July 17th 2025
Sanjay Doddamani, MD, MBA, a former senior advisor to the Center for Medicare and Medicaid Innovation, and internist and cardiologist by training, explains how the Wasteful and Inappropriate Service Reduction (WISeR) Model hopes to work, and addresses concerns about delays and denials from revamped prior authorization processes.
Israeli study finds the added antibody protection from a fourth COVID-19 vaccine dose is not enough to prevent Omicron infection; Texas abortion law remains in effect after appeals court ruling; insurer spending for the unproven COVID-19 drug ivermectin was estimated at $2.5 million for a week last summer.
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Genomic Profiling for NSCLC Improves Survival Outcomes With Modest Budget Impact
January 14th 2022An increase in the use of comprehensive genomic profiling among patients with advanced non–small cell lung cancer (NSCLC) was associated with additional life-years gained and a low-cost budget impact.
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Contributor: How Health Care Companies Can Use Upskilling to Navigate the Great Resignation
January 13th 2022The Great Resignation is sending health care workers out of the industry in massive numbers, and this, coupled with the ongoing transformation of health care, is creating the perfect storm. Alleviating their stress, burnout, and disengagement is a necessary first step. But the proper development, training, and upskilling is also crucial.
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CMS Says It Will Limit Biogen’s AD Drug to Patients in Clinical Trials
January 11th 2022In a National Coverage Determination decision memo released Tuesday, CMS said it will gather public comment for 30 days about its plan to limit coverage for Alzheimer disease (AD) biologics that target plaque buildup in the brain to patients enrolled in certain clinical trials.
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The Biden administration announced a requirement for insurance companies and group health plans to cover the cost of at-home COVID-19 tests; critical staffing shortages are reported nationwide amid record surges in COVID-19 cases and hospitalizations; the first-ever successful animal-to-human heart transplant was announced.
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How Does CGP Testing Align With Recommendations, Impact Budgets?
January 10th 2022Posters from the Academy of Managed Care Pharmacy Nexus 2021 meeting detailed how coverage of genetic testing aligns with current guidelines as well as the potential budget impact of expanding access to comprehensive genomic profiling (CGP).
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Real-World Study Finds Dupilumab Safe, Effective for Moderate-to-Severe Atopic Dermatitis
January 6th 2022Korean patients with moderate-to-severe atopic dermatitis achieved and maintained markedly improved skin clearance with dupilumab treatment in a real-world setting, including in the face and hands.
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Primary Care During COVID-19: Looking at Payer, Provider Cooperation
January 4th 2022On this episode of Managed Care Cast, we bring you part 1 of an 8-part video conversation with Blue Cross Blue Shield of North Carolina and Newton Family Physicians about how they adapted to deliver health care in 2020 and 2021.
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Projected US Savings From Biosimilars, 2021-2025
Projected savings from biosimilars from 2021 to 2025 were $38.4 billion vs conditions as of quarter 4 of 2020 and were driven by new biosimilar entry. Savings were $124.5 billion under an upper-bound scenario.
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Anthony Fauci, MD, said the CDC is considering changes to its guidance requiring a negative COVID-19 test after 5-day quarantine; bipartisan legislation banning surprise medical billing goes into effect; booster vaccine programs may be limiting global vaccine supply for low- and middle-income countries.
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AJMC® Conversations: BCBS NC and Newton Family Physicians—Turning to Prevention
December 31st 2021This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 8.
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This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 7.
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AJMC® Conversations: BCBS NC and Newton Family Physicians—NC’s Transition to Medicaid
December 31st 2021This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 5.
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AJMC® Conversations: BCBS NC and Newton Family Physicians—Aligning Incentives to Lower Costs
December 31st 2021This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 5.
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AJMC® Conversations: BCBS NC and Newton Family Physicians—Replenishing the Health Care Workforce
December 31st 2021This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 4.
Watch
This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 3.
Watch
AJMC® Conversations: BCBS NC and Newton Family Physicians—Impact of Value-Based Care on Primary Care
December 31st 2021This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 2.
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AJMC® Conversations: BCBS NC and Newton Family Physicians—The Pandemic and Primary Care
December 31st 2021This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 1.
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Parkinson Disease Lengthens ICU Stays, but Does Not Increase Mortality
December 22nd 2021A new study comparing intensive care unit stays among patients with Parkinson disease and controls without the disease found the former have more severe illness, but both groups have similar survival rates.
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