Last week, Humana published its 10th annual Value-Based Care (VBC) Report for 2023. The report found that Medicare Advantage patients in value-based arrangements were more likely to receive preventive care and were hospitalized less frequently.
The report found that because clinicians are incentivized to provide patients with...
New studies are showing the benefits of value-based care organizations, including the rapid rise of accountable care organizations (ACOs).
Physician participation in accountable care organizations (ACOs) has increased to represent most doctors, according to a survey of 3,500 physicians by the American Medical Association (AMA)....Arizona News
AHCCCS released a new Olmstead Plan that outlines priorities within the healthcare delivery system for people at risk of institutionalization, including those with behavioral needs and members enrolled in the Arizona Long Term Care System (ALTCS).
The 1999 United States Supreme Court Olmstead decision provided a legal framework for...
As the nursing home industry pushes back on the Biden administration's proposal for mandatory federal staffing minimums, a new study suggests the U.S. may want to pivot away from recruitment and towards staffing retention in order to stabilize staffing rates.
Last month, Medicare proposed a new rule that would require long-term care...
From January 2022 to January 2023, 4,264 prescription drugs had price increases, of which 46% or 1,982 were increased above the inflation rate, according to ASPE researchers in a recent study.
Drug manufacturers make most of their prescription drug retail price changes in January and July annually and may change the list price at any...
A new study reviews the volume of advertisements that seniors receive during or around the Medicare enrollment period, and how these reports relate to recent changes in how Medicare Advantage programs will be expected to conduct future advertising campaigns.
The Commonwealth Fund found that "certain marketing experiences reported in ...
Under the Inflation Reduction Act (IRA) people with Medicare may pay a lower coinsurance for some Part B drugs if the drug’s price increases faster than the rate of inflation.
The IRA, signed by President Biden in 2022, applied to Part D the same year, whereas Part B took effect in 2023. The Centers for Medicare & Medicaid...
The Biden administration released its list of 10 drugs for direct price negotiations with manufacturers. The highly anticipated list is the most recent step in enacting a part of the Inflation Reduction Act (IRA) of 2022. The drugs listed are largely treatments related to Type 2 diabetes, blood thinning, arthritis and cancer...
A new class of highly popular diabetes drugs have changed the landscape for conventional wisdom on obesity and weight loss, but cost of the drug and weight stigma are preventing the drug from widespread authorization by insurers, including Medicare.
Ozempic and its sister drug Wegovy, produced by NovoNordisk, were the first of two...CMS Rules
Hospital-based end stage renal disease (ESRD) facilities are poised to receive a 2.6% increase in the ESRD prospective payment proposed rule for 2024, but home-based dialysis care is gaining traction. Experts are also recommending earlier screening for chronic kidney disease.
Under the 2024 End Stage Renal Disease Prospective Payment...National News
The Centers for Medicare and Medicaid Services (CMS) announced they would pay the 1,600 hospitals that participate in the 340B drug discount program a total of $9 billion in lump sum payments in response to the Supreme Court decision that found the program underpaid for prescription drugs. But the Medicare program also announced that it...
The U.S. Chamber of Commerce has filed suit against the federal government, challenging the Medicare drug price negotiation program.
The lawsuit is the second of an expected many against the new program which was authorized by the Inflation Reduction Act last summer. The Chamber of Commerce, which refers to itself as the "world's...
Nursing homes are decrying the severity of the nursing workforce shortage as the minimum staffing proposal looms large.
More than 500 nursing home providers joined a protest on Capitol Hill this week to sound the alarm on legislation that could implement a minimum staffing measure for nursing homes. According to Skilled Nursing News,...CMS Rules
Last Thursday, the Centers for Medicare and Medicaid Services (CMS) announced that it would reverse course on anti-amyloid treatments for Alzheimer's patients and cover Leqembi should it receive full approval from the U.S. Food and Drug Administration (FDA). June is Alzheimer's Awareness month.
Leqembi, produced by Biogen and Eisai,...National News
Pharmaceutical manufacturer Merck has filed a lawsuit against the federal government in an effort to stop Medicare drug price negotiations before they even begin.
The company filed its lawsuit on Tuesday in U.S. District Court in Washington D.C., and said that the drug price negotiation program would necessarily violate the company's...
Beginning next week, every skilled nursing facility in the country will undergo a five-claim audit as the Centers for Medicare and Medicaid Services (CMS) aims to get improper payments under control. Meanwhile, nursing homes are expressing concern about the effects that Medicaid redeterminations and subsequent disenrollment's could have...
Today is the last day of the COVID-19 public health emergency (PHE), and policies are rapidly shifting to accommodate the post-pandemic healthcare landscape in the U.S.
On Tuesday, the Drug Enforcement Administration (DEA) announced that it would continue allowances for telehealth companies to prescribe controlled substances for six...
Last week, the Centers for Medicare and Medicaid Services (CMS) proposed two new rules that would require private entities that manage Medicaid and Children's Health Insurance Plan (CHIP) plans to enforce national maximum standards for appointment wait times and will require managed care organizations (MCOs) to monitor compliance.
The...Arizona Comings & Goings
On Tuesday, CVS Health announced that it had completed its acquisition of Oak Street Health, a primary care provider which boasts 170 medical centers in 21 states. The acquisition is the latest in a long line of efforts by retailers to break into healthcare.
CVS Health paid $10.6 billion in cash for the network, and intends to grow...National News
As pressure mounts from stakeholders and lawmakers, Eli Lilly, producer of the experimental Alzheimer's antibody drug donanemab, is saying that it expects the Centers for Medicare and Medicaid Services (CMS) to reverse its prohibition of anti-amyloids.
A bipartisan group of nearly half of U.S. state attorneys general sent a letter to...
