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Commentary

Anne Headshot
Commentary
Long-Term, High-Impact Nursing Care Solutions Promote High-Value Care
05/06/2024
Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN
It's no secret that nursing is in a state of crisis. From the onset of the COVID-19 pandemic to now, nurses nationwide have increasingly battled rising burnout and stress–all while caring for higher-acuity patients, with less support. Anne...
It's no secret that nursing is in a state of crisis. From the onset of the COVID-19 pandemic to now, nurses nationwide have increasingly battled rising burnout and stress–all while caring for higher-acuity patients, with less support. Anne...
It's no secret that nursing is...
05/06/2024
First Report Managed Care
Headshots
Commentary
Harnessing Innovation to Improve Maternal Health
04/09/2024

Britteny Matero, partner and senior vice president, Market Access, Innsena, and Jaime Bland, DNP, RN, president and chief executive officer, CyncHealth

Britteny Matero, partner and senior v...
The US faces a critical maternal health crisis, with high maternal mortality rates exacerbated by COVID-19 and racial disparities. Institutional changes are needed to prevent these largely preventable deaths, and two experts highlight...
The US faces a critical maternal health crisis, with high maternal mortality rates exacerbated by COVID-19 and racial disparities. Institutional changes are needed to prevent these largely preventable deaths, and two experts highlight...
The US faces a critical maternal...
04/09/2024
First Report Managed Care
Shannon Smith Headshot
Commentary
Adapting to Change: Navigating the New CMS Prior Authorization Guidelines in Health Care
04/02/2024

Shannon Smith, RN, BSN

Shannon Smith, RN, BSN
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry...
04/02/2024
First Report Managed Care

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Julie Schulz headshot
Commentary
How Lab Values Can Close the Gap Between Patients With Undiagnosed and Under-Staged Chronic Kidney Disease
03/27/2024

By Julie Schulz, MD, MPH

By Julie Schulz, MD, MPH
Chronic kidney disease (CKD) is an insidious condition with devastating consequences when detected and treated too late. While primary care physicians usually make the initial diagnosis, regular screening is not routine for the general...
Chronic kidney disease (CKD) is an insidious condition with devastating consequences when detected and treated too late. While primary care physicians usually make the initial diagnosis, regular screening is not routine for the general...
Chronic kidney disease (CKD) is...
03/27/2024
First Report Managed Care
Kevin/Avikar Hedshots
Commentary
From Data to Decision: How Generative AI is Shaping Patient Care Pathways
03/20/2024

Kevin Riley, CEO, President, Zyter|TruCare; Avikar Govil, Insights Health Product Manager, Zyter|TruCare

Kevin Riley, CEO, President, Zyter|Tr...
The rapid evolution of Generative Artificial Intelligence (Gen AI) is fundamentally transforming the health care industry, ushering in an era of increased personalization, efficiency, and improved patient outcomes. In this commentary, experts...
The rapid evolution of Generative Artificial Intelligence (Gen AI) is fundamentally transforming the health care industry, ushering in an era of increased personalization, efficiency, and improved patient outcomes. In this commentary, experts...
The rapid evolution of...
03/20/2024
First Report Managed Care
James Wallace Headshot
Commentary
The Key to Improving Medication Adherence: The “Right” Medication for Each Patient
03/08/2024

James Wallace, CEO of DecisionRx

James Wallace, CEO of DecisionRx ...
Medication adherence poses a significant challenge in health care, with far-reaching consequences for patients and the health care system. It is a complex issue influenced by various factors, including undesirable side effects, lack of...
Medication adherence poses a significant challenge in health care, with far-reaching consequences for patients and the health care system. It is a complex issue influenced by various factors, including undesirable side effects, lack of...
Medication adherence poses a...
03/08/2024
First Report Managed Care

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Commentary
Next-Generation Utilization Management: Managing Utilization and Cost Without Denial of Service​​​
03/01/2024

Amit Gupta, MD, Medical Director, Clinical Strategy at Sagility

Amit Gupta, MD, Medical Director, Cli...
Utilization management is evolving from a cost-centric process to a focus on quality of care, with trends including exception-based authorization handling and value-based arrangements to reduce administrative burden and provider abrasion.
Utilization management is evolving from a cost-centric process to a focus on quality of care, with trends including exception-based authorization handling and value-based arrangements to reduce administrative burden and provider abrasion.
Utilization management is...
03/01/2024
First Report Managed Care
Commentary
Unlocking Health Care Efficiency: CMS Overhauls Prior Authorization in Landmark Interoperability Rule—What Payers Need to Know Now
03/01/2024

