Reimbursement

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Texas Oncology logo | Image: Texas Oncology
Texas Oncology to Roll Out Canopy for ePROs After Head-to-Head Pilot

March 18th 2025

Debra Patt, MD, PhD, MBA, executive vice president of Public Policy and Strategy for Texas Oncology, said the practice received positive feedback from nurses and patients during a pilot that concluded in February.

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

January 29th 2025

Class action book and gavel | Image credit: Zerbor – stock.adobe.com
GoodRx, PBMs Hit by Price Fixing Lawsuits

November 5th 2024

Screenshot of an interview with Stuart Staggs
The Challenge of Addressing Drug Spend to Drive Down Total Cost of Care in EOM

October 27th 2024

Stethoscope on money | Image credit: utah51 - adobe.stock.com
Pressure on Congress to Reform Medicare Physician Fee Schedule, Prevent Reimbursement Cuts

October 17th 2024

More News

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.
Image of a dollar sign
February 3rd 2023

Inflation Reduction Act Could Cut Medicare Drug Spending by 5%, Study Suggests

Jared Kaltwasser
The bill could have saved CMS about $26.5 billion had it been in place from 2018-2020, the study showed.
Interview with Dennis Scanlon, PhD
February 1st 2023

Dr Dennis Scanlon Discusses the Impact of the COVID-19 Pandemic on Medicaid Coverage

Justina Petrullo
With the public health emergency soon coming to an end, people covered by Medicaid will encounter new barriers, discusses Dennis Scanlon, PhD, professor of health policy and administration, Penn State University.
graphic illustrating costs
January 31st 2023

Canadian Study Shows Greater Alignment Between Clinical Benefit, Cancer Drug Prices

Allison Inserro
In Canada, monthly prices were significantly different for cancer drugs with substantial clinical benefit vs low benefit.
graphic depicting drug costs
January 30th 2023

IRA Insulin Cap Could Have Saved Medicare Beneficiaries Millions in 2020

Skylar Jeremias
An HHS report said that if the Inflation Reduction Act (IRA) had been implemented in 2020, Medicare Part D beneficiaries could have saved a total of $734 million, averaging out to about $500 per member.
ASH Guideline Champions Detail Ways to Improve Quality and Outcomes, Trim Hospitalizations
January 19th 2023

ASH Guideline Champions Detail Ways to Improve Quality and Outcomes, Trim Hospitalizations

Mary Caffrey
Coverage from the 64th American Society of Hematology Annual Meeting and Exposition, held December 10-13, 2022, in New Orleans, Louisiana.
Adding Social Factors to Risk Adjustment Not Enough to Reach Health Equity, Paper Says
January 12th 2023

Adding Social Factors to Risk Adjustment Not Enough to Reach Health Equity, Paper Says

Rose McNulty
To best improve health equity, population-based payment models should both incorporate social goals and increase payment for historically marginalized communities, a recent study has found.
Ken Cohen Interview
January 12th 2023

Dr Ken Cohen Offers Possible Solutions to Reducing Wasteful Health Care

Laura Joszt, MA Justina Petrullo
Creating new incentive models and transparently sharing data in a way that changes behaviors are 2 ways to reduce low-value care in the health care system, explains Ken Cohen, MD, director of translational research for Optum Care.
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January 11th 2023

Associations Between Physician Practice Models and Health Information Exchange

J. Mac McCullough, PhD, MPH Chad Stecher, PhD
A survey of all Arizona physicians found that accountable care organization, clinically integrated network, or integrated delivery network participation was associated with higher use of health information exchange. However, there are exceptions and important barriers noted.
image representing cost cutting
January 11th 2023

HHS Outlines Timeline to Negotiate Medicare Drug Prices

Allison Inserro
The 10 drugs selected for Medicare Part D price negotiation with HHS will be announced on September 1, 2023, HHS said Wednesday.
Mike Koroscik, MBA, MHA, Allina Health
January 6th 2023

Allina Health’s Mike Koroscik on Helping Patients Navigate Cancer-Related Financial Toxicity

Maggie L. Shaw
We want to make it easy for our patients to manage and navigate the financial toxicity they encounter from their cancer care, noted Mike Koroscik, MBA, MHA, vice president of oncology, Allina Health and the Allina Health Cancer Institute.
top 5 content about reimbursement issues 2022
December 30th 2022

Top 5 Most-Viewed Reimbursement Content in 2022

AJMC Staff
The top 5 pieces of content published on AJMC.com relating to reimbursement issues included 2 on the significance of a California law giving Medicare beneficiaries access to expert oncology care; other articles looked at the work involved in value-based care models and CMS news.
Graphic with the words "The Top 5 The American Journal of Accountable Care articles of 2022"
December 26th 2022

