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July 2016 - FRMC

Managed Care Q&A
The Patient-Centered Medical Home of the Future
07/14/2016
Sean McGuire
An interview with Michael S Barr, MD, MBA, MACP, executive vice president, NCQA
An interview with Michael S Barr, MD, MBA, MACP, executive vice president, NCQA
An interview with Michael S...
07/14/2016
First Report Managed Care
News Connection
NIH, FDA, and VA Do Their Part to Advance Precision Medicine Initiative
07/14/2016
The National Institutes of Health (NIH) is partnering with the US Department of Veterans Affairs (VA) to enroll veterans in the Precision Medicine Initiative (PMI) Cohort Program as participants in the largest ever study of its kind, the...
The National Institutes of Health (NIH) is partnering with the US Department of Veterans Affairs (VA) to enroll veterans in the Precision Medicine Initiative (PMI) Cohort Program as participants in the largest ever study of its kind, the...
The National Institutes of...
07/14/2016
First Report Managed Care
News Connection
Native American Tribes Fear High Health Care Costs
07/14/2016
Native American tribes are facing crippling health care costs as a result of their large employer status per the Affordable Care Act (ACA). 
Native American tribes are facing crippling health care costs as a result of their large employer status per the Affordable Care Act (ACA). 
Native American tribes are...
07/14/2016
First Report Managed Care
News Connection
For Cervical Cancer, Two Tests Are Better Than One
07/14/2016
An HPV test has been approved for primary cervical cancer screening in women aged 25 years or older.
An HPV test has been approved for primary cervical cancer screening in women aged 25 years or older.
An HPV test has been approved...
07/14/2016
First Report Managed Care
News Connection
Spending Patterns for End-of-Life Care Set in Motion 1 Year Before Death
07/14/2016
Using 2012 data from the Centers for Medicare & Medicaid Services, reearchers identified four unique spending trajectories in end-of-life care.
Using 2012 data from the Centers for Medicare & Medicaid Services, reearchers identified four unique spending trajectories in end-of-life care.
Using 2012 data from the Centers...
07/14/2016
First Report Managed Care
News Connection
USPSTF Updates Colorectal Cancer Screening Recommendations
07/14/2016
The US Preventive Services Task Force has found that screening with several different methods can more accurately detect early-stage colorectal cancer.
The US Preventive Services Task Force has found that screening with several different methods can more accurately detect early-stage colorectal cancer.
The US Preventive Services Task...
07/14/2016
First Report Managed Care
News Connection
Program Enhances Use of Comparative Effectiveness Research Among Pharmacists
07/14/2016
Comparative effectiveness research provides real-world evidence for improving the quality of care and achieving better patient outcomes.
Comparative effectiveness research provides real-world evidence for improving the quality of care and achieving better patient outcomes.
Comparative effectiveness...
07/14/2016
First Report Managed Care
News Connection
New Guidelines for Deadly Infection Advocate Early Diagnosis, Antifungal Treatment
07/14/2016
The Infectious Diseases Society of America recently released new guidelines for the diagnosis and treatment of allergic, chronic, and invasive aspergillosis.
The Infectious Diseases Society of America recently released new guidelines for the diagnosis and treatment of allergic, chronic, and invasive aspergillosis.
The Infectious Diseases Society...
07/14/2016
First Report Managed Care
News Connection
Treatment for ASD Among Children Lags Despite State Insurance Mandates
07/14/2016
Implementation of state-level mandates requiring commercial health plans to cover services for children with autism spectrum disorder increased the amount of children diagnosed with the disorder but the proportion of children receiving...
Implementation of state-level mandates requiring commercial health plans to cover services for children with autism spectrum disorder increased the amount of children diagnosed with the disorder but the proportion of children receiving...
Implementation of state-level...
07/14/2016
First Report Managed Care
News Connection
Employers Contract Directly With Health Care Systems to Cut Costs
07/14/2016
Boeing announced that it would contract directly with southern California’s MemorialCare Health System for employee benefits.
Boeing announced that it would contract directly with southern California’s MemorialCare Health System for employee benefits.
Boeing announced that it would...
07/14/2016
First Report Managed Care
News Connection
Costs of Cancer Care Defy Expectations
07/14/2016
Although the growing number of people living with cancer and the introduction of new therapies are associated with an increase in cancer care costs, a new report from Milliman Inc, commissioned by the Community Oncology Alliance, sheds light...
