Price and End Points. For Cancer Drugs, There Is a Disconnect, Research Finds

October 31, 2022

Overall survival is considered a more definitive end point. But according to Vinay Prasad, M.D., M.P.H., and colleagues , drugs approved based on progression-free survival and overall response rate were priced higher than those approved based on overall survival.

Gregory Warren Discusses Measuring Value and Scaling Up Value-Based Contracting

September 13, 2022

Thus far, value-based contracts for prescription drugs has not been transformative because of the scalability challenge for payers, explained Gregory Warren, FSA, FCA, MAAA, partner and consulting actuary with Axene Health Partners.

Low-revenue MSSP ACOs Produced Better Results in 2021 Than High-revenue ACOs: CMS

August 30, 2022

The Centers for Medicare and Medicaid Services released results today showing that on a per capita basis, the net savings for low-revenue accountable care organizations (ACOs) was higher than the net savings for high-revenue ACOs.

It’s Time to Tame the “Diagnostic-Coding Arms Race”: NEJM Opinion Piece

July 29, 2022

The trend of primary care practices and businesses bearing risk has pitfalls. A trio of experts have suggestions for how they can be avoided, including taking steps to de-emphasizing diagnostic coding in the calculations that determine payment.

Why Social Determinants of Health Are a Critical Factor for Preventing Member Risk Escalation in the Value-Based Care Equation

June 27, 2022

Medicaid managed care organization (MCOs) may be better equipped to address social determinants of health (SDOH) and health equity than payers who use fee-for-service models because SDOH are central to many requirements for MCOs, including those pertaining to population health management, health equity and care coordination.