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August 2016 - FRMC

Department
Underuse of Medicare Annual Wellness Visits Impedes Cognitive Impairment Detection
08/15/2016
Recent research presented at AAIC 2016 in Toronto revealed that underuse of Medicare Annual Wellness Visits (AWV) represents missed opportunities to screen for early signs of cognitive impairment and to promote cognitive health.
Recent research presented at AAIC 2016 in Toronto revealed that underuse of Medicare Annual Wellness Visits (AWV) represents missed opportunities to screen for early signs of cognitive impairment and to promote cognitive health.
Recent research presented at...
08/15/2016
First Report Managed Care
Department
Reducing Use of Antipsychotics While Effectively Treating Behavioral, Psychological Symptoms of Dementia
08/15/2016
New data from the Halting Antipsychotic use in Long Term care project (HALT) showed that it is possible to deliver effective care to patients suffering from the behavioral and psychological symptoms of dementia (BPSD) while also reducing the...
New data from the Halting Antipsychotic use in Long Term care project (HALT) showed that it is possible to deliver effective care to patients suffering from the behavioral and psychological symptoms of dementia (BPSD) while also reducing the...
New data from the Halting...
08/15/2016
First Report Managed Care
Department
Treating Alzheimer’s Linked to Lower Mortality, Health Care Costs
08/15/2016
Patients with Alzheimer’s disease who received treatment had lower health care costs and lower mortality rates when compared with patients with Alzheimer’s disease who did not receive treatment for the condition, according to research...
Patients with Alzheimer’s disease who received treatment had lower health care costs and lower mortality rates when compared with patients with Alzheimer’s disease who did not receive treatment for the condition, according to research...
Patients with Alzheimer’s...
08/15/2016
First Report Managed Care
Drawing Battle Lines: Expansion of Nurse Practitioner Authority Within the VA
08/15/2016
Mary Beth Nierengarten
A newly proposed rule to extend full practice authority to all VA advanced nurse practitioners meets opposition from physician associations. 
A newly proposed rule to extend full practice authority to all VA advanced nurse practitioners meets opposition from physician associations. 
A newly proposed rule to extend...
08/15/2016
First Report Managed Care
The Challenges of Managing Complex Populations Through Public Programs
08/15/2016
Dean Celia
Often, managing complex populations through public programs can be difficult due to things like patient inexperience with the health care system and transience.
Often, managing complex populations through public programs can be difficult due to things like patient inexperience with the health care system and transience.
Often, managing complex...
08/15/2016
First Report Managed Care
News
Debate Over Health Plan-Driven Clinical Pathways Continues
08/15/2016
Dean Celia
While a California bill to restrict payer-driven clinical pathways was defeated, a similar bill was recently proposed in Connecticut, further stoking the debate between whether or not payers should be allowed to have input in the development...
While a California bill to restrict payer-driven clinical pathways was defeated, a similar bill was recently proposed in Connecticut, further stoking the debate between whether or not payers should be allowed to have input in the development...
While a California bill to...
08/15/2016
First Report Managed Care
Market Dominance Puts Some Health Care Organizations Under a Microscope
08/15/2016
Dean Celia
Although UPMC has not been accused of preventing steering, it has been under the microscope in the past. 
Although UPMC has not been accused of preventing steering, it has been under the microscope in the past. 
Although UPMC has not been...
08/15/2016
First Report Managed Care
Managed Care Q&A
Understanding the Complexities of MACRA
08/15/2016
Sean McGuire
An interview with Jeffrey D Clough, MD, assistant professor of medicine, Duke University School of Medicine.
An interview with Jeffrey D Clough, MD, assistant professor of medicine, Duke University School of Medicine.
An interview with Jeffrey D...
08/15/2016
First Report Managed Care
News Connection
HOPE Act Gains Support in House
08/15/2016
The Health Outcomes, Planning, and Education (HOPE) for Alzheimer’s Act, a bill designed to reduce health care costs by reimbursing prompt diagnosis and care planning for Alzheimer’s disease, gained bipartisan support in Congress, according...
