CMS Announces Timeline to Value-Based Payments and Large Employers Plan to Drive Down Cost of Specialty Drugs
This week in healthcare, CMS will accelerate plans to shift to a value-based model and a study finds that employers are aiming to “tightly manage” pricey specialty drug costs.
In a recent press conference, Health and Human Services (HHS) Secretary Sylvia Burwell said that CMS will be “setting clear goals–and establishing a clear timeline–for moving from volume to value in Medicare payments. We will use benchmarks and metrics to measure our progress; and hold ourselves accountable for reaching our goals.”
A recent study from the National Business Group on Health has found that “more than half of large employers in 2016 will aim to more tightly manage employees’ use of high-priced specialty drugs, one of the fastest-growing expenses in their health plans.”
This op-ed piece by Utah State Senators Evan Vickers (R) and Gene Davis (D) calls on Congress to address questions about the 340B drug program such as, “What exactly defines a “safety-net” hospital, and should they make significant profits from 340B? Exactly which patients qualify to receive 340B drugs? Is it acceptable for institutions to sell 340B drugs at retail prices through commercial insurers and keep the difference?”
FierceHealthcare interviewed healthcare leaders for this special report about “some of the obstacles to innovation and how these unique ventures offer lasting lessons to healthcare leaders who want to drive change in the industry.”
This article argues that in order to boost the use of bundled payments and “accelerate this payment model’s transition into the mainstream, payers and providers must collaborate to determine how to define certain episodes of care.”
A new survey has found that “About 60 percent of uninsured adults eligible for financial assistance said they don’t have insurance because the costs of buying a health plan are too high,” and 23 percent of uninsured adults find the cost too high because their states did not expand Medicaid.
A recent letter from dozens of oncologists to the drug industry argued that “drug companies have been hiking the cost of medicines by leaps and bounds that far exceed the rate of inflation” and urged drugmakers to lower the price of cancer medicines.
Humana’s predictive data analysis practices “have already helped it identify almost 2 million members at high risk of diseases and closed 4.3 million instances of gaps in care by identifying which members would benefit from regular communication with a provider.”
A recent study of Healthcare.gov and a dozen state-run insurance marketplaces found that “the websites were more likely to feature helpful decision tools for consumers in the second open enrollment period, though the researchers note that such tools are still not available on all exchanges.”
Through his own experience, Thomas D’Amico, MD, reflects on the past, present, and future of NCCN.
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