The Centers for Medicare & Medicaid Services (CMS) closed on June 27 the public comment period for its proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA). This means that Medicare will soon change its payment system to emphasize value over volume, and physicians caring for Medicare patients will need to make decisions about how to adapt their practices to the new incentives.
With biosimilar biological products moving from the lab to the marketplace, key policy and regulatory questions are being actively debated, with important implications for industry, patients, and the health care system.
Recent pharmaceutical innovations offer unprecedented possibilities for curing, treating, or preventing a range of diseases. However, patients, providers and payers alike have raised concerns about the affordability and sustainability of these drugs. As a response to price increases of both single-source and generic drugs, some stakeholders are calling for a move towards basing payments on value, and some payers and pharmaceutical manufacturers are exploring ways to base payments on outcomes. However, many challenges remain.
Medicare is testing new ways to pay for medical services, emphasizing value rather than volume, and evidence is beginning to build about successes and challenges. This briefing will examine what we know so far about the basic models, savings, quality, the impact on patients and the prospects for replication.
A governor met with reporters Friday, February 19 to discuss the latest health care innovations and changes they are pursuing or implementing. Gov. Asa Hutchinson, R-Ark., discussed his experience with the state’s program to move newly eligible Medicaid beneficiaries to qualified health plans, and his intentions for changes moving forward.
A top Federal Trade Commission official, along with key experts, met with reporters Dec. 15 to discuss the recent surge in health care consolidation; the driving forces behind this trend; and the implications for policymakers and enforcers.
In 2014, there were a total of 1,299 mergers and acquisitions in the health care sector – a record number, up from 1,035 the year before. This briefing will discussed the driving forces behind this recent increase in consolidation; the scope and extent of consolidation among doctors, hospitals and insurers; implications for consumers and other stakeholders; and the roles of the Department of Justice and the Federal Trade Commission.
Evidence shows that medication adherence—the extent to which a person takes medications as prescribed by their health care providers—is associated with improved health care outcomes for many costly chronic conditions, including heart disease, diabetes, and asthma. However, only 50% percent of Americans are estimated to take their medications as prescribed, and non-adherence is estimated to result in added direct and indirect costs to the healthcare system of over $300 billion per year. The challenges and policy questions surrounding medication adherence affect Medicare, Medicaid, and the private sector – and offer a window into broader questions surrounding the ability of our health care system to coordinate care, particularly for people with multiple chronic conditions. In this briefing, top experts from the public and private sectors explored key policy, practical, and research questions surrounding medication adherence and management of medications.
Behavioral health conditions, including mental health issues and substance use disorders, affect nearly one in five Americans and account for $57 billion in health care costs annually. This briefing discussed current initiatives to integrate behavioral and physical health care services in order to improve quality of care and reduce overall health care costs.
Innovative drugs have brought about significant progress in treating costly and complex conditions. While there is agreement among many stakeholders that some of these breakthrough drugs have had a positive impact on Americans’ health and life expectancy, increasing prices have also caused some confusion about the methods by which drug prices are determined. The goal of this briefing was to discuss recent prescription drug price trends, as well as demystify the pricing process. It identified contributors to the rising prices of many drugs, including shareholder interests and R&D costs, in addition to explaining possible future pricing-related challenges for manufacturers, providers, and consumers.
The Alliance for Health Reform has released a new toolkit, “Biosimilars: Unpacking Complex Issues.” The Affordable Care Act created an expedited licensure pathway for biosimilars, and, in March 2015, the U.S. approved the first biosimilar, leaving policy makers, regulators, providers and stakeholders to grapple with regulatory and financial questions.
Join us for a special breakfast for reporters, where former FDA Commissioner Andrew von Eschenbach will give you the latest on the fast-moving 21st Century Cures legislation. Karen Riley, deputy director of strategy at the FDA’s Office of External Affairs, will also be available to answer questions. The briefing comes just a week after the House Energy and Commerce Committee unveiled bipartisan draft legislation. The committee may begin voting on the measure as early as next week.
This event examined innovative efforts in both the private and public sectors to move toward a health system that is more patient-centered, cost-efficient and delivers better outcomes. It will address efforts underway at the Center for Medicare and Medicaid Innovation (CMMI) and other federal agencies to spur innovation and prioritize a shift toward higher quality care, as well as the progress made by the private sector in improving quality and reducing costs through innovation.
The briefing explored the trends in health care costs in both the public and private sectors. It explained recent moderate growth rates, along with possible reasons and prospects for the future. This session was especially helpful to congressional staff members new to the issue, but also served as a useful review for anyone working on health care policy.
Almost three in ten Medicare beneficiaries are enrolled in the Medicare Advantage (MA) program, which offers a choice of competing private health plans – typically managed care plans such as HMOs and PPOs. The Affordable Care Act (ACA) made significant changes to the way Medicare Advantage plans are paid, including tying a portion of payments to a quality star rating system. Despite predictions that MA enrollment would drop in the wake of scheduled payment reductions to the program, the percentage of seniors who are choosing to enroll in MA plans is still growing. However, the impact of upcoming reductions remains the subject of much debate.
The United States spends more than $125 billion annually on cancer care. By 2022, there will be 18 million people with cancer and by 2030 cancer incidence is expected to rise by 2.3 million new cases per year. The high cost of cancer drugs and the “buy and bill” model of paying for them under Medicare have received significant attention. But other factors, such as highly-variable practice patterns and a lack of meaningful engagement of patients in care decisions, have also been called into question.
With the cost of repealing the Sustainable Growth Rate for Medicare Physician Payment lower than ever, many suggest that 2014 is the year that permanent change may finally be realized. This toolkit provides a brief summary of the history of the SGR, including the recent actions by the House Energy and Commerce, House Ways and Means, and Senate Finance committees to repeal and reform the flawed physician payment system.
Congress is as close as it has ever been to scrapping the Medicare sustainable growth rate (SGR) for an alternative system of paying doctors based on the quality – rather than the quantity – of services.