Industry Analysis

Pharma, health insurers square off about the healthcare provisions in the Inflation Reduction Act that passed the Senate yesterday. The PhRMA was sharply critical of the provisions that would empower CMS to negotiate the prices of a selected number of drugs. AHIP praised the extension of more generous ACA premium subsidies.

Automation not only eases the financial pressure these organizations are often under but requires less manpower, which helps overcome challenges associated with worker shortages, all while supporting a positive vendor relationship.

The program started before specialty drugs became such a large expense for Medicare and its beneficiaries. Congress is considering legislation that would cap beneficiary out-of-pocket costs and require price discounts from manufacturers.

Some experts want to see more funding for hospice care in the home. Others say the advantages of hospice in a hospital or nursing home have been underrated.

Price-transparency rule allows insurers to cut MLR payments by using incentives to encourage consumers to choose low-cost, high-value providers.

Beauty may be in the eye of the beholder, but drug price trends are in the way you crunch the numbers.

As personalized medicine grows, so does the need for specialized management of laboratory testing.

Although health systems say they deliver better health outcomes and lower costs, research on how physicians are compensated suggest otherwise.

Patients are likely to continue to choose to recover at home rather than go to skilled nursing facilities, according to a new report by Trella Health.

Equity is a central part of healthcare quality, but health plans often lack information on individual members’ race and ethnicity, making assessing and improving health outcomes challenging.

Coverage requirements may result in premium hikes next year, say some health plan executives.

Like the entirety of the world, the COVID-19 pandemic exposed many issues in the medical industry. One area in particular: the clinical trials space developed many challenges as a result to the height and continuous battle of the pandemic.

CDC figures from June 2020 show that about 41% of adults had opted to delay visiting a medical provider. Now, 20-plus months later, care avoidance of common chronic and acute conditions has only worsened.

In this first part of a two-part video series, Wes Gilson, senior director MR of Business Development at Siemens Healthineers, addresses why improving access to magnetic resonance imaging (MRI) is crucial to advancing health equity, and what barriers are limiting that access to patients.

Most Health plans and much of healthcare, overall, have had their feet on the gas when it comes to more patient-centered care or consumer choice services. COVID-19 has clearly made it all about the consumer in many ways, but more specifically, in making care much more accessible.

A look at the challenges hospitals face due to an insufficient supply chain—and how to address them.

Main Line Health in suburban Philadelphia has solicited ideas for inventions from nurses. Barbara Wadsworth, the healthcare system’s chief operating officer with 35 years experience as a nurse, has invented a device for cushioning patient falls in the bathroom.

Hiring assistants that work virtually and outsourcing medical coding are two ways that providers can navigate through these times of increasing cost pressures and staffing shortages.

In the sixth year of Medicare’s Independence at Home Demonstration program, the initiative saved $41 per member per month, an amount that CMS says was not statistically significant and was lower than the savings the program produced in earlier years.

The Community Aging in Place—Advancing Better Living for Elders (CAPABLE) program developed at the university’s nursing school is designed to keep older people who are frail, have chronic medical conditions or can’t complete activities of daily living in their homes by providing care and help from conventional healthcare professionals — nurses, occupational therapists — but also from people who can do minor house repairs.

Keeping older people in their homes has cost and care advantages. Yet Medicare and Medicaid are still geared toward paying for care in institutionalized settings.

Special purpose acquisition companies took off as investment vehicles in healthcare. Increased regulatory oversight and some flagging stock prices may cool off the trend.

A Kaiser Family Foundation survey found that all the responding programs had at least one initiative to expand behavioral health services.

A 2022 report by the Department of Labor cites specific examples of health plans and health insurance issuers failing to ensure parity. For instance, a health insurance issuer covered nutritional counseling for medical conditions like diabetes, but not for mental health conditions such as anorexia nervosa, bulimia nervosa and binge-eating disorder.