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Analysis of the Oncology Care Model
Bruce Feinberg, DO; Scott Gottlieb, MD; and Ted Okon, MBA, discuss the recent establishment of the Oncology Care Model by the CMS and compare its structure with the Community Oncology Alliance’s Oncology Medical Home model.
Mr Okon describes how the Oncology Care Model is similar to the Oncology Medical Home model. He explains that under both, the reimbursement structure involves care coordination fees and performance-based fees based on key measures. But while the Oncology Care Model seems enticing in theory, notes Dr Feinberg, there are some concerns about it.
Mr Okon explains that when this new model was developed, certain stakeholders did not have the opportunity to share their concerns, and not all feedback was taken into account. Furthermore, he notes, there are too many performance measures under this new model. “We don’t need all of those measures,” he says.
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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Eliminating Enhanced PTCs Would Have Cascading Economic Impacts, Report Estimates
March 6th 2025Enhanced premium tax credits (PTCs) have made marketplace health insurance more affordable, and eliminating them could have sweeping impacts on consumers and the health care industry, according to a new report.
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Facilitators of and Barriers to Medicaid Investment in Electronic Consultation Services
March 5th 2025In this qualitative investigation, leaders of Medicaid managed care plans were interviewed to identify facilitators of and barriers to electronic consultation for specialty care delivery.
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