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Real-World Digitally Based Diabetes Management Program Implementation by a Large Employer

March 4th 2025

This study offers new insights to self-insured employers and health plans related to investment in digitally based disease management programs and enrollee engagement.

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ERISA Industry Committee Sues Minnesota Over PBM Law

January 3rd 2025

AJMC
Prescription Rebate Guarantees: Employer Insights

July 19th 2024

To Expand Access to Cancer Expertise, Collaboration Is Key
To Expand Access to Cancer Expertise, Collaboration Is Key

February 20th 2023

stack of newspapers
What We’re Reading: Pediatric Vaccine Schedule Updated; Workplace Toll on Health; Drugmakers Lobby Against IRA Impact

October 21st 2022

More News

COVID-19 Exposes Cracks in Paid Sick Leave Policies
March 20th 2020

COVID-19 Exposes Cracks in Paid Sick Leave Policies

Allison Inserro
The president signed into law Wednesday the temporary Family First Coronavirus Response Act, which provides short-term paid sick leave benefits and longer-term paid family leave for some workers affected by the virus. However, it is not universal and provides for various exclusions.
Aligning Employer, Patient Needs: How Integrating Patient-Centered Care Can Promote Greater Value From Healthcare Spending
March 18th 2020

Aligning Employer, Patient Needs: How Integrating Patient-Centered Care Can Promote Greater Value From Healthcare Spending

Matthew Gavidia
In a webinar moderated by Thomas Parry, PhD, president of the Integrated Benefits Institute, an employer panel discussed value, application, and barriers to strategies involving the integration of employee needs and interests into benefit programs.
Dr Jeremy Whalen Cites Patient Safety, Total Cost of Care as Key Policy Goals for Prime Therapeutics
March 17th 2020

Dr Jeremy Whalen Cites Patient Safety, Total Cost of Care as Key Policy Goals for Prime Therapeutics

Patient safety is paramount when deciding how to roll out a new program or even if a program should be developed or not, said Jeremy Whalen, PharmD, BCOP, specialty clinical program director for oncology at Prime Therapeutics.
Telehealth During COVID-19: How Hospitals, Healthcare Providers Are Optimizing Virtual Care
March 14th 2020

Telehealth During COVID-19: How Hospitals, Healthcare Providers Are Optimizing Virtual Care

Matthew Gavidia
Amid the COVID-19 pandemic, patients, as well as their physicians, have been put at risk while seeking or providing other healthcare. While several barriers to care have inhibited telehealth in the past, recent actions by CMS, HHS, and other governing bodies have sought to expand its availability nationwide. NYU Langone Health's telehealth service Virtual Urgent Care connects members with clinicians via phone or tablet to provide care without potential coronavirus exposure.
Dr Bruce Sherman: Disproportionate Effects of Co-pay Accumulator Programs Across Populations
March 10th 2020

Dr Bruce Sherman: Disproportionate Effects of Co-pay Accumulator Programs Across Populations

Co-pay accumulator adjustment programs can have different effects for individuals with varying health plan types or income levels, explained Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.
Dr Bruce Sherman Looks Forward to Ongoing Research on the Impacts of Co-pay Accumulator Adjustment Programs
March 4th 2020

Dr Bruce Sherman Looks Forward to Ongoing Research on the Impacts of Co-pay Accumulator Adjustment Programs

Ongoing studies are aiming to determine how co-pay accumulator adjustment programs affect individuals’ medication adherence and persistence, with the hope that the results will inform employers on more equitable benefits strategies, according to Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.
Medicaid Expansion Fails to Promote Increased Community Benefit Spending in Nonprofit Hospitals
February 26th 2020

Medicaid Expansion Fails to Promote Increased Community Benefit Spending in Nonprofit Hospitals

Matthew Gavidia
In nonprofit hospitals within states that expanded Medicaid, significant decreases in uncompensated care was reported, with additional increases in unreimbursed Medicaid expenses indicating that Medicaid expansion had no substantial effect on community benefit spending.
Out-of-Network Primary Care Associated With Greater Beneficiary Spending in Medicare ACOs, Study Finds
February 25th 2020

Out-of-Network Primary Care Associated With Greater Beneficiary Spending in Medicare ACOs, Study Finds

Alison Rodriguez
Out-of-network primary care may be associated with higher per-beneficiary spending in Medicare accountable care organizations (ACOs), reported a recent study published in Health Affairs.
Dr Bruce Sherman: Why Co-pay Accumulator Programs Are an Unlikely Fit for High-Cost Therapies
February 25th 2020

