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The article focuses on the concerns about high and rising drug prices in U.S. as policymakers are considering options for modifying the Medicare Part D prescription- drug benefit to reduce spending by beneficiaries and taxpayers. It mentions high prices create a substantial burden for patients that may reduce treatment uptake and adherence and also mentions Medicare spending in Part D's catastrophic-coverage phase in which Medicare pays more percent of expenditures.

Background: Health care providers who participate as an accountable care organization (ACO) in the voluntary Medicare Shared Savings Program (MSSP) have incentives to lower spending for Medicare patients while achieving high performance on a set of quality measures. Little is known about the extent to which early savings achieved by ACOs in the program have grown and been replicated by ACOs that entered the program in later years. ACOs that are physician groups have stronger incentives to lower spending than hospital-integrated ACOs.Methods: Using fee-for-service Medicare claims from 2009 through 2015, we performed difference-in-differences analyses to compare changes in Medicare spending for patients in ACOs before and after entry into the MSSP with concurrent changes in spending for local patients served by providers not participating in the MSSP (control group). We estimated differential changes (i.e., the between-group difference in the change from the pre-entry period) separately for hospital-integrated ACOs and physician-group ACOs that entered the MSSP in 2012, 2013, or 2014.Results: MSSP participation was associated with differential spending reductions in physician-group ACOs. These reductions grew with longer participation in the program and were significantly greater than the reductions in hospital-integrated ACOs. By 2015, the mean differential change in per-patient Medicare spending was -$474 (-4.9% of the pre-entry mean, P<0.001) for physician-group ACOs that entered in 2012, -$342 (-3.5% of the pre-entry mean, P<0.001) for those that entered in 2013, and -$156 (-1.6% of the pre-entry mean, P=0.009) for those that entered in 2014. The corresponding differential changes for hospital-integrated ACOs were -$169 (P=0.005), -$18 (P=0.78), and $88 (P=0.14), which were significantly lower than for physician-group ACOs (P<0.001). Spending reductions in physician-group ACOs constituted a net savings to Medicare of $256.4 million in 2015, whereas spending reductions in hospital-integrated ACOs were offset by bonus payments.Conclusions: After 3 years of the MSSP, participation in shared-savings contracts by physician groups was associated with savings for Medicare that grew over the study period, whereas hospital-integrated ACOs did not produce savings (on average) during the same period. (Funded by the National Institute on Aging.). [ABSTRACT FROM AUTHOR]

The article highlights the drug spending, price, and affordability problems in the U.S. It mentions Medicare's purchasing rules tilt the bargaining process in favor of the pharmaceutical industry at the expense of consumers and taxpayers and also mentions pharmacy benefit managers and insurers offering private Medicare Part D plans can obtain lower prices on drugs.

The article reviews the promise and reality of price transparency as a means of facilitating price shopping. Topics discussed include an information that price-transparency initiatives differ in how they define and report the price of health care services; information on NH HealthCost website which provides pricing information for patients; and current benefit design of most health insurance marketplaces does not encourage price shopping.

The article focuses on challenges to treatment and prevention of HIV with generic drugs in the U.S. It states that combination of antiretroviral therapy (ART) has remarkably improved survival rates among people with HIV, and mentions that modification of brand name products coupled with aggressive marketing of modified products have created obstructions to uptake of generics. It notes that generic ART medications might help address budget shortfalls related to Medicaid programs.

The article presents the authors' views on the economics of pricing pharmaceutical treatments and medical devices based on indication of their utilization. They explain the varied responses to a treatment with the type of tumor and biomarkers of disease. The authors thinks that proliferation of precision medicine for genomic, proteomic, and structural biomarkers of identified patients will have greater treatment benefits.

The article reports that the Medicare Shared Savings Program (MSSP) has produced modest savings for Medicare and been popular among health care providers, with 561 participating accountable care organizations (ACOs) covering nearly a third of the fee-for-service Medicare population in the year 2018. It presents information on the Merit- Based Incentive Payment System (MIPS).

