A new study found that 4 in 10 requests for children's biologic medications were denied, with delays taking weeks and putting kids at risk. The study suggests changes to the prior authorization process to make it faster and simpler, allowing children to access necessary medications without long waits.
Nonprofit hospitals in high-need communities offer similar eligibility for free care as hospitals in lower-need communities. However, hospitals in high-need communities provide more charity care and report more bad debt. Tying financial assistance policies to community need could better protect patients from medical debt.
A Stanford University study analyzed 14.4 billion health records and found conventional methods may overestimate long COVID's range and duration. The study suggests that a synthetic-control design can help isolate COVID's real symptoms and accurately measure their duration.
A study found that over half of highly frail breast cancer survivors over 66 years old had no Medicare home health care in a given year. Despite being eligible, these survivors often lack the necessary care due to limited coverage, leaving them vulnerable to health complications.
The new regulations require eligible patients to document 80 hours of employment or similar activities each month, potentially leading to loss of insurance coverage. Physicians face increased administrative burdens, pressure to document patients' medical needs, and declining Medicaid payments, ultimately compromising patient care.
Researchers found that only 24% of callers received an appointment with an in-network provider, highlighting the need for accurate provider directories. The study also uncovered 'ghost' providers and networks that appear on paper but aren't accessible to patients.
According to a new poll, 60% of older adults spend less than an hour choosing their Medicare coverage during Open Enrollment, with 27% not reviewing their options at all. 80% stick with their current coverage, and 25% consult Medicare's plan-finding tool or hotline as their most important source of information.
A cross-sectional study found that postpartum women with commercial insurance in the US are initiating GLP-1 receptor agonists at varying rates. The study's results provide insight into the treatment patterns of postpartum women with diabetes, highlighting the need for increased awareness and education.
Researchers found substitution effects between obesity-labeled and diabetes-labeled GLP-1 receptor agonists, which vary by state coverage policies. The study suggests that these effects could impact coverage decisions for obesity treatment in Medicaid.
A new study found that hospitals and insurers use public threats to negotiate better deals, leaving patients and families caught in the middle. The study analyzed 14,918 relationships and found that 8% of episodes of brinkmanship resulted in a hospital leaving the network, but 72% were resolved without an actual network exit.
The study identified several barriers to integrating peer support into Medicare-funded care, including limited knowledge of navigation codes and billing requirements. Facilitators included the potential to expand access and reduce inappropriate hospitalizations.
A new study reveals that workers with variable hours and incomes are more likely to rely on Medicaid or ACA Marketplace plans, which may be affected by 2027 changes. Millions of low- and middle-income workers with irregular schedules will be particularly susceptible to Medicaid disenrollment due to fluctuating work hours.
A new study by Michigan Medicine found that heart surgery infection rates vary significantly across U.S. hospitals, with some experiencing nearly double the risk of others. By reducing infections, hospitals could prevent 2,600 infections and reduce Medicare spending by $441 million annually.
A new FAU study pinpoints non-fatal overdose hotspots in Palm Beach County, revealing associations between overdose locations and built-environment features. Outdoor overdoses were more likely to occur near gas stations, major transportation corridors, and in non-residential areas, with housing instability emerging as a strong factor.
A new study finds that Medicaid ACOs in Massachusetts improved maternal healthcare quality and equity by incorporating maternal metrics and initiatives, but faced challenges in meeting metrics and implementing new initiatives. The researchers offer recommendations to overcome barriers in maternal healthcare delivery.
A Virginia study led by George Mason University professor Alison Cuellar found that both forms of Medicaid paid substantially less than Medicare Advantage, employer-sponsored, and marketplace plans for routine preventive visits. Medicaid managed care plans paid 25% less than Medicare plans and more than 40% less than marketplace plans.
A new study found that nearly 20% of eligible adults in Medicaid expansion states are at risk of losing health coverage due to insufficient or inconsistent work hours. Women, unmarried people, and those with limited education are disproportionately affected.
Developing new complex medical conditions is associated with higher disenrollment rates among Medicare Advantage beneficiaries, particularly to traditional Medicare. States with Medigap guaranteed issue and community rating protections have higher disenrollment rates among beneficiaries with multiple new conditions.
A cohort study of pregnant females with opioid use disorder found higher discontinuation rates for Black females compared to White females, with less disparity for methadone treatment. Persistent racial and ethnic inequities in treatment retention were observed during and after pregnancy.
A multiprogram enrollment application can conserve valuable time and resources by enabling people to apply to several public benefit programs at once. States can simplify applications by shortening them, incorporating autopopulated responses, and updating systems to identify complex cases.