Dr Bruce Sherman: Why Co-pay Accumulator Programs Are an Unlikely Fit for High-Cost Therapies

Co-pay accumulator adjustment programs will probably not be used for high-cost therapies because deductible amounts are trivial compared with their price tags and because these novel treatments are used for small populations, said Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.
Expect Reference-Based Pricing to Get a Serious Reboot
February 22nd 2020

Expect Reference-Based Pricing to Get a Serious Reboot

Dave Chase
Reference-based pricing is about to get a serious reboot, with even more healthcare purchasers engaging in the practice and those that are already using it reviewing existing contracts with increased scrutiny.
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February 20th 2020

Managed Care in 2020 and Beyond: The Decade for Integrated, Individualized Care

Cardinal Innovations Healthcare
Cardinal Innovations Healthcare is the largest specialty health plan in the country, insuring more than 850,000 North Carolinians with complex needs. Using a community-based model of care management, Cardinal Innovations has led the way in developing services, processes and solutions that improve the lives of our members and their families. Recognized for operational excellence, innovative solutions and superior outcomes for members, accuracy and speed of payments to providers, and cost-effective funds management, Cardinal Innovations is a leading healthcare company in the United States.
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February 20th 2020

Speaking of Employers: Purchasers Detail the Challenges of Getting a Handle on Oncology Care Costs

Mary Caffrey
As today’s employers try to balance the need to provide healthcare for their workers while keeping an eye on cost, they are banding together to learn more about cancer care and how to gain value for the millions they are spending. Last fall during the Community Oncology Alliance Payer Exchange Summit, leaders from employer and purchasing groups shared experiences from their members in a roundtable discussion.
Dr Bruce Sherman Describes Ways Employers Can Tweak Co-pay Accumulator Programs to Help Patients
February 19th 2020

Dr Bruce Sherman Describes Ways Employers Can Tweak Co-pay Accumulator Programs to Help Patients

According to Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions, there are several ways that employers can alleviate the impacts of co-pay accumulator adjustment programs on their employees, including by increasing awareness of the programs, expanding preventive drug lists, subsidizing benefits for low-income workers, and considering the true financial impact of these programs.
Latest HCCI Report Shows Continued Increases for Those With Employer-Sponsored Health Insurance
February 14th 2020

Latest HCCI Report Shows Continued Increases for Those With Employer-Sponsored Health Insurance

Allison Inserro
Workers with health insurance through their jobs saw out-of-pocket costs rise 14.5%, or $114, between 2014 and 2018, and also increased the use of psychiatry services and substance use facilities.
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February 11th 2020

Progress of Health Policy, Data Advancements Shows Both Improvement and Struggle

Allison Inserro
The evolution of data in healthcare in combination with policy advancements demonstrates how far the field has come but also brings up new challenges.
As Cancer Care Evolves, Site of Care Should Evolve, Too
February 8th 2020

As Cancer Care Evolves, Site of Care Should Evolve, Too

Jeremy Schafer, PharmD, MBA
What We're Reading: Young Adults Skip Benefits; $4 Million Stolen From Welfare Fund; New Measles Cases in Los Angeles
February 7th 2020

What We're Reading: Young Adults Skip Benefits; $4 Million Stolen From Welfare Fund; New Measles Cases in Los Angeles

AJMC Staff
A study shows young adults prefer short-term perks to long-term benefits; $4 million has been stolen from Mississippi's welfare fund; Los Angeles has reported 5 confirmed cases of measles.
Dr Bruce Sherman Discusses Unintended Consequences of Co-pay Accumulator Programs
February 6th 2020

Dr Bruce Sherman Discusses Unintended Consequences of Co-pay Accumulator Programs

While co-pay accumulator programs may appear to save employers money, they may lead to medication nonadherence if a prescription becomes too expensive for a patient to fill, which could potentially result in higher expenditures, cautioned Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.
PAPER OF THE WEEK: Benefit-Based Co-pay and the Origins of Value-Based Insurance Design
February 1st 2020

PAPER OF THE WEEK: Benefit-Based Co-pay and the Origins of Value-Based Insurance Design

Mary Caffrey
This week's paper from our editors-in-chief presented the idea of tying a prescription drug's cost-sharing to its clinical value to the patient.
V-BID X for Employers: A Framework Designed to Promote Employee Access to High-Value Drugs, Services
January 31st 2020

V-BID X for Employers: A Framework Designed to Promote Employee Access to High-Value Drugs, Services