Background: In the Medicare Shared Savings Program (MSSP), accountable care organizations (ACOs) have financial incentives to lower spending and improve quality. We used quasi-experimental methods to assess the early performance of MSSP ACOs.Methods: Using Medicare claims from 2009 through 2013 and a difference-in-differences design, we compared changes in spending and in performance on quality measures from before the start of ACO contracts to after the start of the contracts between beneficiaries served by the 220 ACOs entering the MSSP in mid-2012 (2012 ACO cohort) or January 2013 (2013 ACO cohort) and those served by non-ACO providers (control group), with adjustment for geographic area and beneficiary characteristics. We analyzed the 2012 and 2013 ACO cohorts separately because entry time could reflect the capacity of an ACO to achieve savings. We compared ACO savings according to organizational structure, baseline spending, and concurrent ACO contracting with commercial insurers.Results: Adjusted Medicare spending and spending trends were similar in the ACO cohorts and the control group during the precontract period. In 2013, the differential change (i.e., the between-group difference in the change from the precontract period) in total adjusted annual spending was -$144 per beneficiary in the 2012 ACO cohort as compared with the control group (P=0.02), consistent with a 1.4% savings, but only -$3 per beneficiary in the 2013 ACO cohort as compared with the control group (P=0.96). Estimated savings were consistently greater in independent primary care groups than in hospital-integrated groups among 2012 and 2013 MSSP entrants (P=0.005 for interaction). MSSP contracts were associated with improved performance on some quality measures and unchanged performance on others.Conclusions: The first full year of MSSP contracts was associated with early reductions in Medicare spending among 2012 entrants but not among 2013 entrants. Savings were greater in independent primary care groups than in hospital-integrated groups. [ABSTRACT FROM AUTHOR]

The authors discuss the transparency legislation on medication costs in U.S. Topics include the view of the policymakers and the opponents of the transparency bill, requirement for pharmaceutical companies to disclose research and development costs, and drug prices. They also mentioned factors that could limit the efficacy of state initiatives.

The article discusses the aversion of the collision between the reforms targeting the consumers and the health care provider. Topics discussed include the efforts for the promotion of the higher-value care, the growth of interest to reform the health care delivery, and the important requirements set by the U.S. Affordable Care Act (ACA) for health plans.

The authors comment on calls for pharmaceutical policy reform in the U.S. amidst the high prices of prescription drugs. Topics covered include congressional investigations which examine the way in which drug companies set prices, policy proposals identified by lawmakers and others to address the affordability of prescription drugs, and concerns over direct negotiation of prescription-drug prices by the federal government.

The article offers information on the condition of health care system of Australia. Topics include the country's universal, tax-financed comprehensive health insurance Australian Medicare, the country's Pharmaceutical Benefits Scheme, and the public hospital funding initiative based on case-mix-adjusted volume. It also presents a table on the selected characteristics of the health care system and health outcomes in Australia.

The article discusses the alternative payment models (APMs) in Medicare and other payers. Topics mention including vulnerable population such as people with disabilties and people living in poverty, studies which shows value-based payment programs and associate payment to measure which examines access to care.

The article offers information on the use of biosimilar drugs. Topics discussed include increase in the price of biologic drugs; approval of biologic product by he Food and Drug Administration (FDA); attitude of physicians in prescribing biosimilar drugs; and nonproprietary names in the label for all FDA-approved drugs and databases used by physicians and pharmacists.

The article focuses on several aspects of "Medicare for All" which was proposed by U.S. politician Bernie Sanders in September 2017. It mentions that Medicare for All is expected to lift a substantial financial burden from low and middle-income families, their health insurance premiums to wealthier U.S. citizens by raising their taxes. It also mentions that single-payer plan, Medicare in the U.S. appears to constrain rising costs more tightly than private insurers do.

The article discusses the limited savings that has been generated by accountable care organizations (ACOs), thereby impeding the growth and transformation of Medicare.

The article reports that the U.S. prices of older generic medications such as albuterol sulfate, enalapril and fluoxetine have increased. Topics discussed include high prescription-drug spending market because of exclusivity and negotiating power, prohibition of prescription drugs importation under the Food, Drug, and Cosmetic Act, and need of alternative strategies to provide less expensive medications.

The article focuses on the preliminary injunctions issued by the U.S. Department of Justice (DOJ) halting the merger deals announced by the health insurers in the U.S. It mentions the similar defeats suffered by hospitals at the hand of the U.S. Federal Trade Commission (FTC). The allege of DOJ regarding the loss of a competition in the combined market share of the companies is also discussed.

The article focuses on high cost patients for reducing the high costing in Medicare. Topics discussed include payment models for lower spending by accountable care organizations (ACOs), a table depicting Medicare spending and low-value service use in 2013, and aligning provider incentives with systems-focused strategies to limit wasteful care.

The author discusses aspects of cost containment in the U.S. health care system as of 2016. Topics include the lack of consistent savings for studies of programs or practice models designed to enhance coordination and management of patient care, care coordination as the leading strategy to achieve savings under new payment models, such as the bundled-payment programs and the Medicare accountable care organization, and patient-specific investments to encourage engagement in the treatment plan.

The article focuses on a study which shows that patients prefer staying at home than a medical care facility though the clinical outcome for patients staying in both places is same. Topics discussed include health care delivery focusing on health care providers and not what patients want; focus groups conducted by the Camden Clinical Commissioning Group (CCG) in the United Kingdom showing preference of dying patients to stay at home and minimal costs as one of the goals of health policy.

