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Volume 16, Issue 9, September 2019 - First Report Managed Care

Featured Article

Managed Care Innovator: Jake Frenz
09/18/2019
Dean Celia
Jake Frenz, CEO and founder of SmithRx, outlines his health care vision through the prism of his growing start-up, breaking down what is wrong with the traditional way of managing the pharmacy benefit, and explains how he and his company are...
Jake Frenz, CEO and founder of SmithRx, outlines his health care vision through the prism of his growing start-up, breaking down what is wrong with the traditional way of managing the pharmacy benefit, and explains how he and his company are...
Jake Frenz, CEO and founder of...
09/18/2019
First Report Managed Care
Benefits of Interprofessional Collaborative Practice
09/18/2019
Mary Beth Nierengarten
As health care costs in the United States continue to climb, strategies to shift the direction of health care delivery to ensure better quality at lower cost remain front and center of the health care debate.
As health care costs in the United States continue to climb, strategies to shift the direction of health care delivery to ensure better quality at lower cost remain front and center of the health care debate.
As health care costs in the...
09/18/2019
First Report Managed Care
Physician Fatigue in the EHR Era
09/18/2019
Paul Nicolaus
Electronic health records have been blamed as a significant source of physician frustration and even burnout. Is it possible for managed care leaders to turn this technology from a burden to a boon?
Electronic health records have been blamed as a significant source of physician frustration and even burnout. Is it possible for managed care leaders to turn this technology from a burden to a boon?
Electronic health records have...
09/18/2019
First Report Managed Care
Formulary Frontlines®
Costly Burden of Managing Multiple Sclerosis
09/18/2019
Eileen Koutnik-Fotopoulos
In addition to physical and emotional impact of MS, the economic burden is considerable, ranking second among all chronic conditions in direct costs behind congestive heart failure.
In addition to physical and emotional impact of MS, the economic burden is considerable, ranking second among all chronic conditions in direct costs behind congestive heart failure.
In addition to physical and...
09/18/2019
First Report Managed Care
Managed Care Q&A
Using Real-World Data the Right Way
09/18/2019
Edan Stanley
Pramod John, PhD, CEO of VIVIO Health, discusses a recent presentation where he spoke about using real-world data to drive better outcomes and lower costs, as well as weighs the benefits of value-based care.
Pramod John, PhD, CEO of VIVIO Health, discusses a recent presentation where he spoke about using real-world data to drive better outcomes and lower costs, as well as weighs the benefits of value-based care.
Pramod John, PhD, CEO of VIVIO...
09/18/2019
First Report Managed Care
Interview
The Benefits of Leveraging and Integrating Cloud-Based Technology
09/18/2019
Julie Gould
In a recent podcast, Jim Adams, CIO of AllianceRx Walgreens Prime and Sean Creehan, president of pharmacy business of Inovalon, break down the different uses of technology in the health care sector and highlight how patients can benefit from...
In a recent podcast, Jim Adams, CIO of AllianceRx Walgreens Prime and Sean Creehan, president of pharmacy business of Inovalon, break down the different uses of technology in the health care sector and highlight how patients can benefit from...
In a recent podcast, Jim Adams,...
09/18/2019
First Report Managed Care
Conference Insider
What to Expect at Health Care Quality Congress 2019, An Official Conference by NCQA
09/18/2019
Returning this October 2-4 in Dallas, TX is Health Care Quality Congress (HQC) 2019, an official conference by NCQA. This meeting was formerly offered as two regional meetings focused on health plan accreditation and HEDIS and was merged...
Returning this October 2-4 in Dallas, TX is Health Care Quality Congress (HQC) 2019, an official conference by NCQA. This meeting was formerly offered as two regional meetings focused on health plan accreditation and HEDIS and was merged...
Returning this October 2-4 in...
09/18/2019
First Report Managed Care
Conference Insider
Use of a PCMH Model in an Employer-Based Worksite Clinic Lowers Costs, Improves Care
09/18/2019
During a recent session at PCMH Congress 2019, Kathryn E Gibson, MD, FAAFP, medical director of health and wellness at ARUP Laboratories, identified rationale for the alignment of workplace health needs and PCMH principles, described the...
During a recent session at PCMH Congress 2019, Kathryn E Gibson, MD, FAAFP, medical director of health and wellness at ARUP Laboratories, identified rationale for the alignment of workplace health needs and PCMH principles, described the...
During a recent session at PCMH...
09/18/2019
First Report Managed Care
Conference Insider
How Telehealth Polices Help Shape Care, Improve Access to Quality
09/18/2019
Mei Wa Kwong, JD, executive director at Center for Connected Health Policy (CCHP), discusses how CCHP, an organization working to advance telehealth policies, improves health outcomes as well as access to quality services, during a session at...
Mei Wa Kwong, JD, executive director at Center for Connected Health Policy (CCHP), discusses how CCHP, an organization working to advance telehealth policies, improves health outcomes as well as access to quality services, during a session at...
Mei Wa Kwong, JD, executive...
09/18/2019
First Report Managed Care
Conference Insider
Why Investment in Primary Care Through PCMH Utilization is Important
09/18/2019
Ann Greiner, MCP, president and CEO of Patient Centered Primary Care Collaborative, Washington, DC, kicked off the first session of PCMH Congress 2019. Ms Greiner first explained that primary care is being reinvented with PCMH. She said that...
Ann Greiner, MCP, president and CEO of Patient Centered Primary Care Collaborative, Washington, DC, kicked off the first session of PCMH Congress 2019. Ms Greiner first explained that primary care is being reinvented with PCMH. She said that...
Ann Greiner, MCP, president and...
09/18/2019
First Report Managed Care
News Connection
Random Plasma Glucose Tests Predict Diabetes Diagnosis
09/18/2019
Random blood tests could be used to predict the development of diabetes and lead to earlier treatment and better outcomes, suggests a study published online in PLoS One.
Random blood tests could be used to predict the development of diabetes and lead to earlier treatment and better outcomes, suggests a study published online in PLoS One.
Random blood tests could be used...
09/18/2019
First Report Managed Care
News Connection
Low Use of Diabetes Prevention Activities Among At-Risk Adults
09/18/2019
Participation in lifestyle modification programs to prevent diabetes is “exceedingly low” among US adults at risk of type 2 diabetes, according to a study published in JAMA Network Open.
Participation in lifestyle modification programs to prevent diabetes is “exceedingly low” among US adults at risk of type 2 diabetes, according to a study published in JAMA Network Open.
Participation in lifestyle...
09/18/2019
First Report Managed Care
News Connection
Long-Term Metformin Use Among Veteran Population Lowers Incidence of Neurodegenerative Disease
09/18/2019
