Reimbursement

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

May 7th 2025

The National Comprehensive Cancer Network (NCCN) policy summit highlighted the need for improved communication between oncology and primary care to enhance cancer survivor outcomes and care transitions.

Patient navigation | Image credit: AON
With Thyme Care Partnership, AON Achieves $6M in Savings in EOM’s First Performance Period

April 22nd 2025

inflation reduction act | Image credit: Vitalii Vodolazskyi -stock.adobe.com
The IRA’s Unintended Consequences for Drug Pricing and Coverage

April 2nd 2025

Texas Oncology logo | Image: Texas Oncology
Texas Oncology to Roll Out Canopy for ePROs After Head-to-Head Pilot

March 18th 2025

Kirollos Hanna, PharmD
Embracing EOM, Enhancing Collaboration and Cost Management: Dr Kirollos Hanna

January 29th 2025

More News

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.
CMS logo
June 30th 2023

Unknown Number of Practices Drop From EOM as Deadline Nears; Billing Flaw Questioned

Mary Caffrey
Ahead of tonight's deadline for practices to decide whether to join the Enhancing Oncology Model, CMS published a list of participants that is already outdated. A possible flaw in the model's breast cancer methodology has some practices weighing their options.
doctor and patient consult
June 21st 2023

MedPAC Recommends Congress Approve Site-Neutral Medicare Reimbursement

Richard Payerchin
Officials note it could slow acquisition of physicians’ offices, but hospitals bristle at prospect.
Sachin Jain, MD, MBA
June 15th 2023

SCAN, CareOregon Move to Retire Medical Debt a “Wake Up Call” for Health Care Industry

Mary Caffrey
The health plans, which have announced their intent to join forces, retired $345,000 in debt in the areas they serve.
Most Community Oncology Practices Give Thumbs Down to Enhancing Oncology Model, Survey Finds
June 6th 2023

Most Community Oncology Practices Give Thumbs Down to Enhancing Oncology Model, Survey Finds

The Enhancing Oncology Model, announced in July 2022 during the final days of its predecessor, the Oncology Care Model (OCM), has a similar framework as the early alternative payment model for oncology in Medicare, but there are key differences in reimbursement and especially in practices’ requirements to take on risk.
Private Payer Reimbursing Doctor For Telemedicine: © leowolfert - stock.adobe.com
June 4th 2023

Group Highlights Discrepancies Between Claims, Survey Cost Data Among Medicare Patients

Jaime Rosenberg
With Medicare-aged Americans accounting for over 15% of the population and significant health care costs, stakeholders have leveraged various approaches, including the Medicare Current Beneficiary Survey, for estimating costs.
Loving adult daughter hug senior Caucasian mother: © Svitlana - stock.adobe.com
June 2nd 2023

Medicare Patients With HSNCC Fare Better Than Younger Counterparts

Jaime Rosenberg
Deemed the “Medicare” effect, patients aged 65 years who have Medicare coverage had an increased incidence of head and neck squamous cell carcinoma (HNSCC) but were less likely to receive a late-stage diagnosis and had lower mortality rates.
Nicholas Bagley, JD, Michigan Law
May 29th 2023

Nicholas Bagley Talks About What Can Be Gained From Continued Discussion of the Braidwood Case

Julia Bonavitacola
Nicholas Bagley, JD, professor at Michigan Law at the University of Michigan, speaks about the benefits of ongoing communication about the effects of the Braidwood ruling and what will be done to keep preventive care accessible.
Financial Burden of Treatment Often Left Out of QoL Assessment in Oncology RCTs
May 24th 2023

Financial Burden of Treatment Often Left Out of QoL Assessment in Oncology RCTs

Jaime Rosenberg
Of the studies, 47% did not directly ask patients about financial difficulties associated with their cancer.
Oncology Medical Home Ready for Wider Use in Practices, Panelists Say
May 22nd 2023

Oncology Medical Home Ready for Wider Use in Practices, Panelists Say

Mary Caffrey
Coverage from the Greater Philadelphia Business Coalition on Health (GPBCH) daylong Oncology Management Summit, held April 4, 2023.
Helping Employers Understand Their Role in Managing Oncology Benefits, Costs
May 22nd 2023

Helping Employers Understand Their Role in Managing Oncology Benefits, Costs

Mary Caffrey
Coverage from the Greater Philadelphia Business Coalition on Health (GPBCH) daylong Oncology Management Summit, held April 4, 2023.
Nicholas Bagley, JD, Michigan Law
May 22nd 2023

Nicholas Bagley Discusses Congressional Action That Can Counteract the Braidwood Ruling

Julia Bonavitacola
Nicholas Bagley, JD, professor at Michigan Law at the University of Michigan, discusses how Congress can help address the consequences of Braidwood v Becerra.
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