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Volume 17, Issue 7, August 2020 - First Report Managed Care

Featured Article

Is Capitation Making a Comeback?
08/13/2020
Dean Celia
In the face of plummeting provider reimbursement due to the COVID-19 pandemic, fixed-fee pay models are getting a closer look. First Report Managed Care consulted an expert panel about capitation’s pros and cons, whether it has staying power,...
In the face of plummeting provider reimbursement due to the COVID-19 pandemic, fixed-fee pay models are getting a closer look. First Report Managed Care consulted an expert panel about capitation’s pros and cons, whether it has staying power,...
In the face of plummeting...
08/13/2020
First Report Managed Care
First Report
HEOR First Report: A Deeper Look at the Benefits of Hemlibra
08/31/2020
Edan Stanley
Karen Powell, PharmD, MS, Pharmacy Solutions Coordinator, Conduent, discusses a recent study in which she and her colleagues measured the cost effectiveness and utilizations rates associated with emicizumab-kxwh treatment for patients with...
Karen Powell, PharmD, MS, Pharmacy Solutions Coordinator, Conduent, discusses a recent study in which she and her colleagues measured the cost effectiveness and utilizations rates associated with emicizumab-kxwh treatment for patients with...
Karen Powell, PharmD, MS,...
08/31/2020
First Report Managed Care
First Report
Decreased Medication, Utilization Costs Identified With Emicizumab-kxwh Therapy for Hemophilia
08/31/2020
Edan Stanley
Emicizumab-kxwh, which was approved by the FDA in November 2017 to prevent or reduce the frequency of bleeding episodes in patients with hemophilia (HEM) A and FVIII inhibitors, was found to be associated with decreased medication and...
Emicizumab-kxwh, which was approved by the FDA in November 2017 to prevent or reduce the frequency of bleeding episodes in patients with hemophilia (HEM) A and FVIII inhibitors, was found to be associated with decreased medication and...
Emicizumab-kxwh, which was...
08/31/2020
First Report Managed Care
Formulary Frontlines®
Migraine and Payer Management Challenges
08/31/2020
Edan Stanley
Headache is extremely common in the general population, but despite its high prevalence and impairment, migraine is often not recognized or effectively treated. Because new classes of drugs and nondrug treatments continue to surface, more...
Headache is extremely common in the general population, but despite its high prevalence and impairment, migraine is often not recognized or effectively treated. Because new classes of drugs and nondrug treatments continue to surface, more...
Headache is extremely common in...
08/31/2020
First Report Managed Care
Viewpoint
Three Steps to Identify and Address Social Determinants of Health
08/31/2020
Jessica Schiller, RN, BSN, MAS
Social determinants of health (SDoH) reflect a wide variety of factors, including where people live, their education level, their occupation, and their ability to access support networks.
Social determinants of health (SDoH) reflect a wide variety of factors, including where people live, their education level, their occupation, and their ability to access support networks.
Social determinants of health...
08/31/2020
First Report Managed Care
Commentary
How Health Care Organizations Can Counter Vaccine Hesitancy
08/31/2020
Maria Perrin
The advent of the COVID-19 public health crisis has surfaced many challenges—both old and new—for the health care industry. It’s catalyzed us to re-examine the disparities in health care for minority groups; the future of telehealth as a...
The advent of the COVID-19 public health crisis has surfaced many challenges—both old and new—for the health care industry. It’s catalyzed us to re-examine the disparities in health care for minority groups; the future of telehealth as a...
The advent of the COVID-19...
08/31/2020
First Report Managed Care
Commentary
How Physicians Lead Through a Crisis
08/31/2020
Eva Luo, MD, MBA; Christopher Awtrey, MD, MHCDS; Alexa B. Kimball, MD, MPH
Since late February 2020, the novel coronavirus has been the single item on our agenda as we debrief internally what has since consumed every facet of leading a health care provider organization.
Since late February 2020, the novel coronavirus has been the single item on our agenda as we debrief internally what has since consumed every facet of leading a health care provider organization.
Since late February 2020, the...
08/31/2020
First Report Managed Care
Integrated Healthcare Executive
Improving Processes Within Health Care Systems Through AI, Natural Language Processing
08/31/2020
Julie Gould
Integrated Healthcare Executive recently spoke with Joe Ferro, president of abeo Technology Solutions and founder of TRUSTEDi10, regarding the use of artificial intelligence (AI) and natural language processing within health care systems.
Integrated Healthcare Executive recently spoke with Joe Ferro, president of abeo Technology Solutions and founder of TRUSTEDi10, regarding the use of artificial intelligence (AI) and natural language processing within health care systems.
Integrated Healthcare Executive...
08/31/2020
First Report Managed Care
Veterans Health Today
Recognizing Causes of Alcohol Use Disorder
08/31/2020
Lifetime drug use disorder, greater alcohol use at baseline, and trauma-related characteristics were independently associated with developing alcohol use disorder within 7 years of follow-up in US military veterans, according to a study...
Lifetime drug use disorder, greater alcohol use at baseline, and trauma-related characteristics were independently associated with developing alcohol use disorder within 7 years of follow-up in US military veterans, according to a study...
Lifetime drug use disorder,...
08/31/2020
First Report Managed Care
Veterans Health Today
To Reduce Suicide Risk in Veterans, Efforts Must Include Functioning, Well-being
08/31/2020
Mental health services to reduce suicide risk among US veterans should focus on maintaining or improving basic functioning (living, financial, and vocational) and well-being (social, psychological, and spiritual), suggests findings from a...
Mental health services to reduce suicide risk among US veterans should focus on maintaining or improving basic functioning (living, financial, and vocational) and well-being (social, psychological, and spiritual), suggests findings from a...