Michael Gould, AVP, Interoperability Strategy at ZeOmega

Michael Gould, AVP, Interoperability ...
CMS has published the Interoperability and Prior Authorization final rule to drive transformative outcomes in the health care ecosystem, requiring payers and providers to adopt new standards and FHIR APIs to reduce inefficiencies and improve...
CMS has published the Interoperability and Prior Authorization final rule to drive transformative outcomes in the health care ecosystem, requiring payers and providers to adopt new standards and FHIR APIs to reduce inefficiencies and improve...
CMS has published the...
03/01/2024
First Report Managed Care
Alex Sommer
Commentary
What Insurance Plans Need to Know About Biomarker Legislation
02/14/2024

Alex Sommer, vice president, State Government Affairs, Avalon Healthcare Solutions

Alex Sommer, vice president, State Go...
Biomarker bills are merely the latest in what is likely to be a wave of legislation mandating coverage of new tests and therapies that are part of the growth in precision medicine. This will make it increasingly difficult for plans to control...
Biomarker bills are merely the latest in what is likely to be a wave of legislation mandating coverage of new tests and therapies that are part of the growth in precision medicine. This will make it increasingly difficult for plans to control...
Biomarker bills are merely the...
02/14/2024
First Report Managed Care

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Christie Headshot
Commentary
How Medicare Advantage Plans Can Prepare for the CMS Health Equity Index
02/13/2024

Christie Teigland, PhD, VP of Research Science and Advanced Analytics, Inovalon

Christie Teigland, PhD, VP of Researc...
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare Advantage (MA) and Part D Final Rule, CMS is enhancing the Star Ratings program by implementing a Health Equity Index (HEI) reward to incentivize MA and Part D contracts with 500 or more members to address...
As part of the 2024 Medicare...
02/13/2024
First Report Managed Care

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FRMC Volume 21, Issue 1

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March 2024
Volume 21
Issue 1
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News
CMS Issues Rules on Loss Ratios for Medicare Plans
02/19/2013
02/19/2013
First Report Managed Care
News
Why Are Some Patients Still Paying for HIV Preventive Care?
03/04/2022

Sarah Varney, Kaiser Health News 

Sarah Varney, Kaiser Health News  ...
As of January 2021, HIV preventive care was supposed to be free in the United States, but there are patients still paying for treatment.
As of January 2021, HIV preventive care was supposed to be free in the United States, but there are patients still paying for treatment.
As of January 2021, HIV...
03/04/2022
First Report Managed Care
News
Doctors limit new Medicare patients
06/21/2010
06/21/2010
First Report Managed Care
News
Patients Plagued by High, Unexpected Bills From Emergency Room Visits
11/16/2016
Two Yale economists are calling for states to end a practice that allows some doctors to surprise patients with large medical bills after visits to a hospital emergency room.
Two Yale economists are calling for states to end a practice that allows some doctors to surprise patients with large medical bills after visits to a hospital emergency room.
Two Yale economists are calling...
11/16/2016
First Report Managed Care
News
Mental Disorders Top the List of US Spending by Health Conditions
06/01/2016
When estimating what the United States spends annually for medical conditions for the entire US population, mental disorders top the list, with an annual spending of $201 billion in 2013.
When estimating what the United States spends annually for medical conditions for the entire US population, mental disorders top the list, with an annual spending of $201 billion in 2013.
When estimating what the United...
06/01/2016
First Report Managed Care

Video Insights

Tejaswi Kompala
Videos
Personalizing Weight Loss Management With GLP-1 Agonists
04/05/2024

Featuring Tejaswi Kompala, MD, head of cardiometabolic clinical strategy, Teladoc 

Featuring Tejaswi Kompala, MD, head o...
Delve into the rising demand for anti-obesity medications, the complexities of obesity management, and the importance of personalized approaches in improving cardiometabolic health in this insightful interview.
Delve into the rising demand for anti-obesity medications, the complexities of obesity management, and the importance of personalized approaches in improving cardiometabolic health in this insightful interview.
Delve into the rising demand for...
04/05/2024
First Report Managed Care
Zaubler Headshot
Videos
Integrating Behavioral Health Services to Reduce ED Visits: Substance Use Disorder and Social Determinants of Health
03/27/2024

Featuring Tom Zaubler, MD, MPH, CMO at NeuroFlow

Featuring Tom Zaubler, MD, MPH, CMO a...
Join us for the continuation of an engaging two-part series showcasing an expert dedicated to reducing emergency department visits through the integration of behavioral health practices. Dr Zaubler will share invaluable insights into...
Join us for the continuation of an engaging two-part series showcasing an expert dedicated to reducing emergency department visits through the integration of behavioral health practices. Dr Zaubler will share invaluable insights into...
Join us for the continuation of...
03/27/2024
First Report Managed Care
Zaubler Headshot
Videos
Integrating Behavioral Health Services to Reduce ED Visits: Suicide Prevention and Preemptive Primary Care
03/25/2024

