Reimbursement

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With Thyme Care Partnership, AON Achieves $6M in Savings in EOM’s First Performance Period

By Mary Caffrey

April 22nd 2025

inflation reduction act | Image credit: Vitalii Vodolazskyi -stock.adobe.com

The IRA’s Unintended Consequences for Drug Pricing and Coverage

By Skylar Jeremias

April 2nd 2025

Texas Oncology to Roll Out Canopy for ePROs After Head-to-Head Pilot

By Mary Caffrey
Rose McNulty

March 18th 2025

Kirollos Hanna, PharmD

Embracing EOM, Enhancing Collaboration and Cost Management: Dr Kirollos Hanna

By Kyle Munz
Kirollos Hanna, PharmD

January 29th 2025

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GoodRx, PBMs Hit by Price Fixing Lawsuits

By Hayden E. Klein

November 5th 2024

More News

Oncology Practices Keep Pace With PBMs, in Court and Beyond

April 5th 2024

Oncology Practices Keep Pace With PBMs, in Court and Beyond

This panel at the Community Oncology Alliance conference discussed the impact of pharmacy benefit manager (PBM) response to the end of direct and indirect remuneration fees, which has been dramatic cuts to cancer drug reimbursement.

April 1st 2024

COA 2024: Back in Orlando With Reimbursement Challenges Topping the Agenda

The annual Community Oncology Conference comes on the heels of a cyberattack that has caused significant disruption to providers, and many have sought relief from payers in areas such as prior authorization.

Kathy Oubre, MS | Image credit: LinkedIn

April 1st 2024

After Cyberattack, Oncology Practices Respond, Adapt Amid Calls for Reform

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March 29th 2024

Health Equity Adjustments in Medicare HVBP Program Will Benefit Safety Net Hospitals, Study Says

Medicare’s upcoming health equity adjustment in the Hospital Value-Based Purchasing (HVBP) program will reduce disproportionate penalization among safety net hospitals and those serving high proportions of Black patients, according to a recent study.

Al Benson, MD

March 22nd 2024

Dr Al Benson on Reimbursement for Supportive Care When Treating Patients With Cancer

Hayden E. Klein Rose McNulty

Al Benson, MD, FACP, FACCC, FASCO, medical oncologist at Northwestern University Feinberg School of Medicine and associate director of the Robert E. Tillery Comprehensive Cancer Center, discussed findings from a national survey assessing barriers to comprehensive cancer care delivery.

AMA President Blasts Payers’ Response to Cyberattack

March 14th 2024

AMA President Blasts Payers’ Response to Cyberattack

As pressure from the Biden administration on UnitedHealth Group increases, physicians' groups weigh in following the unprecedented hack on Change Healthcare.

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March 13th 2024

Fragmented Payer System, Vulnerable Supply Chain Among Threats to Accessing Essential Medicines

Christina Mattina

During a session of the 2024 V-BID Summit, panelists Stacie Dusetzina, PhD, and Inma Hernandez, PharmD, PhD, discussed how access to essential medications is curtailed not just by the longstanding complexities of insurance design but also by emerging threats such as supply chain weaknesses and cyberattacks.

What We're Reading

March 13th 2024

What We’re Reading: 340B Contract Pharmacies; Nursing Home Ownership; Health Items in Proposed Budget

An appeals court rules against the Pharmaceutical Research and Manufacturers of America in a 340B contract pharmacy dispute; for-profit investors’ acquisition of nursing homes has raised concerns about the quality of care provided in these facilities; President Joe Biden’s proposed budget for 2025 includes changes that would do away with the current system of biosimilar interchangeability.

Where Have All the Doctors Gone? Medicare Physician Payment Cuts Threaten Patient Access to Quality Care

March 12th 2024

Where Have All the Doctors Gone? Medicare Physician Payment Cuts Threaten Patient Access to Quality Care

The author calls on Congress to address reimbursement shortfalls that are contributing to a growing physician shortage, with rural areas the hardest hit.

Biden Calls for Expanding Efforts to Control Drug Prices

March 8th 2024

Biden Calls for Expanding Efforts to Control Drug Prices

In his State of the Union Address, the president called for expanding the number of drugs subject to Medicare price negotiations and extending a $2000 out-of-pocket cap beyond seniors.

AJMC

March 6th 2024

Increased Medicare Payments for Homeless Patients Provide New Opportunities for Care

Jack Tsai, PhD, MSCP

A new federal rule will provide higher Medicare payments for homeless patients, which may encourage hospitals to identify these patients and help them with their needs.

What We’re Reading: Case for Cost Free Preventative Services; Medicare Pay Bump; MA Home Health Care Disparities

March 4th 2024

What We’re Reading: Case for Cost-Free Preventive Services; Medicare Pay Bump; MA Home Health Care Disparities

Appeals court to review ruling wiping out some cost-free preventative services; a new legislation aims to boost reimbursement rates for medical providers; changes to coverage may limit elderly home care access

Leslie Busby, MD, Rocky Mountain Cancer Centers

February 29th 2024

Cancer Care Plans Within ACOs Must Center Patients First: Dr Leslie Busby

Hayden E. Klein Rose McNulty

Leslie Busby, MD, chairman of the US Oncology Network Pharmacy & Therapeutics Committee, discusses the process of developing patient-centered care plans within the framework of an accountable care organization (ACO) and the importance of staying up to date with the latest best practices and therapies.