The Health Outcomes, Planning, and Education (HOPE) for Alzheimer’s Act, a bill designed to reduce health care costs by reimbursing prompt diagnosis and care planning for Alzheimer’s disease, gained bipartisan support in Congress, according...
The Health Outcomes, Planning,...
08/15/2016
First Report Managed Care
News Connection
CDC Report: Most State Prisons Cover Basic Health Needs
08/15/2016
Recent research in the Centers for Disease Control and Prevention’s (CDC) National Health Statistics Reports found that most US states provide adequate health care within prisons, including mental health care, infectious disease screenings,...
Recent research in the Centers for Disease Control and Prevention’s (CDC) National Health Statistics Reports found that most US states provide adequate health care within prisons, including mental health care, infectious disease screenings,...
Recent research in the Centers...
08/15/2016
First Report Managed Care
News Connection
CMS Approves Arizona’s Return to CHIP
08/15/2016
The state of Arizona is rejoining the Children’s Health Insurance Program (CHIP) after shutting it down in 2009 in response to the recession.
The state of Arizona is rejoining the Children’s Health Insurance Program (CHIP) after shutting it down in 2009 in response to the recession.
The state of Arizona is...
08/15/2016
First Report Managed Care
News Connection
Biosimilar TNF-α Inhibitors Comparable to Their Branded Biologics
08/15/2016
Biosimilar tumor necrosis factor-alpha (TNF-α) inhibitors have very similar safety and effectiveness as their reference biologics, according to a recent systematic review and meta-analysis..
Biosimilar tumor necrosis factor-alpha (TNF-α) inhibitors have very similar safety and effectiveness as their reference biologics, according to a recent systematic review and meta-analysis..
Biosimilar tumor necrosis...
08/15/2016
First Report Managed Care
News Connection
Enhanced Model Looks Beyond Comorbidities to Better Predict Hospitalization Risk
08/15/2016
An enhanced risk prediction model that considers not only chronic comorbidities but also health factors not typically accounted for in other models improved risk prediction for emergency department (ED) use and hospitalization among a group...
An enhanced risk prediction model that considers not only chronic comorbidities but also health factors not typically accounted for in other models improved risk prediction for emergency department (ED) use and hospitalization among a group...
An enhanced risk prediction...
08/15/2016
First Report Managed Care
News
Dataset Produces Different Results on Safety, Effectiveness of Effient vs Plavix
08/15/2016
Safety and effectiveness analyses comparing the antiplatelets Effient and Plavix after percutaneous coronary intervention demonstrated different findings.
Safety and effectiveness analyses comparing the antiplatelets Effient and Plavix after percutaneous coronary intervention demonstrated different findings.
Safety and effectiveness...
08/15/2016
First Report Managed Care
News Connection
CMS Efforts to Prevent Fraud Score Billions in Savings
08/15/2016
A recent report from the CMS shows that efforts to prevent fraudulent and improper payments in Medicare and Medicaid saved billions of dollars.
A recent report from the CMS shows that efforts to prevent fraudulent and improper payments in Medicare and Medicaid saved billions of dollars.
A recent report from the...
08/15/2016
First Report Managed Care
News Connection
Financial Speculation in Drug Development Inflates Costs, Decreases Access to Medicines
08/15/2016
Recent research in The BMJ posits that when pharmaceutical companies acquire promising drug compounds through late-stage bidding wars that escalate “development costs,” and then turn around and charge exorbitant prices that primarily benefit...
Recent research in The BMJ posits that when pharmaceutical companies acquire promising drug compounds through late-stage bidding wars that escalate “development costs,” and then turn around and charge exorbitant prices that primarily benefit...
Recent research in The BMJ...
08/15/2016
First Report Managed Care
News Connection
US Physicians Self-Report Rationing Behavior
08/15/2016
Results of a national survey of US physicians conducted to evaluate self-reported rationing behavior showed that more than half of respondents said they participated in behavior consistent with rationing.
