Reimbursement

Latest News

COA badge | Image: COA
For Community Oncology, Good News in PFS Offset by Potential Wreckage of MFP Proposal

July 15th 2025

CMS proposes the 2026 Physician Fee Schedule (PFS), addressing payment disparities in oncology, but the community oncology community warns of financial threats from the Inflation Reduction Act. Updates reflect late Tuesday release of the proposed 2026 schedule for the Hospital Outpatient Prospective Payment System.

Rise in drug pricing | Image Credit: Alex Puhovoy - stock.adobe.com
Medicare Inflation Rebates Show Limited Impact on Drug Price Trends

July 14th 2025

Image credit: Canva Illustration | Mary Caffrey
Practical Considerations for AI in Community Oncology

July 8th 2025

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

July 7th 2025

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

More News

Kenneth Endo, MHA, BS, RTT | Image Credit: PIH Health Whittier Hospital
October 13th 2023

Oncology Financial Navigator Ensures Vital Care Access, Eases Economic Burden

Maggie L. Shaw
According to the National Cancer Institute, in the year following a cancer diagnosis, the average cost of medical care plus medication exceeds $42,000, with some treatments having a price tag of more than $1 million.
Health insurance concept using blocks with icons | Image credit: REDPIXEL - stock.adobe.com
October 7th 2023

Cigna to Pay $172M to Settle Claims of Wrongful Reimbursement by Medicare Advantage

Richard Payerchin
Cigna will pay $172 million to resolve allegations that it submitted inaccurate diagnosis codes for Medicare Advantage plan enrollees in order to increase payments from Medicare.
dr rajini katipamula-malisetti
October 6th 2023

Dr Rajini Katipamula-Malisetti: Minnesota Oncology Takes Value Very Seriously

Brooke McCormick
Rajini Katipamula-Malisetti, MD, executive vice president of Minnesota Oncology, defined value-based cancer care and its importance.
COA logo | Image credit: Community Oncology Alliance
October 6th 2023

COA: Inflation Cut Value of Medicare Payments by 28% Over Decade

AJMC Staff
The effects of flat or reduced reimbursements alongside inflation have been quantified in a report by Avalere Health, prepared for the Community Oncology Alliance (COA.)
rhonda henschel
October 3rd 2023

US Oncology Network’s Rhonda Henschel Discusses Value-Based Care, Payer Relations Initiatives

Brooke McCormick
Rhonda Henschel, US Oncology Network's vice president of payer relations, summarized what she learned from the Minnesota Oncology IVBM and discussed new developments in the value-based cancer care space.
Nicolas Ferreyros, Community Oncology Alliance
September 27th 2023

Collaboration Is Key to Success in Alternative Payment Models, Says COA’s Nick Ferreyros

Maggie L. Shaw
The number one ingredient that an oncology-based alternative payment model needs to succeed is collaboration, explained Nicolas Ferreyros, managing director of policy, advocacy, and communications, Community Oncology Alliance (COA).
Headshot of Karen Kobelski, MBA
September 25th 2023

Contributor: MA Plans Can Leverage Advanced Technology to Shore Up Risk Adjustment Practices

Karen Kobelski, MBA
Faced with new government regulations, Medicare Advantage (MA) organizations should be utilizing technology to increase the accuracy of their coding, mitigate their risk, and ensure appropriate care for members.
Nick Ferreyros, Community Oncology Alliance
September 20th 2023

COA’s Nick Ferreyros Addresses Oncology Policy Changes and the IRA

Maggie L. Shaw
We are in the midst of a transformative time in oncology that could also be a little scary if you are not prepared, said Nicolas Ferreyros, managing director of policy, advocacy, and communications, Community Oncology Alliance.
Jackson Williams, JD | Image Credit: Dialysis Patient Citizens
September 17th 2023

Contributor: Medicare’s Leadership Needs to Confront Our Shrinking US Workforce

Jackson Williams, JD
Medicare’s administered pricing system has never had to deal with labor scarcity before.
Paper people chain
September 13th 2023

