New Analysis Shows Out-of-Pocket Spending Based on List Price
New analysis from Amundsen Consulting, a division of QuintilesIMS, shows that more than half of commercially insured patients’ out-of-pocket spending for brand medicines is based on full list prices. Even though rebates paid by biopharmaceutical companies can substantially reduce the prices insurers and pharmacy benefit managers (PBMs) pay for brand medicines, insurers use list prices—rather than discounted prices—to determine how much to charge patients with deductibles and coinsurance. The newly released data show cost sharing for nearly one in five brand prescriptions filled in the commercial market is based...
Source: Policy and Medicine - May 2, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
A Nurse, A Wall, And A Bloody Forehead
As a nurse career coach, I hear a lot of stories, and some of those stories revolve around the way that nursing has sucked the life out of a nurse ' s ambition and self-confidence. And what I see is that nurses who feel demoralized and beaten down sometimes stay in jobs that are killing them because they just don ' t see another way. A Wall and a Nurse ' s Bloody ForeheadWhen a nurse is hitting a wall, she or he needs to move away from the wall and find a door or window to slip through. But what I see over and over again is nurses banging their heads against the same wall over and over until their proverbial foreheads...
Source: Digital Doorway - May 1, 2017 Category: Nursing Tags: burnout career career development career management careers healthcare careers nurse nurse burnout nurse career nurse careers nurses nursing Source Type: blogs
FDA Supports Research to Reduce Health Disparities
The Office of Minority Health (OMH) and the Food and Drug Administration (FDA) are collaborating to identify and address health disparities. Health disparities refer to differences in the health status of different groups of people. These differences may affect how often a disease occurs (frequency), how serious a disease is (severity), or how often a disease results in death (mortality) among certain groups. Health disparities exist for many conditions, including HIV/AIDS, hepatitis, diabetes, cancer, and heart disease. Racial and ethnic minorities may be more likely to have these diseases or may be more likely to have s...
Source: BHIC - April 28, 2017 Category: Databases & Libraries Authors: terri ottosen Tags: Articles Minority Health Concerns Public Health consumer health health disparities Source Type: blogs
Value-Based Pricing For Pharmaceuticals In The Trump Administration
Everyone seems to agree: Drug prices are too damn high. Scandalous prices for new drugs and enormous price hikes on old drugs have focused public ire on the pharmaceutical industry. A bipartisan consensus has emerged that something must be done to tackle drug prices.
There’s less consensus, however, about what that something ought to be. Allowing Medicare to negotiate drug prices is one popular possibility; outright price controls are also under discussion. But with Republicans in control of both Congress and the White House, neither appears to be on the policy agenda. But one market-friendly alternative, “value-based ...
Source: Health Affairs Blog - April 27, 2017 Category: Health Management Authors: Rachel Sachs, Nicholas Bagley and Darius Lakdawalla Tags: Costs and Spending Drugs and Medical Innovation Medicaid and CHIP Medicare Payment Policy Centers for Medicare and Medicaid Services drug pricing outcome-based pricing valued-based pricing Source Type: blogs
Health Policy ’s Gordian Knot: Rethinking Cost Control
Medical spending has resumed its long-term rise. After several years of deceptive stability in the last, deep recession’s wake, health spending rose by 3.7 percentage points more than general inflation in 2014, then by 5.8 percentage points more in 2015, to a 17.8 percent share of the US economy.
Not only does this spending rise threaten the United States’ fiscal stability and capacity to address other needs; it is undermining the promise of health care for all. To manage rising costs, insurers are hiking premiums, narrowing their networks, and raising deductibles and copayments, making purchase of coverage less appeal...
Source: Health Affairs Blog - April 26, 2017 Category: Health Management Authors: Gregg Bloche, Neel Sukhatme and John L. Marshall Tags: Costs and Spending Drugs and Medical Technology Health IT Insurance and Coverage Payment Policy intellectual property patents Research and Development value-based payment Source Type: blogs
Why vaccines are important for our country ’s financial health, too
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Imagine there was a simple treatment that could be given to babies and toddlers that was not only remarkably effective in preventing illness, but also inexpensive. And imagine that this treatment was not only inexpensive, but also lowered overall health care costs.
There’s no need to imagine; the treatment exists. It’s called immunization.
It’s National Infant Immunization Week, a time to recognize and celebrate immunization. It’s during infancy that we give the most vaccines, but the benefits extend far beyond infancy and beyond those babies. The protection lasts for years, keeping b...
Source: Harvard Health Blog - April 25, 2017 Category: Consumer Health News Authors: Claire McCarthy, MD Tags: Children's Health Health policy Infectious diseases Managing your health care Parenting Prevention Vaccines Source Type: blogs
A Good Deal For Eliminating Hepatitis C: Saving Money And Lives
The conundrum of hepatitis C is well known. The virus kills more than 20,000 Americans each year, more, according to Centers for Disease Control and Prevention, than the other 60 infectious causes of death combined. A cure is in hand, but is out of reach for many because it costs tens of thousands of dollars per patient. The problem is most acute in state Medicaid programs and prisons, where 700,000 people need treatment but only 20,000 a year will get it. The price controls some have asked for would make treatment affordable, but would also be likely to chill innovation in pharmaceutical companies, the very innovation tha...
Source: Health Affairs Blog - April 24, 2017 Category: Health Management Authors: Neeraj Sood, Gillian Buckley and Brian Strom Tags: Costs and Spending Drugs and Medical Innovation Medicaid and CHIP hepatitis C Source Type: blogs
The Payment Reform Landscape: For Employers, Keep Pushing Ahead
With all the tumult in Washington, D.C. surrounding health care reform, it is hard to know which reforms will be prioritized at the federal level and whether provider payment reform will still be a central focus. But in some corners of the health care Marketplace, efforts to implement payment reform continue, building on experimentation to better understand how to increase value. These efforts are coming from private employers, other large purchasers of health care, and the health plans that act as their agents.
