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Rutzler Headshot
Commentary
Clean-up Your Defenses: Why Health Plans Can't Afford to Wait on Fraud Hygiene
12/08/2025
Erin Rutzler
Health plans must urgently shift from reactive, manual fraud efforts to proactive, technology-driven prepay strategies—supported by unified teams and expert talent—to combat increasingly fast, sophisticated fraud, waste, and abuse schemes and...
Health plans must urgently shift from reactive, manual fraud efforts to proactive, technology-driven prepay strategies—supported by unified teams and expert talent—to combat increasingly fast, sophisticated fraud, waste, and abuse schemes and...
Health plans must urgently shift...
12/08/2025
First Report Managed Care
Dyke Headshot
Commentary
Amid Competing Performance Improvement Dollars, Call Center Advancements Take Center Stage
11/25/2025
David Dyke
Amid competing performance improvement dollars, call center advancements have moved center stage as health care organizations strive to improve patient access and experience. Reactive call centers, characterized by long wait times, complex...
Amid competing performance improvement dollars, call center advancements have moved center stage as health care organizations strive to improve patient access and experience. Reactive call centers, characterized by long wait times, complex...
Amid competing performance...
11/25/2025
First Report Managed Care
Campbell Headshot
Commentary
AI Diagnostics in Health Care: Promise, Peril, and the Path Forward
09/17/2025
Ivor Campbell
AI-powered health diagnostics promise unprecedented access to care but raise urgent questions about accuracy, regulation, and trust.
AI-powered health diagnostics promise unprecedented access to care but raise urgent questions about accuracy, regulation, and trust.
AI-powered health diagnostics...
09/17/2025
First Report Managed Care
Zimmerman Headshot
Commentary
The Growing Power of AI and Real-World Data in Commercialization
08/27/2025
Elliot Zimmerman
Real-world data (RWD) is becoming a critical tool for commercialization, helping companies better understand disease progression, patients’ responses to drugs, and strategies for long-term treatment.
Real-world data (RWD) is becoming a critical tool for commercialization, helping companies better understand disease progression, patients’ responses to drugs, and strategies for long-term treatment.
Real-world data (RWD) is...
08/27/2025
First Report Managed Care
Amol Dalvi Headshot
Commentary
From Pressure to Progress: How Health Care CIOs Are Using IT Strategy to Strengthen Patient Care
08/04/2025
Amol Dalvi
Faced with rising operational costs, workforce shortages, and shifting patient expectations, organizations are being asked to deliver better care with fewer resources. For CIOs, this means rethinking IT strategy not just as a support...
Faced with rising operational costs, workforce shortages, and shifting patient expectations, organizations are being asked to deliver better care with fewer resources. For CIOs, this means rethinking IT strategy not just as a support...
Faced with rising operational...
08/04/2025
First Report Managed Care
Helio Headshot
Commentary
Dodging the Side Effects of Cloud Provider Support: A Prescription for Health Care IT Flexibility and Efficiency
07/29/2025
Helio Matsumoto
To stay competitive and deliver high-quality outcomes, providers must leverage digital transformation while ensuring operational stability. Yet many health care systems are still heavily dependent on software vendors whose support models and...
To stay competitive and deliver high-quality outcomes, providers must leverage digital transformation while ensuring operational stability. Yet many health care systems are still heavily dependent on software vendors whose support models and...
To stay competitive and deliver...
07/29/2025
First Report Managed Care
John Santana
Commentary
Cyber Risk Is a Deal Risk: What Health Care Investors Need to Know Now
07/10/2025
John Santana
Private equity investors pride themselves on identifying value others overlook. But in health care, one of the most material risks to operational performance, regulatory compliance, and long-term value is often missed—or underestimated. That...
Private equity investors pride themselves on identifying value others overlook. But in health care, one of the most material risks to operational performance, regulatory compliance, and long-term value is often missed—or underestimated. That...
Private equity investors pride...
07/10/2025
First Report Managed Care
Headshots
Commentary
Using Technology to Advance Health Equity at the Community Level
01/24/2025
Melanie Thomas; Timothy McDonald, MD, JD
Improving patient safety and health equity requires addressing systemic inequities, using connected technology, and implementing evidence-based measures to ensure safer, more equitable care.
Improving patient safety and health equity requires addressing systemic inequities, using connected technology, and implementing evidence-based measures to ensure safer, more equitable care.
Improving patient safety and...
01/24/2025
First Report Managed Care
Sharma Headshot
Commentary
AI Trends Transforming Health Care Contact Centers in 2025
12/09/2024
Abhishek Danturi Sharma, MD
The health care contact center landscape is undergoing a revolution, driven by rapid advancements in artificial intelligence (AI). These cutting-edge technologies are reshaping how interactions are managed and enabling more efficient...
The health care contact center landscape is undergoing a revolution, driven by rapid advancements in artificial intelligence (AI). These cutting-edge technologies are reshaping how interactions are managed and enabling more efficient...
The health care contact center...
12/09/2024
First Report Managed Care
CJ Floros
Commentary
Finding More of Tomorrow’s Health System Executives on Today’s Frontline Teams
10/18/2024
CJ Floros
Nurse leaders are uniquely positioned to drive operational excellence and innovation in health care, but face challenges in advancing to C-suite roles traditionally held by non-clinical leaders.
Nurse leaders are uniquely positioned to drive operational excellence and innovation in health care, but face challenges in advancing to C-suite roles traditionally held by non-clinical leaders.
Nurse leaders are uniquely...
10/18/2024
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

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

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