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GoodRx, PBMs Hit by Price Fixing Lawsuits

November 5th 2024

Independent pharmacies have filed 3 class action lawsuits against GoodRx Holdings and major pharmacy benefit managers (PBMs).

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The Challenge of Addressing Drug Spend to Drive Down Total Cost of Care in EOM

October 27th 2024

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Pressure on Congress to Reform Medicare Physician Fee Schedule, Prevent Reimbursement Cuts

October 17th 2024

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The Daily Balancing Act of Value-Based Cancer Care

October 14th 2024

Doing Things Differently: Wilfong Moves to Thyme Care
Doing Things Differently: Wilfong Moves to Thyme Care

October 12th 2024

More News

Robin Gelburd JD
May 3rd 2023

Contributor: Telehealth Utilization Fell Nearly 7% Nationally in February 2023

Robin Gelburd, JD
The decline followed 3 months of growth from November 2022 to January 2023.
Mark Fendrick
May 1st 2023

Dr Mark Fendrick Talks About Clinical Effects of the Braidwood Ruling

Julia Bonavitacola
A. Mark Fendrick, MD, co–editor in chief of The American Journal of Managed Care® and director of the V-BID Center at the University of Michigan, discusses how the Braidwood ruling can affect the efficacy of preventive care.
Dr Lee Norman
April 30th 2023

Real-Time Data Necessary for Clinical Decision-Making, Says Dr Lee Norman

Allison Inserro
Challenges around data are mostly around data itself, particularly if it is not timely, says Lee A. Norman, MD, MHS, MBA, the senior medical director for Optum Care Kansas City.
Business accounting concept, Business man using calculator with computer laptop, budget and loan paper in office. Business accounting concept, Business man using calculator with computer laptop, budget and loan paper in office: © Jirapong - stock.adobe.com
April 29th 2023

Many Oncology RCTs Do Not Adequately Capture Financial Toxicity

Gianna Melillo
Financial toxicity is defined as financial hardship related to cancer and can have major effects on patients’ quality of life
Businessman using tablet analyzing sales data and economic growth graph chart. Business strategy. Abstract icon. Digital marketing: © ipopba - stock.adobe.com
April 27th 2023

County-Based Insurance Option Linked With Reduced ACA Premium Growth

Gianna Melillo
Researchers set out to collect empirical evidence on how a capitated risk-based county plan performs as a viable public option in the Affordable Care Act (ACA) marketplace in California
Nicholas Bagley
April 24th 2023

Nicholas Bagley Speaks About Braidwood v Becerra Background, Implications

Julia Bonavitacola
Nicholas Bagley, JD, of Michigan Law, University of Michigan, explained what the Braidwood v Becerra court case was about and how the ruling affected preventive care across the country.
Lee Norman MD
April 23rd 2023

Dr Lee Norman on the Role of Providers When Adopting New Care Models

Allison Inserro
Using evidence and being open-minded are 2 strategies for providers shifting to new models of delivering care, says Lee A. Norman, MD, MHS, MBA, senior medical director for Optum Care Kansas City.
Coverage From the 2023 COA Community Oncology Conference
April 18th 2023

Coverage From the 2023 COA Community Oncology Conference

Mary Caffrey
The Community Oncology Alliance celebrated its 20th year at the Community Oncology Conference held March 23-24, 2023, in Kissimmee, Florida.
Dr Lee Norman on What to Consider in Value-Based Care Implementation
April 18th 2023

Dr Lee Norman on What to Consider in Value-Based Care Implementation

Allison Inserro
Lee A. Norman, MD, MHS, MBA, who spoke at The American Journal of Managed Care®’s Institute for Value-Based Medicine® event on population health March 9, 2023, in Kansas City, Missouri, discusses the shift to value-based care.
TailorMed’s Manners: Addressing Financial Concerns in Cancer Care Improves Overall Patient Experience
April 17th 2023

TailorMed’s Manners: Addressing Financial Concerns in Cancer Care Improves Overall Patient Experience

Interview by Mary Caffrey
Evidence-Based Oncology™ (EBO) spoke with TailorMed's Ian Manners about the financial assistance and consumer protection landscape, and what the cost of cancer care means to patient experience and outcomes.
EBO logo
April 17th 2023

EOM Payments Are Not Sufficient to Achieve Health Equity Goals

Kashyap Patel, MD
The CEO of Carolina Blood and Cancer Care Associates discusses challenges with the proposed Enhancing Oncology Model.
Amid Concerns, Will Practices Take Part in the Enhancing Oncology Model?
April 17th 2023

Amid Concerns, Will Practices Take Part in the Enhancing Oncology Model?

Mary Caffrey
Oncologists express concerns about the replacement for the Oncology Care Model; the EOM is set to start July 1, 2023.
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April 10th 2023

Population Turnover and Leakage in Commercial ACOs

Nicole M. Benson, MD, MBI Mary Price, MA Christine Vogeli, PhD Maryann M. Vienneau, BS Mallika L. Mendu, MD, MBA Amy Flaster, MD, MBA Lisa Balentine, BASc Lindsay Jubelt, MD, MS Gregg S. Meyer, MD, MSc John Hsu, MD, MBA, MSCE
Payment models that align financial incentives of payers, providers, and patients can mitigate spending growth in thoughtful ways, but the details of the models matter.
insurance coverage depicted through health care services under an umbrella
March 22nd 2023

Building Better Equity-Based Benefit Designs

Laura Joszt, MA
Panelists at the Value-Based Insurance Design Summit discussed ways their organizations are looking to create a better benefit design to promote health equity and address known disparities.
Nicolas Ferreyros, BA, managing director, The Community Oncology Alliance
March 22nd 2023