While employers are sure to be affected in many ways by changes to federal health care laws, much of the cost an...
Source: Health Affairs Blog - April 21, 2017 Category: Health Management Authors: Suzanne Delbanco and Andréa Elizabeth Caballero Tags: Costs and Spending Featured Insurance and Coverage Payment Policy Quality Behavioral Health employer-sponsored health coverage maternity care Payment Reform Source Type: blogs
A New Attempt Emerges To Bridge GOP Divisions On AHCA (Updated)
April 21 Update: New Aid For State Formulary Review At REGTAP
On April 17, 2017, CMS announced that it would be turning the job of drug formulary review for qualified health plans over to state regulators in the thirteen HealthCare.gov states that have plan management responsibility. On April 19, CMS offered at its REGTAP.info website (registration required) a seminar on the qualified health plan (QHP) application review tools for prescription drugs that the states may use for these reviews.
The EHB Category and Class Drug Count Tool, which is new for the 2018 QHP review period, reviews drug lists to ensure that QHPs com...
Source: Health Affairs Blog - April 20, 2017 Category: Health Management Authors: Timothy Jost Tags: Costs and Spending Featured Following the ACA Insurance and Coverage Source Type: blogs
Medicaid Responds To The Opioid Epidemic: Regulating Prescribing And Finding Ways To Expand Treatment Access
Medicaid programs are at the center of the opioid epidemic. Nearly 12 percent of adults covered by Medicaid have a substance use disorder, including opioid use disorder. Available data suggest that Medicaid beneficiaries are prescribed painkillers at higher rates than non-Medicaid patients and have a higher risk of overdose, from both prescription opioids and illegal versions including heroin and fentanyl. In addition to the human toll, abuse of opioids has significant financial effects. In 2010, Arizona Medicaid paid for more than half of all opioid-related emergency department admissions, and in 2012, 81 percent of the $...
Source: Health Affairs Blog - April 11, 2017 Category: Health Management Authors: Amy Bernstein and Nevena Minor Tags: Costs and Spending Medicaid and CHIP Public Health opioid epidemic preferred drug lists prescription drug abuse prescription drug monitoring programs prior authorization requirements Section 1115 Waivers Source Type: blogs
Baby boomer? Why aren ’t you getting tested for hep C?
Are you a baby boomer? Have you been tested for hepatitis C virus (HCV)? Do you know why you should be tested for hepatitis C? Do you even know what hepatitis C is?
According to research published by my colleagues from the American Cancer Society in the American Journal of Preventive Medicine, the odds are overwhelming that if you are in the boomer generation you have not been tested for the virus. And that has me wondering why that is the case: Could it be that we don’t know about hepatitis C? Could it be that our health professionals aren’t recommending testing? Could it be that the costs of treatment may be seen as...
Source: Kevin, M.D. - Medical Weblog - April 11, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/j-leonard-lichtenfeld" rel="tag" > J. Leonard Lichtenfeld, MD < /a > Tags: Conditions Cancer GI Source Type: blogs
Another Uninformed Commentary Regarding The myHR Appears In The Mainstream Press.
This appeared during last week:We can gain a lot by sharing our sensitive health dataSam Crosby
Published: March 29, 2017 - 12:00AM Years back, I worked with a group of people who had contracted Hepatitis C. The experience of one woman stayed with me. Julie looked every inch your average working mum. Hep C was a hangover of a past life she was desperate to escape. But when she confided her positive status to a co-worker, word spread throughout her office. She found herself shunned by one group of fearful colleagues, and pitied by another.Julie's story stuck with me, because it was such a stri...
Source: Australian Health Information Technology - April 11, 2017 Category: Information Technology Authors: Dr David More MB PhD FACHI Source Type: blogs
Key Mechanisms That Define Health City Cayman Islands ’ Value Innovation
Conclusion
Building on NH’s goal of delivering the highest quality care at the lowest possible cost, HCCI represents a refreshing and potentially highly disruptive approach to globally competitive medicine.
HCCI offers unquestionably high quality care at surprisingly affordable prices, but the model’s marketability is being tested by the US market, which is all but locked in by special interest structures. For example, health plans seeking to make health care cost more, rather than less – net earnings may be a percentage of total expenditures – may see nearshore care as counter to their interests. Brokers m...
Source: The Health Care Blog - April 4, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
The viruses in your blood
If you have ever received a blood transfusion, along with the red blood cells, leukocytes, plasma and other components, you also were infused with a collection of viruses. A recent study of the blood virome of over 8,000 healthy individuals revealed 19 different DNA viruses in 42% of the subjects.
Viral DNA sequences were identified among the genome sequences of 8,240 individuals that were determined from blood. Of the 1 petabyte (1 million gigabytes) of sequence data that were generated, about 5% did not correspond to human DNA. Within this fraction, sequences of 94 different viruses were identified. Nineteen of the...
Source: virology blog - March 24, 2017 Category: Virology Authors: Vincent Racaniello Tags: Basic virology Information blood viruses transfusion viral virome Source Type: blogs
2016-2025 Projections of National Health Expenditures Data Released
National health expenditure is expected to grow an average of 5.6% annually from 2016 through 2025, according to a report published by Health Affairs (authored by the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT)).
National health spending growth is projected to outpace projected Gross Domestic Product (GDP) growth by 1.2%. The report also projects that the health share of GDP will rise from 17.8% in 2015 to 19.9% by 2025. Growth in national health expenditures over this period is likely to be largely influenced by faster growth in medical prices, as compared to recent historically low...
Source: Policy and Medicine - March 19, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
