Rates are far too high and health insurers are the big losers. Is it time to institute financial penalties? “Insurance companies could and should prioritize safety in hospitals more than they are doing,” says John Santa, MD, director of the Consumer Reports Health Ratings Center.
Questions abound. Will new rules cause all costs to rise? Will insurers then need to raise premiums because they are operating under the medical loss ratio rules under the Affordable Care Act? Will plans limit care by arguing that some mental health treatments are not medically necessary? Stay tuned.
The former head of CMS is proud of helping launch Medicare Advantage and Medicare Part D. He wishes he could have done more, however, and the private sector gives him a chance. Scully turns his considerable talents to smoothing transitions from hospitals to acute-care settings.
An exceptionally articulate and knowledgeable patient describes how Xiaflex made a world of difference in treating hand-disabling Dupuytren’s disease. Jack McCain, a regular contributor to Managed Care, is grateful that the breakthrough medication let him avoid painful palmar fasciectomy surgery. His surgeon’s grateful, as well.
The technology keeps improving, which means that a bigger proportion of the population will have the disease and those people will live longer. Try prevention, say experts. Cholesterol is relatively easy to deal with but only about 70% of Americans get screened every five years.
Moody’s doesn’t exactly stick its neck out in its prediction that utilization will rise. There are a lot of qualifications and many experts expect the rate to remain flat, as it has in recent years. You’ll never guess the wild card. Yep, the Affordable Care Act.
The tests and risk criteria are often misunderstood, not only by patients, but doctors as well. The tests are frequently ordered for people who do not require them. Cigna’s counselors make their recommendations for or against testing based on risk assessment.
There are some viruses that cancer patients want — the viruses that attack the disease. In a trial involving patients with stage 3 or 4 melanoma, talimogene laherparepvec, or T-vec, Amgen’s cancer-fighting virus, came out swinging against granulocyte-macrophage colony-stimulating factor (GM-CSF).
The number of specialty drugs and biologics making it to market slipped from 25 in 2012 to 13 last year. Cancer continues to be a hotbed of specialty drug development. Of the 13 specialty drugs and biologics approved last year, nine carry oncology indications and hefty price tags. None were chemotherapies.
The system’s effect on the private sector has actually been underestimated. Medicare price changes often lead to amplified swings on the private side.
Compulsory medical insurance with a twist: Plans play a crucial role
Despite last year’s fiasco at Penn State and growing concern about the effectiveness of such programs, employers are still believers