Top 5 AJAC Articles for 2022

AJMC Staff
The top content published in The American Journal of Accountable Care® (AJAC) covered redesigning health care, value-based care, and novel payment models, like the ACO REACH model.
Top 5 Most-Read SAP Content of 2022
December 23rd 2022

Top 5 Most-Read SAP Content of 2022

Julia Bonavitacola
The most-read articles related to our Strategic Alliance Partnership (SAP) program focused on behavioral health, oncology care, and partner news.
Sachin Jain, MD, MBA
December 22nd 2022

Dr Sachin Jain on Combining SCAN Group and CareOregon: “We’re Trying to Build a Very Different Kind of Company”

Mary Caffrey
The combined resources of CareOregon and SCAN Group’s health plan and care delivery subsidiaries, operating under the HealthRight umbrella, will have revenues of $6.8 billion and will serve nearly 800,000 health plan members.
EBO logo
December 21st 2022

PBM Fees Put the “GER” in Danger for Specialty Pharmacies

Darrell L. Willyard, PharmD Alexis V. Fanshier, BA
Bo Gamble
December 21st 2022

COA’s Bo Gamble: Slowing Down, but Not Stepping Away From Bringing Quality to Cancer Care

Mary Caffrey
Vineet Arora, MD, MAPP
December 18th 2022

Dr Vineet Arora: Balancing Reimbursement Incentives With What Matters to Clinicians

Christina Mattina
Our current health care reimbursement system rewards procedures and undervalues the time spent talking with patients and learning their history, which speaks to the need for primary care redesign, according to Vineet Arora, MD, MAPP, dean for medical education at UChicago Medicine.
OneOncology logo
December 13th 2022

OneOncology Physician Leadership Conference: Inaugural Meeting 2022

Mary Caffrey
Coverage from the first day of the inaugural OneOncology Physician Leadership Conference, held November 11-13, 2022, in Nashville, Tennessee.
COA Payer Exchange Summit: 2022 Coverage
December 12th 2022

COA Payer Exchange Summit: 2022 Coverage

Mary Caffrey
Coverage from the Community Oncology Alliance Payer Exchange Summit, held in Tyson's Corner, Virginia, October 24-25, 2022.
Pharmacy
December 9th 2022

ICYMI: Notable Topics From the 2022 Asembia Specialty Pharmacy Summit

AJMC Staff
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December 9th 2022

Organizational Capacity Among Hospitals in Medicare and Commercial Bundled Payments

John Urwin, MD Amol S. Navathe, MD, PhD Lingmei Zhou, MS Jay Bhatt, DO Peter D. Kralovec, BA Joshua M. Liao, MD, MSc
A national survey demonstrated differences in organizational capacity between hospitals participating in Medicare bundled payment programs and those coparticipating in both Medicare and commercial bundled payment programs.
Headshot of Terry Wilcox, CEO of Patients Rising
December 8th 2022

Contributor: To Protect Patient Access, Congress Must Block Medicare Physician Payment Cuts

Terry Wilcox
Impending cuts to Medicare physician services could have an overwhelmingly negative impact on millions of older patients and individuals with disabilities across the country.
Young patient recovering from cancer
December 6th 2022

How Public Insurance Creates Barriers for Childhood Cancer Survivors

Celeste Krewson
In a recent study, it was found that individuals with public health insurance had worse health competence beliefs, reducing transition goals, expectations, and beliefs.
Evidence-Based Oncology logo
December 2nd 2022

Breaking New Ground in Episodes of Care, Including CAR T-Cell Therapy

Mary Caffrey
Coverage from the Institute for Value-Based Medicine® session with Astera Cancer Care in Edison, New Jersey, held November 3, 2022.
image of stethoscope on money
November 29th 2022

HDHPs Deter Women From Additional Testing After Abnormal Mammogram, Study Says

AJMC Staff
The groups who told researchers they would be more likely to skip additional testing had lower levels of income or education and were more likely to be on Medicaid or be uninsured, among other factors.
image of stethoscope on US money
November 24th 2022

Survey Illustrates High Receptiveness From Payers to Alternative Payment Models

Justina Petrullo
A survey conducted by the Health Care Payment Learning and Action Network found that “more plans are using incentives in value-based care arrangements to improve health equity.”
image of health insurance form
November 14th 2022

Study Examines Insurance Switching in the Perinatal Period in Massachusetts

AJMC Staff
While those with Medicaid insurance were more likely to have an insurance transition before or after giving birth, those with private insurance were also found to have insurance changes.
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