Payers

This article outlines strategies insurers can use to mitigate their risks related to prescription opioid abuse by members, while addressing this serious public health problem.

Health plans are fundamentally transforming the delivery of healthcare for patients by reforming payment models, coordinating care, and partnering with providers.

Dr. Mark Fendrick, MD, Professor of Medicine and Health Management and Policy, Schools of Medicine and Public Health, University of Michigan, Co-Editor-in-Chief, The American Journal of Managed Care, says that there are levers organizations and stakeholders can pull to achieve the goal of improving quality and value in cancer care.

"Oncology is a very emotional area," says Jan Berger, MD, MJ, President & CEO, Health Intelligence Partners, Editor-in-Chief, The American Journal of Pharmacy Benefits.

In this video, Robert Bo Gamble, Director, Strategic Practice Initiatives, Community Oncology Alliance, Washington, DC, says that it is critical for payers and providers to come together in oncology management.

New revenue models in healthcare are causing innovative payer-provider partnerships. John Harris, MBA, spoke about some of these new partnerships and how all stakeholders must consider each other's mindsets when choosing a model that works for them.

Implementing an accountable care organization model can be a rigorous process. With so many stakeholders, it is necessary for all those involved in the process to collaborate and communicate effectively throughout the transition. For these reasons, it is essential for any organization to have the proper leadership in place to ensure a smooth implementation.

Michael E. Chernew, PhD; Lee N. Newcomer, MD, MHA; and Sandra M. Swain, MD; examine the treatment benefits, cost concerns, and insurance coverage strategies for pertuzumab.

Mark Zitter, MBA, CEO of the Zitter Group, states that oncology pathways can standardize the way care is delivered while improving quality and reducing costs.

To improve formulary design processes and support payers in providing more effective healthcare, policy makers should consider involving commercial payers in the development of comparative effectiveness research and creation of research and treatment guidelines.

Comparative effectiveness research and pragmatic clinical trials are valued methods to address the limitations of traditional randomized trials, answer questions of cost-effectiveness or noninferiority, and inform data-driven dialogue and decision making by stakeholders.