Reimbursement

Keeping up-to-date on information, whether it is about clinical matters or information systems, is critical to a deliberate learning mindset that is beneficial to health care providers, says Lee A. Norman, MD, MHS, MBA, the senior medical director for Optum Care Kansas City.

The decline followed 3 months of growth from November 2022 to January 2023.

A. Mark Fendrick, MD, co–editor in chief of The American Journal of Managed Care® and director of the V-BID Center at the University of Michigan, discusses how the Braidwood ruling can affect the efficacy of preventive care.

Challenges around data are mostly around data itself, particularly if it is not timely, says Lee A. Norman, MD, MHS, MBA, the senior medical director for Optum Care Kansas City.

Financial toxicity is defined as financial hardship related to cancer and can have major effects on patients’ quality of life

Researchers set out to collect empirical evidence on how a capitated risk-based county plan performs as a viable public option in the Affordable Care Act (ACA) marketplace in California

Nicholas Bagley, JD, of Michigan Law, University of Michigan, explained what the Braidwood v Becerra court case was about and how the ruling affected preventive care across the country.

Using evidence and being open-minded are 2 strategies for providers shifting to new models of delivering care, says Lee A. Norman, MD, MHS, MBA, senior medical director for Optum Care Kansas City.

The Community Oncology Alliance celebrated its 20th year at the Community Oncology Conference held March 23-24, 2023, in Kissimmee, Florida.

Lee A. Norman, MD, MHS, MBA, who spoke at The American Journal of Managed Care®’s Institute for Value-Based Medicine® event on population health March 9, 2023, in Kansas City, Missouri, discusses the shift to value-based care.

Evidence-Based Oncology™ (EBO) spoke with TailorMed's Ian Manners about the financial assistance and consumer protection landscape, and what the cost of cancer care means to patient experience and outcomes.

The CEO of Carolina Blood and Cancer Care Associates discusses challenges with the proposed Enhancing Oncology Model.

Oncologists express concerns about the replacement for the Oncology Care Model; the EOM is set to start July 1, 2023.

Payment models that align financial incentives of payers, providers, and patients can mitigate spending growth in thoughtful ways, but the details of the models matter.

Panelists at the Value-Based Insurance Design Summit discussed ways their organizations are looking to create a better benefit design to promote health equity and address known disparities.

Growing bipartisan awareness of issues with the 340B drug pricing program will hopefully lead to reform, says Nicolas Ferreyros, BA, managing director of policy, advocacy, and communications at the Community Oncology Alliance.

CMS must account for inclusion of COVID years in 2023 ACO REACH benchmarks to avoid unfairly penalizing REACH ACOs.

Dennis Scanlon, PhD, professor of health policy and administration at the Pennsylvania State University, discusses how expanded benefits in a Medicare Advantage plan can sometimes come with more limited provider networks, and how the Office of the Inspector General is identifying problems in these plans.

Dennis Scanlon, PhD, professor of health policy and administration at the Pennsylvania State University, discusses how extra benefit coverage and the choice to shop for plan options are some factors driving Medicare Advantage (MA) program growth.

Using data from 632 primary care practices, the authors show that the CMS Practice Assessment Tool has adequate predictive validity for participation in alternative payment models.

Targeting everyday chronic conditions to rare diseases that require costly, sometimes 1-time treatments, CMS Tuesday announced an intent to test 3 new models in an effort to lower drug prices and widen access to expensive, life-changing therapies for patients in Medicare and Medicaid.

Rates of preventive oral health services among pediatric medical visits in Florida were similar whether visits were paid via Medicaid comprehensive managed care or fee for service.

Dennis Scanlon, PhD, professor of health policy and administration at the Pennsylvania State University, discusses some of the reasoning behind Part D benefits changes in the Inflation Reduction Act (IRA) and the cost questions that remain.

The Biden administration released 2 sets of guidance documents for pharmaceutical manufacturers about how it plans to implement the new Medicare Prescription Drug Inflation Rebate Program as required under the Inflation Reduction Act, and said some beneficiaries could see lower coinsurance for some Part B drugs as soon as April 1.

Drug costs, particularly for immunotherapies, contributed to the rising cost of care during the last 6 months of life for a fee-for-service Medicare beneficiary, according to a recent study.