First Report Managed Care

Regulatory Insights

Subsidies, Savings, and Stalemates: What Congress's Year-End Gridlock Means for Health Plans in 2026

As health policy debates resurface in Washington, unresolved battles over Affordable Care Act (ACA) subsidies, health savings accounts, and pharmacy benefit manager (PBM) reform are shaping a high-stakes landscape for payers heading into the new year.

Formulary Frontlines

Comparative Review of Migraine Therapeutics Coverage Across 3 Major Health Plans

Our latest Formulary Frontlines analysis compares how Blue Cross Blue Shield, Cigna, and UnitedHealthcare manage coverage across key migraine treatment classes, revealing striking differences in tiering, utilization management, and access philosophy.

Free On-Demand Webinar

Specialty Pharmacy in Flux: Cost, Access & Policy in a Rapidly Changing Market

From explosive demand for GLP-1s and new policy pressures to emerging technologies and affordability challenges, the industry is at a crossroads.

In this exclusive First Report Managed Care webinar, our expert panel unpacks the complex forces reshaping the market—and what stakeholders must do to adapt.

News

Specialist Access Eliminates Racial Gaps in Rheumatoid Arthritis DMARD Use

01/12/2026

Lisa Kuhns, PhD, MD

Racial inequities in access to modern rheumatoid arthritis (RA) therapies persist across the United States, but disappear among patients who reach rheumatology care, according to study results published in The Journal of Rheumatology.

Racial inequities in access to...

01/12/2026

First Report Managed Care

News

CMS Establishes Office of Rural Health Transformation Nationwide

01/09/2026

Grace Taylor, MS, MA

The Centers for Medicare & Medicaid Services (CMS) has formally launched the Office of Rural Health Transformation, creating a dedicated hub to oversee a $50 billion, 5-year effort to strengthen rural health systems and expand access to care...

The Centers for Medicare &...

01/09/2026

First Report Managed Care

News

HHS Revises Childcare Payment Rules, Restoring Attendance-Based Billing

01/05/2026

Hannah Musick

HHS announced it will roll back childcare payment rules, restore attendance-based billing, and revise oversight requirements for federally funded programs.

HHS announced it will roll back...

01/05/2026

First Report Managed Care

News

AI Navigator Launched to Support Medicaid and SNAP Members Amid Policy Shifts

12/22/2025

Hannah Musick

Social health platform Pyx Health has launched an AI-driven navigator aimed at helping US Medicaid and Supplemental Nutrition Assistance Program (SNAP) beneficiaries comply with new policy requirements under the One Big Beautiful Bill Act...

Social health platform Pyx...

12/22/2025

First Report Managed Care

News

CMS Unveils LEAD Model to Succeed ACO REACH in 2027

12/19/2025

Grace Taylor, MS, MA

The Centers for Medicare & Medicaid Services (CMS) is set to replace the Accountable Care Organization (ACO) REACH model with its longest-ever accountable care demonstration, a 10-year Long-Term Enhanced ACO Design (LEAD) model aimed at...

The Centers for Medicare &...

12/19/2025

First Report Managed Care

News

Rising Denials and Payer Audits Intensify Financial Strain on Hospitals in 2025

12/16/2025

Lisa Kuhns, PhD, MD

Hospitals are facing rising financial pressure as denial amounts and payer audits continue to climb in 2025, signaling an unsustainable trend for many health systems, according to a new report from billing compliance and revenue integrity...

Hospitals are facing rising...

12/16/2025

First Report Managed Care

News

Racial and Ethnic Differences Shape NSCLC Treatment Decision-Making in the US

12/11/2025

Hannah Musick

A new US survey study reveals significant racial and ethnic differences in how patients with non–small cell lung cancer (NSCLC) and their oncologists prioritize treatment goals, cultural needs, and shared decision-making, underscoring the...

A new US survey study reveals...

12/11/2025

First Report Managed Care

News

A New Era for Medicaid: CMS Unveils the Blueprint for Engagement, Integrity, and Sustainability

12/09/2025

Danielle Sposato

The Centers for Medicare & Medicaid Services (CMS) released new guidance detailing how states should implement major Medicaid reforms included in the Working Families Tax Cut (WFTC) legislation (Public Law 119-21). These reforms mark some of...

The Centers for Medicare &...

12/09/2025

First Report Managed Care

News

Immune Marker Profiles Distinguish cSCC From BCC in Tumor Microenvironment Study

12/04/2025

Grace Taylor, MS, MA

A comprehensive tumor microenvironment analysis uncovers key immune marker patterns that sharply distinguish cutaneous squamous cell carcinoma (cSCC) from basal cell carcinoma (BCC), pointing to new opportunities for clinical risk...

A comprehensive tumor...

12/04/2025

First Report Managed Care

News

Higher Health Care Burden in Multiple Myeloma With Extramedullary Disease, Study Finds

12/02/2025

Grace Taylor, MS, MA

A study presented at the 22nd International Myeloma Society (IMS) Annual Meeting shows that extramedullary disease significantly increases health care utilization and costs for patients with triple-class–exposed (TCE) relapsed/refractory...

