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HIV/AIDS treatment drastically reduces mortality and helps to limit transmission
The caveats: About 40,000 Americans are newly infected every year. And HIV infection is still among the top 10 leading causes of death among Americans between the ages of 25 and 44.
Palliative care improves quality of life and symptoms
The caveats: It is difficult to study. The strongest evidence is for palliative care in hospitals.
VBID improves adherence and outcomes
The caveats: Recent research says the evidence for improved outcomes was of moderate quality. And VBID still hasn’t proved its mettle as a cost saver.
Community health workers improve outcomes, reduce costs
The caveat: The evidence, though mainly positive, is mixed.
California program cuts maternal deaths in half
The caveats: California stands out as the exception to the rule. And its program is thorough and fairly involved.
Antiviral drugs have made hepatitis C eminently treatable
The caveat: The prices are now falling for various reasons, but the high cost still means many who might benefit don’t have access to the medications.
Bundled payments for joint replacement reduce expenditures, don’t compromise quality
The caveat: Joint replacements might be a sweet spot for bundled payments. They might not work as well for other episodes of care.
Financial incentives encourage pregnant women to quit smoking
The caveats: They may need to be part of larger programs to be effective. And smoking rates have fallen but remain stubbornly high among people without privilege.
Nurse practitioners provide quality primary care at a lower cost than physicians
The caveats: Most of the evidence involves routine care. It is uncertain whether nurse practitioners will be willing to work in rural areas to fill the primary care void.
With MIPS we just don’t know yet
Michael D. Dalzell
The caveats: P4P programs don’t have a great track record, and avoiding risky patients may prove to be an unintended consequence.
Insurers on a Shopping Spree For All Sorts of Providers
Vertical integration may make sense in the era of value-based care. But will the combinations limit patient choice–and pass antitrust muster?
Acute Kidney Injury: Increasingly Common, Often Insidious, Possibly Deadly. But Worth Testing For?
Testing for biomarkers of acute kidney injury might help with treatment and prognosis. But there’s a lot of uncertainty about how useful it would be right now.
How Medicare Advantage Plans Are Paid: The Devils–and the Insights–Are in the Details
Assessing the Legal and Practical Implications of Copay Accumulator and Maximizer Programs
HRT Has an Uncertainty Problem. Does Compounding Make It Worse?
The Medicare Advantage Advantage–For Insurers, It’s a Sweet Deal, Indeed!
U.S. Women’s Health: Not So Great
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Senate grills drugmaker CEOs, the most sweeping Medicare-for-all plan yet, & a Washington State effort to identify low-value health care services
More Americans riled about drug prices, bispecific antibodies have arrived, CMS rule requires more interoperability
IN THIS ISSUE
Legislation & Regulation
Back From the Dead. ACA Exchange Market Looking Healthy, Hale, and Competitive
Richard Mark Kirkner
But why? Trump administration wants credit for turnaround, but another take says it happened despite, not because of, the administration’s policies.
The Payers’ Playbook
There’s a Better Way To Do Step Therapy
Patient advocates say ‘fail first’ rules should be available online and decisions on physician appeals should be made within 72 hours–and in a day when it is an emergency.
An APM That Would Actually Work
François de Brantes
A Different Lens: Evaluating Quality of Care From the Consumer Perspective
Patient-Reported Outcomes: You’ll Get a Lot More Response if You Make It Fun To Do
Neil Minkoff, MD
Accountable Care Organis[z]ations Get Different Look in Olde England
News & Commentary
New England, Midwest States Score High in NCQA Rankings
News & Commentary
Device Prices Higher For U.S. Hospitals
News & Commentary
Briefly Noted November 2018
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Managed Care News Archive
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2019 Media Kit
2018 Media Kit
2019 Space and Material Due Dates
Submitting Original Research
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