Nicolas Ferreyros: There Is Growing Recognition the 340B Program Is "Out of Control"

Pearl Steinzor
Growing bipartisan awareness of issues with the 340B drug pricing program will hopefully lead to reform, says Nicolas Ferreyros, BA, managing director of policy, advocacy, and communications at the Community Oncology Alliance.
stethoscope on money
March 21st 2023

Contributor: COVID-19’s Impact on ACO REACH Deserves CMS' Attention

David Pittman, BS Samuel Johnmeyer
CMS must account for inclusion of COVID years in 2023 ACO REACH benchmarks to avoid unfairly penalizing REACH ACOs.
Dr Dennis Scanlon Smiling
February 26th 2023

Dr Dennis Scanlon Discusses What to Be Aware of as Medicare Advantage Programs Grow

Justina Petrullo
Dennis Scanlon, PhD, professor of health policy and administration at the Pennsylvania State University, discusses how expanded benefits in a Medicare Advantage plan can sometimes come with more limited provider networks, and how the Office of the Inspector General is identifying problems in these plans.
Shifting From OCM to EOM: What Stays and What Goes?
February 23rd 2023

Shifting From OCM to EOM: What Stays and What Goes?

Hayden E. Klein
Dr Dennis Scanlon Says More MA Options, Benefits Significantly Reshape Medicare
February 22nd 2023

Dr Dennis Scanlon Says More MA Options, Benefits Significantly Reshape Medicare

Justina Petrullo
Dennis Scanlon, PhD, professor of health policy and administration at the Pennsylvania State University, discusses how extra benefit coverage and the choice to shop for plan options are some factors driving Medicare Advantage (MA) program growth.
State Legislatures Lead the Way on Policy Reform to Protect Personalized Medicine
February 22nd 2023

State Legislatures Lead the Way on Policy Reform to Protect Personalized Medicine

Angela Storseth-Cooper Lalan Wilfong, MD
The Role of Specialty Pharmacies in Improving Prescription Drug Access and Affordability for Consumers
February 22nd 2023

The Role of Specialty Pharmacies in Improving Prescription Drug Access and Affordability for Consumers

Sergio Santiviago, JD Jeanette Thornton, MPA
Fireside Chat: Data, Champions, and Culture Are Keys to Driving Value-Based Care
February 21st 2023

Fireside Chat: Data, Champions, and Culture Are Keys to Driving Value-Based Care

Mary Caffrey
Value-Based Care Asks: Are We Being Kind to Our Patients?
February 21st 2023

Value-Based Care Asks: Are We Being Kind to Our Patients?

Maggie L. Shaw
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February 15th 2023

CMS Practice Assessment Tool Validity for Alternative Payment Models

Malaz A. Boustani, MD, MPH Anthony J. Perkins, MS Mary L. Davis-Ajami, PhD, MBA, MS, FNP-C, RN Kosali I. Simon, PhD Chiang-Hua Chang, PhD Craig A. Solid, PhD Patrick O. Monahan, PhD
Using data from 632 primary care practices, the authors show that the CMS Practice Assessment Tool has adequate predictive validity for participation in alternative payment models.
money clip
February 14th 2023

CMS Outlines 3 New Drug Pricing Models Targeting Wide Scope of Therapies

Allison Inserro
Targeting everyday chronic conditions to rare diseases that require costly, sometimes 1-time treatments, CMS Tuesday announced an intent to test 3 new models in an effort to lower drug prices and widen access to expensive, life-changing therapies for patients in Medicare and Medicaid.
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February 13th 2023

Pediatric Oral Health Services in Medicaid Managed Care and Fee for Service

Annie Yu-An Chen, DDS, MS Isaac M. Opper, PhD Andrew W. Dick, PhD Bradley D. Stein, MD, PhD Ashley M. Kranz, PhD
Rates of preventive oral health services among pediatric medical visits in Florida were similar whether visits were paid via Medicaid comprehensive managed care or fee for service.
Dennis Scanlon, PhD, Professor of Health Policy and Administration, Penn State University
February 12th 2023

Dr Dennis Scanlon Discusses IRA Part D Changes Intended to Expand Access

Justina Petrullo
Dennis Scanlon, PhD, professor of health policy and administration at the Pennsylvania State University, discusses some of the reasoning behind Part D benefits changes in the Inflation Reduction Act (IRA) and the cost questions that remain.
picture of stethoscope on money
February 10th 2023

CMS Releases Guidance on the Math Behind Part B, Part D Drug Rebates

Allison Inserro
The Biden administration released 2 sets of guidance documents for pharmaceutical manufacturers about how it plans to implement the new Medicare Prescription Drug Inflation Rebate Program as required under the Inflation Reduction Act, and said some beneficiaries could see lower coinsurance for some Part B drugs as soon as April 1.
Cancer care costs at the end of life
February 7th 2023

Examining Trends in Outpatient Cancer Costs in Medicare During Last 6 Months of Life

Allison Inserro
Drug costs, particularly for immunotherapies, contributed to the rising cost of care during the last 6 months of life for a fee-for-service Medicare beneficiary, according to a recent study.
Mitch Perry, Senior Vice President, Chief Financial Officer, Blue Cross Blue Shield North Carolina
February 5th 2023

Contributor: For Better or Worse, Inflation Isn’t New to Health Insurers

Mitch Perry
In this column, a health insurance executive discusses 2 ways to address rising inflation, including moving past the traditional fee-for-service payment model.
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