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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 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 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
Jadhav headshot
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 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
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 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
Commentary
Exploring Power Imbalances in Managed Care
10/24/2025
Private insurers’ unchecked market dominance is straining providers with below-inflation reimbursement, rising administrative hurdles, and regulatory inaction—pressuring hospitals to consolidate, fueling care delays, and prompting urgent...
Private insurers’ unchecked market dominance is straining providers with below-inflation reimbursement, rising administrative hurdles, and regulatory inaction—pressuring hospitals to consolidate, fueling care delays, and prompting urgent...
Private insurers’ unchecked...
10/24/2025
First Report Managed Care
Vashi Headshot
Commentary
How Health Insurers Can Implement AI Tools
10/06/2025
Deepan Vashi
This series has covered how health insurers can see real benefit from artificial intelligence (AI) in claims processing, appeals and grievances, member care, risk adjustment, and quality. In our final segment, we look at best practices for...
This series has covered how health insurers can see real benefit from artificial intelligence (AI) in claims processing, appeals and grievances, member care, risk adjustment, and quality. In our final segment, we look at best practices for...
This series has covered how...
10/06/2025
First Report Managed Care
Pratt Headshot
Commentary
Time: The Critical Resource Rural Hospitals Can’t Afford to Waste
09/26/2025
Mark Pratt
Rural health care staff members don’t just wear many hats—they often wear them all at once. In many communities, one person might be handling registration, billing, and collections while also answering phones or covering a front desk. When...
Rural health care staff members don’t just wear many hats—they often wear them all at once. In many communities, one person might be handling registration, billing, and collections while also answering phones or covering a front desk. When...
Rural health care staff members...
09/26/2025
First Report Managed Care
Holt Headshot
Commentary
Escaping the Black Hole: Why Post-Acute Blind Spots Are Hospitals’ Biggest Value-Based Risk
09/26/2025
Steve Holt
To succeed under new CMS value-based care models, hospitals must close the “post-acute black hole” by improving data exchange, strengthening care transitions, building high-quality post-acute partnerships, and leveraging predictive and...
To succeed under new CMS value-based care models, hospitals must close the “post-acute black hole” by improving data exchange, strengthening care transitions, building high-quality post-acute partnerships, and leveraging predictive and...
To succeed under new CMS...
09/26/2025
First Report Managed Care
Vashi Headshot
Commentary
Optimizing Risk Adjustment and Quality Measurement With AI
09/15/2025
Deepan Vashi
As we’ve covered in the earlier entries in this series, artificial intelligence (AI) is proving useful in streamlining health plan operations of all sorts. AI tools can also augment human expertise for optimal results in less structured but...
As we’ve covered in the earlier entries in this series, artificial intelligence (AI) is proving useful in streamlining health plan operations of all sorts. AI tools can also augment human expertise for optimal results in less structured but...
As we’ve covered in the earlier...
09/15/2025
First Report Managed Care
Cell & Gene Watch
Scaling CGT Capacity for a Growing Pipeline: Current Progress and Ongoing Hurdles
08/28/2025
Joe DePinto
The cell and gene therapy pipeline is rapidly expanding into new disease areas, but realizing its full potential will require manufacturing innovation, value chain coordination, and new pricing models to balance cost, access, and scale.
The cell and gene therapy pipeline is rapidly expanding into new disease areas, but realizing its full potential will require manufacturing innovation, value chain coordination, and new pricing models to balance cost, access, and scale.
The cell and gene therapy...
08/28/2025
First Report Managed Care

Behind the Bill

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 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 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 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 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 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 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 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 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, 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 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

Trending Articles

Cover Story
Federal Oversight of Managed Care a Priority
03/01/2024
Mary Beth Nierengarten
In 2022, Medicare Advantage plans covered 50% of Medicare enrollees, costing the federal government $403 billion, while 81% of Medicaid enrollees received care through managed care for $254 billion. The Health and Human Services Office of...
In 2022, Medicare Advantage plans covered 50% of Medicare enrollees, costing the federal government $403 billion, while 81% of Medicaid enrollees received care through managed care for $254 billion. The Health and Human Services Office of...
In 2022, Medicare Advantage...
03/01/2024
First Report Managed Care
News
Fecal Microbiota Transplant for Patients With IBD and rCDI: Safety and Efficacy
03/28/2024

Emry Lloyd

Emry Lloyd
Patients with recurrent Clostridioides difficile infection have shown significant results when administered a fecal microbiota transplant. This study evaluated the safety and efficacy of using a fecal microbiota transplant for patients with...
Patients with recurrent Clostridioides difficile infection have shown significant results when administered a fecal microbiota transplant. This study evaluated the safety and efficacy of using a fecal microbiota transplant for patients with...
Patients with recurrent...
03/28/2024
First Report Managed Care
News
Analysis Shows Proposed CMS ‘Best Price’ Rule May Increase Rebate Liability, Impacting Medicaid
04/26/2024
Dean Celia
A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...
A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...
A proposed rule from Centers for...
04/26/2024
First Report Managed Care
Carmine DeNardo Headshot
Interview
The Evolving Landscape of Specialty Pharmacy: PROs and PROMs Insights
05/28/2024
Following Asembia 2024, an expert emphasizes the critical role of specialty pharmacies in patient care and highlights payers' increasing coverage of high-cost biologics and oncology medications, driven by value-based contracts and real-world...
Following Asembia 2024, an expert emphasizes the critical role of specialty pharmacies in patient care and highlights payers' increasing coverage of high-cost biologics and oncology medications, driven by value-based contracts and real-world...
Following Asembia 2024, an...
05/28/2024
First Report Managed Care
Blog
An IRA Progress Report: What We Know (and Don’t Know) Two Years in
07/09/2024
In this blog the HMP Market Access Intelligence team breaks down the knowns and unknowns of the Inflation Reduction Act's impact on drug price negotiations and what the future may hold.
In this blog the HMP Market Access Intelligence team breaks down the knowns and unknowns of the Inflation Reduction Act's impact on drug price negotiations and what the future may hold.
In this blog the HMP Market...
07/09/2024
First Report Managed Care

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