A study presented at the 22nd...

12/02/2025

First Report Managed Care

KOL Insights

Regulatory Insights

Subsidies, Savings, and Stalemates: What Congress's Year-End Gridlock Means for Health Plans in 2026

12/05/2025

Adam Colborn, JD

As health policy debates resurface in Washington, unresolved battles over ACA subsidies, health savings accounts, and PBM reform are shaping a high-stakes landscape for payers heading into the new year.

As health policy debates...

12/05/2025

First Report Managed Care

Cell & Gene Watch

Reaching Patients Where They Are: Moving CGT Care into the Community

12/05/2025

Joe DePinto

As cell and gene therapies rapidly advance, shrinking the nation’s growing “CGT deserts” by expanding capabilities in community care settings is essential to ensure that breakthrough treatments reach patients equitably—not just those living...

As cell and gene therapies...

12/05/2025

First Report Managed Care

MANAGED CARE Q&A

SDOH Interventions and Managed Care Performance: A Roadmap for Health Plans

12/05/2025

Karen Iapoce, RNC, MSN, CPHQ, LSSBB

Karen Iapoce explains how integrating social determinants of health into managed care workflows can drive measurable improvements in outcomes and Stars performance.

Karen Iapoce explains how...

12/05/2025

First Report Managed Care

Commentary

Data Doesn’t Save Lives. Insight Does.

12/05/2025

Sujay Jadhav

Real-world data alone cannot advance drug development; only expertly curated, clinically grounded insight can drive meaningful improvements in clinical trials.

Real-world data alone cannot...

12/05/2025

First Report Managed Care

Interview

How the IRA Is Reshaping Drug Evaluation Through Medicare-Focused Real-World Evidence

12/04/2025

Ashis Kumar Das, PhD, MD, MPH

Discover how the Inflation Reduction Act (IRA) is transforming drug value assessment as Ashis Das, MD, PhD, breaks down what the Centers for Medicare & Medicaid Services (CMS) expects from manufacturers in today’s Medicare landscape.

Discover how the Inflation...

12/04/2025

First Report Managed Care

Interview

Navigating Medicaid Turbulence: What Community Providers Need to Know

12/01/2025

Jeff Brandes

Jeff Brandes discusses the national impact of Medicaid cuts, the administrative challenges forcing eligible patients off coverage, and the mounting strain on safety-net clinics.

Jeff Brandes discusses the...

12/01/2025

First Report Managed Care

MANAGED CARE Q&A

Turning Data into Equity: How Advanced Analytics and SDOH Integration Are Redefining Value-Based Care

11/25/2025

Michael Hoxter

Michael Hoxter, Chief Technology Officer at Lightbeam Health Solutions, discusses how advanced analytics, artificial intelligence (AI), and social determinants of health data are transforming population health management, driving efficiency,...

Michael Hoxter, Chief Technology...

11/25/2025

First Report Managed Care

MANAGED CARE Q&A

Right-Sizing Star Ratings: How Health Plans Can Adapt to a Changing Landscape

11/25/2025

Marge Ciancetta

Cotiviti’s Marge Ciancetta highlights how mid-sized Medicare Advantage plans leverage local insight, operational agility, and innovation to outperform larger national competitors.

Cotiviti’s Marge Ciancetta...

11/25/2025

First Report Managed Care

MANAGED CARE Q&A

The Potential of AI as a Clinical Co‑Pilot

11/24/2025

Gregory Whisman, MD, MBA

A guest expert explores how artificial intelligence is emerging as a clinical co-pilot by streamlining administrative burdens, enhancing patient targeting and engagement, and supporting predictive care strategies to improve quality, reduce...

A guest expert explores how...

11/24/2025

First Report Managed Care

Commentary

Biologics: Combating Big Spend in Small Doses

11/24/2025

Krithika Srivats

A guest expert discusses how biologic drugs like monoclonal antibodies are driving soaring health care costs, but data-driven strategies and greater use of biosimilars may offer payers a powerful path to rein in spending without compromising...

A guest expert discusses how...

11/24/2025

First Report Managed Care

Issue Features

Interactive Features

Quiz

Mobile Health’s Expanding Role in Bridging Care Gaps Across the US

11/11/2025

First Report Managed Care

Quiz

Member Engagement Options Under New Digital Marketplace

10/14/2025

True or False: UnitedHealthcare’s new UHC Store is a digital marketplace that allows members to purchase health insurance plans directly from the company.

True or False:...

10/14/2025

First Report Managed Care

Quiz

How AI Transforms Medicare Advantage Operations

09/15/2025

Learn more about how AI tools reshape MA risk adjustment and HEDIS performance.

Learn more about how AI tools...

09/15/2025

First Report Managed Care

Quiz

How Well Do You Know CMS Interoperability?

