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Transparency and PBMs. Moral hazard of HAART. Accents and social hierarchy. What is a community healthcare worker? RJK, Jr. vs. Gavi
Month: April 2026
CMMI’s Advancing Chronic Care with Effective Scalable Solutions (ACCESS) Model Explained
In May 2025, CMS’s Center for Medicare & Medicaid Innovation (CMMI) unveiled it’s “Make America Healthy Again” vision. CMMI models focus on not only “protecting the federal taxpayer,” but also (i) promoting evidence-based prevention, (ii) empowering people to achieve their health goals, and (iii) driving choice and competition for people. CMMI has introduced a number…
340B is a Hidden Tax Expenditure
That is the argument made by Ike Brannon and Anthony Lo Sasso in a recent Health Affairs Forefront article. 340B allows hospitals serving low income communities to purchase pharmaceuticals at discounted rates, but then receive full price reimbursement from payers (e.g., commercial insurers, Medicare). It is not clear that the 340B program even benefits low-income…
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Simulate the risk AI displaces your job (methodology) LA’s “Great Stone Mother” Hospital. KFF CEO: What’s Wrong with U.S. Health Care CDC blocks publication of a study showing benefits of COVID vaccine Meta, AI and layoffs.
How are payers and providers using AI? And why isn’t AI reducing administrative cost?
The Peterson Health Technology Institute (PHTI) recently released a report titled: “Administrative AI: Current Use and Potential Impact.” The report was based on a workshop PHTI convened with senior leaders from health systems, health plans, technology developers, investment firms, and federal agencies in order to discuss how technology and policy can enable AI to reduce…
What is the purpose of cost sharing for cell & gene therapies?
This is the question that a recent AJMCcommentary by William Shrank, Ellen Kelsay, and Mark Fendrick aims to answer. When talking about cell and gene therapies, the authors argue that cost sharing is not being used to avoid unnecessary use of low value care, but rather as a form of rationing that creates disparities in…
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What can we learn about nursing and AI from The Pitt. FDA expediting first-in-human trials? IIA. Measles back in SF. US fertility at all-time low.
Impact of Continuous Glucose Monitoring on Clinical Outcomes and Productivity Losses Among People Living With Type 2 Diabetes Not Using Insulin From an Employer’s Perspective
That is the title of a new paper out yesterday in the Journal of Diabetes Science and Technology from my FTI colleague Marie Steele-Adjognon, along with Martha E. Shepherd, Jon Harris-Shapiro, David Hines, Abraham Lee and Yeesha Poon. The abstract is below. Background: This study evaluated the impact of continuous glucose monitoring (CGM) on health…
Two visions for value – Why GCEA and HEMA clash on drug pricing
That is the title of my latest Perspectives from the Healthcare Economist article published in The Evidence Base this week. Here is the teaser: In this guest column, healthcare economist Jason Shafrin (FTI Consulting and Mann School of Pharmacy, University of Southern California) explores a widening divide over how health systems define value, and what that means…
Why your measurement of medication adherence may be flawed
Proportion of days covered (PDC) is the most widely endorsed measure of medication adherence. For instance, the Centers for Medicare & Medicaid Services (CMS) uses PDC as its preferred adherence measure for its Quality Rating System for many chronic conditions (e.g., hypertension, diabetes, and hyperlipidemia). However, your PDC measure may be flawed depending on what…