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Volume 16, Issue 3, March 2019 - First Report Managed Care

Featured Article

Revisiting Association Health Plans
03/20/2019
Dean Celia
In early 2018, the US Department of Labor proposed a rule that would alter the regulation of association health plans. Now, one year after our original February 2018 analysis of the deregulation, we turn to our panel of experts to gain...
In early 2018, the US Department of Labor proposed a rule that would alter the regulation of association health plans. Now, one year after our original February 2018 analysis of the deregulation, we turn to our panel of experts to gain...
In early 2018, the US Department...
03/20/2019
First Report Managed Care
Partial Medicaid Expansion and ACA Enhanced Matching
03/20/2019
Mary Beth Nierengarten
Utah is the latest state to ask approval for partial Medicaid expansion with enhanced federal funds, capping enrollment for nonelderly adults up to 100% of the federal poverty level and using per capita caps to constrain federal costs. If...
Utah is the latest state to ask approval for partial Medicaid expansion with enhanced federal funds, capping enrollment for nonelderly adults up to 100% of the federal poverty level and using per capita caps to constrain federal costs. If...
Utah is the latest state to ask...
03/20/2019
First Report Managed Care
Formulary Frontlines®
Adapting to a Changing Landscape of Rheumatoid Arthritis Therapies
03/20/2019
Kara Rosania, MS
Rheumatoid arthritis (RA) continues to affect as many as 1.5 million adults in the United States.
Rheumatoid arthritis (RA) continues to affect as many as 1.5 million adults in the United States.
Rheumatoid arthritis (RA)...
03/20/2019
First Report Managed Care
Viewpoint
Beyond the Current Standard of Care for Pediatric ADHD: A New Era of Digital Therapeutics
03/20/2019
Madison Preib, MPH; Philip L. Cyr, MPH; Joseph Honcz; Robert L. Findling, MBA, MD
As the most common neurodevelopment disorder of childhood, attention-deficit/hyperactivity disorder (ADHD) places a significant burden on the US health care system.1-5 In today’s changing medical climate, there is growing pressure to improve...
As the most common neurodevelopment disorder of childhood, attention-deficit/hyperactivity disorder (ADHD) places a significant burden on the US health care system.1-5 In today’s changing medical climate, there is growing pressure to improve...
As the most common...
03/20/2019
First Report Managed Care
Interview
Integrating a Robust Single Platform EMR to Improve Care Quality
03/20/2019
Julie Gould
Chris Voigt is the chief technology officer at Privia Health, a physician practice management and population health technology company. He has more than 14 years experience in the health care interoperability field, including leading...
Chris Voigt is the chief technology officer at Privia Health, a physician practice management and population health technology company. He has more than 14 years experience in the health care interoperability field, including leading...
Chris Voigt is the chief...
03/20/2019
First Report Managed Care
Commentary
Steven Lieberman, MD, Discusses Positive Trends in VA Wait Times
03/20/2019
In a podcast hosted on Veterans Health Today, Steven Lieberman, MD, acting principal deputy under secretary for health at the Veterans Health Administration, explained the history of wait times within the VA and discusses how they have...
In a podcast hosted on Veterans Health Today, Steven Lieberman, MD, acting principal deputy under secretary for health at the Veterans Health Administration, explained the history of wait times within the VA and discusses how they have...
In a podcast hosted on Veterans...
03/20/2019
First Report Managed Care
News Connection
CMS, ONC Propose New Requirements to Improve Interoperability
03/20/2019
The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) proposed new rules to increase interoperability of electronic health care records.
The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) proposed new rules to increase interoperability of electronic health care records.
The Centers for Medicare &...
03/20/2019
First Report Managed Care
News Connection
Medicare and Medicaid Spending Growth Slower Than Private Insurers
03/20/2019
According to an analysis published by the Urban Institute, spending growth was slower for those enrolled in Medicare and Medicaid than those enrolled with in a private insurance plan between 2006 and 2017.
According to an analysis published by the Urban Institute, spending growth was slower for those enrolled in Medicare and Medicaid than those enrolled with in a private insurance plan between 2006 and 2017.
According to an analysis...
03/20/2019
First Report Managed Care
News Connection
Praluent US List Price to Be Cut by 60%
03/20/2019
Regeneron and Sanofi revealed in a press release plans to reduce the cost of their cholesterol treatment drug, Praluent (alirocumab), by 60%. This decision is one in a series of choices to make Praluent more available and affordable to...
Regeneron and Sanofi revealed in a press release plans to reduce the cost of their cholesterol treatment drug, Praluent (alirocumab), by 60%. This decision is one in a series of choices to make Praluent more available and affordable to...
Regeneron and Sanofi revealed in...
03/20/2019
First Report Managed Care
News Connection
HHS, CMS Innovation Center Announce New Payment Model to Improve Medicare Beneficiaries’ Emergency Needs
03/20/2019
The US Department of Health and Human Services (HHS) and Center for Medicare & Medicaid Innovation Center, “which tests innovative payment and service delivery models to lower costs and improve the quality of care,” launched a new payment...
