Reimbursement

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KFF Survey: Most Consumers Find Prior Authorization Is a Major Problem

July 25th 2025

A new survey reveals widespread consumer frustration with prior authorization, highlighting the need for urgent reform in insurance coverage.

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Commentary: Americans Can’t Afford to Lose Access to Their Doctors

July 24th 2025

Planned Parenthood | Image credit: William A. Morgan - stock.adobe.com
Supreme Court Case, Budget Bill Could Have Devastating Effects on Planned Parenthood: Q&A With Danika Severino Wynn, CNM

July 23rd 2025

Christine Pfaff, MBA, RPh | Image: LinkedIn
COA Welcomes Christine Pfaff, MBA, RPh, to Leadership Team

July 22nd 2025

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

July 15th 2025

More News

COA logo | image credit: COA
October 25th 2023

COA’s Policy Agenda Gains Steam on Capitol Hill, as the House Elects a Speaker

Mary Caffrey
There is bipartisan support in the Congress for the Community Oncology Alliance's (COA) key agenda items, with hope that some will pass by year’s end.
COA logo | image credit; COA
October 24th 2023

Confronting the Dynamics of Medicare Benefits When Those Eligible Are Still Working

Mary Caffrey
Community oncology practices are witnessing a new dynamic in which more Medicare-eligible patients are still covered by commercial insurance, according to speakers at the Community Oncology Alliance Payer Exchange Summit, held October 23-24, 2023.
EBO logo
October 20th 2023

The Challenges of Treating Cancer When the Patient Lives Far From Care

Peter Page
Christine Pfaff, RPh
October 17th 2023

Christine Pfaff on Ensuring Patient Access to Affordable Treatments

Laura Joszt, MA Maggie L. Shaw
To ensure patients are getting timely access to their treatments, there needs to be better collaboration between payers and providers, said Christine Pfaff, RPh, senior regional director of operations, American Oncology Network.
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.
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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.
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