Reimbursement

Coverage from the Institute for Value-Based Medicine session in Dallas, Texas, held May 21,2026.

Dermatologists spend 13 hours weekly on prior authorization as health plans tout an 11% reduction in requests.

CMS proposes major Medicare reforms to ACOs, physician pay, and MIPS reporting, aiming to reward outcomes over service volume by 2029.

Health system executives say Medicaid cuts, payer disputes, and misaligned incentives are driving the affordability crisis in 2026.

The message rate tripled, rising by 153% from 2020 to 2025, adding clinician workload and exposing equity gaps that managed care must address.

McKesson and The US Oncology Network find EOM attribution often mislabels cancer episodes—especially oral therapy—threatening value-based care accuracy and accountability.

Cardinal Health hires ex-FCS leader Nathan Walcker to drive The Specialty Alliance's growth, including managed services in gastroenterology and urology.

Commercial health care costs are projected to grow 9% in 2027, driven by AI billing tools, pharmacy spend, and provider consolidation, per a PwC report.

A CMS proposed rule would make the Medicare Drug Price Negotiation Program permanent, covering up to 20 drugs per year starting in 2029.

Worse kidney function and higher proteinuria at biopsy predicted significantly greater health care use over 2 years in patients with IgA nephropathy.

Pharmacy deserts affect 1 in 7 Americans, and hospital-owned specialty pharmacies can help close the gap in medication access.

On paper, the OCM cost Medicare millions. A decade later, physicians say its lessons are priceless.

Remote therapeutic monitoring with ePROs powered by AI cuts hospitalizations and boosts therapy time—now a key oncology leader promotes guidelines and reimbursement to make it standard of care.

Community oncology practices face major infrastructure and reimbursement gaps when delivering bispecific antibodies.

Medication adherence is a key to improving outcomes, reducing costs, and strengthens the patient experience, making it an important lens into how health care is serving patients

The COA Community Oncology Conference will tackle AI, the rollout of bispecifics and CAR T in the community setting, plus reimbursement, radiation oncology, and patient access strategies.

Quality metrics for screening tests must evolve to mandate diagnostic resolution, ensuring financial and clinical incentives prioritize the complete screening continuum over initial test uptake.

High co-payments for potentially curative cell and gene therapies create avoidable access barriers; value-based insurance design should eliminate patient cost sharing for these therapies.

The expiration of subsides for health coverage starting in 2026 has left millions facing higher premiums with little notice.

Todd Doyle, MD, of OneOncology, warns that commercial payers lag on updating bundled codes, which has slashed radiation oncology revenue and risks community cancer access in 2026.

Prior authorization and PBM utilization management delay oncology and hematology novel therapies, shifting reimbursement risk to patients in Medicare Advantage.

KFF Health Tracking Poll finds prior authorization tops patient hassles; Drew Altman, PhD, warns complexity delays care, hitting chronic patients hardest.

Value-based care in oncology: why CMS’ models have fallen short and how new partners can sustain navigation, symptom monitoring, and savings.

Lalan Wilfong, MD, a medical oncologist well known for his work in practice transformation, said he looks forward to creating "something more or less from scratch."

The law stems from the case of a beneficiary of the state workers health plan, repeatedly denied an alternative cancer treatment, only to be approved after he was too ill to be a candidate.