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News
CMS Issues Preliminary Guidance on Medicaid State Directed Payments Ahead of Final Rule
09/15/2025
Grace Taylor, MS, MA
The Centers for Medicare & Medicaid Services (CMS) has released preliminary guidance to states on new payment limits for Medicaid State Directed Payments, giving payers and managed care programs an early look at significant changes taking...
The Centers for Medicare & Medicaid Services (CMS) has released preliminary guidance to states on new payment limits for Medicaid State Directed Payments, giving payers and managed care programs an early look at significant changes taking...
The Centers for Medicare &...
09/15/2025
First Report Managed Care
News
Hochul’s Medicaid Spending Surges, With Persistent Focus on Quality by Experts
08/27/2025
Danielle Sposato
Governor Kathy Hochul has added $17 billion in new state Medicaid spending over four years, a 61% increase that outpaces all other state-funded programs combined. Despite this unprecedented investment, according to a newly published article...
Governor Kathy Hochul has added $17 billion in new state Medicaid spending over four years, a 61% increase that outpaces all other state-funded programs combined. Despite this unprecedented investment, according to a newly published article...
Governor Kathy Hochul has added...
08/27/2025
First Report Managed Care
News
Medicare Advantage Plans See Double-Digit Satisfaction Drop as Medical Costs Soar
08/22/2025
Juliet Gallagher
Member satisfaction with Medicare Advantage (MA) plans has seen a significant decline, according to J.D. Power’s 2025 report, reflecting a broader set of financial and policy pressures now facing the MA landscape.
Member satisfaction with Medicare Advantage (MA) plans has seen a significant decline, according to J.D. Power’s 2025 report, reflecting a broader set of financial and policy pressures now facing the MA landscape.
Member satisfaction with...
08/22/2025
First Report Managed Care
News
Medicare Advantage Plans See Double-Digit Satisfaction Drop as Medical Costs Soar
08/22/2025
Juliet Gallagher
Member satisfaction with Medicare Advantage (MA) plans has seen a significant decline, according to J.D. Power’s 2025 report, reflecting a broader set of financial and policy pressures now facing the MA landscape.
Member satisfaction with Medicare Advantage (MA) plans has seen a significant decline, according to J.D. Power’s 2025 report, reflecting a broader set of financial and policy pressures now facing the MA landscape.
Member satisfaction with...
08/22/2025
First Report Managed Care
News
Physician Exodus from Medicare Surges Post-COVID: Alarming Rise Among Primary Care Providers
08/01/2025
Grace Taylor, MS, MA
Physician departures from Medicare have surged post-pandemic, with primary care and solo practitioners leading the exodus, raising urgent questions about coverage stability and network adequacy.
Physician departures from Medicare have surged post-pandemic, with primary care and solo practitioners leading the exodus, raising urgent questions about coverage stability and network adequacy.
Physician departures from...
08/01/2025
First Report Managed Care
News
Health Outcomes Are Superior in Fill-Risk Medicare Advantage vs Traditional Medicare
07/21/2025
Lisa Kuhns, PhD, MD
Medicare Advantage (MA) plans with 2-sided risk arrangements consistently outperform traditional Medicare (TM) on measures of quality and efficiency, according to a study published in The American Journal of Managed Care.
Medicare Advantage (MA) plans with 2-sided risk arrangements consistently outperform traditional Medicare (TM) on measures of quality and efficiency, according to a study published in The American Journal of Managed Care.
Medicare Advantage (MA) plans...
07/21/2025
First Report Managed Care
News
Managed Care Insurers Brace for Q2 Declines Amid Policy Shifts and Rising Costs
07/17/2025
Grace Taylor, MS, MA
Most major US health insurers are expected to report lower Q2 earnings as rising Medicare Advantage costs and looming Medicaid policy changes weigh heavily on financial performance.
Most major US health insurers are expected to report lower Q2 earnings as rising Medicare Advantage costs and looming Medicaid policy changes weigh heavily on financial performance.
Most major US health insurers...
07/17/2025
First Report Managed Care
News
North Carolina Expands Medicaid Managed Care to Encompass Behavioral Health, I/DD Populations
07/10/2025
Grace Taylor, MS, MA
North Carolina's Medicaid overhaul takes a major step forward as tailored managed care plans finally launch for residents with complex behavioral health and developmental needs.
