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

close up of money
November 2nd 2022

Medicare Fee Schedule Expands Access to Some Services but Cuts Physician Reimbursement 4.5%

Laura Joszt, MA
The 2023 Physician Fee Schedule final rule was released and swiftly drew condemnations from physician leaders because of a 4.5% cut to reimbursement.
Dr Joseph Alvarnas Explains Cancer Care Equity Act for Medi-Cal Beneficiaries
October 29th 2022

Dr Joseph Alvarnas Explains Cancer Care Equity Act for Medi-Cal Beneficiaries

Matthew Gavidia
Joseph Alvarnas, MD, vice president of government affairs at City of Hope and chief clinical adviser of AccessHope in Duarte, California, discusses the recently passed Cancer Care Equity Act in California that provides access to clinical trials and advanced care for Medi-Cal beneficiaries.
Redesigning Benefits, Value-Based Agreements With Better Cancer Care in Mind
October 29th 2022

Redesigning Benefits, Value-Based Agreements With Better Cancer Care in Mind

Mary Caffrey
The quest to deliver better cancer care—with better outcomes and patient experience—is not a one-size-fits-all journey, as seen in panels during the Community Oncology Alliance (COA) Payer Exchange Summit, held in Tyson’s Corner, Virginia.
California Takes a Step Toward Bringing Equity in Cancer Care
October 22nd 2022

California Takes a Step Toward Bringing Equity in Cancer Care

Joseph Alvarnas, MD
The new law will expand access for Medi-Cal patients who receive a complex cancer diagnosis and represents a critical first step in fulfilling the promise of the California Cancer Patients Bill of Rights, a resolution adopted by the legislature in 2021.
Minnesota Oncology Leaders, Partners Find Value in Putting Patients First
October 21st 2022

Minnesota Oncology Leaders, Partners Find Value in Putting Patients First

Mary Caffrey
Coverage from the Minnesota meeting of the Institute for Value-Based Medicine, chaired by Rajini Katipamula-Malisetti, MD, vice president of medical oncology at Minnesota Oncology.
Wither the RO Model: Focusing on Access to Spread the Value of Radiation Therapy
October 20th 2022

Wither the RO Model: Focusing on Access to Spread the Value of Radiation Therapy

Anne Hubbard, MBA
insurance
October 14th 2022

AMA Report Evaluates PBM Competition and Vertical Integration With Insurers

Laura Joszt, MA
While a majority of national lives are covered by vertically integrated insurers, the proportion varies widely at the state level from as low as 6% to as high as 97% of covered lives, according to a new American Medical Association (AMA) report about competition in the pharmacy benefit manager (PBM) sector and insurance.
Glenn Balasky, Rocky Mountain Cancer Centers
October 12th 2022

Glenn Balasky Highlights Continued Value-Based Oncology Care Efforts With Private Payers

Laura Joszt, MA
Even though there is a 1-year gap between the Oncology Care Model and the Enhancing Oncology Model, there remain value-based oncology payment programs with private payers, said Glenn Balasky, executive director of Rocky Mountain Cancer Centers.
image of stethoscope on bills
October 6th 2022

Prior Authorization Can Work in MA but Not Without Changes, Researchers Say

Pearl Steinzor
In a recent opinion published in JAMA, health policy researchers reviewed the advantages and disadvantages of prior authorization in Medicare Advantage (MA) to identify key areas that need improvement.
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October 4th 2022

Turnover Among New Medicare Advantage Enrollees May Be Greater Than Perceived

Jeffrey Dong, MD Alan M. Zaslavsky, PhD John Z. Ayanian, MD, MPP Bruce E. Landon, MD, MBA
Enrollees who join Medicare Advantage undergo significant turnover in the years following enrollment.
All 14 OneOncology Practices Apply for EOM
October 3rd 2022

All 14 OneOncology Practices Apply for EOM

AJMC Staff
The Enhancing Oncology Model (EOM) will be the successor to the Oncology Care Model.
Stephen M. Schleicher, MD, MBA, chief medical officer, Tennessee Oncology
October 2nd 2022

Dr Stephen Schleicher: Culture, People, Analytics Contributed to OCM Success

Maggie L. Shaw Mary Caffrey
Co-hosted by Memorial Sloan Kettering Cancer Center, the most recent Institute for Value-Based Medicine® event took place on September 22, with a focus on improving cancer care delivery through innovation.
Elderly woman sitting
September 28th 2022

Alzheimer Disease Drug Lecanemab Successfully Reduces Cognitive, Functional Decline

Laura Joszt, MA
The topline results showed the phase 3 trial met both the primary endpoint and all secondary endpoints.
Ted Okon, MBA
August 10th 2022

Ted Okon Explains the Narrow SCOTUS Ruling on 340B Reimbursements

Laura Joszt, MA
The ruling by the Supreme Court on 340B reimbursements was narrow, but it sets up a future reimbursement reduction by HHS that is even greater based on survey data, said Ted Okon, MBA, executive director, Community Oncology Alliance.
Conference Coverage: ACCC 2022 AMCCBS
April 14th 2022

Conference Coverage: ACCC 2022 AMCCBS

Mary Caffrey
Coverage from the Association of Community Cancer Centers 2022 Annual Meeting and Cancer Center Business Summit, held in Washington, DC, March 2-4.
Alvarnas
August 18th 2021