Results of a national survey of US physicians conducted to evaluate self-reported rationing behavior showed that more than half of respondents said they participated in behavior consistent with rationing.
Results of a national survey of...
08/15/2016
First Report Managed Care
Formulary Frontlines®
Immunotherapies for Melanoma: Worth the Cost?
08/15/2016
Kara Rosania, MS; Ann W. Latner, JD
Although melanoma, an aggressive malignant cancer of melanocytes, represents less than 5% of skin cancers, it accounts for approximately 75% of skin cancer-related deaths, according to the American Cancer Society. 
Although melanoma, an aggressive malignant cancer of melanocytes, represents less than 5% of skin cancers, it accounts for approximately 75% of skin cancer-related deaths, according to the American Cancer Society. 
Although melanoma, an aggressive...
08/15/2016
First Report Managed Care
Department
UK Rheumatologists Diverge From NICE Guidance on Costs
08/15/2016
Research presented at the EULAR 2016 Congress showed that rheumatologists in the UK diverge from the National Institute for Health and Care Excellence’s (NICE) TNF inhibitor prescribing guidance when treating patients with rheumatoid...
Research presented at the EULAR 2016 Congress showed that rheumatologists in the UK diverge from the National Institute for Health and Care Excellence’s (NICE) TNF inhibitor prescribing guidance when treating patients with rheumatoid...
Research presented at the EULAR...
08/15/2016
First Report Managed Care
Department
Reduced Humira Formulation Produces Less Injection Site Pain
08/15/2016
A reduced formulation of Humira (adalimumab; Abbvie Inc) for the treatment of rheumatoid arthritis produced less adverse events, specifically injection site pain, when compared with the current formulation, according to data presented at the...
A reduced formulation of Humira (adalimumab; Abbvie Inc) for the treatment of rheumatoid arthritis produced less adverse events, specifically injection site pain, when compared with the current formulation, according to data presented at the...
A reduced formulation of Humira...
08/15/2016
First Report Managed Care
Department
Studies Show Gene Profiling Increases Treatment Response, Reduces Costs
08/15/2016
Two studies presented at the EULAR 2016 Congress showed that gene profiling can be used to quickly identify which rheumatoid arthritis (RA) patients are not responding to therapies, decreasing long-term joint damage and avoiding costs wasted...
Two studies presented at the EULAR 2016 Congress showed that gene profiling can be used to quickly identify which rheumatoid arthritis (RA) patients are not responding to therapies, decreasing long-term joint damage and avoiding costs wasted...
Two studies presented at the...
08/15/2016
First Report Managed Care
Department
Remicade Cross-reaction Suggests Switching to Biosimilars Not Optimal for All Patients
08/15/2016
Antibodies produced in response to the biological treatment Remicade cross (infliximab; Janssen Biotech) react with antibodies produced by the drug’s biosimilars, suggesting that patients treated with Remicade should not be switched to a...
Antibodies produced in response to the biological treatment Remicade cross (infliximab; Janssen Biotech) react with antibodies produced by the drug’s biosimilars, suggesting that patients treated with Remicade should not be switched to a...
Antibodies produced in response...
08/15/2016
First Report Managed Care
Department
Patient Participation in Health Care Planning Optimizes Outcomes
08/15/2016
Researchers who presented data at the EULAR 2016 Congress found that stimulating a team relationship between health care providers (HCPs) and patients regarding treatment planning may help to improve patient outcomes.  
Researchers who presented data at the EULAR 2016 Congress found that stimulating a team relationship between health care providers (HCPs) and patients regarding treatment planning may help to improve patient outcomes.  
Researchers who presented data...
08/15/2016
First Report Managed Care
Department
Discontinuation Rates Low Among Patients Taking Xeljanz Monotherapy for RA
08/15/2016
Patients treated with Xeljanz (tofacitinib) monotherapy for long-term treatment of rheumatoid arthritis had low rates of discontinuation.
