Effective technology can fund quality improvement and pay-for-performance efforts
The healthcare industry appears poised on the brink of establishing a nationally recognized pay-for-performance standard that will reward those healthcare providers who demonstrate quality-of-care improvement, while penalizing those unable to deliver results that meet the established criteria. This pay-for-performance (P4P) initiative is largely a response to employers and consumers, who are increasingly inundated with data about what constitutes quality, as their healthcare costs increase. The resulting consumer and media outcry, coupled with reports of medical errors, turned the healthcare industry on its head, compelling regulators, watchdog organizations and healthcare associations to establish financial incentives to drive improvements in the quality of healthcare being delivered.
Expect Democrats to flex their oversight powers even if President Donald Trump’s veto power blocks their efforts to reverse Medicaid cuts or restore enhanced ACA subsidies. The administration’s most-favored-nation policies and HHS Secretary Kennedy will probably be in the hot seat.
Health plans should be using data, digital tools and human support to identify potential disruptions early, and whether a member is changing plans or managing a new health condition, the experience should feel guided rather than overwhelming.
Pretax adjusted income from operations from Express Scripts, Cigna's pharmacy benefit manager, fell by 21.5% compared with the third quarter of 2025, while income from operations of its specialty drug business jumped by 15%.
Annesha White, Pharm.D., M.S., Ph.D., and Fredrick Manasseh, Pharm.D., MBA, BCGP, explain where AI helps managed care pharmacy, where bias creeps in and what skills pharmacists need to oversee it.
Value-based care has scored some cost-saving successes, says Christopher Stanley, M.D., MBA, president of Henry Ford Health's Populance. Health systems that build their own value-based care strategy, rather than adopting particular models one by one, will be in the best position to succeed, he says.
The second half of our conversation with Christopher Stanley, M.D., MBA, the president of Henry Ford Health's Populance and the newest member of the Managed Healthcare Executive editorial advisory board.
The first part of our conversation with Christopher Stanley, M.D., MBA, the president of Henry Ford Health's Populance and the newest member of the Managed Healthcare Executive editorial advisory board.
