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Volume 16, Issue 10, October 2019 - First Report Managed Care

Featured Article

What are the Democratic Candidates Really Saying About Health Care?
10/17/2019
Dean Celia
As candidates continue to debate health care, our experts took a look beyond the rhetoric and main talking points of five of the leading democratic contenders to analyze what they are—and potentially are not—telling payers, providers, and...
As candidates continue to debate health care, our experts took a look beyond the rhetoric and main talking points of five of the leading democratic contenders to analyze what they are—and potentially are not—telling payers, providers, and...
As candidates continue to debate...
10/17/2019
First Report Managed Care
New Payment Models Tackle Medicaid Drug Spending
10/17/2019
Paul Nicolaus
Several states are pursuing alternative payment models for prescription drugs to curb spending and address public health crises, but experts say these new strategies face a variety of challenges on their way to implementation.
Several states are pursuing alternative payment models for prescription drugs to curb spending and address public health crises, but experts say these new strategies face a variety of challenges on their way to implementation.
Several states are pursuing...
10/17/2019
First Report Managed Care
The Compassion of Care: Benefits to Patients and Providers
10/17/2019
Mary Beth Nierengarten
As politics continue to play an ever-present role in the future of health care, providers, patients, plans, and other professionals are looking for ways to improve care quality and build meaningful, successful connections among their care...
As politics continue to play an ever-present role in the future of health care, providers, patients, plans, and other professionals are looking for ways to improve care quality and build meaningful, successful connections among their care...
As politics continue to play an...
10/17/2019
First Report Managed Care
Conference Insider
Understanding the Importance of Partnerships in Health Care
10/17/2019
Ambria Moore, BA, PMP, and Denise Parker, both delegate oversight project managers at BlueCross BlueShield (BCBS) of Tennessee, provided tips and techniques for professionals to keep organizations engaged, accountable, and in an ongoing state...
Ambria Moore, BA, PMP, and Denise Parker, both delegate oversight project managers at BlueCross BlueShield (BCBS) of Tennessee, provided tips and techniques for professionals to keep organizations engaged, accountable, and in an ongoing state...
Ambria Moore, BA, PMP, and...
10/17/2019
First Report Managed Care
Conference Insider
How Population Health and Care Quality Relate
10/17/2019
David Nash, MD, MBA, launched the second annual Health Care Quality Congress 2019 with his session entitled, “Population Health and Quality: Two Peas in a Pod,” where he discussed how managing population health can help improve health care...
David Nash, MD, MBA, launched the second annual Health Care Quality Congress 2019 with his session entitled, “Population Health and Quality: Two Peas in a Pod,” where he discussed how managing population health can help improve health care...
David Nash, MD, MBA, launched...
10/17/2019
First Report Managed Care
Conference Insider
What is the Collaborative Care Model and How Does it Work?
10/17/2019
Nicole Andrews, MPH, PCDC, recently discussed the elements of the collaborative care model at Heath Care Quality Congress 2019, and she explained the models impact on health care cost and analyzed payment incentives for integrating the model.
Nicole Andrews, MPH, PCDC, recently discussed the elements of the collaborative care model at Heath Care Quality Congress 2019, and she explained the models impact on health care cost and analyzed payment incentives for integrating the model.
Nicole Andrews, MPH, PCDC,...
10/17/2019
First Report Managed Care
Conference Insider
Interview: Care Coordinators Improve Care Quality
10/17/2019
Lori Francis, MBA, PCMH CCE, a program management specialist at BlueCross BlueShield recently spoke with First Report Managed Care at Health Care Quality Congress 2019, on the benefits of using embedded care coordinators to improve physician...
Lori Francis, MBA, PCMH CCE, a program management specialist at BlueCross BlueShield recently spoke with First Report Managed Care at Health Care Quality Congress 2019, on the benefits of using embedded care coordinators to improve physician...
Lori Francis, MBA, PCMH CCE, a...
10/17/2019
First Report Managed Care
Conference Insider
Implementing PROMs in Primary Care and Understanding Chronic Pain
10/17/2019
Sarah Hudson Scholle, MPH, DrPH, and Daren Anderson, MD, addressed issues surrounding the implementation of patient-reported outcome measures (PROM) in the primary care setting.
Sarah Hudson Scholle, MPH, DrPH, and Daren Anderson, MD, addressed issues surrounding the implementation of patient-reported outcome measures (PROM) in the primary care setting.
Sarah Hudson Scholle, MPH, DrPH,...
