CMS’s International Pricing Model For Medicare Part B Drugs: Implementation Issues

PAUL GINSBURG | July 9, 2019

article image
For many years, Americans have paid significantly more than the rest of the world for prescription drugs. Medicare spent an estimated $140 billion in 2017 on outpatient prescription drugs, with this large total fueled by double-digit annual spending growth since 2013.[1] To lower the Part B portion of drug spending, the Trump Administration has proposed a demonstration project tying Medicare reimbursement for outpatient, physician-administered drugs to international prices.

Spotlight

HMS

HMS provides the broadest suite of healthcare cost containment solutions to help payers improve performance. We deliver coordination of benefits, payment integrity, and data solutions to state agencies, federal programs, health plans, and employers. We offer scalable services — from supplemental to full outsourcing. Using innovative technology through powerful data services and analytics, we prevent improper payments related to fraud, waste, and abuse; and recover on inappropriately paid claims. As a result of our services, customers recover billions of dollars every year and save billions more through the prevention of erroneous payments.

OTHER ARTICLES

Building a Better Healthcare Future

Article | February 25, 2020

Big data, analytics, cloud, and AI are just a few of the key transformational technologies creating a buzz in the healthcare industry as these innovations solve problems on a global scale all the way down to the patient level. Healthcare organizations are leveraging these tools to assist in clinical processes; run more efficient, effective organizations; and address social determinants of health (SDOH) vulnerabilities impacting health outcomes, such as economic and housing instability, food insecurity, and access to community support services.

Read More

Transforming Healthcare From A ‘Service’ To A ‘Product’

Article | April 20, 2020

Healthcare is top of mind as the coronavirus hits hard everywhere. The inefficiencies of the system itself are on full display during the pandemic — where testing is hard to come by, diagnoses and treatments are reactive rather than proactive, and many people do not get the care they need, when they need it. Adrian Aoun, CEO and founder of Forward, a tech-driven healthcare startup, told Karen Webster that it’s possible to build a completely new healthcare ecosystem, beginning with primary care — and the overhaul needs to leverage data and artificial intelligence (AI).

Read More

Can New Technology Drive Health Care’s Future?

Article | April 11, 2020

Over the past twenty-five years most businesses have been revolutionized by the easy availability of cloud and mobile-based computing systems. These technologies have placed power and access into the hands of employees and customers, which in turn has created huge shifts in how transactions get done. Now the companies with the highest market value are both the drivers of and beneficiaries of this transition, notably Apple, Facebook, Amazon and Alphabet (Google), as well as their international rivals like Samsung, Baidu, Tencent and Alibaba. Everyone uses their products every day, and the impact on our lives have been remarkable. Of course, this also impacts how businesses of all types are organized. Underpinning this transformation has been a change from enterprise-specific software to generic cloud-based services—sometimes called SMAC (Social/Sensors/Mobile/Analytics/Cloud). Applications such as data storage, sales management, email and the hardware they ran on were put into enterprises during the 80s and 90s in the client-server era (dominated by Intel and Microsoft). These have now migrated to cloud-based, on-demand services.

Read More

Can EHRs Stand Up Marketplaces for Innovation?

Article | February 26, 2020

The Office of the National Coordinator for Health IT (ONC) continues to advocate for improved data exchange, with the interoperability and information blocking rules being the latest federal push. One of the ONC’s goals with its latest guidance is to establish an ecosystem of innovation, with electronic health records (EHRs) serving as the foundation — i.e., the platform enabling application development and user access. But when it comes developing an EHR-based marketplace for innovation and mandating open APIs, there are many challenges for all players involved — including EHR vendors, tasked with standing up these sustainable marketplaces for innovation, and third-party developers, forced to bet big on which EHR platform(s) to innovate for and hope they chose right. How could the latest interoperability and information blocking guidelines impact the likelihood EHRs will be successful in developing sustainable innovation marketplaces?There are four key factors that stand to impact the success of EHR-based marketplace development, including:

Read More

Spotlight

HMS

HMS provides the broadest suite of healthcare cost containment solutions to help payers improve performance. We deliver coordination of benefits, payment integrity, and data solutions to state agencies, federal programs, health plans, and employers. We offer scalable services — from supplemental to full outsourcing. Using innovative technology through powerful data services and analytics, we prevent improper payments related to fraud, waste, and abuse; and recover on inappropriately paid claims. As a result of our services, customers recover billions of dollars every year and save billions more through the prevention of erroneous payments.

Events