More than 2 years of metformin therapy, compared with no metformin use, was associated with a lower incidence of neurodegenerative disease among older adults with type 2 diabetes who were US veterans, according to a study published online in...
More than 2 years of metformin therapy, compared with no metformin use, was associated with a lower incidence of neurodegenerative disease among older adults with type 2 diabetes who were US veterans, according to a study published online in...
More than 2 years of metformin...
09/18/2019
First Report Managed Care
News Connection
VA, CMS to Improve Safety Surveillance of Meds Given to Veterans
09/18/2019
The Department of Veteran Affairs and Centers for Medicare & Medicaid Services announced they will come together and work to improve drug safety monitoring of prescriptions, including opioids, that are given to veterans.
The Department of Veteran Affairs and Centers for Medicare & Medicaid Services announced they will come together and work to improve drug safety monitoring of prescriptions, including opioids, that are given to veterans.
The Department of Veteran...
09/18/2019
First Report Managed Care
News Connection
VA, Cigna New Partnership Aims at Preventing Opioid Misuse Among Veterans With Chronic Pain
09/18/2019
According to a recent press release, the Department of Veteran Affairs has partnered with Cigna in a new public-private partnership. Together, the two agencies hope to improve the safety and quality of care for veterans with chronic pain who...
According to a recent press release, the Department of Veteran Affairs has partnered with Cigna in a new public-private partnership. Together, the two agencies hope to improve the safety and quality of care for veterans with chronic pain who...
According to a recent press...
09/18/2019
First Report Managed Care
News Connection
VA, Virta Health Partner to Improve Care for Veterans With Type 2 Diabetes
09/18/2019
According to a press release from the Department of Veteran Affairs, the agency has teamed up with Virta Health, a licensed medical provider in all 50 states, to explore a new program focused on improving the health of those with type 2...
According to a press release from the Department of Veteran Affairs, the agency has teamed up with Virta Health, a licensed medical provider in all 50 states, to explore a new program focused on improving the health of those with type 2...
According to a press release...
09/18/2019
First Report Managed Care
News Connection
Universal Health Plan May Not Increase Hospital Care
09/18/2019
As election season approaches, Medicare-for-All and other universal health plan concepts continue to be discussed at length. Authors of a recent study in Annals of Internal Medicine researched a popular concern that such a plan would cause a...
As election season approaches, Medicare-for-All and other universal health plan concepts continue to be discussed at length. Authors of a recent study in Annals of Internal Medicine researched a popular concern that such a plan would cause a...
As election season approaches,...
09/18/2019
First Report Managed Care
News Connection
CVS Caremark Grows Diabetes Care Program, Offers New Tools
09/18/2019
CVS Caremark announced plans to expand upon its Transform Diabetes Care (TDC) program focusing on greater prevention, adding more areas of care and intervention models for patients with diabetes and hypertension.
CVS Caremark announced plans to expand upon its Transform Diabetes Care (TDC) program focusing on greater prevention, adding more areas of care and intervention models for patients with diabetes and hypertension.
CVS Caremark announced plans to...
09/18/2019
First Report Managed Care
News Connection
Burnout Experienced by More Than Two-Thirds of US Physicians
09/18/2019
A new report released by InCrowd, a health care market research insights company, showed that not only do 68% of US physicians surveyed experience some level of burnout, but only 25% believe their facilities adequately address the...
A new report released by InCrowd, a health care market research insights company, showed that not only do 68% of US physicians surveyed experience some level of burnout, but only 25% believe their facilities adequately address the...
A new report released by...
09/18/2019
First Report Managed Care
News Connection
CVS, Aetna Expand Social Determinants of Health Initiatives, Announce New Platform
09/18/2019
Part of their “Building Healthier Communities” initiative, CVS and Aetna recently announced a collaboration project with Unite Us, a social care coordination platform, as one of the first of a series of business programs focused on addressing...
Part of their “Building Healthier Communities” initiative, CVS and Aetna recently announced a collaboration project with Unite Us, a social care coordination platform, as one of the first of a series of business programs focused on addressing...
Part of their “Building...
09/18/2019
First Report Managed Care
News Connection
FDA, HHS Share Proposed Action Plan for Safe Drug Importation
09/18/2019
In a joint effort, the US Department of Health and Human Services (HHS) and the US Food and Drug Administration (FDA) have announced the Safe Importation Action Plan, a project designed to lower out-of-pocket costs, which defines two possible...
In a joint effort, the US Department of Health and Human Services (HHS) and the US Food and Drug Administration (FDA) have announced the Safe Importation Action Plan, a project designed to lower out-of-pocket costs, which defines two possible...
In a joint effort, the US...
09/18/2019
First Report Managed Care
News Connection
Lowered Spending Among Providers Participating in ACOs in Rural, Underserved Areas
09/18/2019
According to study results published in the New England Journal of Medicine, Medicare spending was lower among providers serving in rural and underserved areas who also participated in ACO shared savings contracts.
According to study results published in the New England Journal of Medicine, Medicare spending was lower among providers serving in rural and underserved areas who also participated in ACO shared savings contracts.
According to study results...
09/18/2019
First Report Managed Care
News Connection
CMS Rule Finalized, CAR-T Therapy Covered By Medicare
09/18/2019
CAR-T therapy, a cancer treatment that uses a patient’s own genetically-modified immune cells to fight the disease, will now be covered nationwide by Medicare, according to a final decision released by the Centers for Medicare & Medicaid...
CAR-T therapy, a cancer treatment that uses a patient’s own genetically-modified immune cells to fight the disease, will now be covered nationwide by Medicare, according to a final decision released by the Centers for Medicare & Medicaid...
CAR-T therapy, a cancer...
09/18/2019
First Report Managed Care
News Connection
Surprise Billing on the Rise in Emergency Departments and Inpatient Services
09/18/2019
According to a study published in JAMA Internal Medicine, out-of-network is occurring more frequently and becoming more costly in both emergency department (ED) and inpatient settings.
According to a study published in JAMA Internal Medicine, out-of-network is occurring more frequently and becoming more costly in both emergency department (ED) and inpatient settings.
According to a study published...
09/18/2019
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

