Payers

Kimberly Westrich on Incentivizing Value-Based Care in Benefit Design and Reimbursement Strategies

November 28th 2021, 2:00pm

Video

Kimberly Westrich, MA, vice president of health services research at the National Pharmaceutical Council, discusses the shift to a value-based system from a fee-for-service one and how the health care system can incentivize high-value care.

Melissa Andel on Adding Dental, Hearing, Vision Benefits to Medicare

November 25th 2021, 2:30pm

Video

It’s right to acknowledge that dental, hearing, and vision are important for total health care for Medicare beneficiaries, said Melissa Andel, MPP, vice president of health policy at CommonHealth Solutions.

Daniel Wolfson Discusses Mistrust, Quality Implications in the Health Care System

November 24th 2021, 12:00am

Video

Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation, speaks on factors influencing mistrust of the health care system and efforts to improve quality care.

ACHP President, CEO Ceci Connolly Discusses 2021 Affordability Report

November 23rd 2021, 5:00pm

Podcast

The Alliance of Community Health Plans (ACHP) recently released its 2021 Report on Affordability. In this episode of Managed Care Cast, we speak with the organization about the steps that its payer members are taking to lower costs through offerings such as virtual-first care, remote patient monitoring, and other new products, some of which were created because of the pandemic.

AMCP Nexus Survey: Two-Thirds of Payers Use Biosimilars to Manage Oncology Drug Costs

November 23rd 2021, 4:00pm

Article

As the cost of oncology drugs increases, there has been a growing pressure to manage oncology drug spend, which some payers have done by establishing preferred therapies, including biosimilars.

The Merits of Administrative Benchmarks for Population-Based Payment Programs

November 23rd 2021, 2:00pm

Article

The different approaches to setting benchmarks for population-based payment models (empirical, bidding based, and administratively set) have unique advantages and challenges.

Evaluating Proactive Outreach for Prior Authorization Recertifications in Medicaid Patients

November 16th 2021, 2:00pm

Article

Implementing a proactive provider outreach program resulted in significantly more prior authorization recertifications and a reduction in time to submission.

Teprotumumab, Enhanced Monofocal IOLs Among Hot Topics at AAO 2021

November 15th 2021, 6:35pm

Article

Among many presentations during a hot topics session at the American Academy of Ophthalmology 2021 annual meeting, speakers discussed the first FDA approved therapy for thyroid eye disease and the latest in enhanced monofocal intraocular lenses (IOLs).

Posters at AAO 2021 Analyze ED Utilization for Nonemergency Ophthalmic Conditions

November 13th 2021, 7:00pm

Article

Emergency department utilization for nonemergent ophthalmic conditions is on the rise in the United States, but presentation types vary significantly based on patient demographics, according to 2 posters presented at the American Academy of Ophthalmology (AAO) 2021 meeting.

Uveitic Macular Edema Increases Costs Among Patients With Noninfectious Uveitis

November 12th 2021, 3:40pm

Article

Uveitic macular edema is common in patients with noninfectious uveitis, and its significant burden on patients and payers warrants more specific treatment guidelines to minimize quality-of-life and economic effects.