February 27th 2024

COA Asks CMS to Resolve Express Scripts’ “Underwater” Payments Following End of DIR Fees

The Community Oncology Alliance (COA), which represents independent cancer care practices, has asked CMS to act following a dramatic drop in reimbursements from Express Scripts, Inc. effective January 1, 2024.

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February 23rd 2024

Kathy Oubre on Strategies to Mitigate Challenges When Adopting New Payment Models

Pearl Steinzor Rose McNulty

While adopting new payment models can come with challenges, there are strategies that can help oncology practices optimize their approaches, said Kathy Oubre, MS, CEO of Pontchartrain Cancer Center.

February 16th 2024

Rule Change for Patient Navigation Billing Is a Boon to Oncology Care, Practice Leaders Say

Julia Bonavitacola

Edward R. Arrowsmith, MD, MPH: Trust and Compromise Are Essential in Building Oncology Clinical Care Pathways

February 14th 2024

Edward R. Arrowsmith, MD, MPH: Trust and Compromise Are Essential in Building Oncology Clinical Care Pathways

Hayden E. Klein

From an interview conducted during Patient-Centered Oncology Care 2023.

Technology Helps Community Oncology Practices Implement PCM, CCM

February 14th 2024

Technology Helps Community Oncology Practices Implement PCM, CCM

Cameron Santoro

David A. Eagle, MD

February 12th 2024

Dr David Eagle: CMS Reimbursement Cuts Encourage Trend of Independent Physician Exodus

Giuliana Grossi

Over the past 20 years, Medicare physician pay has plummeted by 26% when adjusted for inflation, while hospital reimbursement has surged by 70%, prompting over 100,000 doctors to abandon independent practice for hospital or corporate employment since 2019.

Dr Lucy Langer

February 1st 2024

How UnitedHealthcare Incorporates Real-World Evidence Into Cancer Care Decision-Making, Policy Formulation

Hayden E. Klein

UnitedHealthcare is incorporating real-world evidence into pathways design and policy formulation, leveraging its members' data to evaluate the impact of different regimens on health resource utilization and costs, explains Lucy Langer, MD, MSHS, national medical director of oncology and genomics at UnitedHealthcare.

January 23rd 2024

Medicare Payment Rule Threatens Access to Life-Sustaining Kidney Care

John P. Butler Jennifer Payton, MHCA, BSN, RN, CNN

The authors call on Congress to reform Medicare reimbursement for dialysis, saying the recent rule puts clinics at risk of closure.

Christina Downey, MD | Image credit: American College of Rheumatology

January 8th 2024

To Preserve Access to Care, Congress Must Repair Medicare’s Broken Payment System

Christina Downey, MD

The author, chair of the Government Affairs Committee with the American College of Rheumatology, calls for support for efforts in Congress to reform the Physician Fee Schedule.

The Top 5 Reimbursement Content of 2023

December 31st 2023

Top 5 Most Popular Reimbursement Content of 2023

Laura Joszt, MA

The most popular reimbursement content of 2023 included coverage of the shift from the Oncology Care Model to the Enhancing Oncology Model, reactions to the 2024 Medicare Physician Fee Schedule, and concerns around denial of services in Medicare Advantage plans.

Lalan Wilfong, MD, in an interview on blue AJMC background

December 28th 2023

Dr Lalan Wilfong Highlights the Challenges of EOM Compared With OCM

Maggie L. Shaw Laura Joszt, MA

While the Enhancing Oncology Model is the successor of the Oncology Care Model, it includes some very real challenges for participating practices, explained Lalan Wilfong, MD, senior vice president of payer and care transformation at The US Oncology Network.

Top 5 AJAC 2023

December 26th 2023

Top 5 Most-Read AJAC Articles of 2023

Christina Mattina

In 2023, the most-read articles published in The American Journal of Accountable Care® (AJAC) highlighted innovative care models, lessons learned from health system partnerships, and much more.

What’s the Early View of the EOM? Partners Offer Their Takes

December 23rd 2023

What’s the Early View of the EOM? Partners Offer Their Takes

Maggie L. Shaw Mary Caffrey

Top 5 AJMC Journal Articles of 2023

December 21st 2023

Top 5 Most-Read AJMC® Journal Articles of 2023

Christina Mattina

In 2023, the most-read articles published in the peer-reviewed The American Journal of Managed Care® (AJMC®) explored predictive models, opioid prescribing, and much more.

Implementing ePROs Is the Lift Worth Taking, Basch Says

December 21st 2023

Implementing ePROs Is the Lift Worth Taking, Basch Says

Coverage from The US Oncology Network Payer Transformation Summit, held September 27-29, 2023, in Atlanta, Georgia.

Miriam Atkins, MD, president of Community Oncology Alliance, during a video interview on blue AJMC background

December 21st 2023

COA’s Dr Miriam Atkins: APMs Can’t Be One Size Fits All

Maggie L. Shaw Laura Joszt, MA

A one-size-fits-all approach to alternative payment models (APMs) often isn’t very fair to community practices, said Miriam Atkins, MD, FACP, president of the Community Oncology Alliance.

AJMC SAP seal

December 21st 2023

Paying for Cancer Care Differently: A Look Into the Future

Coverage from The US Oncology Network Payer Transformation Summit, held September 27-29, 2023, in Atlanta, Georgia.

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