New CMMI Model Supports Health Equity in States, Shifts Care to the Community

Laura Joszt, MA
The AHEAD Model will operate for 11 years and aim to shift health care to community-based settings.
Andre Harvin, PharmD, MS, MBA, Cone Health Cancer Centers
September 10th 2023

Dr Andre Harvin: Specialty Pharmacists Are Integral to Oncology Care

Maggie L. Shaw
Specialty pharmacy is a big area of growth, with opportunity for patients, and specialty pharmacists can help payers and insurers ensure that patients get the full value of oncology medications, noted Andre Harvin, PharmD, MS, MBA, chief pharmacy officer, Oncology Services, Cone Health Cancer Centers.
G.B. John Mancini, MD, University of British Columbia
September 7th 2023

Dr G. B. John Mancini on Payer System Differences Between the US and Canada

Maggie L. Shaw
Care quality is high in both the United States and Canada, but there are commonalities in regard to drug access and cost issues, particularly with advanced medications, noted G. B. John Mancini, MD, University of British Columbia.
group of doctors
September 3rd 2023

MSSP ACOs Saved $1.8M in 2022, Report Sixth Consecutive Year of Savings

Laura Joszt, MA
The Medicare Shared Savings Program (MSSP) generated its second highest annual savings since the program began more than a decade ago.
patient with data points
August 30th 2023

Contributor: ACO Success—Driving Better Outcomes and Liberating Clinicians

Steven Reeves, MD, FACP
Physicians have been facing increasing workloads making it difficult to practice medicine as they were trained, but an accountable care organization might provide an opportunity for real change to deliver high-value, compassionate care.
Money and pills
August 29th 2023

CMS Releases List of 10 Drugs Subject to Price Negotiation Under IRA

Christina Mattina
The 10 drugs, spanning disease states from diabetes to heart failure to rheumatoid arthritis, cost Medicare enrollees a total of $3.4 billion in out-of-pocket costs in 2022. As required by the Inflation Reduction Act (IRA), negotiations between Part D and pharmaceutical companies will take place this year and next, with the negotiated prices taking effect in 2026.
what we're reading logo
August 23rd 2023

What We’re Reading: Insurers Publicly Shamed; HHS Grants for COVID-19 Countermeasures; Medicare Obesity Drug Coverage

AJMC Staff
Patients and physicians are publicly shaming insurance companies on social media for the troublesome prior authorization process; HHS has awarded $1.4 billion in grants for the creation of new technologies and tools to prevent COVID-19 infection; Novo Nordisk has increased lobbying efforts to allow Medicare coverage of weight loss drugs.
AJMC
August 23rd 2023

Hospital Performance in a Statewide Commercial Insurer Episode-Based Incentive Program

Michael P. Thompson, PhD Anne H. Cain-Nielsen, MS Monica L. Yost Karslake, MPH Chelsea A. Pizzo, MPH Jessica M. Yaser, MPH John D. Syrjamaki, MPH Hari Nathan, MD, PhD Edward C. Norton, PhD Scott E. Regenbogen, MD, MPH
Some hospitals were able to outperform others in a commercial insurer episode-based incentive program, but there was little evidence of global reductions in episode spending.
AJMC
August 22nd 2023

Dialysis Costs for a Health System Participating in Value-Based Care

Leslie P. Wong, MD, MBA Anindita Ghosh, MD Jianbo Li, PhD Maged K. Rizk, MD, MBA Jessica A. Hohman, MD, MSc
In a large, integrated health system participating in value-based care, higher costs and utilization were observed before and after unplanned dialysis initiation.
stethoscope on money
August 18th 2023

CMS Announces Updates to ACO REACH for 2024

Laura Joszt, MA
The revisions to the ACO REACH model are expected to add predictability and stability while advancing health equity.
Final EOM List Favors Larger Practices; AON Strategy Helps Smaller Groups
August 15th 2023

