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Commentary
Enhancing Provider Experience Through Electronic Prior Authorization
08/13/2024
Each year the American Medical Association (AMA) surveys its membership to ascertain their feedback concerning prior authorizations (PAs) and the impact of this service on their practice. Reliably, AMA members say that PAs are disruptive to...
Each year the American Medical Association (AMA) surveys its membership to ascertain their feedback concerning prior authorizations (PAs) and the impact of this service on their practice. Reliably, AMA members say that PAs are disruptive to...
Each year the American Medical...
08/13/2024
First Report Managed Care
Commentary
Payer-Provider Synergy: Aligning at the Fulcrum Points
08/05/2024
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration...
08/05/2024
First Report Managed Care
Shannon Smith Headshot
Commentary
Adapting to Change: Navigating the New CMS Prior Authorization Guidelines in Health Care
04/02/2024

Shannon Smith, RN, BSN

Shannon Smith, RN, BSN
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry...
04/02/2024
First Report Managed Care
Commentary
Unlocking Health Care Efficiency: CMS Overhauls Prior Authorization in Landmark Interoperability Rule—What Payers Need to Know Now
03/01/2024
Michael Gould
CMS has published the Interoperability and Prior Authorization final rule to drive transformative outcomes in the health care ecosystem, requiring payers and providers to adopt new standards and FHIR APIs to reduce inefficiencies and improve...
CMS has published the Interoperability and Prior Authorization final rule to drive transformative outcomes in the health care ecosystem, requiring payers and providers to adopt new standards and FHIR APIs to reduce inefficiencies and improve...
CMS has published the...
03/01/2024
First Report Managed Care
Headshot of Alina Czekai, Cohere Health
Commentary
New Legislation Moves the Needle on Prior Authorization Reform
10/07/2022
Alina M. Czekai, MPH
Alina Czekai, MPH, vice president of strategic partnerships, Cohere Health, describes how the Improving Seniors' Timely Access to Care Act will benefit payers, providers, and patients if it is signed into law.
Alina Czekai, MPH, vice president of strategic partnerships, Cohere Health, describes how the Improving Seniors' Timely Access to Care Act will benefit payers, providers, and patients if it is signed into law.
Alina Czekai, MPH, vice...
10/07/2022
First Report Managed Care
Headshot of Gina Kim, Cohere Health
Commentary
Addressing Health Inequities With Prior Authorization
09/16/2022
Gina Kim
"There are numerous factors that contribute to health care disparities in our country. The prior authorization process shouldn’t be one of them," writes Gina Kim, chief product officer, Cohere Health.
"There are numerous factors that contribute to health care disparities in our country. The prior authorization process shouldn’t be one of them," writes Gina Kim, chief product officer, Cohere Health.
"There are numerous factors that...
09/16/2022
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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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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