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Commentary
Want to Engage Health Plan Members? First, Build Trust
03/27/2025
Chandra Y. Osborn, PhD, MPH
Trust in health plans is critically low—especially among those in poor health—but by leading with empathy, removing barriers to care, and using data-driven, personalized strategies rooted in behavioral science, plans can rebuild trust,...
Trust in health plans is critically low—especially among those in poor health—but by leading with empathy, removing barriers to care, and using data-driven, personalized strategies rooted in behavioral science, plans can rebuild trust,...
Trust in health plans is...
03/27/2025
First Report Managed Care
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Commentary
Improving Value-Based Care With Contract Lifecycle Management
03/20/2025
Tom Cowen
Effective value-based contracts require clear definitions, structured data, and automation through contract lifecycle management (CLM) solutions to streamline negotiation, ensure transparency, and adapt to evolving health care policies and...
Effective value-based contracts require clear definitions, structured data, and automation through contract lifecycle management (CLM) solutions to streamline negotiation, ensure transparency, and adapt to evolving health care policies and...
Effective value-based contracts...
03/20/2025
First Report Managed Care
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Commentary
Equitable Health Care in 2025: Experts Share a Vision for Inclusive and Accessible Care
01/23/2025
Experts weigh in on how advancements in AI, smart technology, and innovative care models will drive equitable health care in 2025 by improving access, reducing disparities, and enhancing patient outcomes across underserved populations.
Experts weigh in on how advancements in AI, smart technology, and innovative care models will drive equitable health care in 2025 by improving access, reducing disparities, and enhancing patient outcomes across underserved populations.
Experts weigh in on how...
01/23/2025
First Report Managed Care
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Commentary
How to Maximize the Value of GLP-1 Drugs While Improving Health Equity
01/14/2025
Julie Schulz, MD, MPH; Michael Dovidio, PharmD
GLP-1 drugs present significant financial and health equity challenges, offering transformative benefits for obesity and cardiometabolic disorders while requiring data-driven strategies for cost-effective and equitable access.
GLP-1 drugs present significant financial and health equity challenges, offering transformative benefits for obesity and cardiometabolic disorders while requiring data-driven strategies for cost-effective and equitable access.
GLP-1 drugs present significant...
01/14/2025
First Report Managed Care
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Commentary
How Health Systems Can Meet the Expanding Needs of Specialty Pharmacies
01/03/2025
Health systems must adapt to the growing demand for specialty pharmacies by scaling services, embracing technology, and collaborating with experts to improve patient outcomes, reduce administrative burdens, and navigate regulatory challenges.
Health systems must adapt to the growing demand for specialty pharmacies by scaling services, embracing technology, and collaborating with experts to improve patient outcomes, reduce administrative burdens, and navigate regulatory challenges.
Health systems must adapt to the...
01/03/2025
First Report Managed Care
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Commentary
2024 Trends and 2025 Predictions: Insights From Health Care Leaders on Advancing Medicare, AI Solutions, and Clinical Data Utilization
12/27/2024
In this exclusive commentary for First Report Managed Care, health experts and business leaders explore how advancements in Medicare Advantage, ambient intelligence, generative AI, cybersecurity, risk adjustment, precision oncology, and AI...
In this exclusive commentary for First Report Managed Care, health experts and business leaders explore how advancements in Medicare Advantage, ambient intelligence, generative AI, cybersecurity, risk adjustment, precision oncology, and AI...
In this exclusive commentary for...
12/27/2024
First Report Managed Care
Commentary
Navigating the Decline of Medicare Advantage Star Ratings in 2025: Six Need-to-Knows
11/25/2024
Cindy Henry
The 2025 Medicare Advantage Star Ratings present a new landscape for MA plans, with fewer achieving high ratings due to changes in methodology, utilization patterns, ongoing litigation, and potential impacts of recent election outcomes. Learn...
The 2025 Medicare Advantage Star Ratings present a new landscape for MA plans, with fewer achieving high ratings due to changes in methodology, utilization patterns, ongoing litigation, and potential impacts of recent election outcomes. Learn...
The 2025 Medicare Advantage Star...
11/25/2024
First Report Managed Care
Jason Oswald Headshot
Commentary
The Impact of AI on Health Carrier Underwriting: Insights From Industry Experts
11/08/2024
"As AI continues to evolve, its integration into group health underwriting offers carriers new opportunities to enhance decision-making, streamline operations, and improve overall plan performance," said Jason Oswald, Director of Solution...
"As AI continues to evolve, its integration into group health underwriting offers carriers new opportunities to enhance decision-making, streamline operations, and improve overall plan performance," said Jason Oswald, Director of Solution...
"As AI continues to evolve, its...
11/08/2024
First Report Managed Care
Hawley Headshot
Commentary
Beyond Medical Cost Savings: Optimizing Payment Integrity Value
10/31/2024
Health plan leaders increasingly recognize the value of utilizing technology as a counteroffensive against high medical loss ratios, which are now close to 90% in the large group market. As the industry is poised to face the same pressures in...
Health plan leaders increasingly recognize the value of utilizing technology as a counteroffensive against high medical loss ratios, which are now close to 90% in the large group market. As the industry is poised to face the same pressures in...
Health plan leaders increasingly...
10/31/2024
First Report Managed Care
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Commentary
Transforming Health Care Payer Operations With AI
10/11/2024
Milosz (Milo) Wicinski
Health plans today face mounting pressure to enhance member engagement while improving health outcomes and control rising costs. As health care inflation continues to outpace general inflation across the United States, health plans are...
Health plans today face mounting pressure to enhance member engagement while improving health outcomes and control rising costs. As health care inflation continues to outpace general inflation across the United States, health plans are...
Health plans today face mounting...
10/11/2024
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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