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April 2018 - FRMC

Column

Viewpoint
Understanding Changes to the Medicare Advantage 2019 Risk Adjustment Model
05/07/2018

By Jay Baker, Senior Vice President, Quality and Risk Adjustment Solutions, Advantmed, LLC

By Jay Baker, Senior Vice President, ...
In this Viewpoint, Jay Baker, Senior Vice President, Quality and Risk Adjustment Solutions, Advantmed, LLC, discusses the significant and complex proposed changes to the Medicare Advantage model which will require health plans to make...
In this Viewpoint, Jay Baker, Senior Vice President, Quality and Risk Adjustment Solutions, Advantmed, LLC, discusses the significant and complex proposed changes to the Medicare Advantage model which will require health plans to make...
In this Viewpoint, Jay Baker,...
05/07/2018
First Report Managed Care

Department

News Connection
Ex-VA Secretary Shulkin Leaves With Scathing Comments on Privatization
05/07/2018
After David Shulkin, MD, was abruptly fired by President Donald Trump, he claimed he was pushed out of the Department of Veterans Affairs (VA) by political opponents who saw him as a obstacle to expanding privatization of care at the Agency.
After David Shulkin, MD, was abruptly fired by President Donald Trump, he claimed he was pushed out of the Department of Veterans Affairs (VA) by political opponents who saw him as a obstacle to expanding privatization of care at the Agency.
After David Shulkin, MD, was...
05/07/2018
First Report Managed Care
News Connection
CVS, Aetna Deal Could Cause Antitrust Issues
05/07/2018
A recent report released by the American Antitrust Institute (AAI) alerted the Department of Justice (DOJ) that the proposed merger of CVS and Aetna would hurt consumers and the health care industry.
A recent report released by the American Antitrust Institute (AAI) alerted the Department of Justice (DOJ) that the proposed merger of CVS and Aetna would hurt consumers and the health care industry.
A recent report released by the...
05/07/2018
First Report Managed Care
News Connection
Jardiance Trials Expand With New Exercise Capacity and Heart Failure Trials
05/07/2018
Boehringer Ingelheim and Eli Lilly recently announced that they plan to expand trials of Jardiance (empagliflozin; Boehringer Ingelheim/Eli Lilly) to study impact on exercise ability and heart failure symptoms. 
Boehringer Ingelheim and Eli Lilly recently announced that they plan to expand trials of Jardiance (empagliflozin; Boehringer Ingelheim/Eli Lilly) to study impact on exercise ability and heart failure symptoms. 
Boehringer Ingelheim and Eli...
05/07/2018
First Report Managed Care
News Connection
Genome Sequencing Does Not Increase Downstream Health Care Costs
05/07/2018
A recent study in Genetics in Medicine found that genome sequencing in healthy patients and cardiology patients did not increase downstream health care costs.
A recent study in Genetics in Medicine found that genome sequencing in healthy patients and cardiology patients did not increase downstream health care costs.
A recent study in Genetics in...
05/07/2018
First Report Managed Care
Department
Outcomes-Based Pricing for PCSK9 Inhibitors Does Not Reduce Costs
05/07/2018
Recent research in the Annals of Internal Medicine found that outcomes-based contracting for expensive PCSK9 inhibitors did not reduce drug costs or improve cost-effectiveness of the drug.
Recent research in the Annals of Internal Medicine found that outcomes-based contracting for expensive PCSK9 inhibitors did not reduce drug costs or improve cost-effectiveness of the drug.
Recent research in the Annals of...
05/07/2018
First Report Managed Care
An Inside Look at the Prior Authorization Process
05/07/2018

Dean Celia

Dean Celia
A case in California involving an Aetna medical director who denied treatment without looking at patient records recently caused a stir in the media. We spoke with our experts to review best practices, how to involve nurses and specialists in...
A case in California involving an Aetna medical director who denied treatment without looking at patient records recently caused a stir in the media. We spoke with our experts to review best practices, how to involve nurses and specialists in...
A case in California involving...
05/07/2018
First Report Managed Care