08/18/2025

Learn more about how real-time data integration, artificial intelligence tools, and expanded telehealth access are transforming Medicaid to deliver more equitable, efficient, and patient-centered care.

Learn more about how real-time...

08/18/2025

First Report Managed Care

Quiz

Medicare Advantage Markets Remain Highly Concentrated

08/04/2025

A study found that Medicare Advantage (MA) markets across the US were classified as highly or very highly concentrated in 2024, raising questions about the competitive dynamics of this rapidly growing insurance sector. Learn more.

A study found that Medicare...

08/04/2025

First Report Managed Care

Behind the Bill

The Senate’s $3 Trillion Deal. Tax Relief Now, Medicaid Coverage Loss Later?

07/02/2025

Katie Hayes, MJ

The Senate has done it. After weeks of behind-the-scenes wrangling and last-minute amendments, lawmakers have passed a sprawling tax-and-spending megabill that makes good on a long-standing Republican goal: making the 2017 Trump tax cuts...

The Senate has done it. After...

07/02/2025

First Report Managed Care

Behind the Bill

When a Cap Isn’t Just a Cap: How a Provider Tax Proposal Could Reshape Medicaid Financing

06/25/2025

Katie Hayes, MJ

In Washington, the most consequential policies are often buried in the fine print. One such detail in the Senate Finance Committee’s latest tax and spending proposal would gradually cap provider taxes—a core funding tool states use to pull in...

In Washington, the most...

06/25/2025

First Report Managed Care

Behind the Bill

Rewriting the Safety Net? Inside the Senate’s Changes to Medicaid and the ACA

06/18/2025

Katie Hayes, MJ

Over the past few weeks, I’ve been following the progress of the One Big Beautiful Bill Act (OBBBA), which started in the House with sweeping tax reforms and some eye-catching health care proposals. Now, the Senate has released its (highly...

Over the past few weeks, I’ve...

06/18/2025

First Report Managed Care

Behind the Bill

How States Might Respond to the One Big Beautiful Bill Act

06/11/2025

Katie Hayes, MJ

With the One Big Beautiful Bill Act (OBBBA) still in the hands of the Senate, much of the national conversation has centered on what this legislation would do to federal coverage programs. But regardless of how the federal process unfolds,...

With the One Big Beautiful Bill...

06/11/2025

First Report Managed Care

Behind the Bill

Is the Affordable Care Act on the Chopping Block? What the One Big Beautiful Bill Act Tells Us.

06/04/2025

Katie Hayes, MJ

It’s been weeks of headline-grabbing debate over Medicaid work requirements, and the “One Big Beautiful Bill Act” remains in the Senate as they deliberate over several health care provisions. While the Medicaid provisions sparked most of the...

It’s been weeks of...

06/04/2025

First Report Managed Care

Behind the Bill

From House to Senate: The Journey of Cutting Medicaid

05/28/2025

Katie Hayes, MJ

Last week, the House of Representatives narrowly passed the One Big Beautiful Bill Act (HR 1, 119th Congress) by a single vote, sending the sweeping tax and spending reconciliation package, backed by President Trump, to the Senate. With its...

Last week, the House of...

05/28/2025

First Report Managed Care

Behind the Bill

Eligibility, Paperwork, and Penalties: The Not-So-Hidden Costs of Medicaid ‘Reform’

05/21/2025

Katie Hayes, MJ

It’s been another eventful week in health policy—a phrase that’s quickly becoming routine. This time, House Republicans advanced a sweeping budget reconciliation bill, designed to implement elements of the March budget resolution, with a...

It’s been another eventful week...

05/21/2025

First Report Managed Care

Behind the Bill

A Busy Week in Drug Pricing Policy: Aligning US Drug Prices With Global Standards?

05/14/2025

Katie Hayes, MJ

It’s been a busy few days for drug pricing policy. While I’d love to dig into the details of both President Trump’s latest executive order and the newest Republican bill that would cut Medicaid spending, we don’t have the time—and this isn’t...

It’s been a busy few days for...

05/14/2025

First Report Managed Care

BEHIND THE BILL

When Agencies Lose Power: How 3 Seismic Shifts are Transforming Pharmaceutical Regulation

05/07/2025

Katie Hayes, MJ

In the span of just 9 months, the landscape of administrative law has undergone a transformation so profound that pharmaceutical executives, health care providers, and patients alike are struggling to navigate the new terrain. The Supreme...

In the span of just 9 months,...

05/07/2025

First Report Managed Care

Behind the Bill

The Medicare Paradox, Part 3: Strategic Trade Doesn’t Have to be a Zero-Sum Game

05/07/2025

Katie Hayes, MJ

Over the past 2 weeks, I’ve examined the growing friction between the Section 232 pharmaceutical tariff investigations and the Medicare drug pricing reforms authorized by the Inflation Reduction Act (IRA). These 2 policy agendas—industrial...

Over the past 2 weeks, I’ve...

05/07/2025

First Report Managed Care