North Carolina's Medicaid overhaul takes a major step forward as tailored managed care plans finally launch for residents with complex behavioral health and developmental needs.
North Carolina's Medicaid...
07/10/2025
First Report Managed Care
News
Care Coordinators Face Persistent Barriers in Medicaid SUD Programs, Survey Finds
07/08/2025
Hannah Musick
A survey of Virginia Medicaid care coordinators reveals widespread challenges in supporting patients with substance use disorders, with barriers linked to burnout and variations across managed care organizations.
A survey of Virginia Medicaid care coordinators reveals widespread challenges in supporting patients with substance use disorders, with barriers linked to burnout and variations across managed care organizations.
A survey of Virginia Medicaid...
07/08/2025
First Report Managed Care
News
DOJ and HHS Form Working Group to Intensify Health Care Fraud Enforcement
07/02/2025
Juliet Gallagher
The US Department of Health and Human Services (HHS) and the US Department of Justice (DOJ) announced the formation of the DOJ-HHS False Claims Act (FCA) Working Group, a joint initiative designed to strengthen enforcement efforts against...
The US Department of Health and Human Services (HHS) and the US Department of Justice (DOJ) announced the formation of the DOJ-HHS False Claims Act (FCA) Working Group, a joint initiative designed to strengthen enforcement efforts against...
The US Department of Health and...
07/02/2025
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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Trending Articles

News
Satellite Data Reveals a Link Between NO2 Exposure and Asthma Exacerbations
10/02/2023
Lisa Kuhns, PhD, MD
Incorporating ground-level satellite-derived estimates of NO2 into multivariable models reveals a relationship between NO2 exposure and asthma exacerbations, according to a study published in AMIA Joint Summits on Translational Science.
Incorporating ground-level satellite-derived estimates of NO2 into multivariable models reveals a relationship between NO2 exposure and asthma exacerbations, according to a study published in AMIA Joint Summits on Translational Science.
Incorporating ground-level...
10/02/2023
First Report Managed Care
News
Biosimilars: Uptake and Pricing in the US, Germany, and Switzerland
10/20/2023
Danielle Sposato
Various countries have implemented policies and regulatory pathways, such as the US's Biological Price Competition and Innovation Act and a similar approval pathway in the European Union, to facilitate the entry of biosimilars. This study...
Various countries have implemented policies and regulatory pathways, such as the US's Biological Price Competition and Innovation Act and a similar approval pathway in the European Union, to facilitate the entry of biosimilars. This study...
Various countries have...
10/20/2023
First Report Managed Care
Commentary
Review Provides Insight Into FDA Regulations and Prescription Digital Therapeutics as Market Expands
11/09/2023
Yvette C. Terrie, BS Pharm, RPh
As the number of PDTs continues to enter the market, it is important that clinicians and patients are aware of the regulatory processes instituted by the FDA to ensure the efficacy and safety of PDTs, and knowledge about the meticulous and...
As the number of PDTs continues to enter the market, it is important that clinicians and patients are aware of the regulatory processes instituted by the FDA to ensure the efficacy and safety of PDTs, and knowledge about the meticulous and...
As the number of PDTs continues...
11/09/2023
First Report Managed Care
Quiz
Utilization and Spending Changes With Preventive Drug Lists
12/12/2023
True or False: A case-control study found that exempting asthma medications from the deductible through preventive drug lists was associated with a modest absolute increase in adherence to controller medications and significantly reduced...
True or False: A case-control study found that exempting asthma medications from the deductible through preventive drug lists was associated with a modest absolute increase in adherence to controller medications and significantly reduced...
True or False: A case-control...
12/12/2023
First Report Managed Care
KOL Headshots
Commentary
2024 Predictions: Key Trends Identified by Business Leaders and Health Care Experts in Value-Based Care
01/23/2024
In this exclusive commentary for First Report Managed Care, health experts and business leaders share insights into predictions for the 2024 value-based care landscape. Insights highlight trends in behavioral health, AI integration,...
In this exclusive commentary for First Report Managed Care, health experts and business leaders share insights into predictions for the 2024 value-based care landscape. Insights highlight trends in behavioral health, AI integration,...
In this exclusive commentary for...
01/23/2024
First Report Managed Care

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