News

Newsfeed
NCQA Weighs In On Prior Authorization
04/21/2018
The National Committee for Quality Assurance (NCQA) president Margaret O’Kane recently discussed Aetna's prior authorization denials process which is currently being investigated by at least four states.
The National Committee for Quality Assurance (NCQA) president Margaret O’Kane recently discussed Aetna's prior authorization denials process which is currently being investigated by at least four states.
The National Committee for...
04/21/2018
First Report Managed Care
News
How New HHS Policies Could Exacerbate Social Determinants of Health
04/11/2018

Paul Nicolaus

Paul Nicolaus
As the Trump Administration takes measures to broaden the moral and religious rights of health care professionals, critics say these moves may exacerbate existing social determinants of health among LGBT patients.
As the Trump Administration takes measures to broaden the moral and religious rights of health care professionals, critics say these moves may exacerbate existing social determinants of health among LGBT patients.
As the Trump Administration...
04/11/2018
First Report Managed Care
News
Law of the Land? States Attempt At Circumventing the ACA
04/02/2018

Mary Beth Nierengarten

Mary Beth Nierengarten
A number of states have recently launched a range of attacks on the ACA, from offering plans that don’t meet its requirements to challenging its constitutionality.
A number of states have recently launched a range of attacks on the ACA, from offering plans that don’t meet its requirements to challenging its constitutionality.
A number of states have recently...
04/02/2018
First Report Managed Care

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Literature Review: Opioid-Induced Constipation
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These studies focus on the causes, consequences, and management of opioid-induced constipation.
These studies focus on the causes, consequences, and management of opioid-induced constipation.
These studies focus on the...
03/16/2015
First Report Managed Care
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First Report Managed Care
News
FDA Approves Denosumab for New Indication
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The FDA approved denosumab for the treatment of hypercalcemia of malignancy refractory to bisphosphonate therapy.
The FDA approved denosumab for the treatment of hypercalcemia of malignancy refractory to bisphosphonate therapy.
The FDA approved denosumab for...
12/10/2014
First Report Managed Care
News
CMS Announces Voluntary Bundled Payment Model
01/10/2018
The CMS recently announced the launch of a new voluntary bundled payment model that will cover multiple specialties and care services.
The CMS recently announced the launch of a new voluntary bundled payment model that will cover multiple specialties and care services.
The CMS recently announced the...
01/10/2018
First Report Managed Care

Video Insights

Hayward
Videos
Evolving Health Care Contact Centers Into Drivers of Value-Based Care
07/31/2024
Discover how health care contact centers can transform into drivers of value-based care through AI, automation, upskilling agents, and rethinking workflows and metrics to improve patient outcomes and population health.
Discover how health care contact centers can transform into drivers of value-based care through AI, automation, upskilling agents, and rethinking workflows and metrics to improve patient outcomes and population health.
Discover how health care contact...
07/31/2024
First Report Managed Care
Lucille Accetta Headshot
Videos
Enhancing Patient Medication Adherence: Insights and Strategies From Asembia 2024
06/11/2024
Lucille Accetta, PharmD, MBA, MSPH, Senior Vice President of CVS Specialty Operations
Key stakeholders in the health care industry gathered to discuss prevalent topics at this year's Asembia annual summit. Medication adherence emerged as one of the most talked-about issues. In a session led by Lucille Accetta, PharmD, MBA,...
Key stakeholders in the health care industry gathered to discuss prevalent topics at this year's Asembia annual summit. Medication adherence emerged as one of the most talked-about issues. In a session led by Lucille Accetta, PharmD, MBA,...
Key stakeholders in the health...
06/11/2024
First Report Managed Care
Melissa Andel, Principal, CommonHealth Solutions, LLC
Videos
Navigating the Impact of the Inflation Reduction Act: Implications for Payers, Patients, and Manufacturers
05/24/2024
Melissa Andel, Principal, CommonHealth Solutions, LLC
Learn about the impacts of the Inflation Reduction Act on payers and patients, highlighting the changes in Medicare benefits and drug coverage coming in 2025 and 2026.
Learn about the impacts of the Inflation Reduction Act on payers and patients, highlighting the changes in Medicare benefits and drug coverage coming in 2025 and 2026.
Learn about the impacts of the...
05/24/2024
First Report Managed Care
Joe DePinto Headshot
Videos
Navigating Payment Models in the CGT Landscape: Insights and Innovations
05/21/2024
Joe DePinto, Head of Cell, Gene, and Advanced Therapies, McKesson
An expert discusses the evolution and challenges of payment models in the cell and gene therapy (CGT) space reviewed during his session at Asembia 2024.
An expert discusses the evolution and challenges of payment models in the cell and gene therapy (CGT) space reviewed during his session at Asembia 2024.
An expert discusses the...
05/21/2024
First Report Managed Care
Jennifer L. Mathieu Senior Vice President, Professional and Government Affairs at AMCP
Videos
Unlocking the Future of Managed Care Pharmacy: A Deep Dive into Federal Legislation and Regulations
05/15/2024
Jennifer L. Mathieu Senior Vice President, Professional and Government Affairs, AMCP
Learn about developments in federal legislation and regulations within the pharmacy landscape shaping the future of managed care in an interview with a session presenter from AMCP 2024.
Learn about developments in federal legislation and regulations within the pharmacy landscape shaping the future of managed care in an interview with a session presenter from AMCP 2024.
Learn about developments in...
05/15/2024
First Report Managed Care
Tejaswi Kompala
Videos
Personalizing Weight Loss Management With GLP-1 Agonists
04/05/2024

