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Medicare Topic Center

The Latest

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
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
Blog
The Clash Over Medicare: Key Lawsuits Challenging the IRA’s Drug Negotiation Provisions
07/11/2024
The IRA has spawned a series of lawsuits from pharmaceutical companies. Here, we provide the latest status updates on several of them.
The IRA has spawned a series of lawsuits from pharmaceutical companies. Here, we provide the latest status updates on several of them.
The IRA has spawned a series of...
07/11/2024
First Report Managed Care
Alison Lum Headshot
Interview
Transforming Pharmacy Care and Drug Payment Models: Expert Insights From Asembia 2024
06/06/2024
Alison Lum, PharmD, Vice President of Pharmacy Services at Blue Shield of California
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
News
Analysis Shows Proposed CMS ‘Best Price’ Rule May Increase Rebate Liability, Impacting Medicaid
04/26/2024
Dean Celia
A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...
A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...
A proposed rule from Centers for...
04/26/2024
First Report Managed Care
Christie Headshot
Commentary
How Medicare Advantage Plans Can Prepare for the CMS Health Equity Index
02/13/2024

Christie Teigland, PhD, VP of Research Science and Advanced Analytics, Inovalon

Christie Teigland, PhD, VP of Researc...
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare...
02/13/2024
First Report Managed Care
Calum Yacoubian Headshot
Interview
Navigating Medicare Advantage Risk Adjustment Plan Changes
01/09/2024

Featuring Calum Yacoubian, MD, director of NLP Healthcare Strategy at IQVIA 

Featuring Calum Yacoubian, MD, direct...
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

Featuring Michael Gould, Associate Vice President of Interoperability Strategy at ZeOmega, and Cindy Henry, PMP, Director of Population Health Informatics at ZeOmega 

Featuring Michael Gould, Associate Vi...
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

Newsfeed

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
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
Alison Lum, PharmD, Vice President of Pharmacy Services at Blue Shield of California
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
News
Analysis Shows Proposed CMS ‘Best Price’ Rule May Increase Rebate Liability, Impacting Medicaid
04/26/2024
Dean Celia
A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...
A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...
A proposed rule from Centers for...
04/26/2024
First Report Managed Care
Christie Headshot
Commentary
How Medicare Advantage Plans Can Prepare for the CMS Health Equity Index
02/13/2024

Christie Teigland, PhD, VP of Research Science and Advanced Analytics, Inovalon

Christie Teigland, PhD, VP of Researc...
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare...
02/13/2024
First Report Managed Care
Calum Yacoubian Headshot
Interview
Navigating Medicare Advantage Risk Adjustment Plan Changes
01/09/2024

Featuring Calum Yacoubian, MD, director of NLP Healthcare Strategy at IQVIA 

Featuring Calum Yacoubian, MD, direct...
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

Featuring Michael Gould, Associate Vice President of Interoperability Strategy at ZeOmega, and Cindy Henry, PMP, Director of Population Health Informatics at ZeOmega 

Featuring Michael Gould, Associate Vi...
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
News
AHA Voices Concern Over CMS Payment Updates to LTC Hospitals
08/07/2024
The American Hospital Association (AHA) expressed deep concern in response to long-term care (LTC) hospital payment updates finalized by the Centers for Medicare & Medicaid (CMS) on August 1, 2024.
The American Hospital Association (AHA) expressed deep concern in response to long-term care (LTC) hospital payment updates finalized by the Centers for Medicare & Medicaid (CMS) on August 1, 2024.
The American Hospital...
08/07/2024
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
News
Obesity Linked to Distinct Heart Muscle Abnormalities in Patients With HFpEF, Study Finds
08/05/2024
A recent study published in Nature Cardiovascular Research highlighted the significant impact of severe obesity on myocardial ultrastructure in patients with heart failure with preserved ejection fraction (HFpEF), revealing potential...
A recent study published in Nature Cardiovascular Research highlighted the significant impact of severe obesity on myocardial ultrastructure in patients with heart failure with preserved ejection fraction (HFpEF), revealing potential...
A recent study published in...
08/05/2024
First Report Managed Care
News
New Treatment Options Benefit Patients With Relapsed/Refractory Follicular Lymphoma
08/05/2024
Patients with relapsed/refractory follicular lymphoma tend to have a poorer response and shortened progression-free survival with each subsequent treatment, but new treatment options are emerging.
Patients with relapsed/refractory follicular lymphoma tend to have a poorer response and shortened progression-free survival with each subsequent treatment, but new treatment options are emerging.
Patients with...
08/05/2024
First Report Managed Care
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
O & S
Interview
The Impact of Labor Shortages on Long-Term Care and Homecare
07/31/2024
Guest experts weigh in on the ongoing issue of labor shortages in the health care homecare industry as well as solutions for maintaining a robust, engaged, and well-trained workforce.
Guest experts weigh in on the ongoing issue of labor shortages in the health care homecare industry as well as solutions for maintaining a robust, engaged, and well-trained workforce.
Guest experts weigh in on the...
07/31/2024
First Report Managed Care
Gavin Magaha
Interview
Strategies for Managing Duplicate Discounts Under the 340B Drug Discount Program
07/31/2024
Discover insights from an industry expert on 340B policy and compliance as they delve into industry trends, potential reforms, and the future of drug discount programs in the health care landscape.
Discover insights from an industry expert on 340B policy and compliance as they delve into industry trends, potential reforms, and the future of drug discount programs in the health care landscape.
Discover insights from an...
07/31/2024
First Report Managed Care
News
Sun Exposure Linked With Lower Risk of Follicular Lymphoma
07/30/2024
High sun exposure in warmer months may protect against the development of follicular lymphoma, according to a study published in the journal Cancer Epidemiology, Biomarkers & Prevention.
High sun exposure in warmer months may protect against the development of follicular lymphoma, according to a study published in the journal Cancer Epidemiology, Biomarkers & Prevention.
High sun exposure in warmer...
07/30/2024
First Report Managed Care
News
Updated CDC Recommendation for RSV Vaccination in Older Adults
07/29/2024
The Center for Disease Control and Prevention (CDC) vaccine advisory group updated its recommendation for the use of the respiratory syncytial virus (RSV) vaccine in older adults so that people ages 60 to 74 with certain underlying conditions...
The Center for Disease Control and Prevention (CDC) vaccine advisory group updated its recommendation for the use of the respiratory syncytial virus (RSV) vaccine in older adults so that people ages 60 to 74 with certain underlying conditions...
The Center for Disease Control...
07/29/2024
First Report Managed Care
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

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