From the Editor-in-Chief: Shiny New Objects Within a Struggling System

Joseph Alvarnas, MD
"No matter where you go, there you are." Buckaroo Banzai
The Impact of Reinsurance of Gene Therapies on Employer Financial Risk
April 22nd 2021

The Impact of Reinsurance of Gene Therapies on Employer Financial Risk

Marc Hixson, MBA Neil B. Minkoff, MD Kim Gwiazdzinski, MBA, RPh Jim Clement, MHA
stethoscope on a pack of rolled bills, with an American flag backdrop.
March 25th 2021

Report Documents Grim Current Status and Future of US Hospitals

Gianna Melillo
Survey responses of 320 US hospitals highlight the dire consequences of the COVID-19 pandemic on facilities and point to a future of ongoing financial and staffing challenges.
Sachin Kamal-Bahl, PhD; and Bryan Luce, PhD, MBA
February 16th 2021

Contributor: A Practical Path Forward to More Patient-Centered Value Assessment

Sachin Kamal-Bahl, PhD Bryan Luce, PhD, MBA
To ensure that value assessment accounts for patient needs, we need a better understanding of the outcomes that are most important to patients, write authors from COVIA Health Solutions and the University of Washington School of Pharmacy.
Experts Issue Recommendations for Improving Health Care, Costs in 2021
February 1st 2021

Experts Issue Recommendations for Improving Health Care, Costs in 2021

Gianna Melillo
With the ongoing coronavirus disease 2019 pandemic, a rising number of uninsured Americans, and a new Democratic president and Senate majority, 2021 is shaping up to be a dynamic year for health care policy.
Jason Rose
January 24th 2021

Contributor: Implementing Pharmacy-Led Telehealth Strategies to Help Medicare Advantage SNPs Improve Care for Older Adults Amid COVID-19 and Beyond

Jason Z. Rose, MHSA
Pharmacy-led telehealth strategies will position Special Needs Plans (SNPs) for Star Ratings success during the pandemic and for years to come.
Amy Ellis, Northwest Medical Specialties
January 20th 2021

Amy Ellis Discusses Choosing Between Multiple Oncology APMs

With so many different oncology alternative payment models (APMs) available, choosing the right ones to participate in might simply mean finding which ones already align with what a practice is doing, said Amy Ellis, chief quality officer at Northwest Medical Specialties.
Payer Implications on Reforms to Price Transparency
January 17th 2021

Payer Implications on Reforms to Price Transparency

Amid recent reforms on price transparency by CMS and the Trump administration, payers' workloads will substantially increase with notable challenges that include having to maintain accurate prices and the impact of exposed negotiated rates.
Multiple Factors Hinder Uptake of Monoclonal Antibody Therapeutics for COVID-19
January 14th 2021

Multiple Factors Hinder Uptake of Monoclonal Antibody Therapeutics for COVID-19

Gianna Melillo
The US Surgeon General, Vice Admiral Jerome Adams, MD, and other officials urged for greater uptake of FDA-approved treatments for coronavirus disease 2019 (COVID-19) in an effort to slow the surge of cases requiring hospitalization. However, logistic, monetary, and efficacy concerns may have drastically limited the amount of biologic treatments actually administered to patients.
Picture of insulin
January 13th 2021

Endocrine Society Calls for Negotiated Insulin Prices in Medicare

Allison Inserro
The statement is aimed at drug companies, policymakers, pharmacy benefit managers, employers, and others, and calls to attention soaring insulin costs, which were the subject of several Congressional hearings in 2019.
Barbara McAneny, MD
January 11th 2021

Dr Barbara McAneny Voices Concern for the Future of Payment Reform

Mary Caffrey
Barbara McAneny, MD, founding partner of New Mexico Oncology Hematology Consultants, discusses why putting risk on oncologists is not the way to fix cost issues in cancer care.
Email being delivered
January 6th 2021

What We’re Reading: Pediatric Mental Health; Study on Cognitive Decline, COVID-19 Link; UnitedHealth to Acquire Change Healthcare

AJMC Staff
The coronavirus disease 2019 (COVID-19) pandemic disrupted many mental health services for children; a study on the long-term effects of COVID-19 will soon kick off; a $13-billion deal has been struck for UnitedHealth to buy Change Healthcare.
Sibel Blau, MD, Northwest Medical Specialties, Quality Cancer Care Alliance
January 5th 2021

Dr Sibel Blau Highlights Reimbursement Concerns in Oncology

The economics of cancer care remain a major concern as practices try to figure out how to deal with the cost of providing cancer care, said Sibel Blau, MD, medical oncologist, Northwest Medical Specialties, and president and CEO, Quality Cancer Care Alliance (QCCA).
Barbara McAneny, MD
December 29th 2020

Dr Barbara McAneny on the Pitfalls of Bundled Payment Plans

Mary Caffrey
Barbara McAneny, MD, CEO of New Mexico Oncology Hematology Consultants, gives her insight on the potential pitfalls of bundled payment plans in oncology and how they could potentially work.
Basit Chaudhry, MD, PhD, Tuple Health
December 26th 2020

Dr Basit Chaudhry: Commercial Payers Are Expected to Start Aligning More With Medicare

There is a lot of variation among commercial payers, but broadly speaking they are expected to start moving to adopt what Medicare does, said Basit Chaudhry, MD, PhD, founder of Tuple Health.
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