antiviral drugs have revolutionized the treatment of hepatitis C and have some enthusiastic experts even go so far as to talk about eradicating the disease. The dark cloud in this otherwise rosy picture has been the price tags affixed to these drugs.
Maternity care in the United States is an international disgrace, but not in California thanks to the California Maternal Quality Care Collaborative. Each month, the CMQCC combs through month-old birth certificate data a...Maternity care in the United States is an international disgrace, but not in California thanks to the California Maternal Quality Care Collaborative. Each month, the CMQCC combs through month-old birth certificate data and hospital-provided discharge records for both mothers and babies looking for data to improve pregnancy-related outcomes.
Community health workers liaise between underserved populations and clinicians, help patients and resources to manage disease, and provide health education, informal counseling, and social support. Interest in community...Community health workers liaise between underserved populations and clinicians, help patients and resources to manage disease, and provide health education, informal counseling, and social support. Interest in community health workers is shifting away from narrowly focused intervention on a single disease toward care coordination of multiple chronic conditions.
But proactive interventions cost money. And value-based insurance design is a tactic that runs against the grain of what insurance companies commonly do: Rather than spread the big costs of the few across the many, it as...But proactive interventions cost money. And value-based insurance design is a tactic that runs against the grain of what insurance companies commonly do: Rather than spread the big costs of the few across the many, it aspires to big savings from a few in exchange for small expenditures on the many.
Offering emotional and physical comfort to seriously ill and dying people-the heart of palliative care-certainly seems like the right thing to do. Advocates think so and there's now a body of evidence to support the prov...Offering emotional and physical comfort to seriously ill and dying people-the heart of palliative care-certainly seems like the right thing to do. Advocates think so and there's now a body of evidence to support the provision of palliative care services, especially in hospitals.
Death rates from HIV/AIDS plummeted in the United States from 41,699 in 1995 to 6,456 in 2015. Today, people newly diagnosed with HIV who take their medicine can survive for decades, not just months or years. It's one of...Death rates from HIV/AIDS plummeted in the United States from 41,699 in 1995 to 6,456 in 2015. Today, people newly diagnosed with HIV who take their medicine can survive for decades, not just months or years. It's one of medicine's great achievements.
Starting in January, CMS will let Medicare Advantage plans use step therapy, a cost control strategy sometimes called "fail first." Patient advocates are wary, arguing that the fail first rules should be available online...Starting in January, CMS will let Medicare Advantage plans use step therapy, a cost control strategy sometimes called "fail first." Patient advocates are wary, arguing that the fail first rules should be available online and decisions on physician appeals should be made within 72 hours-and in a day when it is an emergency.
The brighter outlook for 2019 is what happens when the learning curve starts to flatten out. Remember, this market has only existed for five years. Margins over the past six months have exceeded even pre-ACA levels, and...The brighter outlook for 2019 is what happens when the learning curve starts to flatten out. Remember, this market has only existed for five years. Margins over the past six months have exceeded even pre-ACA levels, and loss ratios reached new lows in the second quarter of 2018.
Chhabra A, Fogarty PF, Tortella BJ
… +5 more, Spurden D, Alvir J, McDonald M, Hodge J, Pleil AM
Manag Care
· 2018 Oct · PMID 30309448
PURPOSE: To identify international units (IUs) dispensed and consequent expenditures for standard half-life (SHL) versus extended half-life (EHL) recombinant factor VIII (rFVIII) replacement products in hemophilia A pati...PURPOSE: To identify international units (IUs) dispensed and consequent expenditures for standard half-life (SHL) versus extended half-life (EHL) recombinant factor VIII (rFVIII) replacement products in hemophilia A patients in a real-world setting. DESIGN: Two U.S. claims databases were analyzed. METHODOLOGY: Number of IUs dispensed and quarterly expenditures for rFVIII products were collected from the Optum Clinformatics Data Mart and Truven Health MarketScan Databases. Truven claims were also analyzed for factor IUs dispensed and expenditures for patients with data for ≥3 months before and after switching to an EHL product. RESULTS: The Optum and Truven databases, respectively, included 276 (SHL, n=243; EHL, n=33) and 500 (SHL, n=409; EHL, n=91) hemophilia A patients. Median quarterly factor IUs dispensed in Optum were 10% higher with EHL versus SHL products over nine quarters, and 45% higher with EHL versus SHL products in Truven over 10 quarters. Median quarterly expenditures in the EHL cohort were 51% (individual quarterly medians range, 1%-101%) higher than in the SHL cohort in Optum and 122% higher (individual quarterly medians range, 1%-189%) in Truven. Twenty-nine Truven patients switched to an EHL product; median factor IUs dispensed varied quarterly. The lowest SHL and highest EHL values occurred in the quarter immediately before switching and the first quarter post-switch, respectively. Overall median quarterly expenditures were higher post-switch; this was consistent over seven quarters. CONCLUSION: We found higher expenditures over two years for hemophilia A patients using EHL versus SHL products. Switching to an EHL rFVIII product was associated with variable factor IUs dispensed and consistently higher expenditures.
