They are touted as an alternative to emergency departments. Private companies are seeing an opportunity. But are urgent care centers meeting a demand or creating one?
Insurers and pharmaceutical companies want ICER to umpire debates about drug prices. But some question the cost-effectiveness calculations of the Boston not-for-profit and its dependence on QALYs.
CAR-T treatments are all the rage and showing some remarkable results. But the high price, along with the lack of long-term results, quiets the optimism.
It is a heroic part of the American health system. Lives are saved, the dire consequences avoided. But the air ambulance industry is consolidating, prices are soaring, and insurers and providers continually fight over network issues. One consequence: Surprise billing that leaves patients owing tens of thousands of dollars.
The American College of Emergency Physicians has proposed a payment model that would have ED physicians tracking patients for 30 days after discharge. CMS is mulling it over.
Perinatal quality collaboratives and other responses may help reverse the trend. But payment reform that gets rid of perverse incentives is a prerequisite.
A newspaper series and a state audit put a spotlight on PBM practices in Ohio. Congress and other states are also looking more closely at what PBMs are delivering to Medicaid health plans.
Too often, the prices of health care services and drugs are cloaked in mystery. A growing consensus demands that patients be given a clearer sense, in advance, of what things will cost. But there are obstacles–and some people benefit from the present confusion.
When patients and their medical records are out of whack, it causes harm and wastes money. American attitudes about privacy—and the multitude of competing provider organizations—makes the patient matching problem hard to fix.
The contract between UPMC Health Plan and AstraZeneca will help the brand-name antiplatelet drug compete against generic versions of Plavix by lowering the copay to $10.
“But what happens if no one wants to change? There’s an obsession with fee for service. There’s a familiarity with fee for service. There’s safety in fee for service. It’s hard to get systems to kind of mentally make that pivot.”
Cigna–HealthSpring and Anthem expand their Medicare Advantage offerings to include such things as hot meals and transportation to providers.
Crystal Run will close its health plan at the end of this year. Its losses in the small-group market were driven, in part, by risk adjustment. But another major factor was excessive administrative costs, which were three times as high as the administrative costs at established health plans.
