PubMed Journal Database | Managed care (Langhorne, Pa.) RSS

15:56 EDT 25th March 2019 | BioPortfolio

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Showing PubMed Articles 1–25 of 219 from Managed care (Langhorne, Pa.)

Back from the Dead. ACA Exchange Market Looking Healthy, Hale, and Competitive.

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.

There's a Better Way to Do Step Therapy.

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.

HIV/AIDS treatment drastically reduces mortality and helps limit transmission.

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.

Palliative care improves quality of life and symptoms.

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.

VBID improves adherence and outcomes.

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.

Community health workers improve outcomes, reduce costs.

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.

California program cuts maternal deaths in half.

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.

Antiviral drugs have made hepatitis C eminently treatable.

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.

Bundled payments for joint replacement reduce expenditures, don't compromise quality.

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.

Financial incentives encourage pregnant women to quit smoking.

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.

Nurse practitioners provide quality primary care at a lower cost than physicians.

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.

And with MIPS, we just don't know yet.

It may take a little while longer to ferret out whether MIPS is having CMS's self-described effect-to "drive improvement in care processes and health outcomes, increase the use of health care information, and reduce the cost of care." Already concluding that cost reduction is unlikely, Medpac recommended scraping MIPS altogether.

Insurers on a Shopping Spree For All Sorts of Providers.

UnitedHealth Group, Humana, Centene, and Anthem have announced billions of dollars of deals to acquire primary care practices, hospice providers, and home health care companies. The insurers' foray into provider territory comes as the traditional contours of American health care are in flux.

Acute Kidney Injury: Increasingly Common, Often Insidious, Possibly Deadly. But Worth Testing For?

Tests for AKI biomarkers would be used more widely if their role were better defined, say their proponents. Researchers are tackling the possibilities from many angles. In addition to detecting kidney injury sooner, AKI biomarkers might also be used to assess the riskiness of common kidney stressors.

An APM That Would Actually Work.

Think of this alternative payment model as a large set of event-driven care packages that get triggered by consumer-patients. Each care package can be priced and adjusted for the individual's medical history. Providers who want to bid for the care package can, and what they're offering will be available and comparable to other providers.

A Different Lens: Evaluating Quality of Care From the Consumer Perspective.

CMS continues to push on measuring and reporting information from the consumer perspective for Medicare Advantage and Part D contracts. Others will follow, and we can expect more emphasis on member-reported outcomes and experience measures across all lines of business.

Patient-Reported Outcomes: You'll Get a Lot More Response if You Make It Fun To Do.

It may seem obvious, but people are more likely to remain engaged in an activity if they find it enjoyable-and outcomes back this up. Among the more than 1,000 patients who enrolled in our multiple sclerosis registry, 95% remained active after one year.

Accountable Care Organizations Get Different Look in Olde England.

Britain's National Health Service is taking a good look at how Americans do ACOs. But the move toward accountable care in England has already gotten mired in disputes (and confusion) about what organizational form it should take and whether current proposals are legal.

CVS and the $100,000 QALY.

The PBM unit of the health giant CVS decided that any new drug exceeding $100,000 per quality-adjusted life year (QALY) may be excluded from the formularies that are maintained by its clients. Patient groups (with the backing of pharma) say that the measure is discriminatory.

Why Medicare Advantage enrollment will keep on growing, whatever the politics.

In 2019, a record 36% of Medicare beneficiaries will be getting their benefits in a Medicare Advantage plan. CMS has broadened the services such plans can provide-services that may reduce expensive treatments and injuries. Insurers continue to see the market as a business opportunity. Critics see a slow-motion privatization of the entitlement.

Why bundled payments are poised to take off.

CMS's Bundled Payments for Care Improvement (BPCI) Advanced program signals a willingness among Medicare providers to redesign care and take on risk. More than 1,500 hospitals and physician groups signed up-north of what was expected for a program that includes downside risk from Day 1. Commercial payers are watching closely.

Why the politics will continue to favor protections for Americans with pre-existing conditions.

Is it any wonder that Republican office holders are changing their tune regarding pre-existing conditions? Kaiser Family Foundation polling reports that overwhelming majorities say it is "very important" that the ACA's protections for people with pre-existing conditions (75%) remain. Even 58% of Republicans agree.

Why the ACA is 'not dead yet' and lives on in 2019.

The ACA-and more specifically, the individual ACA exchange market-is doing quite well these days, thank you very much. ACA premium prices have stabilized and even gone down for many plans. In October, CMS announced that the average premium for the second-lowest-cost silver plans for 2019 had decreased by 1.5%.

Why employers are offering more choices in health plans next year.

It's a tight labor market and employer surveys show a modest but steady uptick in employer health benefit spending for the coming year-about 5% on average. Much of that increase will go toward specialty drugs, the benefit with the biggest price hikes.

Why blockchain for health care may be finally turning the corner.

This fall, PricewaterhouseCoopers issued a report on blockchain in health care and outlined six areas where it could have a profound impact: supply chain and inventory management; enrollment and provider data management; back office functions and payments; data management; managing risk and regulatory issues; and research and development.

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