Featuring Tejaswi Kompala, MD, head of cardiometabolic clinical strategy, Teladoc 

Featuring Tejaswi Kompala, MD, head o...
Delve into the rising demand for anti-obesity medications, the complexities of obesity management, and the importance of personalized approaches in improving cardiometabolic health in this insightful interview.
Delve into the rising demand for anti-obesity medications, the complexities of obesity management, and the importance of personalized approaches in improving cardiometabolic health in this insightful interview.
Delve into the rising demand for...
04/05/2024
First Report Managed Care
Zaubler Headshot
Videos
Integrating Behavioral Health Services to Reduce ED Visits: Substance Use Disorder and Social Determinants of Health
03/27/2024

Featuring Tom Zaubler, MD, MPH, CMO at NeuroFlow

Featuring Tom Zaubler, MD, MPH, CMO a...
Join us for the continuation of an engaging two-part series showcasing an expert dedicated to reducing emergency department visits through the integration of behavioral health practices. Dr Zaubler will share invaluable insights into...
Join us for the continuation of an engaging two-part series showcasing an expert dedicated to reducing emergency department visits through the integration of behavioral health practices. Dr Zaubler will share invaluable insights into...
Join us for the continuation of...
03/27/2024
First Report Managed Care
Zaubler Headshot
Videos
Integrating Behavioral Health Services to Reduce ED Visits: Suicide Prevention and Preemptive Primary Care
03/25/2024

Featuring Tom Zaubler, MD, MPH, CMO at NeuroFlow

Featuring Tom Zaubler, MD, MPH, CMO a...
Come join us for the first installment of a captivating two-part series featuring an expert committed to minimizing emergency department visits through the implementation of behavioral health integrations. Dr Zaubler will offer valuable...
Come join us for the first installment of a captivating two-part series featuring an expert committed to minimizing emergency department visits through the implementation of behavioral health integrations. Dr Zaubler will offer valuable...
Come join us for the first...
03/25/2024
First Report Managed Care
Yash Prajapati
Videos
Navigating the Evolution of Digital Solutions in Health Care
02/27/2024

Featuring Yash Prajapati, consultant at ZS Associates 

Featuring Yash Prajapati, consultant ...
Join us in exploring the challenges and opportunities in the development, approval, and integration of digital therapeutic solutions with ZS Associates consultant Yash Prajapati.
Join us in exploring the challenges and opportunities in the development, approval, and integration of digital therapeutic solutions with ZS Associates consultant Yash Prajapati.
Join us in exploring the...
02/27/2024
First Report Managed Care
Mansur Shomali
Videos
Advancements and Challenges in Diabetes Management
02/27/2024

Featuring Mansur Shomali, MD, chief medical officer at Welldoc, endocrinologist at MedStar Health 

Featuring Mansur Shomali, MD, chief m...
Learn about the state of digital therapeutics for disease management such as diabetes care in terms of cost, outcomes, integration, and more with Dr Mansur Shomali, CMO at Welldoc.
Learn about the state of digital therapeutics for disease management such as diabetes care in terms of cost, outcomes, integration, and more with Dr Mansur Shomali, CMO at Welldoc.
Learn about the state of digital...
02/27/2024
First Report Managed Care

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