Final EOM List Favors Larger Practices; AON Strategy Helps Smaller Groups

Mary Caffrey
Olalekan Ajayi, PharmD, MBA, ACCC and Highlands Oncology Group
August 15th 2023

Dr Olalekan Ajayi Discusses What Practices Should Do to Succeed Under the EOM

Maggie L. Shaw
Olalekan Ajayi, PharmD, MBA, 2023-2024 president of the Association of Community Cancer Centers, discusses what practices should do to succeed under the Enhancing Oncology Model (EOM).
people icons and connecting dots and lines
August 11th 2023

Vermont All-Payer ACO Successfully Drove Down Costs, Acute Care Over 4 Years

Laura Joszt, MA
The program, which scales an accountable care organization (ACO) model across all major payers in Vermont, reduced Medicare spending and hospitalizations while improving patient care.
Kimberly Hartsfield, EVP, Growth Enablement, Visiquate
August 4th 2023

Medicaid Redeterminations Create New Financial Challenges for Hospitals

Kimberly Hartsfield
Hospitals and health systems have been operating in the most challenging financial environment in history, and now they face another looming headwind—the impact of Medicaid redeterminations.
stethoscope on money
July 28th 2023

Value-Based Care Could Get Boost by New Bill in Washington

Richard Payerchin
Physicians and health care groups have lined up to support the Value in Health Care Act, which could create new incentives to adopt value-based care.
Provider holding a tablet showing patient data
July 26th 2023

AMA, AHIP, NAACOS Release Playbook on Data Sharing Best Practices for Value-Based Care

Laura Joszt, MA
The playbook from the 3 organizations highlights 5 best practices for data sharing from organizations with real-world experience in value-based care arrangements.
stethoscope on money
July 21st 2023

Physician Groups Mostly Unhappy With Proposed Medicare Fee Schedule

Jeffrey Bendix
The proposed fee schedule for 2024 would reduce payments by 3.4%. Most responses were swift and negative.
Final Tally Lists 44 Practices in EOM, but It's Complicated
July 12th 2023

Final Tally Lists 44 Practices in EOM, but It's Complicated

Mary Caffrey
The Enhancing Oncology Model (EOM) attracted more than 2800 practitioners across 561 sites of care; a group of practices in the American Oncology Network enrolled under a single tax ID number.
Close up of money
July 10th 2023

CMS Proposes $9 Billion Lump-Sum Repayment to 340B Hospitals

Laura Joszt, MA
After the Supreme Court ruled reimbursement cuts to 340B hospitals were done unlawfully, CMS is proposing to repay hospitals and providers in the program with a lump sum that has repercussions for other hospitals because of the agency’s need to be budget neutral.
Enhancing Oncology Model Attracts Key Practices, Leaders Who Had Success in the OCM
July 6th 2023

Enhancing Oncology Model Attracts Key Practices, Leaders Who Had Success in the OCM

Mary Caffrey
While the final number of EOM practices will be fewer than the numbers in the OCM, the presence of Tennessee Oncology, Texas Oncology, and Northwest Medical Specialties will ensure participation of key leaders who succeeded in the OCM and have weighed in on what's needed in its replacement.
health policy
July 3rd 2023

Poster Talks Explore How Policy, Payer Incentives Affect Cancer Care, Outcomes

Mary Caffrey
Speakers elaborated on health care delivery and regulatory policy posters presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting. This article will appear in the ASCO recap edition of Evidence-Based Oncology.
<123456789>

2 Commerce Drive
Suite 100
Cranbury, NJ 08512

© 2025 MJH Life Sciences® and AJMC®.
All rights reserved.

About
Contact
Editorial Boards
Advertise
Do Not Sell My Information
Terms & Conditions
Privacy Policy
AJMC Managed Markets Network Logo
CH LogoCenter for Biosimilars Logo