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Care Delivery

 

Anthem has been criticized and even sued over policies in several states where it won’t pay for emergency room visits it later determines to be unnecessary. The insurer has now softened those restrictions, but American College of Emergency Physicians (ACEP) said the changes don’t go far enough.

Purdue Pharma, best known for making and selling OxyContin, announced Feb. 10 that it will stop marketing opioid drugs to physicians. The company also stated it will lay off half of its sales force, with the remaining staff of 200 focusing on other medications.

Medicaid patients face a host of challenges in accessing care, with reliable, timely transportation often being a major consideration. A recently published study, though, showed rates of missed primary care appointments were unaffected when Medicaid patients were offered free ridesharing services.

Some 11.8 million people signed up for coverage through the Affordable Care Act (ACA)’s insurance exchanges for 2018, down from 12.2 million the year before. Considering changes that were expected to depress enrollment—like HHS shortening the open enrollment period for Healthcare.gov and cutting its advertising budget by 90 percent—signups “remained generally stable,” according to a report from the National Academy for State Health Policy (NASHP).

In 2011, as outlined in the Affordable Care Act (ACA), Medicare began offering wellness visits at no cost to fee-for-service beneficiaries. The goal of the annual checkup was to introduce preventative care and address specific risks such as depression and risk of falling.

 

Recent Headlines

Changes to Anthem’s ER policy not good enough, say ER docs

Anthem has been criticized and even sued over policies in several states where it won’t pay for emergency room visits it later determines to be unnecessary. The insurer has now softened those restrictions, but American College of Emergency Physicians (ACEP) said the changes don’t go far enough.

Purdue Pharma, producer of OxyContin, stops promoting opioids to physicians

Purdue Pharma, best known for making and selling OxyContin, announced Feb. 10 that it will stop marketing opioid drugs to physicians. The company also stated it will lay off half of its sales force, with the remaining staff of 200 focusing on other medications.

Ridesharing doesn’t reduce missed appointments for Medicaid patients

Medicaid patients face a host of challenges in accessing care, with reliable, timely transportation often being a major consideration. A recently published study, though, showed rates of missed primary care appointments were unaffected when Medicaid patients were offered free ridesharing services.

ACA exchange enrollment dropped by less-than-expected 3.7%

Some 11.8 million people signed up for coverage through the Affordable Care Act (ACA)’s insurance exchanges for 2018, down from 12.2 million the year before. Considering changes that were expected to depress enrollment—like HHS shortening the open enrollment period for Healthcare.gov and cutting its advertising budget by 90 percent—signups “remained generally stable,” according to a report from the National Academy for State Health Policy (NASHP).

Blacks, Medicaid users see fewer annual wellness visits

In 2011, as outlined in the Affordable Care Act (ACA), Medicare began offering wellness visits at no cost to fee-for-service beneficiaries. The goal of the annual checkup was to introduce preventative care and address specific risks such as depression and risk of falling.

CMS cancels Direct Decision Support Model

A model first proposed under the Obama administration to involve outside organizations in engaging sick Medicare beneficiaries about their overall health has now been canceled by CMS.

Disruption or dud? Mixed reaction for Amazon-Berkshire-JPMorgan healthcare plan

The partnership among Amazon, Berkshire Hathaway and JPMorgan Chase to address the “hungry tapeworm” of rising healthcare costs may be a major disruption for the industry’s traditional participants. It could be just another employer-led initiative limited to benefitting workers within those companies, according to financial analysts.

Hospitals not using 340B discounts to help low-income patients

The 340B program was intended to expand resources for hospitals which serve low-income patients by offering discounts on outpatient drugs, but according to researchers from New York University and Harvard Medical School, the financial gains enjoyed by hospitals aren’t resulting in expanded care or improved outcomes for that patient population.

10 predictions for healthcare industry growth in 2018

The need for healthcare companies to adopt emerging technologies to meet the challenges of value-based care will outweigh “political concerns and rising pressures” to cut costs in 2018, according to Frost & Sullivan’s industry outlook report.

AMA: Almost half of older physicians have been sued

In a trio of reports, the American Medical Association (AMA) attacked what it called a “broken” medical liability system, finding that getting sued isn’t uncommon for physicians and can cost tens of thousands of dollars even if a case is dismissed.

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