UnitedHealthcare seems to be jumping onto the accountable care bandwagon in a big way. The insurer says it plans to increase payment to providers through contracts linked to quality and cost-efficiency to $50 billion by 2017. “Our unparalleled experience with accountable care models — and there are many — demonstrates that they can work better for everyone in health care, from patients to payers to care providers,” says Austin Pittman, the president of UnitedHealthcare Networks.... Meanwhile, WellPoint must pay a fine of $1.7 million for exposing the personal information of over 600,000 beneficiaries because an online application database could be hacked. WellPoint informed those who may have been affected and beefed up online security. The hacked data includes names, birthdates, addresses, and Social Security numbers.... You can knock yourself silly exercising but that doesn’t necessarily mean you’ll lose weight, according to researchers at the University of Washington. Even though Americans are exercising more, the obesity epidemic continues to grow. We still consume more calories than we burn off, says the study’s senior author Ali Mokdad, PhD, at the university’s Institute for Health Metrics and Evaluation.... Americans are living longer but not necessarily more happy lives compared to other countries. A study of health statistics in 34 countries published recently in the Journal of the American Medical Association shows that rates of substance abuse, psychiatric disorders, and muscle and joint pain all increased in the United States in the last 20 years. Life expectancy in the U.S. increased from 75.2 in 1990 to 78.2 in 2010.
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.