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Medicare Topic Center

The Latest

Commentary
Payer-Provider Synergy: Aligning at the Fulcrum Points
08/05/2024
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration...
08/05/2024
First Report Managed Care
Brian Esterly Headshot
Interview
Insights on the 2024 Medicare Physician Fee Schedule: Implications and Opportunities for Virtual Care Management Services
07/26/2024
The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed virtual care management (VCM) services to underserved populations. Learn more about the potential implications of these fee...
The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed virtual care management (VCM) services to underserved populations. Learn more about the potential implications of these fee...
The current Medicare Physician...
07/26/2024
First Report Managed Care
Blog
The Clash Over Medicare: Key Lawsuits Challenging the IRA’s Drug Negotiation Provisions
07/11/2024
The IRA has spawned a series of lawsuits from pharmaceutical companies. Here, we provide the latest status updates on several of them.
The IRA has spawned a series of lawsuits from pharmaceutical companies. Here, we provide the latest status updates on several of them.
The IRA has spawned a series of...
07/11/2024
First Report Managed Care
Alison Lum Headshot
Interview
Transforming Pharmacy Care and Drug Payment Models: Expert Insights From Asembia 2024
06/06/2024
Alison Lum, PharmD, Vice President of Pharmacy Services at Blue Shield of California
In this interview, Alison Lum, PharmD, vice president of Pharmacy Services at Blue Shield, discussed the panel she moderated at Asembia 2024 and delved into drug payment options' challenges, including the limitations of copay cards and the...
In this interview, Alison Lum, PharmD, vice president of Pharmacy Services at Blue Shield, discussed the panel she moderated at Asembia 2024 and delved into drug payment options' challenges, including the limitations of copay cards and the...
In this interview, Alison Lum,...
06/06/2024
First Report Managed Care
News
Analysis Shows Proposed CMS ‘Best Price’ Rule May Increase Rebate Liability, Impacting Medicaid
04/26/2024
A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...
A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...
A proposed rule from Centers for...
04/26/2024
First Report Managed Care
Christie Headshot
Commentary
How Medicare Advantage Plans Can Prepare for the CMS Health Equity Index
02/13/2024
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare...
02/13/2024
First Report Managed Care
Calum Yacoubian Headshot
Interview
Navigating Medicare Advantage Risk Adjustment Plan Changes
01/09/2024
Learn about significant changes in the Medicare Advantage Risk Adjustment model (transitioning from version 24 to 28) for payers and providers and the importance of accurate coding and the use of technologies like AI and natural language...
Learn about significant changes in the Medicare Advantage Risk Adjustment model (transitioning from version 24 to 28) for payers and providers and the importance of accurate coding and the use of technologies like AI and natural language...
Learn about significant changes...
01/09/2024
First Report Managed Care
Gould and Henry
Interview
Understanding the Implications of Medicare Advantage Growth
11/30/2023
Learn about the growth of Medicare Advantage and its impact on the health care industry. Michael Gould and Cindy Henry discuss the popularity of Medicare Advantage plans, the potential effects of new regulations, and the importance of strong...
Learn about the growth of Medicare Advantage and its impact on the health care industry. Michael Gould and Cindy Henry discuss the popularity of Medicare Advantage plans, the potential effects of new regulations, and the importance of strong...
Learn about the growth of...
11/30/2023
First Report Managed Care

