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Volume 17, Issue 9, October 2020 - First Report Managed Care

Featured Article

What Primary Care Needs to Survive and Thrive
10/23/2020
Mary Beth Nierengarten
Recent strains on primary care, including the COVID-19 pandemic, have inspired many practicing clinicians, administrators, and payers to examine its sustainability, reimbursement, and develop solutions to save practices.
Recent strains on primary care, including the COVID-19 pandemic, have inspired many practicing clinicians, administrators, and payers to examine its sustainability, reimbursement, and develop solutions to save practices.
Recent strains on primary care,...
10/23/2020
First Report Managed Care

Special Report

First Report
HEOR: Examining the Effectiveness, Costs of Various DLBCL Treatments
10/23/2020
Edan Stanley
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) in the United States, according to the Lymphoma Research Foundation, and worldwide, accounting for about 22% of newly diagnosed cases of B-cell NHL in...
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) in the United States, according to the Lymphoma Research Foundation, and worldwide, accounting for about 22% of newly diagnosed cases of B-cell NHL in...
Diffuse large B-cell lymphoma...
10/23/2020
First Report Managed Care
Literature Review
Regulating the Use of CAR-T Therapy Outside of the Drug Paradigm
10/23/2020
Julie Gould
Currently, chimeric antigen receptor T-cell (CAR-T) therapies are regulated as drugs—often leading to higher prices and barriers to access for patients, as well as financial strains for hospitals. However, in a recent insights article in JAMA...
Currently, chimeric antigen receptor T-cell (CAR-T) therapies are regulated as drugs—often leading to higher prices and barriers to access for patients, as well as financial strains for hospitals. However, in a recent insights article in JAMA...
Currently, chimeric antigen...
10/23/2020
First Report Managed Care
Pharmacy Insight
How to Better Ensure Patients are Aware to Use Pre Tax Funds for OTC Meds, Other Products
10/23/2020
Julie Gould
Marsha Barnes, CEO and founder of The Finance Bar, and Taylor Holgate, Director of Government Affairs at the Consumer Healthcare Products Association, explain why patients are often not familiar with their pre-tax funds and discuss recent...
Marsha Barnes, CEO and founder of The Finance Bar, and Taylor Holgate, Director of Government Affairs at the Consumer Healthcare Products Association, explain why patients are often not familiar with their pre-tax funds and discuss recent...
Marsha Barnes, CEO and founder...
10/23/2020
First Report Managed Care

Department

Veterans Health Today
How Digital Patient Engagement Tools Have Helped Improved Outcomes and Workflows
10/23/2020
Julie Gould
In a recent podcast interview with Veterans Health Today, eVideon’s, Jeff Fallon, CEO, and Spencer Draper, clinical solutions director, and Rocky Mountain Regional VAMC’s, Gregory Crenshaw, veteran experience officer, discuss how the use of...
In a recent podcast interview with Veterans Health Today, eVideon’s, Jeff Fallon, CEO, and Spencer Draper, clinical solutions director, and Rocky Mountain Regional VAMC’s, Gregory Crenshaw, veteran experience officer, discuss how the use of...
In a recent podcast interview...
10/23/2020
First Report Managed Care
News Connection
HIV PrEP Medication Costs US More Than $2 Billion Annually
10/23/2020
Payments for HIV preexposure prophylaxis (PrEP) drugs in the United States totaled more than $2.08 billion in 2018, according to a study published online in the Annals of Internal Medicine.
Payments for HIV preexposure prophylaxis (PrEP) drugs in the United States totaled more than $2.08 billion in 2018, according to a study published online in the Annals of Internal Medicine.
Payments for HIV preexposure...
10/23/2020
First Report Managed Care
News Connection
New UnitedHealthcare Plan Reduces Premiums, Improves Care Coordination
10/23/2020
UnitedHealthcare collaborated with Canopy Health, a physician- and hospital-owned restricted Knox-Keene licensed provider network, to provide consumers with a new health plan focused on improving care coordination and reducing costs.
UnitedHealthcare collaborated with Canopy Health, a physician- and hospital-owned restricted Knox-Keene licensed provider network, to provide consumers with a new health plan focused on improving care coordination and reducing costs.
UnitedHealthcare collaborated...
10/23/2020
First Report Managed Care
News Connection
Examining Racial Differences in Medicare Bundled Payment Joint Replacement Model
10/23/2020
Medicare’s Comprehensive Care for Joint Replacement (CJR) model exists to improve care quality and control spending for older adults needing joint replacement services. Researchers of a study published in JAMA Network Open sought to better...
Medicare’s Comprehensive Care for Joint Replacement (CJR) model exists to improve care quality and control spending for older adults needing joint replacement services. Researchers of a study published in JAMA Network Open sought to better...
Medicare’s Comprehensive Care...
10/23/2020
First Report Managed Care
News Connection
ACA-Funded Medicaid Expansion Increased LTC Use
10/23/2020
According to new research published online in JAMA Network Open, long-term care (LTC) use among newly eligible low-income, middle-aged adults increased following the expansion of Medicaid.
According to new research published online in JAMA Network Open, long-term care (LTC) use among newly eligible low-income, middle-aged adults increased following the expansion of Medicaid.
According to new research...
10/23/2020
First Report Managed Care
News Connection
Analyzing Financial Risk Protections, Insurance Coverage Under ACA
10/23/2020
Since it passed and was implemented 10 years ago, the Patient Protection and Affordable Care Act (ACA) has increased insurance coverage for millions of Americans; however, affordability is still a top concern for consumers and health care...
Since it passed and was implemented 10 years ago, the Patient Protection and Affordable Care Act (ACA) has increased insurance coverage for millions of Americans; however, affordability is still a top concern for consumers and health care...
Since it passed and was...
10/23/2020
First Report Managed Care
News Connection
CMS: ACOs Enrolled in Pathways to Success Program Saved Medicare Billions
10/23/2020
Under the Pathways to Success program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2018, accountable care organizations (ACOs) reported $1.19 billion in net savings to Medicare in 2019.
Under the Pathways to Success program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2018, accountable care organizations (ACOs) reported $1.19 billion in net savings to Medicare in 2019.
Under the Pathways to Success...
10/23/2020
First Report Managed Care