Matthew Gavidia
A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design (V-BID) at the University of Michigan and co-editor-in-chief of The American Journal of Managed Care®, and Suzanne F. Delbanco, PhD, executive director of Catalyst for Payment Reform, discuss V-BID X for employers, a plan constructed through benefit-design and payment reform that works to promote high-value services and deter low-value care.
Employers Pay More When Patients Get Oncology Infusions in Hospital Outpatient Settings
January 30th 2020

Employers Pay More When Patients Get Oncology Infusions in Hospital Outpatient Settings

Matthew Gavidia
Researchers from the Employee Benefit Research Institute (EBRI) estimate that if hospital unit prices matched physician office (PO) prices of cancer drugs, holding drug mix and treatment intensity constant, commercial insurers would have saved $9766 (45%) per user of these medicines in 2016, with statistically significant relative differences ranging from 128.3% (nivolumab) to 428% (fluorouracil).
Dr Bruce Sherman Describes the Purpose and Mechanisms of Co-pay Accumulator Adjustment Programs
January 29th 2020

Dr Bruce Sherman Describes the Purpose and Mechanisms of Co-pay Accumulator Adjustment Programs

Co-pay accumulator adjustment programs are meant to ensure that individuals are responsible for the full amount of their insurance deductible, which should help promote healthcare consumerism, according to Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.
Employing Value-Based Care: An Industry View of Obstacles, Applicable Strategies for Efficient Implementation
January 23rd 2020

Employing Value-Based Care: An Industry View of Obstacles, Applicable Strategies for Efficient Implementation

Matthew Gavidia
Innovaccer’s survey-based report titled, “The Science of Value-based Care: An Industry View,” details the current state of readiness of healthcare organizations in employing value-based care, while also providing tips on how minor changes in one’s system framework can contribute to clinical excellence and technical efficiency.
Dr Bruce Sherman Explains Why Employers Should Consider Population Health in Benefit Design
January 22nd 2020

Dr Bruce Sherman Explains Why Employers Should Consider Population Health in Benefit Design

Population health models that include social determinants of health can help employers design more strategic benefits that will provide an effective solution for all individuals who receive that insurance, said Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.
Coalition Advocates for Biosimilar Uptake to Help Lower Employers' Drug Cost Burden
January 18th 2020

Coalition Advocates for Biosimilar Uptake to Help Lower Employers' Drug Cost Burden

Gianna Melillo
Rising drug costs in the United States are a pressing concern not only for patients who need to receive those drugs, but also for employers. The Employers’ Prescription for Affordable Drugs is a coalition that aims to tackle this problem by working with policy makers and stakeholders to encourage and facilitate more transparency, competition, and value in the healthcare system.
What We're Reading: Employee Sleep Improvements; Republican Supports Medicare Drug Price Negotiations; Sepsis Death Toll
January 17th 2020

What We're Reading: Employee Sleep Improvements; Republican Supports Medicare Drug Price Negotiations; Sepsis Death Toll

AJMC Staff
Along with weight loss, exercise, and nutrition, employers now target sleep improvements in employees; a Republican member of the FTC supports Medicare drug price negotiations; sepsis is likely responsible for 20% of deaths worldwide.
Dr Bruce Sherman: Adding Nuance Can Make Value-Based Insurance Design More Impactful for Employers
January 13th 2020

Dr Bruce Sherman: Adding Nuance Can Make Value-Based Insurance Design More Impactful for Employers

Making benefit design more nuanced through the inclusion of employee variables could help increase the impact of value-based insurance design for employers, said Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.
Dr Bruce Sherman Outlines Successful Employer Strategies for Containing Healthcare Costs
January 7th 2020

Dr Bruce Sherman Outlines Successful Employer Strategies for Containing Healthcare Costs

An array of different techniques, including direct primary care, are being used by employers to manage healthcare costs while keeping care affordable for employees, according to Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.
Nearly 8 in 10 Employers Express Concern About Financial Stability of Workers, Survey Shows
January 2nd 2020

Nearly 8 in 10 Employers Express Concern About Financial Stability of Workers, Survey Shows

Matthew Gavidia
In MassMutual’s 2019 Workplace Financial Wellness Study, survey data gathered by Greenwald & Associates reported that a large majority of employers believe their employees are struggling financially in saving for retirement, settling debt, and dealing with medical costs.
Dr Bruce Sherman Discusses Opportunities for Employers to Emphasize Value When Purchasing Healthcare Plans
December 31st 2019

Dr Bruce Sherman Discusses Opportunities for Employers to Emphasize Value When Purchasing Healthcare Plans

Employers’ decisions around purchasing healthcare plans should focus on a broader measure of value, including employee productivity, not just cost, according to Bruce Sherman, MD, chief medical officer of the National Alliance of Healthcare Purchaser Coalitions.
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