Value-Based Care

Julia Lucaci, PharmD, MS, of Becton, Dickinson and Company, discusses the benefits of blister packaging for chronic medications, advocating for payer incentives to boost medication adherence and improve health outcomes.

Defining "value" in cancer care goes beyond survival and should encompass patient quality of life metrics, said Coral Omene, MD, PhD, of Rutgers Cancer Institute and RWJBarnabas Health.

David Awad, PharmD, BCOP, says pharmacists play a growing role in managing access, safety, and toxicity for these therapies, ensuring treatments are appropriate and sustainable in real-world oncology practice.

Insurance hurdles in value-based cancer care create delays and anxiety for patients and providers, complicating access to essential treatments, explained Coral Omene, MD, PhD, of Rutgers Cancer Institute and RWJBarnabas Health.

Pharmacists enhance value-based care by selecting cost-effective treatments, managing adherence, and preventing hospitalizations through collaborative multidisciplinary teamwork, said Eileen Peng, PharmD, of Astera Cancer Care.

Pharmacists play a crucial role in managing treatment with chimeric antigen receptor T-cell therapy and bispecific antibodies, focusing on patient selection and side effects, explained Eileen Peng, PharmD, of Astera Cancer Care.

Remote symptom monitoring in cancer care reduces hospitalizations, enhances value-based care, and supports diverse patient populations, according to new findings.

Primary care nurse practitioners were found to use low-value care at lower or relatively similar rates compared with the general clinician population.

Lalan Wilfong, MD, of Thyme Care and Texas Oncology, discusses a session on circulating tumor DNA (ctDNA) and shares insight as chair of the Community Oncology Alliance (COA) Payer Reform Committee.

Kate Baker, MD, MMHC, medical director of value-based care at Tennessee Oncology, talks about innovations in cancer care highlighted at the Community Oncology Conference.

Mike Fazio, director of value-based care at Navista, Cardinal Health, discusses a trending topic at the 2025 Community Oncology Conference: optimizing oncology care with technology.

Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.

The California-based entities plan to offer new Medicare Advantage (MA) products in select counties by this fall.

This article reviews underlying barriers to health care access and discusses how a value-based diabetes care model could improve patient outcomes and reduce long-term costs.

Neha Kashalikar, PharmD, director of strategic pharmacy consulting, MassHealth, shares key components that makes a value-based contract successful.

To mark the 30th anniversary of The American Journal of Managed Care® (AJMC®), each issue in 2025 will include a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The April issue features a conversation with Hoangmai H. Pham, MD, MPH, a member of AJMC’s editorial board and the president and CEO of the Institute for Exceptional Care (IEC).

Strategies to enhance virtual care through quality assurance frameworks, technological innovation, and provider support were laid out in a pair of posters presented at the recent AMGA Annual Conference.

Mapping care management needs by defining patient populations and then stratifying them according to risk and their needs can help to spur the transformation of a siloed health care system into an integrated system that is able to better provide holistic, value-based care despite the many transitions that continue among hospital, primary, specialty, and community care environments.

This commentary explains why comparing a launch price with a value-based price from a cost-effectiveness analysis requires further examination.

Although the gap between low and high value has been established in many areas, insurance design has yet to adapt, according to a panel at the 20th annual Value-Based Insurance Design (VBID) Summit.

Jorge García, PharmD, MS, MBA, MHA, highlights the need for infusion pharmacy optimization to sustain oncology care amid rising costs and evolving value-based reimbursement models.

This is the fifth and final article in a series on value-based care and the 4 challenges health care organizations must overcome.

On December 10, 2024, cardiologists, researchers, and value-based care experts gathered in Dallas, Texas, to discuss best practices for implementing advances in cardiology care with a value-based mindset, spanning the care continuum from prevention to treatment.

The second Trump administration is expected to bring changes to Medicaid, Medicare Advantage, and the health insurance exchanges, as well as highlight the Make America Healthy Again (MAHA) movement, speakers at the Value-Based Insurance Design Summit said.

Speakers at the 2025 Value-Based Insurance Design summit recapped the accomplishments made over the past 20 years in designing insurance benefits with value in mind and looked ahead to iterations to come.