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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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