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Episode 8 - Impact of Payment Reform on Prostate Cancer Treatment
Dr Dunn invites fellow panelists to discuss the role of payment reform in managing prostate cancer. He suggests that better-aligned incentives will allow payers and providers to make better decisions about medications or other treatment options.
“We need to change the payment model to lower the reimbursement for medications, but increase the reimbursement for cognitive services and the other things that our providers do for our members,” Dr Dunn says. He adds that providers need to take some responsibility in sharing the risk with other stakeholders.
Dr Kolodziej responds that while the Affordable Care Act has “charted the course,” many providers may still need convincing about new care models.
“You’re going to be accountable for both the cost and quality of care that you deliver to your prostate cancer patients, and that goes from the moment that you screen them to what you decide is their treatment modality to how you treat their advanced disease… every single step,” he says. “What you’re going to do is going to be under the microscope of your risk-bearing entity and that’s going to be your ACO or integrated delivery system, and talk about a dramatic change in dynamics. We won’t be having this talk. You’ll be having it with them.”
New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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Contributor: For Complex Cases, Continuity in Acute Care Is Necessary
April 23rd 2025For patients with complex needs and social challenges like unstable housing, the hospital has become their de facto medical home—yet each visit is a fragmented restart, without continuity, context, or a clear path forward.
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