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Volume 18, Issue 1, January/February 2021 - First Report Managed Care

Featured Article

Cover Story
Online Crowdfunding for Health-Related Expenses Trends Upward
02/12/2021

Dean Celia

Dean Celia
What does this say about the affordability of health care, and are there solutions to minimize reliance on this ubiquitous tool?
What does this say about the affordability of health care, and are there solutions to minimize reliance on this ubiquitous tool?
What does this say about the...
02/12/2021
First Report Managed Care
Feature
Drug Repurposing: Expediting Discovery Through a Novel Algorithmic Framework
02/12/2021

Mary Beth Nierengarten

Mary Beth Nierengarten
As the COVID-19 pandemic continues to stretch the ability and capacity of health care systems—from curbing infection rates, treating severe illness, understanding new variants, to distributing and administering limited vaccine doses—gaps and...
As the COVID-19 pandemic continues to stretch the ability and capacity of health care systems—from curbing infection rates, treating severe illness, understanding new variants, to distributing and administering limited vaccine doses—gaps and...
As the COVID-19 pandemic...
02/12/2021
First Report Managed Care
Literature Review
Examining Lasmiditan for the Acute Treatment of Migraine Compared With Triptans
02/12/2021

Edan Stanley

Edan Stanley
Per the American Migraine foundation, oral and intranasal triptan therapy has proven consistently effective when used to treat migraine earlier in the attack; however, triptan therapy is not effective for all patients with migraine and cannot...
Per the American Migraine foundation, oral and intranasal triptan therapy has proven consistently effective when used to treat migraine earlier in the attack; however, triptan therapy is not effective for all patients with migraine and cannot...
Per the American Migraine...
02/12/2021
First Report Managed Care

Insights

Commentary
Four Health Care Predictions for 2021
02/12/2021

Steve Wigginton, CEO, Icario

Steve Wigginton, CEO, Icario
What should we expect in health care in 2021? Get a jump on the new year with these informed predictions for health plans and members based on what we learned in 2020. As we reflect on an eventful year nobody was expecting, and as we look...
What should we expect in health care in 2021? Get a jump on the new year with these informed predictions for health plans and members based on what we learned in 2020. As we reflect on an eventful year nobody was expecting, and as we look...
What should we expect in health...
02/12/2021
First Report Managed Care
Commentary
The Impact of the Supreme Court’s Pending ACA Decision on Health Plans
02/12/2021

Robin Figueroa, consultant, Freed Associates

Robin Figueroa, consultant, Freed Ass...
On November 10, 2020, the Supreme Court of the United States heard arguments from both sides on California v Texas, which deals with the constitutionality of the 2010 Affordable Care Act (ACA) following the passage of the Tax Cuts and Jobs...
On November 10, 2020, the Supreme Court of the United States heard arguments from both sides on California v Texas, which deals with the constitutionality of the 2010 Affordable Care Act (ACA) following the passage of the Tax Cuts and Jobs...
On November 10, 2020, the...
02/12/2021
First Report Managed Care