A new study suggests that artificial intelligence can enhance the implementation of Medicaid work requirements by helping state agencies keep eligible individuals enrolled. AI tools can analyze existing databases to verify compliance or exemption status, reducing documentation difficulties and administrative complexities. However, huma...
A cohort study found nearly 30% of screened patients had health-related social needs, with higher rates among racial and ethnic minority groups and those publicly insured. Inpatient HRSN screening workflows provide support for equitable reach, preserving benefits for patient groups with disproportionately high social needs.
A cross-sectional study of 172 venture capital-backed maternal health startups identified significant gaps in pregnancy care delivery, particularly for low-income populations. The study found that while startups have the potential to facilitate innovation, few address health equity concerns.
Researchers urge caution on GLP-1 insurance coverage due to massive budget impact and limited data supporting long-term savings. Compounded versions of the medication can be unsafe, and patients require comprehensive support to achieve weight loss and disease prevention.
A cross-sectional study reveals substantial commercial price variation for common cardiovascular services, influenced by payer contracting strategies and market dynamics. The findings underscore the need for greater transparency and regulatory oversight to promote efficient healthcare spending.
A recent study found that frequent formulary rejections of single-source branded drugs in the US lead to delayed or absent treatment, highlighting trade-offs between cost and access to medicines. The study highlights the need for more affordable medication options, particularly for patients with chronic conditions.
After Medicare expanded coverage for Wegovy to prevent heart complications in obese patients with heart disease, prescription fills jumped sharply. However, a significant fraction of eligible beneficiaries still did not receive the treatment.
A cross-sectional study of Medicare beneficiaries age 65 and older found friend caregivers to be an integral part of the caregiving network. They provide essential care without expecting compensation or reimbursement.
A cross-sectional study found significant increases in glucagon-like peptide-1 (GLP-1) per-patient days supplied in employer plans from 2021 to 2024, driven by higher growth in weight loss coverage. This could signal a growing financial burden on patients and payers as drug costs increase over time.
A recent study found that medication use increased after implementation of Medicare annual out-of-pocket cost caps, particularly among the highest-cost medications. This policy change substantially improved patient access to these high-cost medications for Medicare-insured patients.
A clinical trial tested four remote monitoring approaches against usual care and found that none outperformed usual care in reducing readmissions. The study highlights the importance of studying real-world care models to optimize outcomes.
The Medicare $35 insulin out-of-pocket cap implemented in 2023 decreased and stabilized insulin out-of-pocket cost, increasing insulin use. This finding can inform policies to boost insulin access among users with high out-of-pocket cost.
A difference-in-differences analysis found that Georgia's Pathways to Coverage program worsened mental health among low-income adults. This suggests that work requirements may create barriers to coverage and care access, affecting population health and equity.
Institutional Special Needs Plan (I-SNP) enrollment was associated with significantly fewer hospitalizations for nursing home residents with dementia at the end of life, according to a retrospective cohort study. Effect sizes were larger for UnitedHealthcare (UHC) I-SNPs vs non-UHC plans. Plan maturity and volume likely impact success.
The American Society of Anesthesiologists (ASA), American College of Emergency Physicians (ACEP) and American College of Radiology (ACR) applaud the final IDR operations rule as a major step forward for No Surprises Act implementation. The rule reflects meaningful policy changes that address persistent challenges and advances a more fu...
In a cross-sectional study of ambulatory visits, digital after visit summary engagement was found to increase but remained low, especially among unmarried males, non-English-speaking populations, and publicly insured populations. This inefficiency highlights the need to reevaluate postvisit communication in these groups.
A national analysis found that robotic-assisted cholecystectomy remained linked to increased bile duct injury risks despite growing use. The study suggests small differences in overall complication rates between approaches.
A study by Norwegian University of Science and Technology found that private health insurance uptake is linked to poorer health in the population, particularly among those with low education levels. The researchers suggest that policymakers should implement strategies to mitigate this negative effect.
After Dobbs v Jackson, US abortion management shifted towards expectant approaches in ban states, with persistent reliance on suboptimal misoprostol-only regimens. State-level abortion bans were associated with a decrease in management options for individuals with spontaneous abortion in ban states.
A Brown University study found that expanded Medicaid coverage significantly improves one-year mortality rates for young adults with kidney failure. The researchers discovered improvements in pre-dialysis care, increased use of dialysis, and longer dialysis sessions, all leading to better long-term health outcomes.
A retrospective study found lower in-hospital mortality and emergency department use within 30 days of discharge for Medicare beneficiaries undergoing hospital at home compared to traditional inpatient care. However, hospital readmissions within 30 days showed no significant difference between the two approaches.
