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Brian Esterly Headshot
Interview
Insights on the 2024 Medicare Physician Fee Schedule: Implications and Opportunities for Virtual Care Management Services
07/26/2024
The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed virtual care management (VCM) services to underserved populations. Learn more about the potential implications of these fee...
The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed virtual care management (VCM) services to underserved populations. Learn more about the potential implications of these fee...
The current Medicare Physician...
07/26/2024
First Report Managed Care
Alison Lum Headshot
Interview
Transforming Pharmacy Care and Drug Payment Models: Expert Insights From Asembia 2024
06/06/2024
In this interview, Alison Lum, PharmD, vice president of Pharmacy Services at Blue Shield, discussed the panel she moderated at Asembia 2024 and delved into drug payment options' challenges, including the limitations of copay cards and the...
In this interview, Alison Lum, PharmD, vice president of Pharmacy Services at Blue Shield, discussed the panel she moderated at Asembia 2024 and delved into drug payment options' challenges, including the limitations of copay cards and the...
In this interview, Alison Lum,...
06/06/2024
First Report Managed Care
Calum Yacoubian Headshot
Interview
Navigating Medicare Advantage Risk Adjustment Plan Changes
01/09/2024
Calum Yacoubian, MD
Learn about significant changes in the Medicare Advantage Risk Adjustment model (transitioning from version 24 to 28) for payers and providers and the importance of accurate coding and the use of technologies like AI and natural language...
Learn about significant changes in the Medicare Advantage Risk Adjustment model (transitioning from version 24 to 28) for payers and providers and the importance of accurate coding and the use of technologies like AI and natural language...
Learn about significant changes...
01/09/2024
First Report Managed Care
Gould and Henry
Interview
Understanding the Implications of Medicare Advantage Growth
11/30/2023
Michael Gould; Cindy Henry
Learn about the growth of Medicare Advantage and its impact on the health care industry. Michael Gould and Cindy Henry discuss the popularity of Medicare Advantage plans, the potential effects of new regulations, and the importance of strong...
Learn about the growth of Medicare Advantage and its impact on the health care industry. Michael Gould and Cindy Henry discuss the popularity of Medicare Advantage plans, the potential effects of new regulations, and the importance of strong...
Learn about the growth of...
11/30/2023
First Report Managed Care
Headshot of Enam Noor, Insightin Health
Interview
How Health Plans Can Raise CAHPS Scores for Better Star Ratings
09/01/2022
Maria Asimopoulos
Enam Noor, CEO and founder, Insightin Health, shares advice for health plans to raise CAHPS scores and overall Star Ratings by consolidating data, reorganizing workflows, and improving member experience.
Enam Noor, CEO and founder, Insightin Health, shares advice for health plans to raise CAHPS scores and overall Star Ratings by consolidating data, reorganizing workflows, and improving member experience.
Enam Noor, CEO and founder,...
09/01/2022
First Report Managed Care
Headshot of Siran Koroukian, PhD, Case Western Reserve University
Interview
Cancer Prevalence in Male Medicaid Beneficiaries With HIV
03/29/2022
Maria Asimopoulos
Siran M Koroukian, PhD, professor, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, reviews findings from a cross-sectional study of national Medicaid data aimed at determining...
Siran M Koroukian, PhD, professor, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, reviews findings from a cross-sectional study of national Medicaid data aimed at determining...
Siran M Koroukian, PhD,...
03/29/2022
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

News
Authors Call for Novel, Integrated Approaches in RSV Therapeutic Research
04/27/2023
Jolynn Tumolo
In addition to encouraging increased collaboration between bioinformaticians and pharmacologists, the authors recommended the use of new approaches such as nanotechnology, molecular inhibitors, and more.
In addition to encouraging increased collaboration between bioinformaticians and pharmacologists, the authors recommended the use of new approaches such as nanotechnology, molecular inhibitors, and more.
In addition to encouraging...
04/27/2023
Pharmacy Learning Network
News
Examining the Link Between Emergency Department Use and Insurance Coverage
05/26/2023
Julie Gould
“Although Medicaid expansion has provided increased health care coverage for many previously uninsured patients, prior literature suggests that health care utilization and public spending increase with government insurance coverage,” wrote...
“Although Medicaid expansion has provided increased health care coverage for many previously uninsured patients, prior literature suggests that health care utilization and public spending increase with government insurance coverage,” wrote...
“Although Medicaid expansion has...
05/26/2023
First Report Managed Care
Quiz
RSV Vaccine Eligibility
06/21/2023
What patient demographic can now receive the FDA-approved RSV vaccine Arexvy?
What patient demographic can now receive the FDA-approved RSV vaccine Arexvy?
What patient demographic can now...
06/21/2023
First Report Managed Care
News
Men and Women With MS Perceive Functional Trajectories Differently
07/19/2023
Jolynn Tumolo
“A gap in research about the trajectories of function among men and women aging with functional limitations because of MS hinders ability to plan for future needs,” said researchers. 
“A gap in research about the trajectories of function among men and women aging with functional limitations because of MS hinders ability to plan for future needs,” said researchers. 
“A gap in research about the...
07/19/2023
First Report Managed Care
News
RSV Prefusion F Vaccine Prevents RSV Illness in Older Adults
08/10/2023
Jolynn Tumolo
Recent clinical trial findings indicate that the RSVpreF vaccine demonstrated efficacy in preventing RSV-associated respiratory illnesses in older adults with no significant safety concerns.
Recent clinical trial findings indicate that the RSVpreF vaccine demonstrated efficacy in preventing RSV-associated respiratory illnesses in older adults with no significant safety concerns.
Recent clinical trial findings...
08/10/2023
First Report Managed Care

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