Although the growing number of people living with cancer and the introduction of new therapies are associated with an increase in cancer care costs, a new report from Milliman Inc, commissioned by the Community Oncology Alliance, sheds light...
Although the growing number of...
07/14/2016
First Report Managed Care
News Connection
CMS Pilot Program Improves Care for Dual Eligible Older Adults
07/14/2016
The Centers for Medicare & Medicaid Services recently announced positive results of their pilot program to better serve dually eligible Medicare-Medicaid beneficiaries aged 65 years and older.
The Centers for Medicare & Medicaid Services recently announced positive results of their pilot program to better serve dually eligible Medicare-Medicaid beneficiaries aged 65 years and older.
The Centers for Medicare &...
07/14/2016
First Report Managed Care
News
Biosimilar Buzz: Cancer Drug Knock-offs Promise Greater Access to Medications
07/14/2016
Paul Nicolaus
Highly anticipated cancer drug knock-offs provide the possibility of improved access, but cost benefits have not yet been demonstrated.
Highly anticipated cancer drug knock-offs provide the possibility of improved access, but cost benefits have not yet been demonstrated.
Highly anticipated cancer drug...
07/14/2016
First Report Managed Care
Can the Affordable Care Act Really be Repealed?
07/14/2016
Dean Celia
As House Republicans finally release their proposed replacement for the Affordable Care Act, it is unclear whether “repeal and replace” remains politically feasible.
As House Republicans finally release their proposed replacement for the Affordable Care Act, it is unclear whether “repeal and replace” remains politically feasible.
As House Republicans finally...
07/14/2016
First Report Managed Care
VA Overhauls Approach to Care for Veterans With Hepatitis C
07/14/2016
Paul Nicolaus
The largest single provider of care to those with hepatitis C in the United States revs up treatment, begging the question: can others follow suit?
The largest single provider of care to those with hepatitis C in the United States revs up treatment, begging the question: can others follow suit?
The largest single provider of...
07/14/2016
First Report Managed Care
Careers
A Place Patients with Cancer Can Call Home, Part 2
07/14/2016
Dean Celia
John Sprandio, MD, founder of the first NCQA-recognized oncology medical home, explains how his group did it, and offers lessons for managed care.
John Sprandio, MD, founder of the first NCQA-recognized oncology medical home, explains how his group did it, and offers lessons for managed care.
John Sprandio, MD, founder of...
07/14/2016
First Report Managed Care
Careers
A Place Patients with Cancer Can Call Home, Part 1
07/14/2016
Dean Celia
Consultants in Medical Oncology and Hematology became the first National Committee for Quality Assurance-recognized specialty patient-centered medical home and the first oncology medical home. In this interview, John Sprandio describes how...
Consultants in Medical Oncology and Hematology became the first National Committee for Quality Assurance-recognized specialty patient-centered medical home and the first oncology medical home. In this interview, John Sprandio describes how...
Consultants in Medical Oncology...
07/14/2016
First Report Managed Care
Department
AMA Calls on CMS to Drop Proposed Reimbursement Change for Part B Drugs
07/14/2016
The American Medical Association (AMA) is asking the Centers for Medicare & Medicaid Services (CMS) to drop a proposal to change how Medicare reimburses medications under Part B.
The American Medical Association (AMA) is asking the Centers for Medicare & Medicaid Services (CMS) to drop a proposal to change how Medicare reimburses medications under Part B.
The American Medical Association...
07/14/2016
First Report Managed Care
Department
Proposed Medicare Payment Changes Designed to Meet Providers’ Needs
07/14/2016
The proposed rule guiding the new Medicare payment system was driven by physician input, Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services told attendees at the 2016 American Medical Association (AMA) annual...
The proposed rule guiding the new Medicare payment system was driven by physician input, Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services told attendees at the 2016 American Medical Association (AMA) annual...
The proposed rule guiding the...
07/14/2016
First Report Managed Care
Department
New Models of Care Demand Integrated Leadership, Trust
07/14/2016
Integrated leadership is key for promoting the kind of environment necessary for the success of new models of care.
Integrated leadership is key for promoting the kind of environment necessary for the success of new models of care.
Integrated leadership is key for...
07/14/2016
First Report Managed Care
Department
AMA Calls for Improved Coverage for Eating Disorder Treatment
07/14/2016