Patients treated with Xeljanz (tofacitinib) monotherapy for long-term treatment of rheumatoid arthritis had low rates of discontinuation.
Patients treated with Xeljanz...
08/15/2016
First Report Managed Care
Department
Adding Integrated Care Pharmacist May Reduce 30-day Readmission Rates
08/15/2016
According to a poster presentation at the ASHP 2016 Summer Meetings & Exhibition, the addition of an integrated care pharmacists at a community hospital helped to improve care transitions, reduce 30-day readmissions, and reduce health care...
According to a poster presentation at the ASHP 2016 Summer Meetings & Exhibition, the addition of an integrated care pharmacists at a community hospital helped to improve care transitions, reduce 30-day readmissions, and reduce health care...
According to a poster...
08/15/2016
First Report Managed Care
Department
Costs of Innovative Drugs High in Primary Care
08/15/2016
Recently, FDA-approved direct-acting antiviral drugs that attack the hepatitis C virus (HCV) have improved success rates for individuals, with cure rates over 90% in most patients.
Recently, FDA-approved direct-acting antiviral drugs that attack the hepatitis C virus (HCV) have improved success rates for individuals, with cure rates over 90% in most patients.
Recently, FDA-approved...
08/15/2016
First Report Managed Care
Department
Key Health Care Issues Impacting Pharmacy
08/15/2016
Many critical health care issues at the federal and state levels will impact health-system pharmacists. Attendees at ASHP 2016 Summer Meetings & Exhibition were updated on some of the key issues facing pharmacists during a session that...
Many critical health care issues at the federal and state levels will impact health-system pharmacists. Attendees at ASHP 2016 Summer Meetings & Exhibition were updated on some of the key issues facing pharmacists during a session that...
Many critical health care issues...
08/15/2016
First Report Managed Care
Department
Challenges of Limited Distribution Drugs in 340B Program
08/15/2016
The federal 340B drug discount program remains an essential component to ensuring that safety-net hospitals have access to affordable medication, but this program has received unprecedented scrutiny from Congress and the drug industry in...
The federal 340B drug discount program remains an essential component to ensuring that safety-net hospitals have access to affordable medication, but this program has received unprecedented scrutiny from Congress and the drug industry in...
The federal 340B drug discount...
08/15/2016
First Report Managed Care
Department
Clinical Documentation Critical to Pharmacy`s Success
08/15/2016
The newly developed health care environment demands the use of standardized terminologies and coding systems for clinical documentation.
The newly developed health care environment demands the use of standardized terminologies and coding systems for clinical documentation.
The newly developed health care...
08/15/2016
First Report Managed Care

Behind the Bill

Behind the Bill
The Senate’s $3 Trillion Deal. Tax Relief Now, Medicaid Coverage Loss Later?
07/02/2025
Katie Hayes, MJ
The Senate has done it. After weeks of behind-the-scenes wrangling and last-minute amendments, lawmakers have passed a sprawling tax-and-spending megabill that makes good on a long-standing Republican goal: making the 2017 Trump tax cuts...
The Senate has done it. After weeks of behind-the-scenes wrangling and last-minute amendments, lawmakers have passed a sprawling tax-and-spending megabill that makes good on a long-standing Republican goal: making the 2017 Trump tax cuts...
The Senate has done it. After...
07/02/2025
First Report Managed Care
Behind the Bill
When a Cap Isn’t Just a Cap: How a Provider Tax Proposal Could Reshape Medicaid Financing
06/25/2025
Katie Hayes, MJ
In Washington, the most consequential policies are often buried in the fine print. One such detail in the Senate Finance Committee’s latest tax and spending proposal would gradually cap provider taxes—a core funding tool states use to pull in...
In Washington, the most consequential policies are often buried in the fine print. One such detail in the Senate Finance Committee’s latest tax and spending proposal would gradually cap provider taxes—a core funding tool states use to pull in...
