The Federal Trade Commission is suing the titans of the pharmacy benefit manager industry for anticompetitive practices and artificially raising the price of insulin drug prices, the agency announced Friday. The complaint alleges that Optum Rx, Express Scripts and Caremark—all vertically integrated with UnitedHealth Group, Cigna and CVS Health, respectively—caused patients to pay more for life-saving drugs and engaging in “rigging pharmaceutical supply chain competition in their favor.”
The Department of Veterans Affairs has partnered with EHR vendors Oracle Health and Epic to help identify veterans receiving care outside of the VA system. As part of this collaboration, both Oracle Health and Epic have made code available to all their hospital and health system clients, allowing them to integrate the VA's open API into their workflows. The goal of this initiative is to identify veterans under their care, offer them essential support, and provide access to health benefits, including those outlined in the PACT Act.
During a Sept. 17 panel discussion, Susannah Bernheim, M.D., M.H.S., chief quality officer and acting chief medical officer with the CMS Innovation Center, described how CMS alternative payment models are evolving to include patient-reported measures. Bernheim, who was previously senior director of quality measurement at the Yale-New Haven Hospital Centers for Outcomes Research and Evaluation (CORE), was speaking at an Agency for Healthcare Research & Quality meeting about bringing patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) into value-based care.
Bipartisan telehealth extension bill passes in House committee
As expected, the Telehealth Modernization Act of 2024 advanced out of the House Committee on Energy and Commerce Sept. 18 in a wide-ranging markup hearing. The legislation extends critical telehealth provisions for two years that began during the COVID-19 pandemic and were set to expire at the end of the year. Although the provisions are not permanently extended, the bill’s passage by a vote of 41-0 is still seen as a significant win for the governing body.
Since the passing of the Patient Protection and Affordable Care Act (ACA) in 2010, the Center for Medicare and Medicaid Innovation (CMMI) has piloted more than 50 alternative payment models (APMs) designed to improve care across a spectrum of conditions and populations while transitioning away from fee-for-service reimbursement schemes. To date, however, only four of these APMs have been expanded for reducing net spending or improving the quality of patient care. These results ought to catalyze policymakers to seek out innovative approaches to payment reform that can overcome existing challenges.
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