The US Department of Health and Human Services (HHS) and Center for Medicare & Medicaid Innovation Center, “which tests innovative payment and service delivery models to lower costs and improve the quality of care,” launched a new payment...
The US Department of Health and...
03/20/2019
First Report Managed Care
News Connection
Travel, Wait Times Cost $89 Billion Annually for Health Care Service
03/20/2019
According to survey data from the Bureau of Labor Statistics’ American Wait Time Use Survey, spanning 2006 through 2017, travel and wait times were highest for health care services, ranked above legal services, personal care, vehicular...
According to survey data from the Bureau of Labor Statistics’ American Wait Time Use Survey, spanning 2006 through 2017, travel and wait times were highest for health care services, ranked above legal services, personal care, vehicular...
According to survey data from...
03/20/2019
First Report Managed Care
News Connection
Health Care Spending Growth Projected to Rise to 19.4% of GDP in Next Decade
03/20/2019
According to a report in Health Affairs and information from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary, national health expenditures are projected to grow at an average annual rate of 5.5% for 2018 to 2027 and...
According to a report in Health Affairs and information from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary, national health expenditures are projected to grow at an average annual rate of 5.5% for 2018 to 2027 and...
According to a report in Health...
03/20/2019
First Report Managed Care
News Connection
What Is Driving Medicare Advantage Beneficiaries to Disenroll or Switch Plans?
03/20/2019
Research published in JAMA Internal Medicine concluded that high-need Medicare Advantage (MA) beneficiaries and Medicare-Medicaid eligible enrollees are disenrolling or switching plans at a much higher rate than other enrollees.
Research published in JAMA Internal Medicine concluded that high-need Medicare Advantage (MA) beneficiaries and Medicare-Medicaid eligible enrollees are disenrolling or switching plans at a much higher rate than other enrollees.
Research published in JAMA...
03/20/2019
First Report Managed Care
News Connection
One in 10 Patients Experience Adverse Effects from Post-Surgical Opioids
03/20/2019
Among patients who received opioids for the first time after undergoing surgery, 9.1% experienced a potential adverse effect from the drug, according to a study published online in the Journal of Patient Safety.
Among patients who received opioids for the first time after undergoing surgery, 9.1% experienced a potential adverse effect from the drug, according to a study published online in the Journal of Patient Safety.
Among patients who received...
03/20/2019
First Report Managed Care
Conference Insider
Sesame is Now the 9th Most Common Food Allergy in US
03/20/2019
In a study presented at AAAAI, researchers found that sesame is now the ninth most prevalent food allergy in the United States among both children and adults. 
In a study presented at AAAAI, researchers found that sesame is now the ninth most prevalent food allergy in the United States among both children and adults. 
In a study presented at AAAAI,...
03/20/2019
First Report Managed Care
Conference Insider
Peanut Food Equivalents May Help Patient Desensitization
03/20/2019
There are still many questions unanswered about the long-term outcomes of allergy immunotherapy but a new study presented at AAAAI suggests that peanut food equivalents may help patients maintain desensitization after immunotherapy trials.
There are still many questions unanswered about the long-term outcomes of allergy immunotherapy but a new study presented at AAAAI suggests that peanut food equivalents may help patients maintain desensitization after immunotherapy trials.
There are still many questions...
03/20/2019
First Report Managed Care
Conference Insider
New Phase I Peanut Allergy Immunotherapy Trial Produces Promising Results
03/20/2019
According to science released at AAAAI, a new phase 1 peanut allergy immunotherapy trial results in no severe side effects, including anaphylaxis. The immunotherapy is designed to remove risks of acute reactions during treatment. 
According to science released at AAAAI, a new phase 1 peanut allergy immunotherapy trial results in no severe side effects, including anaphylaxis. The immunotherapy is designed to remove risks of acute reactions during treatment. 
According to science released at...
03/20/2019
First Report Managed Care
Conference Insider
Asthma Appears More Common in Opioid Dependent Patients
03/20/2019
In an abstract presented at the 2019 AAAAI Annual Meeting, researchers explained that the prevalence of asthma in opioid dependent patients is greater than the national prevalence of asthma. 
In an abstract presented at the 2019 AAAAI Annual Meeting, researchers explained that the prevalence of asthma in opioid dependent patients is greater than the national prevalence of asthma. 
In an abstract presented at the...
03/20/2019
First Report Managed Care
Conference Insider
Meeting Preview: AMCP 2019
03/20/2019
By choosing to attend the AMCP Annual Meeting 2019 in San Diego, California, March 25-28, managed care pharmacists, physicians, nurses, health plan administrators, and other managed care professionals are providing themselves the opportunity...
By choosing to attend the AMCP Annual Meeting 2019 in San Diego, California, March 25-28, managed care pharmacists, physicians, nurses, health plan administrators, and other managed care professionals are providing themselves the opportunity...
By choosing to attend the AMCP...
03/20/2019
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

