The CAR-T therapy may pass ICER cost-effectiveness muster, but can the health care system afford more drugs like it?The CAR-T therapy may pass ICER cost-effectiveness muster, but can the health care system afford more drugs like it?
The architects of Medical Episode Spending Allowance (MESA) benefits are radically reframing coverage as allowances for episodes of care and have a plan for engaging members in making better choices. MESA could catch on...The architects of Medical Episode Spending Allowance (MESA) benefits are radically reframing coverage as allowances for episodes of care and have a plan for engaging members in making better choices. MESA could catch on quickly, particularly with plan sponsors who have seen consumer-directed plan designs work against them.
They take the brakes off the immune system so it attacks cancer cells. But many people don't respond to checkpoint inhibitors, so researchers are looking for ways to defeat the resistance.They take the brakes off the immune system so it attacks cancer cells. But many people don't respond to checkpoint inhibitors, so researchers are looking for ways to defeat the resistance.
A federal bill would expand access to experimental treatments to seriously ill patients, but critics say the right to try would take away FDA oversight and create a "Wild West." Proponents counter that the FDA's current...A federal bill would expand access to experimental treatments to seriously ill patients, but critics say the right to try would take away FDA oversight and create a "Wild West." Proponents counter that the FDA's current process can be onerous for people with just a few months to live. Meanwhile, most states' right-to-try laws have gone unused.
Consultants predicted it would be a major business. Large employers and insurers were experimenting with it. But medical tourism has not lived up to the heady expectations. The ACA and moderation of increases in health c...Consultants predicted it would be a major business. Large employers and insurers were experimenting with it. But medical tourism has not lived up to the heady expectations. The ACA and moderation of increases in health care costs cooled off interest. Besides, who really wants to go to an unfamiliar place for health care?
Diabetes is the scourge of our times, but we have been chasing the wrong culprits. A simple, $40 test of insulin resistance could put us on the right track.Diabetes is the scourge of our times, but we have been chasing the wrong culprits. A simple, $40 test of insulin resistance could put us on the right track.
These eight questions show that the use of an LBM or a PAP should be just one of the potential results of your laboratory benefit management program, not the program itself. You shouldn't have to pay for services you alr...These eight questions show that the use of an LBM or a PAP should be just one of the potential results of your laboratory benefit management program, not the program itself. You shouldn't have to pay for services you already provide yourselves or add a middleman that's not necessary.
It's a must because there is a cost to keeping the underserved that way whether that means funding integrated primary care to help people live healthier lives or footing the bill when people get care in the emergency dep...It's a must because there is a cost to keeping the underserved that way whether that means funding integrated primary care to help people live healthier lives or footing the bill when people get care in the emergency department.
The randomized controlled trial reigns supreme, but the FDA is working on ways to incorporate real-world evidence into its approval processes.The randomized controlled trial reigns supreme, but the FDA is working on ways to incorporate real-world evidence into its approval processes.
The CMO of Molina Healthcare of Utah grew up, let's say, not rich. He says that and a varied background-including a stint in the Air Force-helps him deal with changing policies involving a challenging population.The CMO of Molina Healthcare of Utah grew up, let's say, not rich. He says that and a varied background-including a stint in the Air Force-helps him deal with changing policies involving a challenging population.
CMS is granting waivers that impose work and other new requirements on some Medicaid beneficiaries. Medicaid managed care plans are wary of the added administrative complexity-and possibly a change in the Medicaid popula...CMS is granting waivers that impose work and other new requirements on some Medicaid beneficiaries. Medicaid managed care plans are wary of the added administrative complexity-and possibly a change in the Medicaid population's risk profile.
A look at three different approaches that seek to address social needs in a strategic and somewhat comprehensive way. At this point, all of them are experiments, and no one knows which will prove to be sustainable, repli...A look at three different approaches that seek to address social needs in a strategic and somewhat comprehensive way. At this point, all of them are experiments, and no one knows which will prove to be sustainable, replicable, or even beneficial to the patients and communities they seek to serve.
