NCQA has published an expanded set of measures, guidelines, and technical specifications to assess standardized, equitable physician practice quality, using data collected from electronic medical records in addition to administrative claim data and paper medical records. These new data sets are available in HEDIS Technical Specifications for Physician Measurement, which contains more than 40 measures of clinical quality, sets standards for the measurement of the cost of care, and provides standardized methods of data collection at the physician office level.... A new strategy proposed by America's Health Insurance Plans would create an independent entity to compare the safety and efficacy of medical procedures and technologies, advocate steps to promote transparency of health care information, speed up the adoption of best practices, and create a new patient-centered dispute resolution mechanism. The strategy also calls for reforming the Food and Drug Administration to improve its ability to assess the long-term safety and effectiveness of newly approved drugs and devices.... Physicians do not routinely consider patients' out-of-pocket costs when recommending expensive medical care, according to researchers at the Center for Studying Health System Change. Although almost 80 percent of physicians consider patient costs when prescribing a generic over a brand-name medication, far fewer consider costs when deciding what diagnostic tests to recommend (40.2 percent) or deciding whether to hospitalize a patient when outpatient treatment is an option (51.2 percent).
House Republicans come out with their ACA alternative. A continuous coverage surcharge replaces the individual mandate. But where’s the CBO score?
The biosimilar segment of the pharmaceutical industry is on fire. Some 700 biosimilars are at some stage of development, and more than 660 companies are involved in some way in the biosimilars land rush. Still, only a handful may get on the market in the next few years.
No one knows how much of an effect biosimilars will have on oncology expenditures. Pricing and market share are in a large, opaque “to be determined” cloud. But there’s certainly potential for a major impact that could lower oncology expenditures by millions, if not billions.
The future of biosimilars in this country is nothing if not uncertain. Most immediately, the U.S. Supreme Court is hearing a case that will determine the timing of the 180-day waiting period before a biosimilar can go on the market. But there are larger and longer-term issues at play as well.
While coupons help individual consumers, they are also having a major impact on the insurance industry and anyone responsible for paying health care bills. Insurers and pharmacy benefit managers complain that they foil formularies and other pricing strategies designed to steer consumers to less-expensive drugs.
The hard truth is that telehealth’s future—its size, its contours—will depend a lot on what payers will be willing to pay for. Currently, commercial plans cover only a limited number of services. In addition, research suggests that there may be quality and utilization problems.
Insurers should consider covering new drug-delivery devices that can improve outcomes while lowering disease-specific pharmacy and long-term overall health care costs. Managing these devices in the pharmacy benefit will consolidate volume-based purchasing and capitalize on PBM strategies for improving adherence.
Basaglar is coming on the scene during tumultuous times for insulin products. Manufacturers are under attack for price hikes. There are allegations of backroom rebate deals. And a class-action lawsuit has been brought on behalf of uninsured patients, charging insulin makers with setting artificially high prices.
Evaluating the quality of telemedicine care is about as easy as evaluating the quality of health care, period, and researchers are still ironing out the methodological kinks. That may be one reason research results are all over the place. This article involved reviewing nine such studies, and the findings are a mixed bag.
If millions of Americans lose Medicaid or private health insurance coverage because of the unACAing of American health care, telehealth may seem like a gimmicky sideshow rather than a good-faith effort to bring health care into the digital century.