Behind the Bill

Behind the Bill
SCOTUS Takes on the Nondelegation Doctrine: Surprising Reactions and What They Mean for Agency Power
04/02/2025
Katie Hayes, MJ
The Supreme Court recently heard arguments in Federal Communication Commission (FCC) v Consumers’ Research, a case that I covered in February and one that could dramatically reshape federal agency authority through the nondelegation...
The Supreme Court recently heard arguments in Federal Communication Commission (FCC) v Consumers’ Research, a case that I covered in February and one that could dramatically reshape federal agency authority through the nondelegation...
The Supreme Court recently heard...
04/02/2025
First Report Managed Care
Behind the Bill
Dr Oz’s Prescription for Making Medicaid “Viable at Every Level”
03/26/2025
Katie Hayes, MJ
On Tuesday, March 25, 2025, the Senate Finance Committee voted to advance Dr Mehmet Oz in his confirmation as the next head of the Centers for Medicare and Medicaid Services (CMS).1 The full Senate vote is expected “soon” (whatever that...
On Tuesday, March 25, 2025, the Senate Finance Committee voted to advance Dr Mehmet Oz in his confirmation as the next head of the Centers for Medicare and Medicaid Services (CMS).1 The full Senate vote is expected “soon” (whatever that...
On Tuesday, March 25, 2025, the...
03/26/2025
First Report Managed Care
Behind the Bill
The $880 Billion Question Continues: Dr Oz's Confirmation and the Future of Medicaid
03/19/2025
Katie Hayes, MJ
Last week, I explored the $880 billion question facing Congress—whether lawmakers could achieve their budget goals without cutting Medicaid. This week, that question took center stage as Dr Mehmet Oz, President Trump's nominee to lead the...
Last week, I explored the $880 billion question facing Congress—whether lawmakers could achieve their budget goals without cutting Medicaid. This week, that question took center stage as Dr Mehmet Oz, President Trump's nominee to lead the...
Last week, I explored the $880...
03/19/2025
First Report Managed Care
Behind the Bill
The $880 Billion Question: Can Congress Cut Spending Without Touching Medicaid?
03/12/2025
Katie Hayes, MJ
I’d like to step away from administrative law for a moment to provide a quick update on Medicaid. With news coming from all sides, what does the future of Medicaid actually look like? The House of Representatives narrowly passed a budget...
I’d like to step away from administrative law for a moment to provide a quick update on Medicaid. With news coming from all sides, what does the future of Medicaid actually look like? The House of Representatives narrowly passed a budget...
I’d like to step away from...
03/12/2025
First Report Managed Care
Behind the Bill
RFK Jr’s Public Comment Ban: The Silent Shift in Health Care Rulemaking
03/05/2025
Katie Hayes, MJ
The erosion of administrative law continues, and with it, the dismantling of decades-long precedent. In June, the Supreme Court overturned a 40-year-old doctrine that allowed federal agencies to interpret their own ambiguous statutes. Later...
The erosion of administrative law continues, and with it, the dismantling of decades-long precedent. In June, the Supreme Court overturned a 40-year-old doctrine that allowed federal agencies to interpret their own ambiguous statutes. Later...
The erosion of administrative...
03/05/2025
First Report Managed Care
Behind the Bill
Prevention Over Pills? The First 2 Weeks of Health Care’s New Direction
02/26/2025
Katie Hayes, MJ
The dust has barely settled from Robert F Kennedy Jr’s confirmation as Secretary of Health and Human Services (HHS), but the changes are already coming fast and furious—a key theme of the Trump Administration’s actions within the last several...
The dust has barely settled from Robert F Kennedy Jr’s confirmation as Secretary of Health and Human Services (HHS), but the changes are already coming fast and furious—a key theme of the Trump Administration’s actions within the last several...
The dust has barely settled from...
02/26/2025
First Report Managed Care
Behind the Bill
The Nondelegation Doctrine: The Next Constitutional Showdown (Part 2)
02/19/2025
Katie Hayes, MJ
Last week, I explored the potential revival of the nondelegation doctrine through Federal Communication Commission v Consumers’ Research. Today, I want to examine what this could mean for health care regulation by considering the parallels...
Last week, I explored the potential revival of the nondelegation doctrine through Federal Communication Commission v Consumers’ Research. Today, I want to examine what this could mean for health care regulation by considering the parallels...
Last week, I explored the...
02/19/2025
First Report Managed Care
Behind the Bill
The Nondelegation Doctrine: The Next Constitutional Showdown (Part 1)
02/12/2025
Katie Hayes, MJ
Just when you thought the dust had settled from the Chevron decision, the Supreme Court is gearing up to hear arguments in Federal Communications Commission v Consumers' Research next month, potentially reviving the long-dormant nondelegation...
Just when you thought the dust had settled from the Chevron decision, the Supreme Court is gearing up to hear arguments in Federal Communications Commission v Consumers' Research next month, potentially reviving the long-dormant nondelegation...
Just when you thought the dust...
02/12/2025
First Report Managed Care
Behind the Bill
No, President Trump Did Not Actually Sign an Executive Order That Would Increase Drug Costs for Beneficiaries
02/05/2025
Katie Hayes, MJ
On inauguration day, President Trump issued an executive order rescinding several Biden-era health care initiatives, including 3 experimental drug pricing models developed by the Center for Medicare and Medicaid Innovation (CMMI). Oh boy did...
On inauguration day, President Trump issued an executive order rescinding several Biden-era health care initiatives, including 3 experimental drug pricing models developed by the Center for Medicare and Medicaid Innovation (CMMI). Oh boy did...
On inauguration day, President...
02/05/2025
First Report Managed Care
Behind the Bill
Robert F. Kennedy Jr’s Confirmation and the Unexpected Turn in the Drug Pricing Debate
01/29/2025
Katie Hayes, MJ
The Plot Thickens in Drug Pricing Drama Just when you thought the drug pricing debate couldn't get more interesting, Robert F. Kennedy Jr adds an unexpected twist. During closed-door Senate meetings, President Trump’s US Department of...
The Plot Thickens in Drug Pricing Drama Just when you thought the drug pricing debate couldn't get more interesting, Robert F. Kennedy Jr adds an unexpected twist. During closed-door Senate meetings, President Trump’s US Department of...
The Plot Thickens in Drug...
01/29/2025
First Report Managed Care