A cohort study found that ultraexpensive drugs in Medicare Part D have limited international availability, highlighting their fiscal significance. Internationally unavailable products often result in higher spending per beneficiary.
A new study found that Michigan Medicaid expansion helped enrollees significantly reduce their medical debt in collections by up to 75% within seven years of enrollment. Additionally, the study shows substantial drops in sub-prime credit scores, improving financial stability and long-term health outcomes.
The study found that out-of-state Chicago Abortion Fund callers traveled more than 3 times the distance to Illinois after Dobbs compared to before. These callers were also more likely to have private or no insurance, be from rural areas, and receive hospital-based care during their pregnancy.
A cross-sectional study found a substantial increase in medication use for opioid use disorder among Medicaid beneficiaries, potentially contributing to reductions in overdose deaths. The study suggests that expanding access to medications for opioid use disorder may be an effective strategy to address the opioid crisis.
A nationally representative study found nearly 1 in 10 U.S. adults with heavy drinking and obesity conditions, highlighting the need for preventive efforts in younger and middle-aged adults without insurance or Medicaid coverage to curb rising rates of alcohol-associated liver disease deaths.
A new analysis from UC San Francisco argues that diagnostics are being overlooked, slowing progress against major diseases despite advances in targeted therapies. The study suggests that nearly half of the world's population lacks adequate access to diagnostics due to inadequate investment and insurance reimbursement.
Long-term opioid therapy prescription rates declined in the US from 2015 to 2023, despite a growing population of older adults receiving these treatments. Approximately 4-5 million patients were prescribed long-term opioids in 2023, with Medicare covering a larger proportion, raising concerns about safety.
Public long-term care insurance in China's pilot program cuts catastrophic health spending by up to 52%, shifting care away from costly medical interventions. This model offers a powerful alternative for value-based end-of-life care.
Advanced or metastatic cancers often go without tumor genomic testing, with those from low-income backgrounds facing longer wait times. JAMA Network Open highlights the need for targeted healthcare policies to bridge these gaps.
A $35 monthly insulin out-of-pocket cap is associated with significantly lower insulin costs, increased access to insulin, and decreased blood glucose levels among Medicare beneficiaries. This finding suggests that federal cost-sharing policies could improve access to essential medications in diabetes.
Coupon programs shifted towards higher-cost drugs, offering larger incentives to offset increasing patient cost-sharing requirements. Manufacturer-sponsored coupons saw a significant decline between 2017 and 2024, while per-claim coupon amounts rose accordingly.
A lower semaglutide price could generate savings that offset the cost of treating an additional 550,000 to 3.6 million Medicare beneficiaries eligible for expanded obesity-indication coverage. This voluntary price agreement may lead to substantial savings for Medicare spending on semaglutide treatment.
A case-control study found that insurance churn is associated with poorer diabetes management, increased insulin use, and acute complications. Continuous insurance coverage for low-income diabetic patients may lower risk of costly preventable complications.
The American Society of Anesthesiologists (ASA) has filed an amicus curiae brief to support NorthStar Anesthesia in a lawsuit with UnitedHealthcare. ASA warns that insurers bypassing Congress' framework undermines the No Surprises Act and threatens patient access to care. The organization advocates for administrative remedies over frau...
A new study reveals that prior authorization requirements for heart failure medications can significantly delay pharmacy fills, particularly for those with lower socioeconomic status or Medicaid insurance. The study found that patients with prior authorization prescriptions took three times as long to fill their ARNI prescriptions and ...
A $3 million NIH grant funds a national study on Medicare Advantage's new non-medical benefits, including groceries, meal deliveries, utilities, transportation, and other services. The study will examine the impact of these benefits on health care use and patient outcomes.
Patients who are dual-eligible for Medicare and Medicaid, or enrolled in Medicare Advantage plans, are less likely to receive high-quality postacute care after a stroke. This disparity highlights the need for equitable access to specialized care to improve outcomes for high-need patients.
A new study reveals that neighborhood characteristics, including poverty and lower educational attainment, are associated with higher COPD-related emergency department visits and hospitalizations. Community-level interventions targeting these risk factors can help improve quality of life and reduce acute care use.
SourceCOPD Foundation·JournalChronic Obstructive Pulmonary Diseases Journal of the COPD Foundation·TypeObservational study·DateFeb 19, 2026
A study found that 13.4% of young adults with complex medical conditions were disenrolled from Medicaid at age 19, compared to 35.6% without such conditions. The study highlights the significant impact of coverage disruptions on health outcomes for medically complex patients.