Providers and payers are being asked to tackle the 'upstream' causes of poor health. Medicaid managed care organizations are being asked to screen enrollees for social needs. Some targeted efforts have translated into co...Providers and payers are being asked to tackle the 'upstream' causes of poor health. Medicaid managed care organizations are being asked to screen enrollees for social needs. Some targeted efforts have translated into cost savings and make sense in value-based arrangements. But are we asking the health sector to take on too much?
Deaths of women from opioid addiction spiked 400%, according to CDC data. Alison Colbert of Duquesne University argues for a gender-specific approach.Deaths of women from opioid addiction spiked 400%, according to CDC data. Alison Colbert of Duquesne University argues for a gender-specific approach.
The CNN story once again puts controversy about prior authorization into the spotlight. But is it necessary to review a patient's entire medical record?The CNN story once again puts controversy about prior authorization into the spotlight. But is it necessary to review a patient's entire medical record?
The direct-acting virals revolutionized the treatment of hepatitis C. They also ushered turbocharged pricing. At least patients-and society-got a major health benefit in return.The direct-acting virals revolutionized the treatment of hepatitis C. They also ushered turbocharged pricing. At least patients-and society-got a major health benefit in return.
Social determinants of health come into focus to keep beneficiaries out of the hospital.Social determinants of health come into focus to keep beneficiaries out of the hospital.
PURPOSE: Understand current provider approaches to the evaluation of various partnerships under accountable care contracts and create a framework to help accountable care organizations (ACOs) better assess their partners...PURPOSE: Understand current provider approaches to the evaluation of various partnerships under accountable care contracts and create a framework to help accountable care organizations (ACOs) better assess their partnerships. DESIGN: Study included (1) an in-depth literature review of materials describing high-value health care organizations as a foundation for draft framework development, (2) an expert panel convened to evaluate the framework and help prioritize provider types to evaluate, and (3) interviews with representatives of ACOs and entities representing various types of health care providers. METHODOLOGY: Authors created a draft partnership framework derived from the literature review for expert panel feedback. An updated draft framework was then shared with active ACO leaders prior to qualitative interviews. All interviews were transcribed and coded using a mixed-methods analysis platform. RESULTS: We found little research that took a comprehensive view of health care provider competencies and characteristics and by extension few resources to help ACOs fill competency gaps through partnerships. The ACOs interviewed were all actively engaged in provider partnerships and were learning and establishing best practices for provider partnerships. CONCLUSIONS: Accountable care offers incentives for entities to improve the cost and quality of health care. To accomplish this in an effective way, ACOs must recognize the needs of their assigned populations and work to provide comprehensive care management across the spectrum of provider types. Accomplishing this will also require ACOs to create novel partnership arrangements and learn how to manage populations most effectively. ACOs need a framework for evaluating potential partners that will help risk-bearing providers establish the partnerships that will enable them to achieve their goals. This paper makes specific recommendations on how state and federal policy could facilitate better and more effective provider partnerships.
Once they have the right platforms in place, insurers can layer on predictive analytics, digital medical records, and other innovations that promise to make health care costs more manageable-and in the process make healt...Once they have the right platforms in place, insurers can layer on predictive analytics, digital medical records, and other innovations that promise to make health care costs more manageable-and in the process make health insurers more competitive with the likes of CVS and maybe, eventually, Amazon.
Implementation of efforts to screen older people for fall risk-and to intervene before falls occur-have been scattershot at best. Ongoing studies of fall prevention called STRIDE (Strategies to Reduce Injuries and Develo...Implementation of efforts to screen older people for fall risk-and to intervene before falls occur-have been scattershot at best. Ongoing studies of fall prevention called STRIDE (Strategies to Reduce Injuries and Develop Confidence in Elders) might change that. The studies look at whether clinicians can implement a fall-prevention program across rural, urban, and suburban treatment settings.