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Trending Articles

Elizabeth Brem University of California Irvine
Videos
Analyzing Patient Selection and the Utility of CNS Prophylaxis for Patients With DLBCL
04/20/2023
In a debate at the 2023 Great Debates & Updates in Hematologic Malignancies conference in New York, New York, Elizabeth A. Brem, MD, analyzed the role of central nervous system prophylaxis for patients with DLBCL.
In a debate at the 2023 Great Debates & Updates in Hematologic Malignancies conference in New York, New York, Elizabeth A. Brem, MD, analyzed the role of central nervous system prophylaxis for patients with DLBCL.
In a debate at the 2023 Great...
04/20/2023
Oncology
News
Thousands Face Medicaid Coverage Disruptions in South Dakota and North Carolina
05/18/2023
Arielle Zionts
Now that the public health emergency has expired, individuals may lose coverage but then requalify several months later in states which have recently approved Medicaid expansion.
Now that the public health emergency has expired, individuals may lose coverage but then requalify several months later in states which have recently approved Medicaid expansion.
Now that the public health...
05/18/2023
First Report Managed Care
News
Digital Therapeutics "Viable Solution" for Mental Health Needs
06/07/2023
Jolynn Tumolo
“The participants were willing to utilize digital therapeutics if available, and even preferred this type of support compared to actually visiting a clinic,” researchers wrote.
“The participants were willing to utilize digital therapeutics if available, and even preferred this type of support compared to actually visiting a clinic,” researchers wrote.
“The participants were willing...
06/07/2023
First Report Managed Care
News
First Gene Therapy for Severe Hemophilia A Is Approved
06/29/2023
Amanda Balbi
This approval comes after a safety and effectiveness trial showed that the treatment improved participants’ annualized bleeding rate after 3 years.
This approval comes after a safety and effectiveness trial showed that the treatment improved participants’ annualized bleeding rate after 3 years.
This approval comes after a...
06/29/2023
First Report Managed Care
Stock image of a doctor holding a phone
Commentary
Prescription Digital Therapeutics: Ongoing Efforts to Expand Awareness, Integrate Into Clinical Practice
07/28/2023
Yvette C. Terrie, BS Pharm, RPh
Yvette Terrie shares digital therapeutic updates regarding FDA approvals, recent and upcoming clinical trials, and current industry regulations.
Yvette Terrie shares digital therapeutic updates regarding FDA approvals, recent and upcoming clinical trials, and current industry regulations.
Yvette Terrie shares digital...
07/28/2023
First Report Managed Care

October 2020 Volume 17 Issue 9

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