New policy adopted by the American Medical Association (AMA) at its annual meeting in Chicago, IL (June 11-15, 2016) calls for equal health care access and payment for eating disorders.
New policy adopted by the American Medical Association (AMA) at its annual meeting in Chicago, IL (June 11-15, 2016) calls for equal health care access and payment for eating disorders.
New policy adopted by the...
07/14/2016
First Report Managed Care
Department
Health Plans Should Cover Diabetes Prevention Programs, AMA Says
07/14/2016
The American Medical Association (AMA) is calling for public and private health insurers to include the Centers for Disease Control and Prevention (CDC)’s National Diabetes Prevention Program as a covered benefit for beneficiaries at risk of...
The American Medical Association (AMA) is calling for public and private health insurers to include the Centers for Disease Control and Prevention (CDC)’s National Diabetes Prevention Program as a covered benefit for beneficiaries at risk of...
The American Medical Association...
07/14/2016
First Report Managed Care
Department
Quality and Value: Measuring and Utilizing Both in Your Practice
07/14/2016
What the Value Framework is intended to do is take elements of care doctors already view as being important—clinical benefit, toxicity, cost—and make them part of the discussion at the point of care for patients. This is especially important...
What the Value Framework is intended to do is take elements of care doctors already view as being important—clinical benefit, toxicity, cost—and make them part of the discussion at the point of care for patients. This is especially important...
What the Value Framework is...
07/14/2016
First Report Managed Care
Department
Improved Outcomes With Value-Based Care Program for IBD
07/14/2016
One year after implementation, a value-based health care (VBHC) program for patients with inflammatory bowel disease (IBD) showed less use of steroids, imaging studies, emergency room visits and hospitalizations, and increased biomarker...
One year after implementation, a value-based health care (VBHC) program for patients with inflammatory bowel disease (IBD) showed less use of steroids, imaging studies, emergency room visits and hospitalizations, and increased biomarker...
One year after implementation, a...
07/14/2016
First Report Managed Care
Department
Improving Psychosocial and Lifestyle Factors Reduces Health Care Utilization for IBD
07/14/2016
Addressing the psychosocial needs of patients with inflammatory bowel disease may improve medical and psychosocial outcomes.
Addressing the psychosocial needs of patients with inflammatory bowel disease may improve medical and psychosocial outcomes.
Addressing the psychosocial...
07/14/2016
First Report Managed Care
Department
New IRIS Data Shows Pioglitazone Slows Type 2 Diabetes Progression
07/14/2016
New data from the IRIS trial showed that pioglitazone reduced the likelihood of progression to diabetes in those with insulin resistance and cerebrovascular disease.
New data from the IRIS trial showed that pioglitazone reduced the likelihood of progression to diabetes in those with insulin resistance and cerebrovascular disease.
New data from the IRIS trial...
07/14/2016
First Report Managed Care
Department
Lifestyle Intervention Reduces HbA1C Among African Americans
07/14/2016
African Americans with type 2 diabetes experience increased morbidity and mortality. Prior diabetes self-management programs have failed to demonstrate long-term efficacy in this population.
African Americans with type 2 diabetes experience increased morbidity and mortality. Prior diabetes self-management programs have failed to demonstrate long-term efficacy in this population.
African Americans with type 2...
07/14/2016
First Report Managed Care
Department
Quality of Life Measures Critical in Diabetes Management
07/14/2016
Health-related quality of life (HRQOL) is an important area of investigation that continues to gain recognition and is a critical element of diabetes research, treatment, and care, according to a panel of experts who discussed this topic...
Health-related quality of life (HRQOL) is an important area of investigation that continues to gain recognition and is a critical element of diabetes research, treatment, and care, according to a panel of experts who discussed this topic...
Health-related quality of life...
07/14/2016
First Report Managed Care
Department
Liraglutide Significantly Cuts Heart Risk, LEADER Trial Shows
07/14/2016
Data from the LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results-A Long Term Evaluation) trial showed a reduction in major cardiovascular events with the glucose-lowering drug liraglutide (Victoza;...
Data from the LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results-A Long Term Evaluation) trial showed a reduction in major cardiovascular events with the glucose-lowering drug liraglutide (Victoza;...
Data from the LEADER...
07/14/2016
First Report Managed Care