The market forces pushing health care to evolve from volume to value are intensifying. At the same time, the culture change, capabilities, assets, methods, and mindset required to redefine the health care paradigm are st...The market forces pushing health care to evolve from volume to value are intensifying. At the same time, the culture change, capabilities, assets, methods, and mindset required to redefine the health care paradigm are staggering. Unlike corporate initiatives, we simply can't get there thinking quarter to quarter. But we will get there.
There are some valuable lessons for pharmaceutical manufacturers in provider alternative payment models (APMs), but whether pharmaceutical APMs succeed or fail will depend on finding solutions to operational and logistic...There are some valuable lessons for pharmaceutical manufacturers in provider alternative payment models (APMs), but whether pharmaceutical APMs succeed or fail will depend on finding solutions to operational and logistical challenges-some of which are unique to the pharmaceutical industry. Pharmaceutical APMs may require the collection of information beyond the claims data that many provider APMs depend on.
Multiple sclerosis is an on-again, off-again condition that vexes patients and their loved ones. The unpredictability makes is difficult to manage in all respects, especially with escalating prices wreaking havoc with th...Multiple sclerosis is an on-again, off-again condition that vexes patients and their loved ones. The unpredictability makes is difficult to manage in all respects, especially with escalating prices wreaking havoc with the cost effectiveness of the medications used to contain the disease.
With no experience in elected office, President Trump came into power with a thin bench. Many of the health care officials in his administration have been recruited from think tanks funded by the Koch brothers. And the K...With no experience in elected office, President Trump came into power with a thin bench. Many of the health care officials in his administration have been recruited from think tanks funded by the Koch brothers. And the Kochs and the president don't see eye to eye (to put it mildly).
Democrats think that they've got a winning issue. Sen. Bernie's Sanders Medicare for All bill is gaining backers, but expanding access to coverage by the public payer may be more practicable. Sander's is just one of a bu...Democrats think that they've got a winning issue. Sen. Bernie's Sanders Medicare for All bill is gaining backers, but expanding access to coverage by the public payer may be more practicable. Sander's is just one of a bunch of Medicare expansion plans. They all have pros and cons, a major con being how to pay for it.
Pharma says rebates are a primary driver of high drug prices because drug companies raise prices in response to payers' demands for rebates in exchange for preferred placement on their formularies. PBMs and payers object...Pharma says rebates are a primary driver of high drug prices because drug companies raise prices in response to payers' demands for rebates in exchange for preferred placement on their formularies. PBMs and payers object. They say the rebates they get from drugmakers are largely passed on to health plans and patients and save consumers billions of dollars in the form of lower premiums and copays.
The alternative payment model (APM) is a nontraditional financial arrangement that rewards health care providers who deliver cost-effective, high-quality care. Now we are facing the possibility that pharmaceutical manufa...The alternative payment model (APM) is a nontraditional financial arrangement that rewards health care providers who deliver cost-effective, high-quality care. Now we are facing the possibility that pharmaceutical manufacturers and insurers will embrace APMs as a payment mechanism in some situations.
The "waste-free formulary" under development by the Pacific Business Group on Health sounds promising, but ultimately may not deliver the impact to self-insured employers its creators are promising. The approach glosses...The "waste-free formulary" under development by the Pacific Business Group on Health sounds promising, but ultimately may not deliver the impact to self-insured employers its creators are promising. The approach glosses over a critical question: What constitutes "high-value"? The definition of value plays a central role in determining the care that patients ultimately receive.