The Business of Diabetes: How The PBM Insulin Scheme Is Poised to Be Disrupted by Civica Rx
So, with this week ' s news focused on other areas (like the Supreme Court), I thought it might be appropriate to focus on something which is still very broken, yet seems poised to be resolved by good old fashioned market forces: insulin prices.The U.S. " market " for insulin is bedeviled by the same problem that causes all U.S. prescription drug prices to be so high: Pharmacy Benefit Managers ( " PBM ' s " ) are manipulating prescription drug discounting behind-the-scenes in order to enrich themselves at everyone else ' s expense. Most discounts PBM ' s collect come in the form of cash rebates, which are paid by pharmaceu...
Source: Scott's Web Log - May 4, 2022 Category: Endocrinology Tags: 2022 biogenerics Biosimilar biosimilars Civica Rx CivicaRx insulin insulin analogs Lilly Novo Nordisk PBM Sanofi Source Type: blogs
How The PBM Insulin Scheme Is Poised to Be Disrupted by Civica Rx
So, with this week ' s news focused on other areas (like the Supreme Court), I thought it might be appropriate to focus on something which is still very broken, yet seems poised to be resolved by good old fashioned market forces: insulin prices.The U.S. " market " for insulin is bedeviled by the same problem that causes all U.S. prescription drug prices to be so high: Pharmacy Benefit Managers ( " PBM ' s " ) are manipulating prescription drug discounting behind-the-scenes in order to enrich themselves at everyone else ' s expense. Most discounts PBM ' s collect come in the form of cash rebates, which are paid by pharmaceu...
Source: Scott's Web Log - May 4, 2022 Category: Endocrinology Tags: 2022 biogenerics Biosimilar biosimilars Civica Rx CivicaRx insulin insulin analogs Lilly Novo Nordisk PBM Sanofi Source Type: blogs
Medicare Advantage Poses Challenges to Health Care Cost-Effectiveness and Equity
This study found that top-rated plans had the greatest disparities in health outcomes between low and high socioeconomic status, Black and White members, and Hispanic and White members. Research assessing hospital readmission rates among Medicare enrollees quantifies the stark differences among those with Advantage plans. Black patients with traditional Medicare were 33% more likely to be readmitted within 30 days as compared to their White counterparts, whereas Black patients with Medicare Advantage were 64% more likely to be readmitted as compared to White patients.
Not only has quality of care been an area of concern...
Source: The Health Care Blog - March 2, 2022 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Medicare amy helburn Health Care Costs Health Disparities Medicare Advantage nirban singh Source Type: blogs
Medicare Advantage Poses Challenges to Health CareCost Effectiveness and Equity
This study found that top-rated plans had the greatest disparities in health outcomes between low and high socioeconomic status, Black and White members, and Hispanic and White members. Research assessing hospital readmission rates among Medicare enrollees quantifies the stark differences among those with Advantage plans. Black patients with traditional Medicare were 33% more likely to be readmitted within 30 days as compared to their White counterparts, whereas Black patients with Medicare Advantage were 64% more likely to be readmitted as compared to White patients.
Not only has quality of care been an area of concern...
Source: The Health Care Blog - March 2, 2022 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Medicare amy helburn Health Care Costs Health Disparities Medicare Advantage nirban singh Source Type: blogs
What the Pandemic Taught Us About Value-based Care
By RICHARD ISSACS
You’ll recall that we ran a long piece (pt 1, pt 2) about Medicare Advantage from former Kaiser Permanente CEO George Halvorson earlier this year. Here’s a somewhat related piece from the current head of the Permanente Medical Group about what actually happened there and elsewhere during the pandemic–Matthew Holt
The COVID-19 pandemic has provided important lessons regarding the structure and delivery of health care in the United States, and one of the most significant takeaways has been the need to shift to value-based models of care.
The urgency for this transformation was cle...
Source: The Health Care Blog - February 17, 2022 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Medical Practice Physicians Kaiser Permanente Medicare Advantage Pandemic Richard Isaacs value-based care Source Type: blogs
Welcome Back Kotter: New York ’ s next 1115 Waiver
The objectives of DSRIP 1.0 – a laundry list of HEDIS measures – made the program difficult to manage “on the ground” and too tightly tied to medical measures of success.
Too many choices. PPS were given choices about which projects they would work on – and by extension – which projects would be funded and measured. The projects were tactically expressed – and therefore too prescriptive – not just defining goals to be achieved – but presuming that DOH knew how goals would best be achieved. In many cases – this mismatch between what to do and how it would be done was...
Source: Docnotes - January 30, 2022 Category: Primary Care Authors: Jacob Tags: Health Politics Technology 1115 DSRIP VBP Source Type: blogs
My 22 Oldest Jokes and Why they Still Matter in 2022
By IAN MORRISON
I have been studying American healthcare for more than 40 years and I have assembled a large number of one-liners over the years. As we enter 2022, I thought I’d share my 22 oldest jokes and why they still matter.
Coming to America
I grew up in Glasgow, Scotland. In Glasgow, healthcare is a right, carrying a machine gun is a privilege. America got it the wrong way round.
Gun violence continues to ravage the United States. We have more guns than people. Kids get gunned down in school playgrounds and classrooms routinely. ...
Source: The Health Care Blog - December 22, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Health Policy American healthcare healthcare quality Source Type: blogs
Perx Health Secures Funding to Bring Daily Engagement In Digital Care to The U.S.