In Washington, the most...
06/25/2025
First Report Managed Care
Behind the Bill
Rewriting the Safety Net? Inside the Senate’s Changes to Medicaid and the ACA
06/18/2025
Katie Hayes, MJ
Over the past few weeks, I’ve been following the progress of the One Big Beautiful Bill Act (OBBBA), which started in the House with sweeping tax reforms and some eye-catching health care proposals. Now, the Senate has released its (highly...
Over the past few weeks, I’ve been following the progress of the One Big Beautiful Bill Act (OBBBA), which started in the House with sweeping tax reforms and some eye-catching health care proposals. Now, the Senate has released its (highly...
Over the past few weeks, I’ve...
06/18/2025
First Report Managed Care
Behind the Bill
How States Might Respond to the One Big Beautiful Bill Act
06/11/2025
Katie Hayes, MJ
With the One Big Beautiful Bill Act (OBBBA) still in the hands of the Senate, much of the national conversation has centered on what this legislation would do to federal coverage programs. But regardless of how the federal process unfolds,...
With the One Big Beautiful Bill Act (OBBBA) still in the hands of the Senate, much of the national conversation has centered on what this legislation would do to federal coverage programs. But regardless of how the federal process unfolds,...
With the One Big Beautiful Bill...
06/11/2025
First Report Managed Care
Behind the Bill
Is the Affordable Care Act on the Chopping Block? What the One Big Beautiful Bill Act Tells Us.
06/04/2025
Katie Hayes, MJ
It’s been weeks of headline-grabbing debate over Medicaid work requirements, and the “One Big Beautiful Bill Act” remains in the Senate as they deliberate over several health care provisions. While the Medicaid provisions sparked most of the...
It’s been weeks of headline-grabbing debate over Medicaid work requirements, and the “One Big Beautiful Bill Act” remains in the Senate as they deliberate over several health care provisions. While the Medicaid provisions sparked most of the...
It’s been weeks of...
06/04/2025
First Report Managed Care
Behind the Bill
From House to Senate: The Journey of Cutting Medicaid
05/28/2025
Katie Hayes, MJ
Last week, the House of Representatives narrowly passed the One Big Beautiful Bill Act (HR 1, 119th Congress) by a single vote, sending the sweeping tax and spending reconciliation package, backed by President Trump, to the Senate. With its...
Last week, the House of Representatives narrowly passed the One Big Beautiful Bill Act (HR 1, 119th Congress) by a single vote, sending the sweeping tax and spending reconciliation package, backed by President Trump, to the Senate. With its...
Last week, the House of...
05/28/2025
First Report Managed Care
Behind the Bill
Eligibility, Paperwork, and Penalties: The Not-So-Hidden Costs of Medicaid ‘Reform’
05/21/2025
Katie Hayes, MJ
It’s been another eventful week in health policy—a phrase that’s quickly becoming routine. This time, House Republicans advanced a sweeping budget reconciliation bill, designed to implement elements of the March budget resolution, with a...
It’s been another eventful week in health policy—a phrase that’s quickly becoming routine. This time, House Republicans advanced a sweeping budget reconciliation bill, designed to implement elements of the March budget resolution, with a...
It’s been another eventful week...
05/21/2025
First Report Managed Care
Behind the Bill
A Busy Week in Drug Pricing Policy: Aligning US Drug Prices With Global Standards?
05/14/2025
Katie Hayes, MJ
It’s been a busy few days for drug pricing policy. While I’d love to dig into the details of both President Trump’s latest executive order and the newest Republican bill that would cut Medicaid spending, we don’t have the time—and this isn’t...
It’s been a busy few days for drug pricing policy. While I’d love to dig into the details of both President Trump’s latest executive order and the newest Republican bill that would cut Medicaid spending, we don’t have the time—and this isn’t...
It’s been a busy few days for...
