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Volume 17, Issue 6, June/July 2020 - First Report Managed Care

Featured Article

Managed Care Innovators: A Modern Approach to Medicare Advantage, An Interview With Rebellis Group Founders Betsy Seals and Debra Devereaux
07/21/2020
Dean Celia
Betsy Seals and Debra Devereaux, MBA, RPh, explain what motivated them to start a managed care consulting firm; how COVID-19 shifted things into hyperdrive; and the keys to success in the rapidly evolving Medicare Advantage space.
Betsy Seals and Debra Devereaux, MBA, RPh, explain what motivated them to start a managed care consulting firm; how COVID-19 shifted things into hyperdrive; and the keys to success in the rapidly evolving Medicare Advantage space.
Betsy Seals and Debra Devereaux,...
07/21/2020
First Report Managed Care
Conference Insider
Hydroxychloroquine Plus Itraconazole Shows No Antitumor Activity in Advanced EOC
07/21/2020
Although the combination of hydroxychloroquine and itraconazole was shown to be feasible in heavily pre-treated patients with platinum-resistant epithelial ovarian cancer (EOC), the regimen did not show any antitumor activity, according to...
Although the combination of hydroxychloroquine and itraconazole was shown to be feasible in heavily pre-treated patients with platinum-resistant epithelial ovarian cancer (EOC), the regimen did not show any antitumor activity, according to...
Although the combination of...
07/21/2020
First Report Managed Care
Commentary
5 Critical Strategies for Health Plans to Connect with Members During a Pandemic
07/21/2020
Lora Alexander
In the midst of the COVID-19 pandemic, engaging and communicating with members has never been more important for health plans. With the situation evolving so rapidly, both globally and locally, plan members run the risk of being confused by...
In the midst of the COVID-19 pandemic, engaging and communicating with members has never been more important for health plans. With the situation evolving so rapidly, both globally and locally, plan members run the risk of being confused by...
In the midst of the COVID-19...
07/21/2020
First Report Managed Care
Viewpoint
Three Reasons Why Medication Adherence is Crucial During COVID-19
07/21/2020
Jason Rose
Medication adherence must become a national priority as we deal with the continued effects of COVID-19.
Medication adherence must become a national priority as we deal with the continued effects of COVID-19.
Medication adherence must become...
07/21/2020
First Report Managed Care
Integrated Healthcare Executive
Taking the Surprise Out of Medical Billing
07/21/2020
Julie Gould
Steve Avery, president and chief client officer of abeo. breaks down the rates of surprise billing within organizations and provides some best practices for providers who want to ensure patients are prepared to meet all of their financial...
Steve Avery, president and chief client officer of abeo. breaks down the rates of surprise billing within organizations and provides some best practices for providers who want to ensure patients are prepared to meet all of their financial...
Steve Avery, president and chief...
07/21/2020
First Report Managed Care
Veterans Health Today
Exercise Appears to Preserve Cognitive Function in Veterans With Depression
07/21/2020
In a nationally representative sample of older US military veterans, the negative effect of depression on cognitive functioning was moderated by a pair of factors that affect brain-derived neurotropic factor (BDNF) function in the brain: BDNF...
In a nationally representative sample of older US military veterans, the negative effect of depression on cognitive functioning was moderated by a pair of factors that affect brain-derived neurotropic factor (BDNF) function in the brain: BDNF...
In a nationally representative...
07/21/2020
First Report Managed Care
Veterans Health Today
Omega-3 Supplements, Fish Intake Not Associated With Lower Risk of Nonfatal Coronary Artery Disease in Veterans
07/21/2020
Neither omega-3 fatty acid supplement use nor fish intake was linked with a lower risk of nonfatal coronary artery disease in US veterans, according to a study in Clinical Nutrition.
Neither omega-3 fatty acid supplement use nor fish intake was linked with a lower risk of nonfatal coronary artery disease in US veterans, according to a study in Clinical Nutrition.
Neither omega-3 fatty acid...
07/21/2020
First Report Managed Care
Veterans Health Today
Vitamin D Deficiency Increases Hospitalization Risk in Veterans With Heart Failure
07/21/2020
The risk of hospitalization in veterans with heart failure was significantly higher for those with vitamin D deficiency, according to a study published in the journal Maturitas. 
The risk of hospitalization in veterans with heart failure was significantly higher for those with vitamin D deficiency, according to a study published in the journal Maturitas. 
The risk of hospitalization in...
07/21/2020
First Report Managed Care
Veterans Health Today
Nonopioid Treatment Option for Chronic Low Back Pain in Veterans
07/21/2020
Julie Gould
Jennifer Naylor, PhD, clinical & experimental psychologist, Durham VA Health Care System and co-director for the VA Mid-Atlantic MIRECC’s Clinical Core, and Chris Marx, MD, staff psychiatrist, Durham VA Health Care System and codDirector for...
Jennifer Naylor, PhD, clinical & experimental psychologist, Durham VA Health Care System and co-director for the VA Mid-Atlantic MIRECC’s Clinical Core, and Chris Marx, MD, staff psychiatrist, Durham VA Health Care System and codDirector for...
Jennifer Naylor, PhD, clinical &...
07/21/2020
First Report Managed Care
News Connection
Comparing Medical Costs, Utilization Rates for Patients With Both Diabetes and Cancer
07/21/2020
In a recent study, researchers found that patients with type 2 diabetes mellitus who have also been diagnosed with cancer incur higher direct medical costs than patients with diabetes alone.
In a recent study, researchers found that patients with type 2 diabetes mellitus who have also been diagnosed with cancer incur higher direct medical costs than patients with diabetes alone.
In a recent study, researchers...
07/21/2020
First Report Managed Care
News Connection
HHS Partners With US-Based Pharma Manufacturers to Address Shortages
07/21/2020
