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Vashi Headshot
Commentary
Optimizing Risk Adjustment and Quality Measurement With AI
09/15/2025
Deepan Vashi
As we’ve covered in the earlier entries in this series, artificial intelligence (AI) is proving useful in streamlining health plan operations of all sorts. AI tools can also augment human expertise for optimal results in less structured but...
As we’ve covered in the earlier entries in this series, artificial intelligence (AI) is proving useful in streamlining health plan operations of all sorts. AI tools can also augment human expertise for optimal results in less structured but...
As we’ve covered in the earlier...
09/15/2025
First Report Managed Care
Beery Headshot
Commentary
Medicaid Cuts Will Endanger the United States’ Most Vulnerable Children
06/19/2025
Taylor Beery
Recently, House and Senate Republicans introduced a sweeping package of Medicaid cuts that would fundamentally reshape the program—reducing enrollment, adding new eligibility barriers, and threatening the care of millions of children. These...
Recently, House and Senate Republicans introduced a sweeping package of Medicaid cuts that would fundamentally reshape the program—reducing enrollment, adding new eligibility barriers, and threatening the care of millions of children. These...
Recently, House and Senate...
06/19/2025
First Report Managed Care
Videos
Evolving Strategies in RA Treatment: Real-World Insights and Access Challenges
06/09/2025
Jonathan Kay, MD; Julie Baak; Juliet Gallagher
This expert roundtable, hosted by First Report Managed Care, explores the evolving rheumatoid arthritis (RA) treatment landscape, highlighting advancements in therapeutic options, challenges with payer-driven access and reimbursement, and the...
This expert roundtable, hosted by First Report Managed Care, explores the evolving rheumatoid arthritis (RA) treatment landscape, highlighting advancements in therapeutic options, challenges with payer-driven access and reimbursement, and the...
This expert roundtable, hosted...
06/09/2025
First Report Managed Care
Dewey Headshot
Commentary
Bridging Care Gaps and Improving Access for Rural Members
05/13/2025
Leah Dewey
Given the significant challenges facing rural communities, health plans should harness their creativity and tenacity when aiming to improve outcomes for their rural members. Plans that are willing to invest in targeted outreach efforts can...
Given the significant challenges facing rural communities, health plans should harness their creativity and tenacity when aiming to improve outcomes for their rural members. Plans that are willing to invest in targeted outreach efforts can...
Given the significant challenges...
05/13/2025
First Report Managed Care
Commentary
Navigating the Decline of Medicare Advantage Star Ratings in 2025: Six Need-to-Knows
11/25/2024
Cindy Henry
The 2025 Medicare Advantage Star Ratings present a new landscape for MA plans, with fewer achieving high ratings due to changes in methodology, utilization patterns, ongoing litigation, and potential impacts of recent election outcomes. Learn...
The 2025 Medicare Advantage Star Ratings present a new landscape for MA plans, with fewer achieving high ratings due to changes in methodology, utilization patterns, ongoing litigation, and potential impacts of recent election outcomes. Learn...
The 2025 Medicare Advantage Star...
11/25/2024
First Report Managed Care
Shannon Smith, RN, BSN
Commentary
Navigating the CY 2025 CMS Physician Fee Schedule Proposals: Strategic Insights for Health Care Leaders
09/30/2024
Shannon Smith, RN, BSN
The Centers for Medicare & Medicaid Services (CMS) has released its calendar year (CY) 2025 physician fee schedule proposals. In this commentary, an expert breaks down the key components and their implications for health care organizations.
The Centers for Medicare & Medicaid Services (CMS) has released its calendar year (CY) 2025 physician fee schedule proposals. In this commentary, an expert breaks down the key components and their implications for health care organizations.
The Centers for Medicare &...
09/30/2024
First Report Managed Care
Commentary
Payer-Provider Synergy: Aligning at the Fulcrum Points
08/05/2024
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration...
08/05/2024
First Report Managed Care
Christie Headshot
Commentary
How Medicare Advantage Plans Can Prepare for the CMS Health Equity Index
02/13/2024
Christie Teigland, PhD
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare...
02/13/2024
First Report Managed Care
Ashley Headshot
Commentary
2025–2026 Star Ratings: The Path to Success
01/09/2024
Ashley McNairy
Even though many Medicare Advantage (MA) health plan executives braced for another year of declining performance on their Star Ratings, seeing their 2024 ratings drop for the second consecutive year has been a tough pill to swallow. Ashley...
Even though many Medicare Advantage (MA) health plan executives braced for another year of declining performance on their Star Ratings, seeing their 2024 ratings drop for the second consecutive year has been a tough pill to swallow. Ashley...
Even though many Medicare...
01/09/2024
First Report Managed Care
Anup Headshot
Commentary
Simple Outreach Tactics Plug Medicaid Redetermination Gaps
12/21/2023
Anup Panthaloor
The unwinding of Medicaid’s continuous enrollment and resulting redetermination activities were supposed to be nearly complete by spring 2024. According to Anup Panthaloor, Firstsource EVP, now, the initiative may be pushed into the summer of...
The unwinding of Medicaid’s continuous enrollment and resulting redetermination activities were supposed to be nearly complete by spring 2024. According to Anup Panthaloor, Firstsource EVP, now, the initiative may be pushed into the summer of...
The unwinding of Medicaid’s...
12/21/2023
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