05/14/2025
First Report Managed Care
BEHIND THE BILL
When Agencies Lose Power: How 3 Seismic Shifts are Transforming Pharmaceutical Regulation
05/07/2025
Katie Hayes, MJ
In the span of just 9 months, the landscape of administrative law has undergone a transformation so profound that pharmaceutical executives, health care providers, and patients alike are struggling to navigate the new terrain. The Supreme...
In the span of just 9 months, the landscape of administrative law has undergone a transformation so profound that pharmaceutical executives, health care providers, and patients alike are struggling to navigate the new terrain. The Supreme...
In the span of just 9 months,...
05/07/2025
First Report Managed Care
Behind the Bill
The Medicare Paradox, Part 3: Strategic Trade Doesn’t Have to be a Zero-Sum Game
05/07/2025
Katie Hayes, MJ
Over the past 2 weeks, I’ve examined the growing friction between the Section 232 pharmaceutical tariff investigations and the Medicare drug pricing reforms authorized by the Inflation Reduction Act (IRA). These 2 policy agendas—industrial...
Over the past 2 weeks, I’ve examined the growing friction between the Section 232 pharmaceutical tariff investigations and the Medicare drug pricing reforms authorized by the Inflation Reduction Act (IRA). These 2 policy agendas—industrial...
Over the past 2 weeks, I’ve...
05/07/2025
First Report Managed Care

Trending Articles

Yash Prajapati
Videos
Navigating the Evolution of Digital Solutions in Health Care
02/27/2024

Featuring Yash Prajapati, consultant at ZS Associates 

Featuring Yash Prajapati, consul...
Join us in exploring the challenges and opportunities in the development, approval, and integration of digital therapeutic solutions with ZS Associates consultant Yash Prajapati.
Join us in exploring the challenges and opportunities in the development, approval, and integration of digital therapeutic solutions with ZS Associates consultant Yash Prajapati.
Join us in exploring the...
02/27/2024
First Report Managed Care
Tejaswi Kompala
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Delve into the rising demand for anti-obesity medications, the complexities of obesity management, and the importance of personalized approaches in improving cardiometabolic health in this insightful interview.
Delve into the rising demand for anti-obesity medications, the complexities of obesity management, and the importance of personalized approaches in improving cardiometabolic health in this insightful interview.
Delve into the rising demand for...
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First Report Managed Care
News
Debate Emerges Over FDA's Plan to Regulate Laboratory Medical Tests
05/03/2024
Hannah Musick
The FDA's new regulations on laboratory-developed tests have sparked debate over access to innovative tests and patient care in the medical field, with opponents arguing that increased oversight could hinder the development of crucial new...
The FDA's new regulations on laboratory-developed tests have sparked debate over access to innovative tests and patient care in the medical field, with opponents arguing that increased oversight could hinder the development of crucial new...
The FDA's new regulations on...
05/03/2024
First Report Managed Care
Interview
Key Pharmaceutical Pipeline Developments: Insights from Industry Experts
05/29/2024
Learn about promising drugs currently in the pharmaceutical pipeline and the impact of FDA interventions from presenters at AMCP 2024.
Learn about promising drugs currently in the pharmaceutical pipeline and the impact of FDA interventions from presenters at AMCP 2024.
Learn about promising drugs...
05/29/2024
First Report Managed Care
News
‘Hidden’ Signs May Signal Subclinical Progression in Early MS
07/15/2024
Jolynn Tumolo
Focusing solely on relapse rates and magnetic resonance imaging (MRI) lesion activity to track disease progression in patients with early multiple sclerosis (MS) may miss indicators of subclinical disease activity, with important implications...
Focusing solely on relapse rates and magnetic resonance imaging (MRI) lesion activity to track disease progression in patients with early multiple sclerosis (MS) may miss indicators of subclinical disease activity, with important implications...
Focusing solely on relapse rates...
07/15/2024
First Report Managed Care

August 2016 Volume 13 Issue 8

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