CMS and insurers talked about what needed to be done to better address the social determinants of health (SDOH) for beneficiaries. That led to a policy, implemented last year by CMS, that allows for the provision of dail...CMS and insurers talked about what needed to be done to better address the social determinants of health (SDOH) for beneficiaries. That led to a policy, implemented last year by CMS, that allows for the provision of daily maintenance care using nonskilled in-home providers, the kind of services usually given in assisted-living facilities.
There was a time when insurers were accused (often rightly) of using wellness to lure healthier beneficiaries into MA. Now, the issue is whether wellness can help health plans manage medical spending. "To the degree they...There was a time when insurers were accused (often rightly) of using wellness to lure healthier beneficiaries into MA. Now, the issue is whether wellness can help health plans manage medical spending. "To the degree they do minimize medical spending, the beneficiaries will presumptively be better off healthwise," says Joseph Newhouse of Harvard.
Effective treatment has helped curb the epidemic, but practical cures have been elusive. Now being tested: a "sterilizing cure" that eradicates HIV from the body, and a "functional cure" that effectively reduces the vira...Effective treatment has helped curb the epidemic, but practical cures have been elusive. Now being tested: a "sterilizing cure" that eradicates HIV from the body, and a "functional cure" that effectively reduces the viral load so it cannot be transmitted or progress to AIDS.
The annual pharmacy costs for single tablet regimens were $6,100 less compared with regimens involving multiple pills, at least among HIV patients who were taking the medicines as intended, according to an Express Script...The annual pharmacy costs for single tablet regimens were $6,100 less compared with regimens involving multiple pills, at least among HIV patients who were taking the medicines as intended, according to an Express Scripts analysis. On average, the company found that health plans could save about $4,160 per patient per year.
Adjusting their vision so it looks past the messenger and focuses on President Trump's stated goal to end AIDS by 2030 isn't easy for HIV/AIDS advocates. But they aren't being entirely dismissive, either. They have some...Adjusting their vision so it looks past the messenger and focuses on President Trump's stated goal to end AIDS by 2030 isn't easy for HIV/AIDS advocates. But they aren't being entirely dismissive, either. They have some faith in, and working relationships with, federal government health officials who will oversee implementation of the plan.
It is a heroic part of the American health system. Lives are saved, the dire consequences avoided. But the air ambulance industry is consolidating, prices are soaring, and insurers and providers continually fight over ne...It is a heroic part of the American health system. Lives are saved, the dire consequences avoided. But the air ambulance industry is consolidating, prices are soaring, and insurers and providers continually fight over network issues. One consequence: Surprise billing that leaves patients owing tens of thousands of dollars.
Doctors returning home from World War II knew that critically ill or injured patients had a better chance of survival if they were treated in a hospital. In 1976, emergency medicine became the country's 23rd recognized m...Doctors returning home from World War II knew that critically ill or injured patients had a better chance of survival if they were treated in a hospital. In 1976, emergency medicine became the country's 23rd recognized medical specialty. A lot happened between points A and B.
It is a high-tech wonder and the product of generations of heavy investment in trauma care. But the emergency department is also the backdoor of the American health care system-a kind of open wound that is symptomatic of...It is a high-tech wonder and the product of generations of heavy investment in trauma care. But the emergency department is also the backdoor of the American health care system-a kind of open wound that is symptomatic of deficiencies of how American health care is organized, delivered, and paid for.
For all the talk about rapid increases in health care costs, we just might be getting better value for it. So say David Wamble, director of health economics at RTI Health Solutions, and colleagues in a recent Health Affa...For all the talk about rapid increases in health care costs, we just might be getting better value for it. So say David Wamble, director of health economics at RTI Health Solutions, and colleagues in a recent Health Affairs article.
Artificial intelligence is creating another new frontier in real-world evidence gathering and analysis. AI's algorithms can approximate-and maybe even surpass-human cognition and judgment in the analysis of complex medic...Artificial intelligence is creating another new frontier in real-world evidence gathering and analysis. AI's algorithms can approximate-and maybe even surpass-human cognition and judgment in the analysis of complex medical data. Sure, humans will sign off, but AI software will do the heavy lifting.
