Unbiased Analysis of Today's Healthcare Issues
Do Medicare Advantage enrollees like plans with more prior authorization? On the one han, one would think the answer is a clear ‘no’. However, higher levels of prior authorization could result in lower premiums, a tradeoff many enrollees may prefer. A paper by Marr, Trivedi and Meyers (2026) aims to answer the question using beneficiary…
A paper by Mark Shepard and Jacob Wallace (2026) has a great overview of the Medicaid managed care program. The first question one may have is, how does Medicaid managed care differ from other forms of government procurement. “In standard public procurement—such as contracting for infrastructure projects—the government specifies desired services, solicits bids, selects winners,…
That is the title of a recent paper out in ClinicoEconomics and Outcomes Research with co-authors Jennifer Vaughn, Nadine Zawadzki, Shurui Zhang, Paul Pinkston, and David Wei. The subtitle is A Comparison of Later Generation TKIs versus Imatinib from Patient and Payer Perspectives. The abstract is below: Purpose: To evaluate the financial impact of treating CML…
KFF reports on the increased use of copay accumulators: Oscar Health is one of many commercial health insurers that use what are often called copay accumulator programs to keep funds that are meant to defray patients’ out-of-pocket costs for expensive specialty drugs. Over the past decade, more insurers have adopted such strategies to reduce their prescription…
Let’s say you’re the CEO of a health plan. A new drug just received approval to treat patients with lung cancer. The drug’s clinical trial examined how well the the drug worked on third line (3L) patients and patients with good funcional ability (e.g., performance status ECOG score of 0 or 1). FDA approved the…
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…
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…
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…
It turns out the answer is Medicare Advantage plans according to a KFF analysis released today. However the reason why Medicare Advantage is more profitable may not be obvious: At the end of 2024, gross margins per enrollee ranged from $608 in the Medicaid managed care market to $1,655 in the Medicare Advantage market. Gross…
That is the findings from a KFF Health Tracking Poll out this month. The survey examines which aspects of accessing care and health insurance are the biggest problem for insured adults. The survey finds that 69% of adults believe prior authorization is a burden. Specifically, the survey asks “When it comes to getting health care,…