When Drug Price Transparency Isn’t Enough
By KRISTINA SMITH & PHIYEN NGUYEN Policymakers and advocates often promote drug price transparency to…
When Drug Price Transparency Isn’t Enough
By KRISTINA SMITH & PHIYEN NGUYEN Policymakers and advocates often promote drug price transparency to lower costs and improve equity. While transparency is an important first step toward accountability and informed public budgeting, it does not guarantee affordable prices or fair access to medicines. Transparency Has Some Benefits Drug price transparency helps show how and…
States’ Management of Medicaid Home Care Spending Ahead of H.R. 1 Effects
Using data from the 23rd KFF survey of officials administering Medicaid home care programs, this issue brief describes the mechanisms states are currently using to limit Medicaid spending on home care and their plans for adopting new mechanisms in state fiscal year (FY) 2026.
A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2025
This data note provides new information about waiting lists in Medicaid home care before many of the provisions in the 2025 reconciliation law go into effect. The data come from KFF’s 23rd survey of officials administering Medicaid home care programs in all 50 states and DC.
How Medicare Pays Medicare Advantage Plans: Issues and Policy Options
This brief explains how Medicare Advantage payments are determined and provides an overview of policy options to change the Medicare Advantage payment system.
Medicare Advantage Glossary
This glossary serves as a guide to the sometimes arcane terms that inhabit the world of Medicare Advantage, the private plan alternative to traditional Medicare.
Chart Reviews Increase Payments to Medicare Advantage Insurers for 1 in 6 Enrollees
Using Medicare Advantage encounter data, this analysis finds that 62% of Medicare Advantage enrollees have at least one chart review record and that diagnoses added from chart reviews increase payments from CMS to insurers for 17% of enrollees. The use of chart reviews varies across the largest Medicare Advantage insurers.
The Case for a Universal Medical Coder in Achieving True Interoperability
A universal medical coder, applied consistently across care settings, offers a practical solution to the enduring challenge of data integrity. The post The Case for a Universal Medical Coder in Achieving True Interoperability appeared first on MedCity News.
A Perfect Storm is Brewing Within the U.S. Healthcare Workforce: Public Policy, Data, and AI Will Help Us Weather It
Weathering the storm will require a bold, multi-pronged approach encompassing legislative action and a data-informed approach that leverages AI technology to plan, recruit, and realign more efficient care models. The post A Perfect Storm is Brewing Within the U.S. Healthcare Workforce: Public Policy, Data, and AI Will Help Us Weather It appeared first on MedCity…
Cáncer de mama y anticonceptivos: un nuevo estudio revela cómo se puede distorsionar la ciencia
Mientras la desinformación sobre la salud de las mujeres se propaga más rápido que nunca, médicos dicen que una nueva investigación sobre los riesgos de los anticonceptivos hormonales pone en evidencia los desafíos de comunicar con matices en la era de las redes sociales. El extenso estudio, realizado en Suecia, siguió a más de 2…
Complaints About Gaps in Medicare Advantage Networks Are Common. Federal Enforcement Is Rare.
Along with the occasional aches and pains, growing older can bring surprise setbacks and serious diseases. Longtime relationships with doctors people trust often make even bad news more tolerable. Losing that support — especially during a health crisis — can be terrifying. That’s why little-known federal requirements are supposed to protect people with privately run…