Department

News Connection
Amazon Ends Joint Health Care Venture With Berkshire Hathaway, JP Morgan
02/12/2021
Amazon, Berkshire Hathaway, and JPMorgan Chase & Co, announced plans to dissolve their joint health care venture, Haven, a firm launched in January 2018, focused on finding solutions to a range of problematic health care trends.
Amazon, Berkshire Hathaway, and JPMorgan Chase & Co, announced plans to dissolve their joint health care venture, Haven, a firm launched in January 2018, focused on finding solutions to a range of problematic health care trends.
Amazon, Berkshire Hathaway, and...
02/12/2021
First Report Managed Care
News Connection
CMS, Part D Capping Out-of-Pocket Insulin Spend Could Improve Adherence
02/12/2021
The Centers for Medicare & Medicaid Services (CMS) recently launched the Senior Savings Model through Part D, which caps insulin out-of-pocket spend at no more than $35 per month for beneficiaries. Researchers of a recent JAMA Network Open...
The Centers for Medicare & Medicaid Services (CMS) recently launched the Senior Savings Model through Part D, which caps insulin out-of-pocket spend at no more than $35 per month for beneficiaries. Researchers of a recent JAMA Network Open...
The Centers for Medicare &...
02/12/2021
First Report Managed Care
News Connection
Medicare Advantage Plans See Enrollment Boosts During Pandemic
02/12/2021
Survey data collected by MedicareAdvantagePlans.org shows that Medicare Advantage (MA) plans are seeing increased enrollment amid the pandemic.
Survey data collected by MedicareAdvantagePlans.org shows that Medicare Advantage (MA) plans are seeing increased enrollment amid the pandemic.
Survey data collected by...
02/12/2021
First Report Managed Care
News Connection
Aetna, CVS Health Expand Transgender Surgery Coverage Offerings
02/12/2021
Aetna, a CVS Health company, announced recently that it is updating policies to expand coverage offerings of gender-affirming surgery to include breast augmentation for transfeminine beneficiaries.
Aetna, a CVS Health company, announced recently that it is updating policies to expand coverage offerings of gender-affirming surgery to include breast augmentation for transfeminine beneficiaries.
Aetna, a CVS Health company,...
02/12/2021
First Report Managed Care
News Connection
Lower Health Care Costs: Survey Shows Consumers Are Not Optimistic
02/12/2021
Prior to the inauguration of President Biden, West Health and Gallup conducted a survey to better understand how Americans feel about the state of health care and the new administration’s promises of reform, but results show that most...
Prior to the inauguration of President Biden, West Health and Gallup conducted a survey to better understand how Americans feel about the state of health care and the new administration’s promises of reform, but results show that most...
Prior to the inauguration of...
02/12/2021
First Report Managed Care
News Connection
ACA Fee Increase Effect on Primary Care Access for Dual-Eligible Beneficiaries
02/12/2021
In an effort to accommodate potential increases in demand for care under the Affordable Care Act (ACA), a fee bump was implemented in 2013 and 2014, increasing Medicaid payments to Medicare levels for certain services for primary care...
In an effort to accommodate potential increases in demand for care under the Affordable Care Act (ACA), a fee bump was implemented in 2013 and 2014, increasing Medicaid payments to Medicare levels for certain services for primary care...
In an effort to accommodate...
02/12/2021
First Report Managed Care

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FRMC Volume 21, Issue 2

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News
Drug Makers to Justify Costs, Disclose Price Hikes under Proposed California Law
06/28/2016
A recently proposed California law that would require drug makers to justify the costs of their treatments and disclose any major price hikes has invoked strong opposition from the pharmaceutical industry. 
A recently proposed California law that would require drug makers to justify the costs of their treatments and disclose any major price hikes has invoked strong opposition from the pharmaceutical industry. 
A recently proposed California...
06/28/2016
First Report Managed Care
News
Audits Reveal Millions in Medicare Advantage Overcharges
11/21/2022

Fred Schulte and Holly Hacker

Fred Schulte and Holly Hacker, Kaiser...
Newly released federal audits showed Medicare Advantage plans overbilled the government by approximately $12 million.
Newly released federal audits showed Medicare Advantage plans overbilled the government by approximately $12 million.
Newly released federal audits...
11/21/2022
First Report Managed Care
Prostate Cancer Treatments Pose Challenges for Managed Care
11/29/2011

Tim Casey

Tim Casey
Atlanta—With the introduction of several new therapies, the treatment for castration-resistant prostate cancer (CRPC) has gone through a dramatic shift in recent years. By the end of the decade, the market for prostate cancer is expected to...
Atlanta—With the introduction of several new therapies, the treatment for castration-resistant prostate cancer (CRPC) has gone through a dramatic shift in recent years. By the end of the decade, the market for prostate cancer is expected to...
Atlanta—With the introduction of...
11/29/2011
First Report Managed Care
News
As Medicaid Budgets Squeezed, States Consider Eccentric Ideas On Cutting Costs
03/30/2011
03/30/2011
First Report Managed Care
News
Progress Made on How Medicare Pays Doctors
05/10/2012
05/10/2012
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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February 2021 Volume 18 Issue 1

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