As hospitals are increasingly held accountable for what happens outside the hospital walls, they need access to better claims data. In a recent study published in November issue of The American Journal of Managed Care®, researchers with the Michigan Value Collaborative found that it is possible to derive episode-level utilization from claims data and it provides a level of postdischarge care precision that is superior to medical records that hospitals have access to.

Read the study:

Validation of a Claims-Based Algorithm to Characterize Episodes of Care: www.ajmc.com/journals/issue/2017/2017-vol23-n11/validation-of-a-claimsbased-algorithm-to-characterize-episodes-of-care

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included Cigna's deal to buy Express Scripts; Seema Verma, Alex Azar, and Scott Gottlieb, MD, made the rounds at health conferences; an analysis finds FDA's accelerated approval pathway has been a success with hematology and oncology drugs.

Read more about the stories in this podcast:

Healthcare Mergers Continue With Deal for Cigna to Acquire Express Scripts: www.ajmc.com/newsroom/cigna-to-acquire-express-scripts-in-67-billion-deal

What We're Reading: Verma on Health Data; More Medicaid Work Requirements; NJ Individual Mandate: www.ajmc.com/newsroom/what-were-reading-verma-on-health-data-more-medicaid-work-requirements-nj-individual-mandate

Azar Tells Insurance Industry Patients Must Be in Charge of Their Own Data: www.ajmc.com/newsroom/azar-tells-insurance-industry-patients-must-be-in-charge-of-their-own-data

FDA's Gottlieb Blames Rebates, Reimbursement Issues for Holding Back Biosimilar Market: www.ajmc.com/newsroom/fdas-gottlieb-blames-rebates-reimbursement-issues-for-holding-back-biosimilar-market

What We're Reading: Azar to Announce Healthcare Actions; Opposition to CMS Opioid Limits; Diabetes Disagreement: www.ajmc.com/newsroom/what-were-reading-azar-to-announce-healthcare-actions-opposition-to-cms-opioid-limits-diabetes-disagreement

Expedited Approval Is Successful for Cancer Therapies, FDA Says: www.ajmc.com/focus-of-the-week/expedited-approval-is-successful-for-cancer-therapies-fda-says

The Shift From Episodic to Continuous Care: Wearable Technology and Telemedicine in Cardiology: www.ajmc.com/managed-care-cast/the-shift-from-episodic-to-continuous-care-wearable-technology-and-telemedicine-in-cardiology

American College of Cardiology’s 67th Annual Scientific Session & Expo: www.ajmc.com/conferences/acc-2018

The Shift From Episodic to Continuous Care: Wearable Technology and Telemedicine in Cardiology by Managed Care Cast

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included a bipartisan group of governors releasing an outline for health reform; a report finds value-based contracts brings down prescription drug co-pays; 20 states file a lawsuit over the constitutionality of the Affordable Care Act.

Read more about the stories in this podcast:

Bipartisan Group of Governors Unveils Blueprint to Reform Health System: www.ajmc.com/focus-of-the-week/bipartisan-group-of-governors-unveils-blueprint-to-reform-health-system

Value-Based Contracts Significantly Decrease Price of Co-Pays for Medications: www.ajmc.com/newsroom/valuebased-contracts-significantly-decrease-price-of-copays-for-medications

Twenty States Allege ACA Is Unconstitutional in Federal Lawsuit: www.ajmc.com/newsroom/twenty-states-allege-aca-is-unconstitutional-in-federal-lawsuit

NCCN Releases Guidelines to Address Treatment Gaps for People With HIV and Cancer: www.ajmc.com/newsroom/nccn-releases-guidelines-to-address-treatment-gaps-for-people-with-hiv-and-cancer

Evidence-Based Oncology – Patient Centered Oncology Care 2017: www.ajmc.com/journals/evidence-based-oncology/2018/patient-centered-oncology-care-2017

This week, the top managed care stories included the Trump administration proposed extending the duration of short-term health plans; a report found that CAR T-cell therapies are worth their high price tags; the new issue of Evidence-Based Oncology® examined current issues in immunotherapy.

Read more about the stories in this podcast:

Trump Administration Proposes Extending Short-Term Health Plans to 12 Months: www.ajmc.com/newsroom/trump-administration-proposes-extending-shortterm-health-plans-to-12-months

What We're Reading: Cost of Healthcare Bills; Albertsons Buying Rite Aid; Pediatric Cancer Therapies: www.ajmc.com/newsroom/what-were-reading-cost-of-healthcare-bills-albertsons-buying-rite-aid-pediatric-cancer-therapies

ICER Report: Costs of Approved CAR T-Cell Therapies Aligned With Clinical Benefit: www.ajmc.com/newsroom/icer-report-costs-of-approved-car-tcell-therapies-aligned-with-clinical-benefit

Evidence-Based Oncology® – February 2018: www.ajmc.com/journals/evidence-based-oncology/2018/february-2018

In healthcare, digital care and telemedicine efforts are mostly viewed as an add-on to US healthcare, but that mindset should be flipped, argued Sean Duffy, CEO of Omada Health, in a piece written for The New England Journal of Medicine, titled “In-Person Healthcare as Option B.”

