A significant number of office-based physician practices have yet to implement an electronic health record (EHR), according to Sage Healthcare Division, a developer of EHRs. But their implementation “continues to grow as an increasing number of physicians and staff gain a better understanding of the efficiency and cost-saving benefits,” according to a recent company survey. It notes that federal “meaningful use” incentives are still one of the strongest drivers for most physicians (64 percent) to implement EHR technology, but for 32 percent of those who are in the market for an EHR, insufficient capital is still a key challenge.… The Government Accounting Office surveyed officials in insurance departments in all the states and the District of Columbia about their practices for overseeing premium rates in 2010 and changes they have begun making to enhance their oversight. The GAO noted widespread variability in reviewing, approving, or disapproving rate filings submitted by insurance carriers. Respondents from 38 states reported that all rate filings were reviewed before the rates took effect, while others reported reviewing at least some rate filings after the rates took effect. The types of information they reported reviewing varied, too. For example, nearly all reviewed trends in medical costs and services, but fewer than half reported reviewing carrier capital levels compared to state minimum levels.... Transitions in care are vulnerable periods for patients during hospitalization and a new study suggests admission to the intensive care unit is associated with an especially high risk of medication discontinuation. A study in the August issue of the Journal of the American Medical Association found that patients admitted to the hospital were more likely to experience unintentional discontinuation of medications than a control group. This applied across all medication groups examined. Getting admitted to an ICU was associated with greater risk of medication discontinuation than when hospitalization was not through the ICU, the researchers found.
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.
The results can be tragic. Patients with addictions are unlikely to wait the hours or days it takes health insurers to approve the medications they need. Insurers are changing their practices, but not without some outside pressure.