Mental health services to reduce...
08/31/2020
First Report Managed Care
Veterans Health Today
Group-Based Integrative Health Program Improves Mental Health, Pain in Female Veterans
08/31/2020
Participation in a group-based complementary and integrative health program significantly improved self-reported mental health and pain interfering with work in a pilot sample of female veterans, according to a study published in Explore. 
Participation in a group-based complementary and integrative health program significantly improved self-reported mental health and pain interfering with work in a pilot sample of female veterans, according to a study published in Explore. 
Participation in a group-based...
08/31/2020
First Report Managed Care
Veterans Health Today
The Impact of Patient Education in Oncology/Hematology Care: Empowering Patients in Their Battle Against Cancer
08/31/2020
Yvette C. Terrie, BS Pharm, RPh
As health care providers, we all strive to deliver the best quality of care to our patients and the heroic efforts of health care providers has definitely been validated during the COVID-19 pandemic and their commitments to patient care are...
As health care providers, we all strive to deliver the best quality of care to our patients and the heroic efforts of health care providers has definitely been validated during the COVID-19 pandemic and their commitments to patient care are...
As health care providers, we all...
08/31/2020
First Report Managed Care
News Connection
Examining Trends in ED Costs of Care for Medicare Beneficiaries
08/31/2020
According to results of a recent JAMA Network Open study, total 30-day costs of emergency department (ED) care for Medicare beneficiaries has decreased over the last several years, which the authors mostly attribute to declining rates of...
According to results of a recent JAMA Network Open study, total 30-day costs of emergency department (ED) care for Medicare beneficiaries has decreased over the last several years, which the authors mostly attribute to declining rates of...
According to results of a recent...
08/31/2020
First Report Managed Care
News Connection
Poor Survival, High Costs for Medicare Patients With Glioblastoma
08/31/2020
In a study of Medicare patients with newly diagnosed glioblastoma, the median overall survival was 5.9 months for those who underwent surgical resection and 3 months for those who did not, according to findings published in Neuro-Oncology...
In a study of Medicare patients with newly diagnosed glioblastoma, the median overall survival was 5.9 months for those who underwent surgical resection and 3 months for those who did not, according to findings published in Neuro-Oncology...
In a study of Medicare patients...
08/31/2020
First Report Managed Care
News Connection
Psoriatic Arthritis May Increase Mortality Risk in Young Adults
08/31/2020
Compared with their peers in the general population, young adults with psoriatic arthritis are at increased mortality risk, according to a study published in Seminars in Arthritis and Rheumatism. 
Compared with their peers in the general population, young adults with psoriatic arthritis are at increased mortality risk, according to a study published in Seminars in Arthritis and Rheumatism. 
Compared with their peers in the...
08/31/2020
First Report Managed Care
News Connection
CMS Shares New Resources Aimed at Protecting NH Residents During the Pandemic
08/31/2020
The Centers for Medicare & Medicaid Services (CMS) recently announced various initiatives designed to address the safety of nursing home (NH) residents as the COVID-19 pandemic continues to spread.
The Centers for Medicare & Medicaid Services (CMS) recently announced various initiatives designed to address the safety of nursing home (NH) residents as the COVID-19 pandemic continues to spread.
The Centers for Medicare &...
08/31/2020
First Report Managed Care
News Connection
Switching SC-TNFi Associated With Higher Nontreatment HCRU
08/31/2020
Patients with inflammatory arthritis who switched from a first-line to a second-line subcutaneous tumor necrosis factor alpha inhibitor (SC-TNFi) incurred significantly higher nontreatment health care resource utilization (HCRU) costs 12...
Patients with inflammatory arthritis who switched from a first-line to a second-line subcutaneous tumor necrosis factor alpha inhibitor (SC-TNFi) incurred significantly higher nontreatment health care resource utilization (HCRU) costs 12...
Patients with inflammatory...
08/31/2020
First Report Managed Care
News Connection
CMS, CDC Announce Reimbursement Options for Counseling COVID-19 Patients
08/31/2020
As maintaining the decline in COVID-19 cases remains a priority, the Centers for Medicare. & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) have announced that physicians and health care providers who counsel...
As maintaining the decline in COVID-19 cases remains a priority, the Centers for Medicare. & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) have announced that physicians and health care providers who counsel...
As maintaining the decline in...
08/31/2020
First Report Managed Care
Study Examines Regional Disparities in Prior Authorization Requirements for HIV PrEP
08/20/2020
Paul Nicolaus
Researchers reveal that the proportion of qualified health plans that require prior authorization for HIV PrEP is highest in the South, suggesting this may be a barrier to access in the region arguably in most need of the drug.
Researchers reveal that the proportion of qualified health plans that require prior authorization for HIV PrEP is highest in the South, suggesting this may be a barrier to access in the region arguably in most need of the drug.
Researchers reveal that the...
08/20/2020
First Report Managed Care
Recovering from COVID-19: Refocus on Health
07/24/2020
Mary Beth Nierengarten
With more news coming out daily on the disproportionate numbers of minorities contracting COVID-19, suffering severe diseases, and dying, the need to address social factors that place minority populations at greater risk of poor health and...
With more news coming out daily on the disproportionate numbers of minorities contracting COVID-19, suffering severe diseases, and dying, the need to address social factors that place minority populations at greater risk of poor health and...
With more news coming out daily...
07/24/2020
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