-Already used by major global insurers and healthcare brands including AIA, QBE, Roche, and AstraZeneca, as well as Australia’s national healthcare system, Perx solves digital healthcare’s #1 health challenge – daily engagement of patients in digital care -Clinical studies published in the British Medical Journal and American Journal of Managed Care validate that Perx’s precision […] (Source: EMR and HIPAA)
Source: EMR and HIPAA - October 15, 2021 Category: Information Technology Authors: Healthcare IT News Tags: Health IT Company Healthcare IT AirTree Ventures Health IT Funding Jackie Vullinghs patient engagement Perx Health Scott Taylor Source Type: blogs
Case Western Reserve University School of Law: Law-Medicine Center Presented Vincent P. Daniele Speaking On The Role of Managed Care in Today ’s Healthcare System
on September 28th, 2021 - Watch Presentation Here This lecture will discussed the impact of Medicaid... (Source: HealthLawProf Blog)
Source: HealthLawProf Blog - October 15, 2021 Category: Medical Law Authors: Katharine Van Tassel Source Type: blogs
Could smartphones and ride-sharing apps solve transportation in healthcare?
Patients living in rural, suburban or urban areas with poor infrastructure often don’t have the proper means to get to the doctor’s appointment on time. In extreme cases, they have to wait even for emergency situations so much that they can call an ambulance and receive care in a hospital.
Ridesharing companies like Uber and Lyft offer non-emergency medical transportation services, while start-ups, such as Circulation or Ride Health also promise to deal with the issue. Could smartphones and networked services solve transportation in healthcare?
Why is getting to the doctor such a hassle?
Wherever they...
Source: The Medical Futurist - September 23, 2021 Category: Information Technology Authors: berci.mesko Tags: Future of Medicine Health Insurance Healthcare Design Telemedicine & Smartphones Hospital patient startup transportation uber lyft ride-hailing medical transportation NEMT Circulation Kaizen Helth Veyo Ambulnz RoundTrip Source Type: blogs
Inside Vida Health ’ s $110M Series D & Big Push into Digital Mental Health
By JESSICA DaMASSA, WTF HEALTH
It’s another mega-round for a digital health chronic condition management startup, as Vida Health closes its $110M Series D – AND adds a pair of big-name insurers to their cap table. Vida’s Founder & CEO, Stephanie Tilenius, gets into the good news about the funding round, which was led by growth equity fund, General Atlantic, and brought managed care giant Centene (a Vida customer) and multinational insurer AXA into the mix.
Beyond the funding – and the extra “insurance side” endorsement it gives to the virtual chronic condition care space – what’s interesting about...
Source: The Health Care Blog - May 5, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Health Tech Health Technology Jessica DaMassa WTF Health digital mental health Stephanie Tilenius vida health Source Type: blogs
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According to a review of the Commonwealth Fund’s Medicaid managed care contract database for 2018–2019, states showed robust interest in mobile technology even before the current crisis.
(Source: The Commonwealth Fund: Blog)
Source: The Commonwealth Fund: Blog - April 2, 2021 Category: International Medicine & Public Health Authors: Sara Rosenbaum, Rebecca Morris Source Type: blogs
When the Patient Is Their Own Doctor: Roe v. Wade in An Era of Self-Managed Care
Yvonne Lindgren (University of Missouri-Kansas City), When the Patient Is Their Own Doctor: Roe v. Wade in An Era of Self-Managed Care, 107 Cornell L. Rev. (Forthcoming): The Supreme Court in Roe v. Wade framed the abortion right as a... (Source: HealthLawProf Blog)
Source: HealthLawProf Blog - March 13, 2021 Category: Medical Law Authors: Katharine Van Tassel Source Type: blogs
A North Carolina Pediatric Hospitalist Tells Her Pandemic Story to Senator Richard Burr: Thirteen Months (And Counting) In Medical Whistle-blower Hell - Courtesy Of Private Equity/For-Profit Healthcare And Cruelly-Indifferent/Morally-Bankrupt State & Federal Oversight
Author ' s Note: I cannot " sound-bite " the last year - and perhaps it ' s time to write the book. Scroll about half-way down to read the letter to Senator Burr. The bottom line is that for thethird time in 23 years, as a Pediatrician staffing a community hospital, I was fired " with-out cause " immediately after intervening in a neonatal ( " bad baby " ) case, rescuing the situation/ " saving " the baby, and reporting it INTERNALLY to Peer Review. NO discussion. NO recourse. NO review. A total cover-up. And EVERY SINGLE TIME I ' ve asked the state/Federal government to enfor...
Source: Dr.J's HouseCalls - February 28, 2021 Category: American Health Tags: ACA Apollo Global Management ApolloMD Ballad Heath Central Carolina Hospital CMS Duke Lifepoint ETSU Medicaid Medical Whistleblower NCDHHS Pandemic Quality Assruance Randolph Health Richard Burr Trump Source Type: blogs
Signify Health IPO: CEO Kyle Armbrester on $7.1B Market Debut
By JESSICA DaMASSA, WTF HEALTH
Signify Health’s CEO Kyle Armbrester stops by on IPO day! Hours after ringing the bell on $SGFY’s launch on the New York Stock Exchange, Jess DaMassa digs into the health tech company’s $7.1B valuation and plans to help providers, payers, and self-insured employers scale-up their value-based care offerings. Kyle calls it “Value-Based Care 2.0” and, for the uninitiated, does a great job of stepping back and explaining this healthcare payment model’s history and how Signify is building its next-gen approach from the groundwork laid over the past decade.
What’s unique about ...
Source: The Health Care Blog - February 12, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Health Tech Health Technology Jessica DaMassa WTF Health Kyle Armbrestor Signify Health Source Type: blogs