AHPs are not required to cover all of the essential health benefits that ACA-compliant plans do, and they can base premiums on their expected or actual spending for health care rather than setting premiums at the communi...AHPs are not required to cover all of the essential health benefits that ACA-compliant plans do, and they can base premiums on their expected or actual spending for health care rather than setting premiums at the community rate. But critics say you get what you pay for.
It seems that under HHS Secretary Alex Azar, the Center for Medicare and Medicaid Innovation-that ACA-enabled office given almost carte-blanche authority to experiment with new payment and care models-may be getting its...It seems that under HHS Secretary Alex Azar, the Center for Medicare and Medicaid Innovation-that ACA-enabled office given almost carte-blanche authority to experiment with new payment and care models-may be getting its groove back. Adam Boehler, hired last April as CMMI director, has cranked up output with a flurry of new models.
The need for real-time data in health care is universal, but it is particularly pressing for post-acute providers, who are now joining their hospital and health system peers in being held responsible for patient outcomes...The need for real-time data in health care is universal, but it is particularly pressing for post-acute providers, who are now joining their hospital and health system peers in being held responsible for patient outcomes. CMS is watching.
PBMs can play an important role in the pharmaceutical supply chain and are positioned to protect consumers and save them out-of-pocket costs. The emergence of new PBMs, whether inside or outside an insurer, should drive...PBMs can play an important role in the pharmaceutical supply chain and are positioned to protect consumers and save them out-of-pocket costs. The emergence of new PBMs, whether inside or outside an insurer, should drive new solutions and the development of new models.
For Medicare for all to truly work for all Americans it must do more than provide uniform, basic insurance. In health care, as in fashion, consumers need different options. To truly reform health care, solutions must all...For Medicare for all to truly work for all Americans it must do more than provide uniform, basic insurance. In health care, as in fashion, consumers need different options. To truly reform health care, solutions must allow customization and consumer choice.
As of November 2018, there were 8,774 such centers in the U.S, up 8% from 8,125 in 2017, according to the Urgent Care Association. And although they are not exclusively for people with insurance, just under half (47%) of...As of November 2018, there were 8,774 such centers in the U.S, up 8% from 8,125 in 2017, according to the Urgent Care Association. And although they are not exclusively for people with insurance, just under half (47%) of the patients seen in urgent care centers are covered by commercial insurance.
The two CAR-T therapies approved for certain blood cancers have price tags of $475,000 and $373,000-and those prices don't include other costs for services that are integral to the treatments, such as harvesting a patien...The two CAR-T therapies approved for certain blood cancers have price tags of $475,000 and $373,000-and those prices don't include other costs for services that are integral to the treatments, such as harvesting a patient's T cells. Moreover, patients typically have a lengthy hospital stay after treatment.
CMS wants Medicare Advantage plans to provide enrollees with immediate access to their health information starting in 2020. But you can't always get what you want. Insurers are especially worried about programming interf...CMS wants Medicare Advantage plans to provide enrollees with immediate access to their health information starting in 2020. But you can't always get what you want. Insurers are especially worried about programming interface software that will allow their databases to share information with third parties, such as mobile apps.
Too often, the prices of health care services and drugs are cloaked in mystery. A growing consensus demands that patients be given a clearer sense, in advance, of what things will cost. But there are obstacles-and some s...Too often, the prices of health care services and drugs are cloaked in mystery. A growing consensus demands that patients be given a clearer sense, in advance, of what things will cost. But there are obstacles-and some stakeholders benefit from the present confusion.
A study designed to test whether eliminating copays would improve adherence to antiplatelet therapy showed that, yes, indeed, it does. But the results also showed no reduction in major cardiovascular events among those w...A study designed to test whether eliminating copays would improve adherence to antiplatelet therapy showed that, yes, indeed, it does. But the results also showed no reduction in major cardiovascular events among those who stuck with the medication.