Featuring Tom Zaubler, MD, MPH, CMO at NeuroFlow

Featuring Tom Zaubler, MD, MPH, CMO a...
Come join us for the first installment of a captivating two-part series featuring an expert committed to minimizing emergency department visits through the implementation of behavioral health integrations. Dr Zaubler will offer valuable...
Come join us for the first installment of a captivating two-part series featuring an expert committed to minimizing emergency department visits through the implementation of behavioral health integrations. Dr Zaubler will offer valuable...
Come join us for the first...
03/25/2024
First Report Managed Care
Yash Prajapati
Videos
Navigating the Evolution of Digital Solutions in Health Care
02/27/2024

Featuring Yash Prajapati, consultant at ZS Associates 

Featuring Yash Prajapati, consultant ...
Join us in exploring the challenges and opportunities in the development, approval, and integration of digital therapeutic solutions with ZS Associates consultant Yash Prajapati.
Join us in exploring the challenges and opportunities in the development, approval, and integration of digital therapeutic solutions with ZS Associates consultant Yash Prajapati.
Join us in exploring the...
02/27/2024
First Report Managed Care
Mansur Shomali
Videos
Advancements and Challenges in Diabetes Management
02/27/2024

Featuring Mansur Shomali, MD, chief medical officer at Welldoc, endocrinologist at MedStar Health 

Featuring Mansur Shomali, MD, chief m...
Learn about the state of digital therapeutics for disease management such as diabetes care in terms of cost, outcomes, integration, and more with Dr Mansur Shomali, CMO at Welldoc.
Learn about the state of digital therapeutics for disease management such as diabetes care in terms of cost, outcomes, integration, and more with Dr Mansur Shomali, CMO at Welldoc.
Learn about the state of digital...
02/27/2024
First Report Managed Care
kevin cowart md
Videos
Costs and Benefits: How a New Cholesterol-Lowering Drug Compares to Others
10/24/2023

Featuring Kevin Cowart, PharmD, MPH, BCACP, CDCES

Featuring Kevin Cowart, PharmD, MPH, ...
Dr Kevin Cowart, assistant professor at the University of South Florida College of Pharmacy, discusses inclisiran, a new non-statin treatment for high cholesterol.
Dr Kevin Cowart, assistant professor at the University of South Florida College of Pharmacy, discusses inclisiran, a new non-statin treatment for high cholesterol.
Dr Kevin Cowart, assistant...
10/24/2023
First Report Managed Care
John Hennessy Headshot
Videos
Biosimilars, Explained
10/24/2023

Featuring John Hennessey, MBA

Featuring John Hennessey, MBA
In this video, John Hennessey, MBA, Valuate Health Consultancy, explains biosimilars in relation to cancer care: what they are, why they matter, and how they have and haven’t lived up to their promise.
In this video, John Hennessey, MBA, Valuate Health Consultancy, explains biosimilars in relation to cancer care: what they are, why they matter, and how they have and haven’t lived up to their promise.
In this video, John Hennessey,...
10/24/2023
First Report Managed Care
Videos
AVAHO 2023: Andrew Brunner, MD, Discusses Updates in MDS
10/20/2023

Featuring Andrew Brunner, MD

Featuring Andrew Brunner, MD
In this video, Dr Brunner reviews his recent discussion he held at the 2023 AVAHO Annual Meeting, and provides treatment updates in the treatment of MDS.
In this video, Dr Brunner reviews his recent discussion he held at the 2023 AVAHO Annual Meeting, and provides treatment updates in the treatment of MDS.
In this video, Dr Brunner...
10/20/2023
First Report Managed Care
Dr Kesty Headshot
Videos
A Dermatologist's Perspective on Demodex Blepharitis: Causes, Symptoms, and Treatment Options
10/19/2023

Featuring Katarina Kesty, MD, MBA, FAAD, Dermatologist and Medical Director at St. Petersburg Skin and Laser

Featuring Katarina Kesty, MD, MBA, FA...
Katarina Kesty, MD, MBA, FAAD, Dermatologist and Medical Director at St. Petersburg Skin and Laser, weighs in on Demodex blepharitis, a condition characterized by inflammation of the eyelid margin caused by an overpopulation of Demodex mites,...
Katarina Kesty, MD, MBA, FAAD, Dermatologist and Medical Director at St. Petersburg Skin and Laser, weighs in on Demodex blepharitis, a condition characterized by inflammation of the eyelid margin caused by an overpopulation of Demodex mites,...
Katarina Kesty, MD, MBA, FAAD,...
10/19/2023
First Report Managed Care

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