News Wire

Danish example shows that prices in health care might go up
Researchers who bucked the amyloid hypothesis became 'roadkill on the highway to nowhere'
Particularly Serious: Antidepressants, Drugs for Parkinson’s and Epilepsy
Patients Had Improved Lung Function, Fewer Exacerbations
Up to 70% greater risk of bacterial infection, 48% risk for fungal infection
Drug “remarkably effective” at killing range of gram-positive bacteria
Improvements in Association Health Plans and Health Reimbursement Arrangements buck the trend of limiting options for patients.
It can zero in on those in crisis much better than doctors can.
Self-insurance
Jan Greene
Risk doesn’t faze companies as much as rising premiums, and stop-loss offers some financial protection from the outliers.
Viewpoint
François de Brantes
Perinatal quality collaboratives and other responses may help reverse the trend. But payment reform that gets rid of perverse incentives is a prerequisite.
Viewpoint
Michelle Yu
The need for a strong pricing strategy is a foregone conclusion. Hospitals and health systems have a window of opportunity now to craft a thoughtful approach to pricing that avoids common pitfalls and ultimately creates a competitive advantage in the market.
News & Commentary
If something isn’t done and done fast to combat the rising rates of resistance to antibiotics, then the world could face economic damage comparable to that of the 2008–2009 global financial crisis, according to a United Nations report.
Our Yearlong Look: Emergency Care Examined
Jan Greene
The American College of Emergency Physicians has proposed a payment model that would have ED physicians tracking patients for 30 days after discharge. CMS is mulling it over.
CURRENT ISSUE June 2019

Calling All Stakeholders!

Our cover story deals with how ICER may become the cost-effectiveness umpire in health care. We look at how small employers seem to be giving self-insurance consideration. Patient medical records get mixed up and it takes a real physical, emotional and financial toll. What can be done? We continue our yearlong look at the ED, this time how value might enter into the payment equation. Plus, articles on telemedicine, Ohio’s fight against PBMs, and the shameful state of U.S. infant mortality.

Read on officials at insurance plans, hospitals, businesses, pharma companies, and doctor practices.

UPCOMING MEETINGS

Newport, RI
July 10-12, 2019
Washington, DC
July 16-17, 2019
Philadelphia, PA
July 22-23, 2019
San Diego, CA
July 25-26, 2019
Boston, MA
July 31-August 01. 2019
San Diego, California
August 27-29, 2019
The Payers’ Playbook
Joseph Burns
A newspaper series and a state audit put a spotlight on PBM practices in Ohio. Congress and other states are also looking more closely at what PBMs are delivering to Medicaid health plans.
News & Commentary
The agency’s proposal would allow Medicare to raise the maximum on its new technology add-on payment (NTAP) to hospitals from 50% of costs to 65% for CAR-T therapies. So, using $373,500 as a benchmark, Medicare would raise reimbursement from $186,500 to $242,450.
News & Commentary
States want managed Medicaid insurers to do more to address the social determinants of health (SDOH), and the plans should use value-based payment as one way to do it. But, as usual in health care, addressing those needs turns on the how-to-pay question.
Cover Story
Lola Butcher
Insurers and pharmaceutical companies want ICER to umpire debates about drug prices. But some question the cost-effectiveness calculations of the Boston not-for-profit and its dependence on QALYs.