Newsfeed

Commentary
Payer-Provider Synergy: Aligning at the Fulcrum Points
08/05/2024
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration...
08/05/2024
First Report Managed Care
Brian Esterly Headshot
Interview
Insights on the 2024 Medicare Physician Fee Schedule: Implications and Opportunities for Virtual Care Management Services
07/26/2024
The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed virtual care management (VCM) services to underserved populations. Learn more about the potential implications of these fee...
The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed virtual care management (VCM) services to underserved populations. Learn more about the potential implications of these fee...
The current Medicare Physician...
07/26/2024
First Report Managed Care
Alison Lum Headshot
Interview
Transforming Pharmacy Care and Drug Payment Models: Expert Insights From Asembia 2024
06/06/2024
Alison Lum, PharmD, Vice President of Pharmacy Services at Blue Shield of California
In this interview, Alison Lum, PharmD, vice president of Pharmacy Services at Blue Shield, discussed the panel she moderated at Asembia 2024 and delved into drug payment options' challenges, including the limitations of copay cards and the...
In this interview, Alison Lum, PharmD, vice president of Pharmacy Services at Blue Shield, discussed the panel she moderated at Asembia 2024 and delved into drug payment options' challenges, including the limitations of copay cards and the...
In this interview, Alison Lum,...
06/06/2024
First Report Managed Care
News
Analysis Shows Proposed CMS ‘Best Price’ Rule May Increase Rebate Liability, Impacting Medicaid
04/26/2024
A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...
A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...
A proposed rule from Centers for...
04/26/2024
First Report Managed Care
Christie Headshot
Commentary
How Medicare Advantage Plans Can Prepare for the CMS Health Equity Index
02/13/2024
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare...
02/13/2024
First Report Managed Care
Calum Yacoubian Headshot
Interview
Navigating Medicare Advantage Risk Adjustment Plan Changes
01/09/2024
Learn about significant changes in the Medicare Advantage Risk Adjustment model (transitioning from version 24 to 28) for payers and providers and the importance of accurate coding and the use of technologies like AI and natural language...
Learn about significant changes in the Medicare Advantage Risk Adjustment model (transitioning from version 24 to 28) for payers and providers and the importance of accurate coding and the use of technologies like AI and natural language...
Learn about significant changes...
01/09/2024
First Report Managed Care
Gould and Henry
Interview
Understanding the Implications of Medicare Advantage Growth
11/30/2023
Learn about the growth of Medicare Advantage and its impact on the health care industry. Michael Gould and Cindy Henry discuss the popularity of Medicare Advantage plans, the potential effects of new regulations, and the importance of strong...
Learn about the growth of Medicare Advantage and its impact on the health care industry. Michael Gould and Cindy Henry discuss the popularity of Medicare Advantage plans, the potential effects of new regulations, and the importance of strong...
Learn about the growth of...
11/30/2023
First Report Managed Care
News
Assessment of Individual Risk for Epilepsy After CVT Using the DIAS3 Score
11/20/2024
The DIAS3 score, developed and validated using data from over 2200 patients, is a simple clinical tool that predicts the risk of post-CVT epilepsy within 1 and 3 years, showing promise for personalized treatment and decision-making.
The DIAS3 score, developed and validated using data from over 2200 patients, is a simple clinical tool that predicts the risk of post-CVT epilepsy within 1 and 3 years, showing promise for personalized treatment and decision-making.
The DIAS3 score, developed and...
11/20/2024
First Report Managed Care
Ed
Podcasts
Improving Adherence With Long-Acting Antiretroviral Therapy for HIV
11/15/2024
Join our in-depth discussion about the challenges of HIV treatment, the importance of adherence to antiretroviral therapy, and how long-acting ART can improve treatment outcomes.
Join our in-depth discussion about the challenges of HIV treatment, the importance of adherence to antiretroviral therapy, and how long-acting ART can improve treatment outcomes.
Join our in-depth discussion...
11/15/2024
First Report Managed Care
Videos
Bridging the Gaps in Prior Authorization: Challenges, Solutions, and Collaboration for Better Patient Care
11/13/2024
David Sand, MD, MBA, chief medical officer at ZeOmega, discusses the challenges of prior authorization, emphasizing the need for transparency, evidence-based standards, collaboration between payers and providers, and the potential for...
David Sand, MD, MBA, chief medical officer at ZeOmega, discusses the challenges of prior authorization, emphasizing the need for transparency, evidence-based standards, collaboration between payers and providers, and the potential for...
David Sand, MD, MBA, chief...
11/13/2024
First Report Managed Care
News
Using Deep Learning to Measure MS-Specific Brain Damage Beyond Aging
11/11/2024
A new study published in Neurology aimed to differentiate age-related brain changes from multiple sclerosis (MS)-specific neurodegeneration using MRI.
A new study published in Neurology aimed to differentiate age-related brain changes from multiple sclerosis (MS)-specific neurodegeneration using MRI.
A new study published in...
11/11/2024
First Report Managed Care
News
Adverse Event Data Suggest Selective β1-blockers Pose Asthma Risk
11/11/2024
The risks of asthma and asthma-like adverse events appear to be higher with selective β1-blockers than with nonselective blockers and α- and β-blockers.
The risks of asthma and asthma-like adverse events appear to be higher with selective β1-blockers than with nonselective blockers and α- and β-blockers.
The risks of asthma and...
11/11/2024
First Report Managed Care
News
RNAi Therapies Offer New Hope for Patients With Hereditary Transthyretin Amyloidosis
11/08/2024
RNA interference (RNAi)-based treatments for hereditary transthyretin amyloidosis (ATTR) have shown remarkable promise, offering new hope for patients with this rare but devastating genetic disorder.
RNA interference (RNAi)-based treatments for hereditary transthyretin amyloidosis (ATTR) have shown remarkable promise, offering new hope for patients with this rare but devastating genetic disorder.
RNA interference (RNAi)-based...
11/08/2024
First Report Managed Care
News
Revolutionary Single-Dose Gene Therapy Offers New Hope for Adults with Hemophilia B
11/08/2024
A groundbreaking gene therapy for hemophilia B has shown remarkable success in reducing bleeding episodes and improving the quality of life for adult patients, according to a recent international phase III clinical trial.
A groundbreaking gene therapy for hemophilia B has shown remarkable success in reducing bleeding episodes and improving the quality of life for adult patients, according to a recent international phase III clinical trial.
A groundbreaking gene therapy...
11/08/2024
First Report Managed Care
Jason Oswald Headshot
Commentary
The Impact of AI on Health Carrier Underwriting: Insights From Industry Experts
11/08/2024
"As AI continues to evolve, its integration into group health underwriting offers carriers new opportunities to enhance decision-making, streamline operations, and improve overall plan performance," said Jason Oswald, Director of Solution...
"As AI continues to evolve, its integration into group health underwriting offers carriers new opportunities to enhance decision-making, streamline operations, and improve overall plan performance," said Jason Oswald, Director of Solution...
"As AI continues to evolve, its...
11/08/2024
First Report Managed Care
News
Real-World Evidence Supports Efficacy and Safety of Selexipag in Patients With Pulmonary Arterial Hypertension
11/07/2024
Real-world data shows selexipag effectively improves functional class and risk category outcomes in patients with pulmonary arterial hypertension, regardless of maintenance dose.
Real-world data shows selexipag effectively improves functional class and risk category outcomes in patients with pulmonary arterial hypertension, regardless of maintenance dose.
Real-world data shows selexipag...
11/07/2024
First Report Managed Care
News
Clinical Predictors of One-Year Seizure Freedom After SLAH
11/06/2024
A study published in Annals of Clinical and Translational Neurology aimed to predict 1-year seizure freedom for patients undergoing stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE) using a set of...
A study published in Annals of Clinical and Translational Neurology aimed to predict 1-year seizure freedom for patients undergoing stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE) using a set of...
A study published in Annals of...
11/06/2024
First Report Managed Care

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