Duffy and Patricia Salber, MD, MBA, discuss the future of virtual visits, making decisions about when virtual visits are more appropriate than in-person visits, payment for virtual care, and more.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included a report from CMS that found healthcare spending will rise 5.5% over the next 8 years; the budget deal passed by Congress included a number of provisions with long-term health impact; a study found eating a low-carb could help reverse type 2 diabetes.

Read more about the stories in this podcast:

By 2026, National Health Spending Will Climb to 19.7% of Economy, Report Says: www.ajmc.com/newsroom/by-2026-national-health-spending-will-climb-to-197-of-economy-report-says-

Proposed Bipartisan Bill, 2018 Budget Deal Provide Positive Implications for VBID: www.ajmc.com/focus-of-the-week/proposed-bipartisan-bill-2018-budget-deal-provide-positive-implications-for-vbid

Congress Includes Language Protecting the Rights of Diabetes Patients in Budget Deal: www.ajmc.com/newsroom/congress-includes-language-protecting-the-rights-of-diabetes-patients-in-budget-deal

ASCO Review Finds Clinical Pathway Programs Adhere to Guidelines: www.ajmc.com/newsroom/asco-review-finds-clinical-pathway-programs-adhere-to-guidelines

After a Year, Low-Carb Diet Helps Many Patients Reverse Type 2 Diabetes, Lose Weight, and Stop Insulin: www.ajmc.com/focus-of-the-week/after-a-year-low-carb-diet-helps-many-patients-reverse-type-2-diabetes-lose-weight-and-stop-insulin

Medicare Accountable Care Spending Patterns: Shifting Expenditures Associated With Savings: www.ajmc.com/journals/ajac/2018/2018-vol6-n1/medicare-accountable-care-spending-patterns-shifting-expenditures-associated-with-savings

In a new letter published in the February issue of The American Journal of Managed Care, Martin Makary, MD, a professor of surgery at Johns Hopkins University, and his coauthors assessed price markup variation by hospital and by oncology specialty to better understand the financial hardships patients can face when charges for the same service vary widely across hospitals.

The United States healthcare system is about to undergo some changes. The proposed cross-sector merger between CVS Health and Aetna created some waves and it was followed by an even bigger surprise: the partnership between Amazon, JP Morgan Chase, and Berkshire Hathaway to create a new healthcare company.

Rita Numerof, PhD, the co-founder and president of Numerof & Associates, and Patricia Salber, MD, MBA, of The Doctor Weighs In, discuss the changes and the underlying factors that have led to so many attempts to shake up healthcare.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managedcare stories included Indiana being approved as the second state to implement work requirements in Medicaid; research found 5-year survival rates for cancer are increasing; coverage from the American Society of Clinical Oncology's 2018 Genitourinary Symposium.

Read more about the stories in this podcast:

Indiana Joins Kentucky as Second State With Medicaid Work Requirements: www.ajmc.com/newsroom/indiana-joins-kentucky-as-second-state-with-medicaid-work-requirements

What We're Reading: Flu Vaccine Protection; Ind. Drops Medicaid Enrollees; Global Outbreak Prevention: www.ajmc.com/newsroom/what-were-reading-flu-vaccine-protection-ind-drops-medicaid-enrollees-global-outbreak-prevention

What We're Reading: Adherence Pilot; Va. Work Requirement; Disease Linked to Flint Water: www.ajmc.com/newsroom/what-were-reading-adherence-pilot-va-work-requirement-disease-linked-to-flint-water

5-Year Survival Rates for Patients With Cancer Worldwide: www.ajmc.com/newsroom/5year-survival-rates-for-patients-with-cancer-worldwide

Cancer Mortality Statistics and Disparities in the US: Dr Patricia Salber Interviews Dr Otis Brawley: www.ajmc.com/managed-care-cast/cancer-mortality-statistics-and-disparities-in-the-us-dr-patricia-salber-interviews-dr-otis-brawley

Risk-Sharing Contracts Can Potentially Decrease Drug Prices: www.ajmc.com/newsroom/risksharing-contracts-can-potentially-decrease-drug-prices

Genitourinary Cancers Symposium: www.ajmc.com/conferences/gu-symposium-2018