In a study of seven industrialized countries, the United States came in last overall in health system performance, despite having the most expensive health care system. A new Commonwealth Fund report looks at measures of health system performance in five key areas: quality, efficiency, access to care, equity, and the ability to lead long, healthy, productive lives. The other countries ahead of us are Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom. The report says the United States does not get good value for its health care dollars, ranking last despite spending $7,290 per capita on health care in 2007, compared with $3,837 in the Netherlands, which ranked first overall. Commonwealth Fund president and lead author Karen Davis says the findings were “disappointing but not surprising,” but she thinks with the passage of the Patient Protection and Affordable Care Act the U.S. can begin “strengthening primary care and investing in health information technology and quality improvement”.... “One in five medical claims is processed by insurers with errors,” says Nancy H. Nielson, MD, immediate past president of the American Medical Association (AMA). This is echoed by findings from that group’s “National Health Insurer Report Card.” According to the AMA’s findings, the health industry as a whole has about an 80 percent accuracy rate for processing and paying claims. Of the seven insurers reviewed, Coventry Health Care came out on top, with a national accuracy rating of 88.4 percent. Anthem Blue Cross Blue Shield came in last at 74 percent. The seven insurers were Aetna, Anthem BCBS, Cigna, Coventry, Health Care Services Corp., and UnitedHealth Group.... The nation’s employers can expect medical costs to increase by 9 percent in 2011, a decrease of half a percentage point from the 2010 growth rate, according to a recent report issued by the PricewaterhouseCoopers Health Research Institute. For the first time, a majority of the American workforce will have a health insurance deductible of $400 or more, as more employers return to indemnity-style cost-sharing by raising out-of-pocket limits, replacing copayments with coinsurance, and adding high-deductible health plans.
House Republicans come out with their ACA alternative. A continuous coverage surcharge replaces the individual mandate. But where’s the CBO score?
The biosimilar segment of the pharmaceutical industry is on fire. Some 700 biosimilars are at some stage of development, and more than 660 companies are involved in some way in the biosimilars land rush. Still, only a handful may get on the market in the next few years.
No one knows how much of an effect biosimilars will have on oncology expenditures. Pricing and market share are in a large, opaque “to be determined” cloud. But there’s certainly potential for a major impact that could lower oncology expenditures by millions, if not billions.
The future of biosimilars in this country is nothing if not uncertain. Most immediately, the U.S. Supreme Court is hearing a case that will determine the timing of the 180-day waiting period before a biosimilar can go on the market. But there are larger and longer-term issues at play as well.
While coupons help individual consumers, they are also having a major impact on the insurance industry and anyone responsible for paying health care bills. Insurers and pharmacy benefit managers complain that they foil formularies and other pricing strategies designed to steer consumers to less-expensive drugs.
The hard truth is that telehealth’s future—its size, its contours—will depend a lot on what payers will be willing to pay for. Currently, commercial plans cover only a limited number of services. In addition, research suggests that there may be quality and utilization problems.
Insurers should consider covering new drug-delivery devices that can improve outcomes while lowering disease-specific pharmacy and long-term overall health care costs. Managing these devices in the pharmacy benefit will consolidate volume-based purchasing and capitalize on PBM strategies for improving adherence.
Basaglar is coming on the scene during tumultuous times for insulin products. Manufacturers are under attack for price hikes. There are allegations of backroom rebate deals. And a class-action lawsuit has been brought on behalf of uninsured patients, charging insulin makers with setting artificially high prices.
Evaluating the quality of telemedicine care is about as easy as evaluating the quality of health care, period, and researchers are still ironing out the methodological kinks. That may be one reason research results are all over the place. This article involved reviewing nine such studies, and the findings are a mixed bag.
The results can be tragic. Patients with addictions are unlikely to wait the hours or days it takes health insurers to approve the medications they need. Insurers are changing their practices, but not without some outside pressure.