Regulatory

Under the Patient Protection and Affordable Care Act (PPACA) of 2010, Medicare providers, including physician groups and hospitals, will soon have the option to form accountable care organizations (ACOs) to improve quality and efficiency. ACO participants may share financial gains generated from improved clinical and economic performance, provided that quality goals and patient safeguards are met.

Robert Henry: How are decisions being made for conventional pharmaceutical products on the one hand and biologic products on the other? Biologics have a comparative carte blanche—for now. Attempts at cost-containment in biologic treatment have been shown to be counterproductive, punitive, and not cost-effective. How adept are payors in utilizing conventional pharmaceutical products compared with the biotech products?

CMS Coverage Policies for Biologics: Defining a Lagrangian Point for Cost, Quality, and Access

Robert Henry: Medicare's recommendations for erythropoiesis-stimulating agents (ESAs) revolves around several key stakeholders with diverse agendas—those of the US Food and Drug Administration (FDA), the American Society of Hematology (ASH), the American Society of Clinical Oncology (ASCO), and pharmaceutical companies. What are the coverage issues for these various stakeholders?

UnitedHealthcare's Response to the ESA Debate

Robert Henry: In mid-January, UnitedHealthcare announced that it was adopting the National Comprehensive Cancer Network (NCCN) Compendium for coverage purposes. Do you think it is going to influence physicians in the trenches? Also, many guidelines are issued, but they are often ignored. How has the NCCN reached what appears to be a consensus?

Economic/Societal Costs of Adding a Compendium to the Federal Registry

The goal of changing the way patent applications are filed and pursued is to stop the frenetic dance that companies must perform to maximize the period of patent protection.

The Urgency of Health Transformation: Not a Choice, but a Necessity

The area of health and healthcare is one where transformation is not a choice, but a necessity. That reality has been driven home by a number of recent events and ever-growing challenges:

Health and Homeland Security

AHDB Stakeholder Perspective
Robert Henry: At a recent Institute of Medicine annual meeting, Elliott Fisher of Dartmouth quoted Uwe Rhinehart something that you had discussed in the book you co-authored with Alice Rivlin, Restoring Fiscal Sanity 2007: The Health Spending Challenge. You make the point that the same level of care or the same procedure provided in 2 different locations in the United States can vary dramatically in price (even twice as much or more).

Health services research (HSR) explores healthcare costs, quality, and access and seeks ways to improve healthcare delivery, safety, availability, and affordability.

The Golden Age of Health Services Research

On August 22, 2006, President Bush issued an Executive Order—Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs—calling on all federal agencies and those who do healthcare business with the government to engage in collaborative efforts to incorporate the cornerstones of valuedriven healthcare (Table 1). The 4 cornerstones of value-driven healthcare are1:

Medicare's Evolution from Passive Payer to Value-Driven Purchaser of Healthcare

Robert Henry: Our editorial focus is on balancing the clinical, business, and regulatory criteria that guide the US healthcare system. As a new administration is taking over, we would like to ask you what you think those involved in healthcare, especially payers, can expect from this new environment.

Dan Mendelson: The new administration will look at the relationship between health plans and the government in a fundamentally different way from the previous administration.

Health Policy in the New Administration
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