- Center on Health Equity and Access
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- Value-Based Care
The Evolution of Buy-and-Bill
Following a brief discussion of the shortcomings of the buy-and-bill model in oncology, Michael Kolodziej, MD, and Brian Kiss, MD, describe the origins of the model and suggest changes needed based on the evolution of healthcare reimbursement strategies in the United States.
Dr Kolodziej defends the buy-and-bill model, explaining that it originated in the 1980s as a way for practices to help pay for the infrastructure needed for cancer care to be delivered in the community setting rather than in the hospital setting.
Because treatment options in oncology have evolved and oral oncolytics that can be dispensed via practice-based pharmacies are now available, adds Dr Kiss, the latest challenge is determining how to compensate oncologists fairly given the introduction of oral drugs.
Resolving these issues will require agreement and collaboration among multiple stakeholders in healthcare, Dr Kolodziej remarks.
Early Involvement Critical in Treating Immunotherapy-Induced Overlap Syndrome
April 19th 2024A series of case studies reveals the importance of early diagnosis and involvement of special teams of clinicians when dealing with potential cases of overlap syndrome, which encompasses myocarditis, myasthenia gravis, and immune checkpoint inhibitor–related myositis.
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Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
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Government agencies have created an online portal for the public to report potential anticompetitive practices in health care; there are changes coming to the “boxed warning” section for chimeric antigen receptor T-cell therapies (CAR T) to highlight T-cell blood cancer risk; questions about the safety of obesity medications during pregnancy have arisen in women on them who previously struggled with fertility issues.
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Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
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Gene, Light Therapy Combo Shows Promise Against Prostate Cancer Cells in Proof-of-Concept Study
April 18th 2024In their preclinical model, the researchers found efficacy both in vitro and in vivo by using CRISPR-Cas9 to mimic porphyria and combining the technology with light therapy.
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Pegcetacoplan for PNH More Cost-Effective Than Anti-C5 Monoclonal Antibodies
April 18th 2024A cost-utility analysis conducted from the perspective of the Italian health system found that pegcetacoplan was more effective and less costly than 2 complement 5 (C5) inhibitors for the treatment of paroxysmal nocturnal hemoglobinuria (PNH).
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