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Medicare, Medicaid, Health Reform

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Monthly Archives: September 2016

Opioid Recovery and Patient Access to Medication Assisted Treatment in Medicaid, Medicare Part D, and Private Health Insurance

For the 2.4 million Americans with an opioid use disorder, the over 10 million who abuse prescription opioids, and the nearly one million heroin users, access to medication-assisted treatment (MAT) is critically important, according to the National Institute on Drug Abuse (NIDA) and Substance Abuse and Mental Health Services Administration (SAMHSA) guidelines.  However, new research suggests there are problems in patient access...

Drug Pricing Reform: Understanding Indication Specific Pricing of Pharmaceuticals

Today, prices driving prescription drug spending are largely rooted in a long history of pricing by dosing unit.  In most cases, the pricing of a given prescription drug or biologic does not vary by clinical indication it is being used for, whether the use is on-label or off-label, or the product's relative effectiveness for one indication versus another. Indication-specific...

High-Need, High-Cost Patients: Impact of Functional Limitations on Health Care Costs

Health care expenditures are three times greater for patients who have both functional limitations and multiple chronic conditions than for patients without functional limitations. This was the impetus for a recent report, entitled High-Need, High-Cost Patients: Who are They and How Do They Use Health Care?1 The following is a summary of this Commonwealth Fund report’s main points and comparison...

Health Care Payment Reform: Strengths and Weaknesses of 9 Methods for Provider Reimbursement

Health care payment reform efforts focus on substituting cost-effective value for volume and ultimately aligning the financial incentives of provider reimbursement with expectations for patient outcomes, care management, and efficiency.  The complex dynamics and trade-offs of different payment reform models are discussed in a helpful new report from the Urban Institute and Catalyst for Payment Reform - Payment Methods and Benefit Designs:...

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