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- Value-Based Care
Episode 14 - Value-Based Care-Can It Work?
Based on her experience, Maria Lopes, MD, MS, explains that many large employers are adopting a value-based healthcare system. She notes that this may be because larger employers are focused on the long-term benefits of prevention and wellness.
Dr Lopes explains that while some employers offer incentives for meeting certain minimum criteria (eg, getting health risk appraisals), others incorporate value-based benefit designs. In some cases, employers punish employees with disincentives, such as increasing the employee share of the premium increases.
Yehuda Handelsman, MD, FACP, FACE, FNLA, explains that as a result of provider- focused pay-for-performance models of care, physicians may try to avoid treating certain higher-risk patient groups. Dr Handelsman explains that if a physician does not believe that an outcome of improvement for a patient or patient group is possible, there is no incentive to manage them. Jeffrey D. Dunn, PharmD, MBA, notes that most pay-for-performance models are incentive based.
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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RFK Jr Claims HHS Has Not Fired Working Scientists, Canceled Lifesaving Research
May 15th 2025Robert F. Kennedy Jr’s congressional hearing featured numerous statements from the secretary of HHS, including denouncing claims of cutting down the HHS and the National Institutes of Health.
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Trump Administration Walks Back Mental Health Parity in Insurance Coverage
May 13th 2025The Trump administration has decided to further debate the federal rule passed during the Biden administration that guaranteed insurance coverage for treatment of mental illness and substance abuse.
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