Payments to hospitals that adhere to “meaningful use” standards for implementing health information technology seem to be working. Medicare and Medicaid offer incentive payments to hospitals that use health IT under the American Recovery and Reinvestment Act of 2009, aka “the stimulus.” The percentage of U.S. hospitals adopting health IT rose from 16 percent to 35 percent from 2009 to 2011, according to a survey by the American Hospital Association.... Knee replacement surgeries have more than doubled in the last 10 years, according to a study by the U.S. National Institutes of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases. Of people 50 and older, 4.7 percent have had knee replacement.... Medicare Advantage beneficiaries with diabetes see their doctors more often and the emergency room less than diabetes patients in the Medicare fee-for-service program, according to a report in Health Affairs. “Medicare Advantage Chronic Special Needs Plans Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients” shows that health plans “have played a leadership role in bringing programs to the delivery system that are helping patients get appropriate follow-up care and avoid preventable hospital readmissions and emergency room visits,” says Karen Ignagni, president and CEO of America’s Health Insurance Plans, which helped conduct the study.
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.