Advancements and Challenges in Diabetes Management
02/29/2024
02/29/2024
First Report Managed Care
News
LGBT Adults Face Higher Rates of Discrimination and Unfair Treatment in Health Care
04/05/2024
Hannah Musick
A Kaiser Family Foundation (KFF) report reveals the significant discrimination and unfair treatment faced by LGBT adults in the US, impacting mental health and access to health care, particularly for younger, lower-income, and women within...
A Kaiser Family Foundation (KFF) report reveals the significant discrimination and unfair treatment faced by LGBT adults in the US, impacting mental health and access to health care, particularly for younger, lower-income, and women within...
A Kaiser Family Foundation (KFF)...
04/05/2024
First Report Managed Care
News
Demodex Infestation Found in 9 of 10 Eye Clinic Patients Using 2-Minute Technique
05/09/2024
Jolynn Tumolo
Demodex mites were found in the eyelashes of 94% of patients examined with a simple diagnostic technique at a standard ophthalmic practice, according to a study published online in the journal Clinical Ophthalmology.
Demodex mites were found in the eyelashes of 94% of patients examined with a simple diagnostic technique at a standard ophthalmic practice, according to a study published online in the journal Clinical Ophthalmology.
Demodex mites were found in the...
05/09/2024
First Report Managed Care
Conference Coverage
Administrative Health Claims Data Study Highlights Demographics of Patients With Multiple Sclerosis in the US
05/31/2024
Grace Taylor, MS, MA
A new study highlights demographic data on subpopulations of people with multiple sclerosis (MS) in the US based on findings from administrative health claims (AHC) data sets.
A new study highlights demographic data on subpopulations of people with multiple sclerosis (MS) in the US based on findings from administrative health claims (AHC) data sets.
A new study highlights...
05/31/2024
First Report Managed Care
Blog
Why We’re Already Thinking Ahead to 2028 Part B Drug Price Negotiations
07/18/2024
Katie Hayes, MJ
Learn why industry stakeholders should prepare for 2028 negotiations now to ensure long-term financial stability and regulatory compliance.
Learn why industry stakeholders should prepare for 2028 negotiations now to ensure long-term financial stability and regulatory compliance.
Learn why industry stakeholders...
07/18/2024
First Report Managed Care

September 2019 Volume 16 Issue 9

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