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Telehealth, especially for behavioral health, has created new opportunities for dishonest individuals to file fraudulent claims. Health plans can take steps to stop the fraud before it happens.

Some 80% of the clinical data is in an unstructured or semi-structured form within the notes sections of electronic health records. Natural language processing can "read” those notes and extract information without fatigue.

1 out 3 Medicaid patients who might have benefited from targeted therapy —mainly Tagrisso and Alecensa — for metastatic lung cancer did not receive it, according to estimates by a trio Harvard-affiliated researchers.

Researchers examined data from the 2019 and 2021 American Community Survey and found that, nationally, the uninsured rate declined from 11.1% to 10.5%, a change that represents more than 1.6 million people gaining coverage.

A solid majority of respondents said vertical integration among providers is the consolidation trend that is most likely to accelerate this year.

It will be vital for providers of healthcare to consider whether innovations truly improve people’s lives and make care more efficient, or will they just be another layer on the workflow and take clinicians’ time away from patients.

Most of the respondents believe vaccination and antivirals have turned COVID-19 into manageable disease, but there is concern about long COVID-19.

Authors of the study, which was published in Jama Network, found that patients with commercial insurance had total and OOP costs that varied by facility for common EGS conditions without any association with quality of care, even after adjusting for patient, insurance, and clinical factors.

This week the FDA approved new indications for already available therapies, including Brukinsa for chronic lymphocytic leukemia and an accelerated approval for Tukysa for HER2-positive colorectal cancer, as well as an extended-release form of risperidone for schizophrenia. The agency also issued a complete response letter for Lilly's Alzheimer’s drug and accepted an application for a NASH drug.

Thirty-seven percent of the respondents rated themselves as optimistic about the near-term future of U.S. healthcare.

Higher costs for employers and consumers, major layoffs, a decline in the quality of care are some consequences seen by respondents to the Managed Healthcare Executive® State of the Industry survey. Investment in technology that will improve efficiency might be a silver lining.

CMS announced today that 456 accountable care organizations (ACOs) will participate in Medicare Shared Savings Plan program in 2023, a decrease from the 483 ACOs that participated last year. But 132 ACOs have signed up to participate in the ACO REACH, an increase from 99 last year.

Medi-Cal, California's Medicaid program, has contracted with Pear Therapeutics for members in 24 counties to participate in an outpatient program for stimulant use disorder.

Survey shows some support but also some doubt about how effective the efforts will be. A sizable minority (43%) of respondents indicated that they believe stronger incentives are needed.

Lawsuit accuses the companies of using unlawful, unfair, and deceptive practices.

Medicaid officials of 44 states (including the District of Columbia) responded to a KFF survey about policies and trends relating to telehealth delivery of behavioral health services. Officials reported high utilization rates of telehealth services for behavioral health purposes since the beginning of the pandemic and plan to continue telehealth expansion permanently.

The FDA has approved two medications: Rybelsus for first-line treatment of diabetes and asthma rescue combination medication. The agency has accepted an sNDA for Rexulti for Alzheimer’s agitation, and Eisai submits new Alzheimer’s drug for full approval.

Optum Rx’s Humira biosimilar strategy for 2023 was set up to allow for the most value in the first year, said CEO Heather Cianfrocco.

The public health emergency (PHE) has again been renewed for the COVID-19 pandemic as of yesterday by the Biden administration. The announcement was made by the Department of Health and Human Services' (HHS) Secretary Xavier Becerra, which marks it as the 12th renewal.

In this debut podcast series of What's on Your Mind podcast, Perry Cohen, Pharm.D., CEO of The Pharmacy Group, recently shared his thoughts on the current state of healthcare and especially the management of pharmacy costs. This new monthly series brings listeners into the minds of Managed Healthcare Executive's® Editorial Advisory Board members. Cohen has decades of experience in managed care and has been on the editorial advisory board since 1994.

As many as 10 Humira biosimilars may be on the U.S. market before 2023 is over. AbbVie has taken several steps to protect its revenues, including the launches of Skyrizi and Rinvoq.

It was found that excess mortality for this group of people with disabilities was 7.4 times that of community-dwelling Medicaid beneficiaries of the same age who were not receiving home and community-based services, and 26.6 times that of the general population.

Respondents ranked labor shortages and closing healthcare disparities the highest when asked what about most important issues facing U.S. healthcare in 2023.

Tapping the potential of digital pharmacy involves creating conditions that allow pharmacists to build trusting relationships with patients, tighter integration pharmacists into care plans and authentic patient engagement.

The FDA ends the week with the approval of the Alzheimer’s medication lecanemab. Two other approvals include: Olpruva for urea cycle disorders and Wegovy for weight loss in teens. The agency has also accepted several applications, including Genentech’s second bispecific antibody, glofitamab, for blood cancer, UCB’s second application for generalized myasthenia gravis, and a therapy RSV prevention in infants. Two companies have submitted applications: Celltrion for a new formulation of infliximab and Orasis for blurry vision treatment.

Leqembi's starting price is almost half of what Aduhelm's was and the FDA-approved label narrows use to people with early disease. But Medicare coverage restrictions may still apply and there is concern about a side effect called ARIA (amyloid related imaging abnormalities).

Dozens of gene mutations associated with amyotrophic lateral sclerosis have been identified. Drug developers have homed in on a trio of genes.

Here’s how healthcare leaders can start driving their organizations to a more interoperable future.