Reimbursement

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Image credit: Canva Illustration by Mary Caffrey
How AI Can Address the Troubled Business Model in Oncology

July 7th 2025

Artificial intelligence (AI) will transform community oncology, addressing workforce shortages and reimbursement challenges while enhancing patient care and operational efficiency, discussed speakers at Tennessee Oncology's “Tech Innovations in Community Oncology."

Blood sample lab | Image credit: Caris Life Sciences
At ASCO, Testing and AI Rival Drugs for Attention, but Reimbursement Remains a Barrier

July 5th 2025

Without IRA Fix, COA Warns Community Oncology Practices Will Shut Down
Without IRA Fix, COA Warns Community Oncology Practices Will Shut Down

June 30th 2025

Planned Parenthood | Image credit: William A. Morgan - stock.adobe.com
SCOTUS Rules Abortion Clinics Can Not Challenge South Carolina’s Medicaid Order

June 26th 2025

Image provided by NCCN
NCCN Summit Seeks to Build Better Connections Between Oncology and Primary Care

May 7th 2025

More News

Vineet Arora, MD, MAPP
December 18th 2022

Dr Vineet Arora: Balancing Reimbursement Incentives With What Matters to Clinicians

Christina Mattina
Our current health care reimbursement system rewards procedures and undervalues the time spent talking with patients and learning their history, which speaks to the need for primary care redesign, according to Vineet Arora, MD, MAPP, dean for medical education at UChicago Medicine.
OneOncology logo
December 13th 2022

OneOncology Physician Leadership Conference: Inaugural Meeting 2022

Mary Caffrey
Coverage from the first day of the inaugural OneOncology Physician Leadership Conference, held November 11-13, 2022, in Nashville, Tennessee.
COA Payer Exchange Summit: 2022 Coverage
December 12th 2022

COA Payer Exchange Summit: 2022 Coverage

Mary Caffrey
Coverage from the Community Oncology Alliance Payer Exchange Summit, held in Tyson's Corner, Virginia, October 24-25, 2022.
Pharmacy
December 9th 2022

ICYMI: Notable Topics From the 2022 Asembia Specialty Pharmacy Summit

AJMC Staff
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December 9th 2022

Organizational Capacity Among Hospitals in Medicare and Commercial Bundled Payments

John Urwin, MD Amol S. Navathe, MD, PhD Lingmei Zhou, MS Jay Bhatt, DO Peter D. Kralovec, BA Joshua M. Liao, MD, MSc
A national survey demonstrated differences in organizational capacity between hospitals participating in Medicare bundled payment programs and those coparticipating in both Medicare and commercial bundled payment programs.
Headshot of Terry Wilcox, CEO of Patients Rising
December 8th 2022

Contributor: To Protect Patient Access, Congress Must Block Medicare Physician Payment Cuts

Terry Wilcox
Impending cuts to Medicare physician services could have an overwhelmingly negative impact on millions of older patients and individuals with disabilities across the country.
Young patient recovering from cancer
December 6th 2022

How Public Insurance Creates Barriers for Childhood Cancer Survivors

Celeste Krewson
In a recent study, it was found that individuals with public health insurance had worse health competence beliefs, reducing transition goals, expectations, and beliefs.
Evidence-Based Oncology logo
December 2nd 2022

Breaking New Ground in Episodes of Care, Including CAR T-Cell Therapy

Mary Caffrey
Coverage from the Institute for Value-Based Medicine® session with Astera Cancer Care in Edison, New Jersey, held November 3, 2022.
image of stethoscope on money
November 29th 2022

HDHPs Deter Women From Additional Testing After Abnormal Mammogram, Study Says

AJMC Staff
The groups who told researchers they would be more likely to skip additional testing had lower levels of income or education and were more likely to be on Medicaid or be uninsured, among other factors.
image of stethoscope on US money
November 24th 2022

Survey Illustrates High Receptiveness From Payers to Alternative Payment Models

Justina Petrullo
A survey conducted by the Health Care Payment Learning and Action Network found that “more plans are using incentives in value-based care arrangements to improve health equity.”
image of health insurance form
November 14th 2022

Study Examines Insurance Switching in the Perinatal Period in Massachusetts

AJMC Staff
While those with Medicaid insurance were more likely to have an insurance transition before or after giving birth, those with private insurance were also found to have insurance changes.
close up of money
November 2nd 2022

Medicare Fee Schedule Expands Access to Some Services but Cuts Physician Reimbursement 4.5%

Laura Joszt, MA
The 2023 Physician Fee Schedule final rule was released and swiftly drew condemnations from physician leaders because of a 4.5% cut to reimbursement.
Dr Joseph Alvarnas Explains Cancer Care Equity Act for Medi-Cal Beneficiaries
October 29th 2022

Dr Joseph Alvarnas Explains Cancer Care Equity Act for Medi-Cal Beneficiaries

Matthew Gavidia
Joseph Alvarnas, MD, vice president of government affairs at City of Hope and chief clinical adviser of AccessHope in Duarte, California, discusses the recently passed Cancer Care Equity Act in California that provides access to clinical trials and advanced care for Medi-Cal beneficiaries.
Redesigning Benefits, Value-Based Agreements With Better Cancer Care in Mind
October 29th 2022