Pipeline Projections

PIPELINE PROJECTIONS
Emerging Therapies Reshaping Atopic Dermatitis Care
03/26/2026
Roy Moore
Roy Moore outlines how a rapidly expanding atopic dermatitis pipeline is intensifying competition, reshaping payer strategies, and raising the bar for new therapies.
Roy Moore outlines how a rapidly expanding atopic dermatitis pipeline is intensifying competition, reshaping payer strategies, and raising the bar for new therapies.
Roy Moore outlines how a rapidly...
03/26/2026
First Report Managed Care
Pipe
Pipeline Projections
Emerging Migraine Treatments Challenge a Mature Market
11/20/2025
Roy Moore
Roy Moore of Clarivate’s market access team discussed the evolving migraine treatment landscape, highlighting the maturation of the acute and prophylactic markets, the emergence of new therapies such as triptan-COX-2 combinations, gepants,...
Roy Moore of Clarivate’s market access team discussed the evolving migraine treatment landscape, highlighting the maturation of the acute and prophylactic markets, the emergence of new therapies such as triptan-COX-2 combinations, gepants,...
Roy Moore of Clarivate’s market...
11/20/2025
First Report Managed Care
Pipeline Projections
Pipeline Projections
Redefining Asthma Management With Emerging Anti-Inflammatories
10/01/2025
Roy Moore
Roy Moore, a market access expert, discusses the evolving asthma drug pipeline, highlighting upcoming therapies—including Breztri, depemokimab, and masitinib—their potential to improve adherence and outcomes, payer considerations around cost...
Roy Moore, a market access expert, discusses the evolving asthma drug pipeline, highlighting upcoming therapies—including Breztri, depemokimab, and masitinib—their potential to improve adherence and outcomes, payer considerations around cost...
Roy Moore, a market access...
10/01/2025
First Report Managed Care
Pipeline Projections
The Shift in MS Care as Biologics and BTK Inhibitors Advance
07/25/2025
Roy Moore
In this edition of Pipeline Projections, Roy Moore breaks down the rapidly evolving landscape of multiple sclerosis treatments—highlighting the shift from injectables to orals, the rise of monoclonal antibodies, and the promise of innovative...
In this edition of Pipeline Projections, Roy Moore breaks down the rapidly evolving landscape of multiple sclerosis treatments—highlighting the shift from injectables to orals, the rise of monoclonal antibodies, and the promise of innovative...
In this edition of Pipeline...
07/25/2025
First Report Managed Care
Pipeline Projections
How Biosimilars Are Shaping RA Treatment and Reimbursement Strategies
04/29/2025
Roy Moore
In this episode of Pipeline Projections, Roy Moore—Senior Healthcare Research & Data Analyst at Clarivate—discusses the expanding biosimilar pipeline for autoimmune diseases. He highlights recent FDA approvals, formulary and pricing...
In this episode of Pipeline Projections, Roy Moore—Senior Healthcare Research & Data Analyst at Clarivate—discusses the expanding biosimilar pipeline for autoimmune diseases. He highlights recent FDA approvals, formulary and pricing...
In this episode of Pipeline...
04/29/2025
First Report Managed Care

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Behind the Bill

Behind the Bill
HHS Hits Reset on 340B Rebate Model After Court Setbacks
02/11/2026
Juliet Gallagher
The US Department of Health and Human Services (HHS) has formally scrapped its 340B Rebate Model Pilot Program following a series of court rulings that blocked its implementation—signaling a significant pause in one of the most closely...
The US Department of Health and Human Services (HHS) has formally scrapped its 340B Rebate Model Pilot Program following a series of court rulings that blocked its implementation—signaling a significant pause in one of the most closely...
The US Department of Health and...
02/11/2026
First Report Managed Care
Behind the Bill
Funding Package Extends Medicare Telehealth, Enacts PBM Reforms, and Updates Hospital Oversight
02/05/2026
Juliet Gallagher
On February 3, 2026, President Donald Trump signed a broad government funding package that includes multi-year extensions for Medicare teleath and hospital-at-home programs, new oversight requirements for pharmacy benefit managers (PBMs), and...
On February 3, 2026, President Donald Trump signed a broad government funding package that includes multi-year extensions for Medicare teleath and hospital-at-home programs, new oversight requirements for pharmacy benefit managers (PBMs), and...
On February 3, 2026, President...
02/05/2026
First Report Managed Care
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

July 2016 Volume 13 Issue 7

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