Steve Vacarro
Interview
The Role of Electronic Visit Verification in Enhancing Quality, Efficiency, and Medicaid Integrity
02/29/2024

Featuring Stephen Vaccaro, president, HHAeXchange

Featuring Stephen Vaccaro, president,...
In this interview, an expert discusses the importance of Electronic Visit Verification (EVV) in homecare services. EVV ensures accurate documentation of homecare visits, leading to improved patient outcomes and quality of care. Medicaid has a...
In this interview, an expert discusses the importance of Electronic Visit Verification (EVV) in homecare services. EVV ensures accurate documentation of homecare visits, leading to improved patient outcomes and quality of care. Medicaid has a...
In this interview, an expert...
02/29/2024
First Report Managed Care
News
From Indolent to Aggressive: Understanding Lymphoma Transformation
04/09/2024
Hannah Musick
“Histologic transformation of indolent lymphoma to aggressive lymphoma, most commonly DLBCL, represents a well-recognized event,” said researchers. “While work in the past decade has shed light on many of the genetic and biological changes of...
“Histologic transformation of indolent lymphoma to aggressive lymphoma, most commonly DLBCL, represents a well-recognized event,” said researchers. “While work in the past decade has shed light on many of the genetic and biological changes of...
“Histologic transformation of...
04/09/2024
First Report Managed Care
News
Hospital Costs May Be Higher for Patients With Private Insurance
05/14/2024
Hannah Musick
A recent research report reveals that individuals with private health insurance pay 254% more for hospital procedures than Medicare rates, leading to potentially increased costs for millions of Americans.
A recent research report reveals that individuals with private health insurance pay 254% more for hospital procedures than Medicare rates, leading to potentially increased costs for millions of Americans.
A recent research report reveals...
05/14/2024
First Report Managed Care
News
Fitusiran Prophylaxis Shows Promise for Protection Against Bleeding for Patients With Hemophilia A or B
06/05/2024
Grace Taylor, MS, MA
A phase 3 study evaluated the efficacy and safety of fitusiran in males with hemophilia A or B who were receiving bypassing agent (BPA)/clotting factor concentrate (CFC) prophylaxis.
A phase 3 study evaluated the efficacy and safety of fitusiran in males with hemophilia A or B who were receiving bypassing agent (BPA)/clotting factor concentrate (CFC) prophylaxis.
A phase 3 study evaluated the...
06/05/2024
First Report Managed Care
Infographic
The Efficacy and Safety of an Oral Phosphodiesterase 4B (PDE4B) Inhibitor, BI 1015550, in Patients With Idiopathic Pulmonary Fibrosis (IPF): A Phase 2 Clinical Trial
07/24/2024
This infographic summarizes a recent Phase 2 clinical trial evaluating the efficacy and safety of an oral phosphodiesterase inhibitor in patients with idiopathic pulmonary fibrosis (IPF).
This infographic summarizes a recent Phase 2 clinical trial evaluating the efficacy and safety of an oral phosphodiesterase inhibitor in patients with idiopathic pulmonary fibrosis (IPF).
This infographic summarizes a...
07/24/2024
First Report Managed Care

March 2019 Volume 16 Issue 3

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