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“Excellence” doesn’t come solely from targeted efforts at extracting wasteful spending. True “excellence” comes from health systems making fundamental changes to the way they do business, namely by adopting a market-based model in which costs are connected to quality and providers are therefore held accountable for the outcomes they produce.

This week, the top managed care news included a new guide that balances curbs on opioid abuse with the needs of patients with chronic pain; HHS proposed reforming antikickback rules to help boost value-based care; a report found flaws with Medicaid work requirements.

The 12 Democratic candidates for president spent a good deal of time at their debate Tuesday night discussing healthcare; a group of state attorneys general tried to convince a US District Court judge to give them more time to create a settlement in their opioid lawsuits but failed; Alexion Pharmaceuticals agreed to buy small biotech Achillion Pharmaceuticals in a deal initially valued at $930 million.

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