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Managed Care

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https://www.readbyqxmd.com/read/29272244/a-conversation-with-stephen-w-schondelmeyer-drug-and-health-care-spending-a-bubble-that-will-burst-unless-we-do-something
#1
Peter Wehrwein
This professor of pharmaceutical economics in the University of Minnesota College of Pharmacy says that the rising level of health care spending is unsustainable. He argues that drug price increases should be reviewed and PBMs should be regulated. "We need [a] bona fide rate regulation review body that can meaningfully evaluate the information presented by drug companies."
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272243/copayments-not-counting-toward-the-deductible-could-have-unintended-consequences
#2
Jeremy Schafer, Ami Gopalan
Starting this year, many PBMs rolled out a new type of cost-share program that will not count copay assistance dollars toward a patient's deductible and out-of-pocket maximum. This might put some patients in a bind. Patients face big, unaffordable drug bills when the assistance maximum is reached, but before they have met their deductibles. Adherence to the specialty drug could fall off sharply if patients hit the copay program limit and cannot afford therapy.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272242/the-self-driving-patient-how-health-care-will-catch-up
#3
Bruce Pyenson, Gillian Woollett
Some providers will resent less obedient patients, but others will enthusiastically support more individually appropriate solutions and take risks with their patients. It's likely that the early adopters (most likely the more affluent and educated) will soon become a noticeable minority in some physicians' offices.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272241/better-for-patients-or-better-for-business-do-we-really-have-to-choose
#4
Zachary Hafner
A trend that is likely to continue in 2018 is the rise of consumerism and expansion of the consumer-driven marketplace. But investing in this is pricey and in an era of shrinking margins is "better for patients" always "better for business?" The Advisory Board's Zachary Hafner answers with a resounding "yes!"
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272240/hospital-consolidation-ftc-may-be-a-stick-in-the-spokes-of-hospital-mergers
#5
Richard Mark Kirkner
For instance, in the case of Sanford Health's acquisition of Mid Dakota Clinic in North Dakota, the agency challenged the deal, claiming that the merged entity would control 75% or more of primary care and other health services in the Bismarck-Mandan metropolitan area.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272239/medicaid-work-requirements-and-expansion-in-the-offing
#6
Susan Ladika
CMS chief Seema Verma wants to reshape the entitlement program that covers about 62 million people. Verma endorses "community engagement" - work or community service - as a condition for "able-bodied" people to get Medicaid coverage and accused the Obama administration of the "soft bigotry of low expectations" for opposing such a requirement.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272238/opioids-part-2-novel-therapies-could-help-wean-americans-off-opioids
#7
Thomas Reinke
Opioids remain the go-to products because they target the mu opioid receptor, which has been shown to be the most effective pathway to reduce pain. The holy grail for drug developers is an agent that stifles pain without producing the euphoria and addiction of opioids.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272237/opioids-part-1-health-insurers-pushed-to-take-steps-to-curb-the-epidemic
#8
Joseph Burns
Blame for the epidemic has focused on drugmakers, drug wholesalers, and physicians who prescribed opioids too liberally. This fall, fingers pointed at health insurers. Investigative reporting showed that coverage policies that restricted access to less addictive medications might have helped fueled the epidemic.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272236/aca-repeal-part-2-star-turn-for-state-regulators-as-insurance-markets-will-continue-to-be-a-partisan-battleground
#9
Jan Greene
Whether in a red or blue state, the state commissioner jobs do require decent working relationships with insurance companies, particularly in precarious times as insurers threaten to leave some areas with no ACA coverage because of poor market conditions or dithering in Washington, D.C.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272235/aca-repeal-headed-for-a-whimper-not-a-bang
#10
Robert Calandra
A year ago you probably couldn't find a Las Vegas bookmaker willing to give odds that the ACA would still be the law of the land in 2018. Turns out that repealing Obamacare and crafting a replacement acceptable to various factions of the GOP is not so easy.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272234/value-based-care-5-not-so-easy-pieces
#11
Michael D Dalzell
Here they are: Value-based care can't be done one slice at a time, new value-based models will take aim at variations in care, the patient may gain a stronger voice, the tail cold wag the dog, and value-based care will create haves and have-nots. Some predictability from the federal government would be welcome.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272233/disasters-in-the-wake-of-the-2017-annus-horribilis-preparedness-rules-to-get-tougher
#12
Susan Ladika
Federal and state officials have moved this year to impose some preparedness requirements on providers that will have an effect in 2018 and years beyond. For instance, CMS' finalized emergency preparedness rules for health care providers that serve Medicare and Medicaid patients went into effect last month.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272232/pbms-will-the-amazon-cometh
#13
Robert Calandra
PBM consultant Linda Cahn says that if Amazon gets into the PBM business it could insist that drugmakers simultaneously submit the net discount price for each of their drugs for the subsequent six months. Amazon could then publicize every drug's actual price, by drug and by therapeutic category.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272231/drug-prices-why-so-high-and-why-so-complicated
#14
Timothy Kelley
For all the Strum und Drang, experts foresee neither a hurry-up nor a halt for 2018, just a fairly steady continued rise at roughly last year's higher-than-inflation pace. The Drug Price Forecast, for example (based on hospital and nonacute settings, but not retail pharmacy), reports that that means a tidy year-over-year increase of 7.61%.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29272230/csr-cuts-bring-unintended-consequences-prompt-state-responses
#15
Richard Mark Kirkner
Eliminating the cost-sharing payments (CSRs) to insurers to hold down out-of-pocket costs for low-income people who purchase individual health plans may wind up actually increasing overall federal spending by driving up premium subsidies to cover higher price plans.
December 2017: Managed Care
https://www.readbyqxmd.com/read/29185981/fda-gives-first-ever-approval-of-drug-to-treat-chagas-disease
#16
Thomas Morrow
The disease is endemic in Latin America, where an estimated 8 million people are affected. It is a lifelong illness and, if untreated, it can result in life-threatening health conditions. Enter benznidazole, which shows we can respond to these new threats in both a medically and an economically responsible manner.
November 2017: Managed Care
https://www.readbyqxmd.com/read/29185980/venture-capital-throws-dough-that-could-fix-health-care-woe
#17
Timothy Kelley
Some experts say that investors funding innovative startup companies can disrupt American health care, making it smarter and more efficient. Others warn that incentives must change if VC money is to make a real difference. It's a trend no one in health care can ignore.
November 2017: Managed Care
https://www.readbyqxmd.com/read/29185979/with-direct-contracting-boeing-cuts-out-the-middleman
#18
Joseph Burns
The company has more than 15,000 employees - or about a third of the eligible employees in those four locations - enrolled in direct contracts. Boeing has dubbed the direct contracts its Preferred Partnership health plan. Should insurers worry that other large companies will cut them out?
November 2017: Managed Care
https://www.readbyqxmd.com/read/29185978/blazing-the-trail-from-volume-to-value
#19
Zachary Hafner
Transforming health care is harder than it looks. That's partly because of a proliferation of pilot programs and point solutions that touch different parts of the elephant but fall short of actually unifying the vision. The time has come to make our way from volume to value.
November 2017: Managed Care
https://www.readbyqxmd.com/read/29185977/answering-the-call-of-the-wild-creates-a-different-kind-of-medical-director
#20
Howard Wolinsky
Will Smith, the co-director of Grand Teton National Park, demonstrates some daring-do to rescue people from mishaps in the mountains of Wyoming. But just like medical directors for health systems, insurance companies, and pharmacy benefits management firms, Smith is in the business of setting policies and protocols.
November 2017: Managed Care
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