10/17/2019
First Report Managed Care
Conference Insider
Strategies for Integrating Behavioral Health Distinction With PCMH
10/17/2019
During one of the sessions at PCMH Congress 2019, Rebecca Durday, MPH, PCMH, CCE, practice advancement strategies, Healthcare Association for New York State, explained the importance of integrating behavioral health into primary care and...
During one of the sessions at PCMH Congress 2019, Rebecca Durday, MPH, PCMH, CCE, practice advancement strategies, Healthcare Association for New York State, explained the importance of integrating behavioral health into primary care and...
During one of the sessions at...
10/17/2019
First Report Managed Care
Conference Insider
Improving Patient Care, Reducing Health Care Burden Through Physician, Health IT Partnerships
10/17/2019
Shivani Malhotra, MD FAAFP, associate program director & assistant professor family medicine, and Emily Leviner, MEd, system administrator, both from The University Of Alabama at Birmingham School of Medicine, recently discussed the adoption...
Shivani Malhotra, MD FAAFP, associate program director & assistant professor family medicine, and Emily Leviner, MEd, system administrator, both from The University Of Alabama at Birmingham School of Medicine, recently discussed the adoption...
Shivani Malhotra, MD FAAFP,...
10/17/2019
First Report Managed Care
Formulary Frontlines®
CGRP Inhibitors May Offer Significant Benefits for Migraine Patients
10/17/2019
Jeff Craven
With the advent of calcitonin gene-related peptide (CGRP) inhibitors, which are either monoclonal antibodies or CGRP receptor agonists that block CGRP proteins in the head and neck, another treatment option has emerged for patients where...
With the advent of calcitonin gene-related peptide (CGRP) inhibitors, which are either monoclonal antibodies or CGRP receptor agonists that block CGRP proteins in the head and neck, another treatment option has emerged for patients where...
With the advent of calcitonin...
10/17/2019
First Report Managed Care
Formulary Frontlines®
CGRP Inhibitors May Offer Significant Benefits for Migraine Patients
10/17/2019
Jeff Craven
With the advent of calcitonin gene-related peptide (CGRP) inhibitors, which are either monoclonal antibodies or CGRP receptor agonists that block CGRP proteins in the head and neck, another treatment option has emerged for patients where...
With the advent of calcitonin gene-related peptide (CGRP) inhibitors, which are either monoclonal antibodies or CGRP receptor agonists that block CGRP proteins in the head and neck, another treatment option has emerged for patients where...
With the advent of calcitonin...
10/17/2019
First Report Managed Care
Managed Care Q&A
Weighing Cost Benefits of Ibrutinib Compared with Traditional Chemoimmunotherapy
10/17/2019
Edan Stanley
Gary Owens, MD, president of Gary Owens Associates and First Report Managed Care editorial advisory board member, shares a payer perspective on treatment options for chronic lymphocytic leukemia, and weighs the benefits and challenges of...
Gary Owens, MD, president of Gary Owens Associates and First Report Managed Care editorial advisory board member, shares a payer perspective on treatment options for chronic lymphocytic leukemia, and weighs the benefits and challenges of...
Gary Owens, MD, president of...
10/17/2019
First Report Managed Care
Integrated Healthcare Executive
Importance of Communication Within a Successful Partnership
10/17/2019
Julie Gould
Lynn Kryfke, RN, MSN, executive direct at Children’s Community Health Plan, and Sumant Rao, senior vice president of performance analytics at Cotiviti, discuss their renewed partnership and highlight what health plans can learn from their...
Lynn Kryfke, RN, MSN, executive direct at Children’s Community Health Plan, and Sumant Rao, senior vice president of performance analytics at Cotiviti, discuss their renewed partnership and highlight what health plans can learn from their...
Lynn Kryfke, RN, MSN, executive...
10/17/2019
First Report Managed Care
Veterans Health Today
Partnership Aims at Improving VA’s Health Care Supply Chain
10/17/2019
According to a recent press release, the Department of Veteran Affairs (VA) announced that it has partnered with the Department of Defense’s (DOD) Defense Logistics Agency (DLA) as an effort to enhance VA’s supply chain management...
According to a recent press release, the Department of Veteran Affairs (VA) announced that it has partnered with the Department of Defense’s (DOD) Defense Logistics Agency (DLA) as an effort to enhance VA’s supply chain management...
According to a recent press...
10/17/2019
First Report Managed Care
Veterans Health Today
VA to Implement New Procedures in 2020 to Improve Medical Information Sharing Among Community Care Providers
10/17/2019
The Department of Veteran Affairs (VA) announced it will implement new procedures by January 2020 aimed at improving medical information sharing among veterans accessing health care in the community. 