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Prajapati Podcast
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Standardizing the Field of Digital Medicine: Insights from an Industry Expert
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Join us in exploring the challenges and opportunities in the development, approval, and integration of digital therapeutic solutions with ZS Associates Consultant Yash Prajapati.
Join us in exploring the...
02/27/2024
First Report Managed Care
News
Identifying Large-Vessel Vasculitis in Polymyalgia Rheumatica: Key Clinical and Laboratory Red Flags
04/05/2024
Lisa Kuhns, PhD, MD
Potential red flags for large-vessel vasculitis in isolated polymyalgia rheumatica (PMR) include inflammatory back pain, significant pelvic involvement, widespread lower extremity pain, marked inflammatory response indicated by specific lab...
Potential red flags for large-vessel vasculitis in isolated polymyalgia rheumatica (PMR) include inflammatory back pain, significant pelvic involvement, widespread lower extremity pain, marked inflammatory response indicated by specific lab...
Potential red flags for...
04/05/2024
First Report Managed Care
Jay Ackerman Headshot
Interview
AI's Impact on Value-Based Care Outcomes
05/07/2024
Artificial intelligence (AI)-powered workflows and prospective analytics are advancing value-based care by improving patient outcomes and reducing costs. In a recent interview, an expert emphasizes that leveraging AI technologies enables...
Artificial intelligence (AI)-powered workflows and prospective analytics are advancing value-based care by improving patient outcomes and reducing costs. In a recent interview, an expert emphasizes that leveraging AI technologies enables...
Artificial intelligence...
05/07/2024
First Report Managed Care
News
Patient Diagnosed With Clinically Isolated Syndrome After Traumatic Brain Injury: Case Study
05/30/2024
Grace Taylor, MS, MA
Researchers presented a case study of a 71-year-old White man who was diagnosed with clinically isolated syndrome (CIS) after experiencing a traumatic brain injury.
Researchers presented a case study of a 71-year-old White man who was diagnosed with clinically isolated syndrome (CIS) after experiencing a traumatic brain injury.
Researchers presented a case...
05/30/2024
First Report Managed Care
FY2025
Behind the Bill
Budget Squeeze for FY 2025: What It Means for HHS and Public Health
07/17/2024
Katie Hayes, MJ
FY 2025 planning shows potential budget cuts for HHS and FDA, which could limit their ability to enforce regulations and address key issues.
FY 2025 planning shows potential budget cuts for HHS and FDA, which could limit their ability to enforce regulations and address key issues.
FY 2025 planning shows potential...
07/17/2024
First Report Managed Care

August 2020 Volume 17 Issue 7

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