The US Department of Health and Human Services (HHS) announced a plan to partner with a team of private industry partners in an effort to expand US-based pharmaceutical manufacturing, reducing the risk of shortages during the COVID-19...
The US Department of Health and Human Services (HHS) announced a plan to partner with a team of private industry partners in an effort to expand US-based pharmaceutical manufacturing, reducing the risk of shortages during the COVID-19...
The US Department of Health and...
07/21/2020
First Report Managed Care
News Connection
ICER Publishes Alternative Vaccine, Therapy Pricing Policies Amid Pandemic
07/21/2020
In an effort to inform both the public and policy makers, the Institute for Clinical and Economic Review (ICER) published a white paper this week entitled “Alternative Policies for Pricing Novel Vaccines and Drug Therapies for COVID-19.”
In an effort to inform both the public and policy makers, the Institute for Clinical and Economic Review (ICER) published a white paper this week entitled “Alternative Policies for Pricing Novel Vaccines and Drug Therapies for COVID-19.”
In an effort to inform both the...
07/21/2020
First Report Managed Care
News Connection
Cardiovascular Disease, Chronic Kidney Disease Affect Mortality in Patients With Diabetes
07/21/2020
Heart disease, stroke, and chronic kidney disease have an independent and cumulative effect on all-cause mortality and medical costs in patients with diabetes, according to a study published online in Diabetes Care.
Heart disease, stroke, and chronic kidney disease have an independent and cumulative effect on all-cause mortality and medical costs in patients with diabetes, according to a study published online in Diabetes Care.
Heart disease, stroke, and...
07/21/2020
First Report Managed Care
News Connection
Nearly Half of Medicare Advantage Enrollees Unaware of Long-Term Care Benefits
07/21/2020
Between 2010 and 2016, knowledge of dental and vision benefits under Medicare Advantage plans grew among enrollees, but the proportion of enrollees aware of nursing home care benefits shrank. Researchers reported their findings online in the...
Between 2010 and 2016, knowledge of dental and vision benefits under Medicare Advantage plans grew among enrollees, but the proportion of enrollees aware of nursing home care benefits shrank. Researchers reported their findings online in the...
Between 2010 and 2016, knowledge...
07/21/2020
First Report Managed Care
News Connection
HHS Commits Billions to Medicaid, CHIP With Provider Relief Funds
07/21/2020
In a recent announcement, the US Department of Health and Human Services (HHS) outlined its plans to provide additional distributions from the Provider Relief Fund to eligible providers that participate in Medicaid and the Children’s Health...
In a recent announcement, the US Department of Health and Human Services (HHS) outlined its plans to provide additional distributions from the Provider Relief Fund to eligible providers that participate in Medicaid and the Children’s Health...
In a recent announcement, the US...
07/21/2020
First Report Managed Care
News Connection
CMS Proposed Rule Supports Value-Based Arrangements, Innovative Therapies
07/21/2020
The Centers for Medicare & Medicaid Services (CMS) proposed new rules that are intended to encourage innovation by allowing states to pay for prescription drugs based on clinical outcomes—fostering more value-based payment arrangements.
The Centers for Medicare & Medicaid Services (CMS) proposed new rules that are intended to encourage innovation by allowing states to pay for prescription drugs based on clinical outcomes—fostering more value-based payment arrangements.
The Centers for Medicare &...
07/21/2020
First Report Managed Care
News Connection
AHIP Report Analyzes Medicaid Managed Care Plans
07/21/2020
As enrollment in Medicaid continues to skyrocket, keeping costs low for both the health plans and consumer is of the utmost importance. AHIP’s latest report shows that Medicaid managed care programs provide value and quality and that more...
As enrollment in Medicaid continues to skyrocket, keeping costs low for both the health plans and consumer is of the utmost importance. AHIP’s latest report shows that Medicaid managed care programs provide value and quality and that more...
As enrollment in Medicaid...
07/21/2020
First Report Managed Care
News Connection
Humana, LabCorp Authorize At-Home COVID Testing
07/21/2020
Humana is launching a pilot home-testing program for its members that will allow them to utilize LabCorp at-home test collection kits for COVID-19. The major insurer also announced a new collaboration with Quest Diagnostics and Walmart that...
Humana is launching a pilot home-testing program for its members that will allow them to utilize LabCorp at-home test collection kits for COVID-19. The major insurer also announced a new collaboration with Quest Diagnostics and Walmart that...
Humana is launching a pilot...
07/21/2020
First Report Managed Care
Using Technology to Address Disparities, Integrate the Social and Medical Needs of Patients
07/02/2020
Mary Beth Nierengarten
Events of the past weeks and months are laying bare the endemic health disparities in the United States. Experts believe technology has a significant role to play in correcting these gaps and providing improved care for all.
Events of the past weeks and months are laying bare the endemic health disparities in the United States. Experts believe technology has a significant role to play in correcting these gaps and providing improved care for all.
Events of the past weeks and...
07/02/2020
First Report Managed Care
Addressing Loneliness and Isolation During COVID-19
06/15/2020
Paul Nicolaus
“While keeping members physically healthy may be a plan’s first priority, with so many people—especially seniors—dealing with increased isolation and loneliness during the pandemic, it’s important to focus on members’ mental health as well,”...
“While keeping members physically healthy may be a plan’s first priority, with so many people—especially seniors—dealing with increased isolation and loneliness during the pandemic, it’s important to focus on members’ mental health as well,”...
“While keeping members...
06/15/2020
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 2020 Volume 17 Issue 6

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