The Department of Veteran Affairs (VA) announced it will implement new procedures by January 2020 aimed at improving medical information sharing among veterans accessing health care in the community. 
The Department of Veteran...
10/17/2019
First Report Managed Care
Veterans Health Today
New Goal Achieved By VA, Over 90,000 Appeal Decisions Delivered
10/17/2019
According to a press release from the Department of Veteran Affairs (VA), the agency has exceeded its goal ahead of schedule regarding appeals decisions for disability benefits and services provided to veterans in 2019.
According to a press release from the Department of Veteran Affairs (VA), the agency has exceeded its goal ahead of schedule regarding appeals decisions for disability benefits and services provided to veterans in 2019.
According to a press release...
10/17/2019
First Report Managed Care
Veterans Health Today
Interview: Improving Prescribing Among Veterans
10/17/2019
Julie Gould
Catherine Chanfreau-Coffinier, PhD, explains how pharmacogenetic testing would impact a large proportion of veterans if it was implemented in the VA population.
Catherine Chanfreau-Coffinier, PhD, explains how pharmacogenetic testing would impact a large proportion of veterans if it was implemented in the VA population.
Catherine Chanfreau-Coffinier,...
10/17/2019
First Report Managed Care
News Connection
Predictive Score Categorizes Potentially Avoidable Readmission Risk
10/17/2019
By identifying factors significantly associated with potentially avoidable readmissions (PAR), Anne-Laure Blanc, PharmD, Pharmacie des Hôpitaux de l’Est Lémanique in Switzerland, and fellow researchers, created and internally validated a...
By identifying factors significantly associated with potentially avoidable readmissions (PAR), Anne-Laure Blanc, PharmD, Pharmacie des Hôpitaux de l’Est Lémanique in Switzerland, and fellow researchers, created and internally validated a...
By identifying factors...
10/17/2019
First Report Managed Care
News Connection
Challenges Managing High-Expenditure Medicaid Beneficiaries
10/17/2019
Social determinants of health, including transportation and housing, are creating obstacles in managing chronic conditions and high-expenditure Medicaid beneficiaries, according to a report published by the United States Government...
Social determinants of health, including transportation and housing, are creating obstacles in managing chronic conditions and high-expenditure Medicaid beneficiaries, according to a report published by the United States Government...
Social determinants of health,...
10/17/2019
First Report Managed Care
News Connection
CMS, Trump Administration Expect Decreased MA Premiums in 2020
10/17/2019
As Medicare open enrollment approaches, the Centers for Medicare & Medicaid Services (CMS) and the Trump administration announced in a press release that on average, 2020 premiums for Medicare Advantage (MA) enrollees are expected to be 23%...
As Medicare open enrollment approaches, the Centers for Medicare & Medicaid Services (CMS) and the Trump administration announced in a press release that on average, 2020 premiums for Medicare Advantage (MA) enrollees are expected to be 23%...
As Medicare open enrollment...
10/17/2019
First Report Managed Care
News Connection
Public Health Program Targeting CVD Risk Proves Cost-Effective
10/17/2019
A statewide public health program that uses community health workers to screen for cardiovascular disease (CVD) risk and provide ongoing support to participants is not only effective but also generates cost savings, according to a new study...
A statewide public health program that uses community health workers to screen for cardiovascular disease (CVD) risk and provide ongoing support to participants is not only effective but also generates cost savings, according to a new study...
A statewide public health...
10/17/2019
First Report Managed Care
News Connection
WHO Says World Must Invest More in Health Care to Eliminate Coverage Gaps
10/17/2019
In lieu of the United Nations General Assembly, the World Health Organization (WHO) released a report stating that if the world intends to meet health care goals set in 2015, countries must increase health care spending by at least 1% of...
In lieu of the United Nations General Assembly, the World Health Organization (WHO) released a report stating that if the world intends to meet health care goals set in 2015, countries must increase health care spending by at least 1% of...
In lieu of the United Nations...
10/17/2019
First Report Managed Care
News Connection
Specialty Drugs Administered Outside of Hospital Setting Could Save $4 Billion
10/17/2019
Changing where specialty drugs are administered could result in reduction of $4 billion in health care costs, according to a report released by UnitedHealth Group.
Changing where specialty drugs are administered could result in reduction of $4 billion in health care costs, according to a report released by UnitedHealth Group.
Changing where specialty drugs...
10/17/2019
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

October 2019 Volume 16 Issue 10

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