Disease management (DM) in the US can trace its roots back to the mid-1980s with the early work of California health plans and has come a long way since then. However, it wasn't until the mid 1990s that disease management became part of mainstream thinking, after several private for-profit companies introduced outsourced disease-management programs to large commercial health insurance providers. The "process/evolution" of DM in the United States has been and continues to be the major difference between disease management in the US and the UK...and other countries.
Bill Kerr of Avalon Heath Solutions says incorporating Z codes into CPT codes for lab and genetic testing would add needed specificity, reduce waste and possibly head off fraud.
States have to turn that information into medical frailty determinations that are clinically credible, consistent, and workable across large Medicaid populations.
A meta-analysis found steatotic liver disease in 75% of patients with sleep-disordered breathing and that CPAP lowered liver enzymes but not liver fat.
Some predicted that drugmakers might boost launch prices to make up for Medicare drug negotiations shrinking profits. Harvard researchers find no evidence of that happening so far.
State PBM reform accelerates through 2026, with Theresa Carnegie of Mintz unpacking new laws, rebate pass-through, spread pricing bans, and compliance risks.