The authors reflect on hospital payment for observation care in the U.S. Payment codes for observation care that were refined by the Centers for Medicare and Medicaid Services (CMS) in November 1996 are mentioned. The authors say inpatient hospitalization has become a main focus of cost control for CMS. Ways observation billing exposes patients to high cost sharing are elaborated.

The article explores how health care administration costs can be reduced in the U.S. The Institute of Medicine (IOM) said that 361 billion dollars are spent annually on health care administration. Standardization plays a critical role in cutting administrative costs. The Department of Health and Human Services (DHHS) is being required by the Affordable Care Act (ACA) to establish detailed rules relating to processing administrative interactions. Also, coverage policies should also be examined.

The author discusses the conflicting goals of stakeholders in the health care industry. Some of the goals he cited are access to services, high quality and cost containment. He points out that achieving high value for patients should be the overall goal of health care delivery. He believes that value should be defined as the health outcomes achieved per dollar and if it is improved, payers, patients, suppliers and providers can all benefit.

In this article, the author expresses his views on the implications of the health care reform in the U.S. in 2009 for physicians. The aim of the health care reform under the administration of U.S. President Barack Obama is to augment the number of Americans who have health insurance coverage. The author also identifies the two tools that health plans may use to control cost including fee reductions for providers and financial disincentives for patients.

The article explains that fiscal reform in the United States can make the Medicare program solvent, reduce health care costs, and provide funding for an extension of health insurance coverage. This can be achieved by reducing the annual growth in per capita spending on Medicare to 2.4 percent nationally. Data shows the per capita spending on Medicare for 1992 through 2006 in five regions including Boston, Massachusetts, San Francisco, California, and East Long Island, New York. Topics include the role of physicians as conservative leaders in the health care system.

The author expresses his thoughts on the decision of the U.S. Congress to scrap the sustainable growth rate formula. Topics include the Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA), abandonment of the 21-percent cut in Medicare physician fees, and the extension of MACRA for two years states' authority to enroll applicants for health benefits.

The author discusses way to increase cost consciousness of consumers regarding health insurance policies. Increasing copayments and coinsurance rates to raise cost sharing levels may reduce expenditures by forcing consumers to reconsider seeking medical care. A majority of elderly people must purchase supplemental insurance to cover cost-sharing obligations. The author suggests the high rate of uninsured Americans explains the low rate of contact between people and physicians. Studies suggest cost sharing reduces use of preventative services such as Pap smears and mammograms.

The authors examines the per capital spending on health care in the U.S. and compare its cost-containment efforts with that of Japan and Germany. The per capital spending on health care in the U.S. is more than double compared with other highly industrialized countries but it is worst when it comes to performance on indicators of health status. They discuss Germany's bundled-payment system and Japan's volume-driven pricing adjustment.

The article presents a proposed health care delivery system for Medicaid in the U.S. called Community Health Center and Academic Medical Partnerships (CHAMPs). Under CHAMPs, the expertise of local academic medical centers (AMCs) and of community health centers (CHCs) are combined. The proposed system seeks to create an accountable care organization (ACO) through teaching health centers (THCs). Advantages of CHAMPs are given, one is a more collaborative method in cost control.

The authors discuss the role of patients in accountable care organizations (ACO) in the U.S. They predict that an increase in patient adherence to an ACO will improve efficiency and savings. They note that multiple ACO are ideal for some patients. They mention the implications of aligning consumer incentives in a way that would encourage patients to seek care within a single ACO for the ability of ACO to achieve their cost-saving and quality goals.

The authors ponder on the issue of control over the health care expenditures in the U.S. They argue that the high health care spending in the country implies the inaccessibility of affordable insurance, and a threat to the economy and competitiveness of the businesses in the country. They claim that controlling health care expenditure increases based on the rate of gross domestic product (GDP) growth will be a reasonable step to reduce costs. The authors also offer ideas on ways to reform health care payment.

The authors reflect on the Robert Wood Johnson Foundation Synthesis Project that focused on the relation of cost reduction to the improvement of the health care needs of patients. According to the authors, the project indicated that care management could be considered as a health care delivery innovation. Care managers have several functions including educating patients about their diseases and medications, coordinating with patients, their families, and physicians to establish a care plan, and risk assessment.

The article discusses the highlights of a roundtable discussion about economics and reform in the U.S., hosted by the "New England Journal of Medicine" on September 14, 2009. It was moderated by Atul A. Gawande of Brigham and Women's Hospital and he was joined by health economics experts Elliott S. Fisher, Jonathan Gruber and Meredith B. Rosenthal. Rosenthal believes that in order to start approaching cost control, one should look at reforming the health care payment system. Gruber remarks on the idea of a public option for insurance coverage.