Redesigning Benefits, Value-Based Agreements With Better Cancer Care in Mind

Mary Caffrey
The quest to deliver better cancer care—with better outcomes and patient experience—is not a one-size-fits-all journey, as seen in panels during the Community Oncology Alliance (COA) Payer Exchange Summit, held in Tyson’s Corner, Virginia.
California Takes a Step Toward Bringing Equity in Cancer Care
October 22nd 2022

California Takes a Step Toward Bringing Equity in Cancer Care

Joseph Alvarnas, MD
The new law will expand access for Medi-Cal patients who receive a complex cancer diagnosis and represents a critical first step in fulfilling the promise of the California Cancer Patients Bill of Rights, a resolution adopted by the legislature in 2021.
Minnesota Oncology Leaders, Partners Find Value in Putting Patients First
October 21st 2022

Minnesota Oncology Leaders, Partners Find Value in Putting Patients First

Mary Caffrey
Coverage from the Minnesota meeting of the Institute for Value-Based Medicine, chaired by Rajini Katipamula-Malisetti, MD, vice president of medical oncology at Minnesota Oncology.
Wither the RO Model: Focusing on Access to Spread the Value of Radiation Therapy
October 20th 2022

Wither the RO Model: Focusing on Access to Spread the Value of Radiation Therapy

Anne Hubbard, MBA
insurance
October 14th 2022

AMA Report Evaluates PBM Competition and Vertical Integration With Insurers

Laura Joszt, MA
While a majority of national lives are covered by vertically integrated insurers, the proportion varies widely at the state level from as low as 6% to as high as 97% of covered lives, according to a new American Medical Association (AMA) report about competition in the pharmacy benefit manager (PBM) sector and insurance.
Glenn Balasky, Rocky Mountain Cancer Centers
October 12th 2022

Glenn Balasky Highlights Continued Value-Based Oncology Care Efforts With Private Payers

Laura Joszt, MA
Even though there is a 1-year gap between the Oncology Care Model and the Enhancing Oncology Model, there remain value-based oncology payment programs with private payers, said Glenn Balasky, executive director of Rocky Mountain Cancer Centers.
image of stethoscope on bills
October 6th 2022

Prior Authorization Can Work in MA but Not Without Changes, Researchers Say

Pearl Steinzor
In a recent opinion published in JAMA, health policy researchers reviewed the advantages and disadvantages of prior authorization in Medicare Advantage (MA) to identify key areas that need improvement.
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October 4th 2022

Turnover Among New Medicare Advantage Enrollees May Be Greater Than Perceived

Jeffrey Dong, MD Alan M. Zaslavsky, PhD John Z. Ayanian, MD, MPP Bruce E. Landon, MD, MBA
Enrollees who join Medicare Advantage undergo significant turnover in the years following enrollment.
All 14 OneOncology Practices Apply for EOM
October 3rd 2022

All 14 OneOncology Practices Apply for EOM

AJMC Staff
The Enhancing Oncology Model (EOM) will be the successor to the Oncology Care Model.
Stephen M. Schleicher, MD, MBA, chief medical officer, Tennessee Oncology
October 2nd 2022

Dr Stephen Schleicher: Culture, People, Analytics Contributed to OCM Success

Maggie L. Shaw Mary Caffrey
Co-hosted by Memorial Sloan Kettering Cancer Center, the most recent Institute for Value-Based Medicine® event took place on September 22, with a focus on improving cancer care delivery through innovation.
Elderly woman sitting
September 28th 2022

Alzheimer Disease Drug Lecanemab Successfully Reduces Cognitive, Functional Decline

Laura Joszt, MA
The topline results showed the phase 3 trial met both the primary endpoint and all secondary endpoints.
Ted Okon, MBA
August 10th 2022

Ted Okon Explains the Narrow SCOTUS Ruling on 340B Reimbursements

Laura Joszt, MA
The ruling by the Supreme Court on 340B reimbursements was narrow, but it sets up a future reimbursement reduction by HHS that is even greater based on survey data, said Ted Okon, MBA, executive director, Community Oncology Alliance.
Conference Coverage: ACCC 2022 AMCCBS
April 14th 2022

Conference Coverage: ACCC 2022 AMCCBS

Mary Caffrey
Coverage from the Association of Community Cancer Centers 2022 Annual Meeting and Cancer Center Business Summit, held in Washington, DC, March 2-4.
Alvarnas
August 18th 2021

From the Editor-in-Chief: Shiny New Objects Within a Struggling System

Joseph Alvarnas, MD
"No matter where you go, there you are." Buckaroo Banzai
The Impact of Reinsurance of Gene Therapies on Employer Financial Risk
April 22nd 2021

The Impact of Reinsurance of Gene Therapies on Employer Financial Risk

Marc Hixson, MBA Neil B. Minkoff, MD Kim Gwiazdzinski, MBA, RPh Jim Clement, MHA
stethoscope on a pack of rolled bills, with an American flag backdrop.
March 25th 2021

Report Documents Grim Current Status and Future of US Hospitals

Gianna Melillo
Survey responses of 320 US hospitals highlight the dire consequences of the COVID-19 pandemic on facilities and point to a future of ongoing financial and staffing challenges.
Sachin Kamal-Bahl, PhD; and Bryan Luce, PhD, MBA
February 16th 2021

Contributor: A Practical Path Forward to More Patient-Centered Value Assessment

Sachin Kamal-Bahl, PhD Bryan Luce, PhD, MBA
To ensure that value assessment accounts for patient needs, we need a better understanding of the outcomes that are most important to patients, write authors from COVIA Health Solutions and the University of Washington School of Pharmacy.
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