News
Dairy, Gluten Show No Major Effect on MS Activity and Quality of Life
02/15/2024
Jolynn Tumolo
Dairy and gluten intake had no substantial effects on disease activity and quality of life in a retrospective study of 186 patients with multiple sclerosis (MS). Researchers published their findings online in Multiple Sclerosis Journal –...
Dairy and gluten intake had no substantial effects on disease activity and quality of life in a retrospective study of 186 patients with multiple sclerosis (MS). Researchers published their findings online in Multiple Sclerosis Journal –...
Dairy and gluten intake had no...
02/15/2024
First Report Managed Care
News
Health Care Administration Inefficiencies: Lessons from the 2024 Medallion Report
03/26/2024
Hannah Musick
Discover the impact of manual processes and staffing challenges on payer enrollment and credentialing workflows in the 2024 State of Payer Enrollment and Credentialing Report by Medallion.
Discover the impact of manual processes and staffing challenges on payer enrollment and credentialing workflows in the 2024 State of Payer Enrollment and Credentialing Report by Medallion.
Discover the impact of manual...
03/26/2024
First Report Managed Care
IPF letters
Formulary Frontlines®
New Therapies in Development for Idiopathic Pulmonary Fibrosis (IPF) Address Existing Challenges With Diagnosis and Management
05/13/2024

Reviewed by Elizabeth Volkmann, MD, MS

Reviewed by Elizabeth Volkmann, MD, M...
IPF is a chronic, progressive interstitial lung disease that presents a significant burden to ~3 million patients worldwide. Despite ongoing challenges with IPF diagnosis and management, new therapies in development are showing promise.
IPF is a chronic, progressive interstitial lung disease that presents a significant burden to ~3 million patients worldwide. Despite ongoing challenges with IPF diagnosis and management, new therapies in development are showing promise.
IPF is a chronic, progressive...
05/13/2024
First Report Managed Care
Conference Coverage
Immune Colitis Associated With Rituximab Therapy in Relapsing Multiple Sclerosis
05/24/2024
Hannah Musick
A case study highlighted rare immune colitis associated with rituximab therapy in a patient with relapsing multiple sclerosis (RMS) and emphasizes the need for increased awareness and monitoring of this potential adverse effect in clinical...
A case study highlighted rare immune colitis associated with rituximab therapy in a patient with relapsing multiple sclerosis (RMS) and emphasizes the need for increased awareness and monitoring of this potential adverse effect in clinical...
A case study highlighted rare...
05/24/2024
First Report Managed Care
Katie Devlin
Interview
Strategies for Adjusting With Health Care Interoperability
07/01/2024
Katie Devlin, DHSc, MS, CPHIMS
In this interview, Katie Devlin, VP of Interoperability at Cotiviti, discusses the impact of major shifts like TEFCA and the CMS Interoperability Rule on health plans, emphasizing the importance of joining a QHIN to increase data...
In this interview, Katie Devlin, VP of Interoperability at Cotiviti, discusses the impact of major shifts like TEFCA and the CMS Interoperability Rule on health plans, emphasizing the importance of joining a QHIN to increase data...
In this interview, Katie Devlin,...
07/01/2024
First Report Managed Care

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