- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
What We're Reading: Birth Control Mandate; Value-Based Contracts; and Planned Parenthood Funding
Tom Price Considering Ending Birth Control Mandate
As Republicans move to repeal and replace the Affordable Care Act (ACA), HHS Secretary Tom Price, MD, may be eyeing the ACA’s birth control mandate, reported The Hill. As a congressman, Price opposed the mandate, which requires insurance companies cover free contraception. Reversing the mandate could be as easy as HHS excluding birth control from the list of women’s preventive health services that must be provided with no cost sharing.
Harvard Pilgrim Signs 2 New Pay-for-Performance Contracts
In Massachusetts, Harvard Pilgrim Health Care has signed 2 value-based contracts to pay for expensive drugs. Boston Globe reported that the deals are for Enbrel, a rheumatoid arthritis drug that costs about $45,000 a year, and Forteo, an osteoporosis drug that costs about $29,000 a year. The Enbrel contract is for 2 years and includes 6 criteria, while the Forteo contract allows Harvard Pilgrim to pay less for the drug over time if patients take it for 2 years.
Texas Cannot Cut Medicaid Funding to Planned Parenthood
Texas has become the latest state where an attempt to cut Medicaid funding to Planned Parenthood has been blocked. According to The New York Times, a federal judge temporarily blocked the state’s efforts because of a lack of evidence that Planned Parenthood providers violated medical or ethical standards. The state’s attorney general said Texas will appeal the injunction.
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.
Read More
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.
Listen
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.
Read More
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.
Listen
Integrated CKD Care Model Cuts ED Visits by 30%, Boosts Specialized Treatment
April 21st 2025An analysis of an interdisciplinary care model for managing chronic kidney disease (CKD) shows hospital admissions dropped by 26% and emergency department (ED) visits decreased by 30% after clinic initiation.
Read More
