In the accountable care model, providers are rewarded for taking steps that produce the best results. Accountable care requires putting the primary care physician at the center, where he or she can focus on the patient’s overall health by coordinating care with other providers.
Considering the challenges they faced during the first open enrollment period, Consumer Operated and Oriented Plans (CO-OPs) overall are doing very well, having signed up some 450,000 members across the nation, or 18% of all ACA exchange plan enrollees to date.
News briefs of interest to MHE readers.
In the shift away from fee-for-service to coordinated care models, healthcare organizations are reaping benefits by bundling payments for particular episodes of care. While still in the early stages, bundled payments promise to save costs and improve quality, and have already improved communication and collaboration among major players along the continuum of care
Employer-sponsored healthcare benefits are not insulated from the changes taking place in the broader healthcare marketplace. However employers, particularly large employers, are attempting to drive the conversation and actions toward issues that are important to them. One of the best ways to do that is to pressure health plans to help them achieve their healthcare goals
espite the fact that approximately 2.74 million patients used anti-obesity drugs in 2011, according to information services company IMS Health, the majority of health plans are following the lead of the Centers for Medicare and Medicaid Services and not covering them.
Two goals of the Affordable Care Act (ACA) are to provide more Americans with health insurance and lower the overall cost of healthcare. Managed Healthcare Executive recently asked four stakeholders to share their thoughts on what the law has accomplished so far, and its future impact.
Hospitals and health plans need each other and can use this relationship to enable improvements that benefit both parties.
The U.S. Supreme Court, in a decision expected by July of 2015, will hear arguments on the legality of the federal tax subsidies available to low and moderate income consumers that are a key component of the Affordable Care Act (ACA).
Certain group health plans that don’t provide minimally-defined coverage for in-patient hospitalization services will be disallowed if they were purchased after Nov. 4, 2014, the U.S. Department of Treasury has announced.
FDA has approved ramucirumab (Cyramza, Eli Lilly) in combination with paclitaxel (a type of chemotherapy) as a treatment for people with advanced or metastatic gastric (stomach) or gastroesophageal junction (GEJ) adenocarcinoma whose cancer has progressed on or after prior fluoropyrimidine- or platinum-containing chemotherapy.
In many ways, autism is a nightmare condition for health plans. Its prevalence appears to be skyrocketing, it typically requires long-term treatment, diagnoses are being made at younger and younger ages, there is a plethora of therapies - some very expensive - and there's no cure.
Audits of Medicare Advantage (MA) plans and healthcare plans offering financial assistance as part of the Affordable Care Act (ACA) will be conducted by the Health and Human Services Office of Inspector General (OIG), according to the Center for Public Integrity.
A new study has found a greater bleeding risk associated with the use of dabigatran (Pradaxa, Boehringer Ingelheim) in patients with nonvalvular atrial fibrillation (AF) than that cited on initial FDA approval of the drug.
FDA has approved simeprevir (Olysio, Janssen) in combination with sofosbuvir (Sovaldi, Gilead) as an oral, interferon- and ribavirin-free treatment option for genotype 1 chronic hepatitis infection in adults.
Rosuvastatin (Crestor, AstraZeneca), a cholesterol-lowering agent, is currently the most-prescribed drug among the 100 most-prescribed and best-selling drugs in the United States. In the past 12 months, new prescriptions and refills for rosuvastatin have been estimated to amount to 23.7 million.
The risk of moderate or severe exacerbations in patients with severe but stable chronic obstructive pulmonary disease (COPD) who receive tiotropium plus salmeterol has been found to be similar among subjects discontinuing inhaled glucocorticoids and subjects continuing their use. Nevertheless, in making decisions about maintenance therapy for these patients the effect of withdrawal of glucocorticoids on their symptoms and pulmonary function should be carefully considered.
While Republicans picked up seven seats in the U.S. Senate on Nov. 4 to assume a majority, recent good news surrounding the Affordable Care Act (ACA) will likely safeguard major aspects of it from GOP repeal.
Providing first-call resolution through a healthcare plan's call center is critical to customer satisfaction.
Specialty drug spending per user has increased considerably in recent years, but still represents a small portion of overall drug spending per beneficiary, according to a study published recently in Health Affairs.
Otezla (apremilast), a small-molecule inhibitor of phosphodiesterase 4 (PDE4), was approved by FDA on March 21, 2014, for the treatment of adult patients with active psoriatic arthritis. On September 23, 2014, it was approved for a second indication, the treatment of patients with moderate-to-severe plaque psoriasis who are candidates for phototherapy or systemic therapy
FDA has approved Flublok (Protein Sciences) recombinant influenza vaccine for all adults aged 18 years and older. Previously, Flublok was indicated for adults aged 18 to 49 years.
Texas-based Memorial Hermann Health System and the Memorial Hermann Physician Network launched a co-branded health plan in a quest to operate more efficiently and grow market share.
FDA drug approvals, fast-track designations
At a time when insurers are expanding their presence on state exchanges and rolling out tech-savvy portals to capture new customers, single state “Blue” insurers are finding themselves hamstrung by regulations and lack of capital.
After beating third quarter Wall Street estimates and with their stock prices at all time highs, the nation’s leading insurers are expanding their presence on state exchanges (also known as marketplaces) in response to a contracting employer-driven market.
Healthcare spending has climbed from roughly 5% of U.S. GDP to nearly 18% as of 2012, an unsustainable rate of growth that jeopardizes America’s fiscal solvency and long-term ability to support programs like Medicare and Medicaid.
FDA has approved once-daily dapagliflozin and metformin hydrochloride extended-release (Xigduo, AstraZeneca) (XR) for the treatment of adults with type 2 diabetes. Xigduo XR is indicated as an adjunct therapy to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when treatment with both dapagliflozin and metformin is appropriate.
In children discharged home with a fracture, both ibuprofen and oral morphine were effective at relieving pain. However, there were no significant differences in efficacy between the 2 agents and oral morphine was associated with more side effects, according to a study published in the Canadian Medical Association Journal.
FDA advisors have recommended approval of a 60-mg dose of edoxaban (Daiichi Sankyo), a once-daily anticoagulant that inhibits Factor Xa, for some atrial fibrillation patients, but suggested limiting its use to those with abnormal kidney function.
