Google's parent firm Alphabet plans to invest $375 million in Oscar Health, and the New York City-based health insurer said it intends to use the money to enter the Medicare Advantage market in 2020 and expand its presence in the individual and small-group markets. Oscar has focused on data science and technology to improve the consumer experience and contain costs, with more than 60% of interactions between the health care system and members occurring on a virtual basis.
CVS Health's pharmacy benefit manager unit, CVS Caremark, launched a new program that will let employers and insurers assess cost-effectiveness of therapies and exclude coverage of drugs with extremely high launch prices. The program, which aims to pressure drugmakers to reduce drug costs, will not target drugs with FDA breakthrough status.
The Continuing Need for Evidence in Healthcare In this free, downloadable white paper from MCG Health, learn about the history of evidence-based medicine, its practical challenges, and challenges around competing recommendations, transparency, and conflicts of interest. Download it here.
The American Academy of Pediatrics' simplified pediatric blood pressure table based on updated guidelines yielded 99.9% sensitivity and 100% negative predictive value, but only 84.4% specificity and 46.9% positive predictive value in identifying youths with elevated BP, according to a study in JAMA Pediatrics. Researchers suggested that basing the simplified table on a higher height percentile for sex and age, rather than BP cutoffs at the fifth percentile, may improve the tool's specificity and PPV without significantly affecting its sensitivity and NPV.
Federal Policy and Medicare’s Economic Impact The first in a series of white papers that will explore the health system, the role of providers, and patient care. Learn about opportunities for differentiation and financial success in a healthcare environment facing looming crises. Access the white paper.
Smoking and nonsmoking women who were exposed to secondhand smoke in childhood had increased odds of developing rheumatoid arthritis, compared with those who were not exposed to secondhand smoke as children, researchers reported in the journal Rheumatology. The findings were based on data involving 98,995 French women followed for up to 30 years.
Heart failure patients who received prepackaged meals that followed Dietary Approaches to Stop Hypertension diet recommendations had a lower risk of hospital readmission within 30 days of discharge, according to a 66-patient study in the journal Circulation: Heart Failure. Both groups in the study were given information about following a sodium-restricted diet, but those who also received meals were limited to 1,500 milligrams of sodium a day.
A recent AHIP survey shows how necessary prior authorization is in improving healthcare quality, safety and affordability. But despite its impact and grounding in evidence-based resources, electronic prior authorization is still vastly underused. Get the details.
It is well known that Americans are grappling with rising healthcare costs and that all sectors of the healthcare industry have a role to play in addressing this issue. Research shows that administrative inefficiencies and medication non-adherence are contributing to rising costs. Fortunately, technological advancements can help health plans alleviate these problems. Find out how.
A Congressional Budget Office report showed Medicaid managed care accounted for 38% of total program spending in 2012. Most US states use some type of managed care in their Medicaid programs, the report said, and in 2014 there were 33 states with comprehensive managed care programs under the Affordable Care Act's Medicaid expansion program.
Medicare Part D has a 73% participation rate among Medicare beneficiaries and premiums have shown little or no growth since the prescription drug program began in 2006. The cost to taxpayers, however, increased from $46 billion in 2007 to $79 billion in 2016, driven mainly from increasing enrollment and higher drug prices, but also by how the program's structure promotes cost growth, writes Austin Frakt of The Incidental Economist.
Driving HSA Engagement with Technology As the market continues to grow for Health Savings Accounts (HSA), so does the importance for education around accountholder behavior. Read the latest UMB Healthcare Services' white paper that discusses how Technology and Data Segmentation can drive HSA Engagement. Read here.
Quality Measurement & Reporting Success View Inovalon's Insight Brief for lessons learned from the 2018 quality reporting season and Inovalon's 2019 quality reporting checklist for success. Access here.
At a National Health Council briefing, FDA Commissioner Scott Gottlieb discussed the importance of patients' perspectives for drug development, reviews and prescribing practices. Gottlieb shared his experience of being diagnosed with stage 1 Hodgkin lymphoma in 2006 and how daunting it was even with his physician saying he had more than a 90% chance of a complete cure.
A Trump administration proposal that would count legal immigrants' use of public health programs such as Medicaid and the Children's Health Insurance Program against them in applications for permanent residency could hurt public health efforts, according to health care leaders and advocacy groups. The proposed changes could increase uncompensated care costs, raise use of emergency departments, put maternal and infant health at risk, increase the risk of disease outbreaks, and shift expenses to state and local governments, they said.
The National Health Law Program filed a lawsuit against the Trump administration to stop the implementation of Medicaid work requirements in Arkansas, arguing the administration has no authority to impose such provisions without action from Congress.
Several states are working on legislation to address the rising cost of drugs, which affects constituents' ability to afford needed medications. In Nevada, the bipartisan Senate Bill 539 will add transparency in formulary changes, pricing and negotiated drug rebates.
AHIP's DM Direct members offer products, services, and strategies that can help health plans leverage their disease management programs to improve care and deliver value. Envolve is the life, health and wellness company dedicated to helping people transform their lives with support, encouragement, and motivation. The company offers an inclusive people-centered approach designed to help in all stages of life.
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