Michael Kolodziej, MD, suggests that payer concerns about the overall structure of the Oncology Care Model caused CMS to delay its letter of intent deadline. In this segment, the managed care stakeholders discuss why payers may be hesitant to apply for enrollment into the program.
Together, Dr Kolodziej; Brian Kiss, MD; and Ted Okon, MBA, comment that the model has great potential to transform the overall delivery of patient care but is far too prescriptive. Mr Okon remarks that the CMS is attempting to “dictate medicine.” However, he adds that despite these far-reaching recommendations, some practices are simply refusing to change their processes.
A variety of performance-based measures need to be evaluated under the Oncology Care Model, notes Dr Kolodziej. Despite reporting on all these different measures, he suggests that there are additional concerns about whether or not a physician will be reimbursed.
Dr Kolodziej also remarks that the model is structured to eliminate practices that have not demonstrated shared savings after 3 years, even though it supposedly considers savings over a 5-year period. Dr Kolodziej and Mr Okon comment that it is difficult for practices to demonstrate savings and increase income within this relatively short time frame.
Ruxolitinib Cream Shows Long-Term Safety in AD, Potential for PN Treatment
March 8th 2025Two posters presented at the 2025 American Academy of Dermatology Annual Meeting reaffirmed the impact of ruxolitinib cream (Opzelura; Incyte) in atopic dermatitis (AD), while late-breaking research highlighted its potential efficacy in prurigo nodularis (PN).
Read More
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.
Listen
Shaping Dermatology's Future by Increasing Access, Data, and Advocacy
March 7th 2025Thy N. Huynh, MD, FAAD, Bruce A. Brod, MHCI, MD, FAAD, and Melissa Piliang, MD, FAAD, discussed expanding access to pediatric dermatology, dermatology data aggregation, and advocacy for Medicare physician payment reform, respectively.
Read More