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What If Costco Designed the Prescription Drugs Sales Model?

Health Populi

Fast-forward through the 1990s and the advent of PBMs — pharmacy benefit management companies — the intermediaries managing drug benefits for health insurance plans. Today, the three largest PBMs, processing about 4 in 5 retail prescription claims, are embedded in large health insurance companies.

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Physician Coding and Billing Enforcement: What to Watch For

YouCompli

For more insights from the Compliance Institute, download our white paper on how compliance professionals can help healthcare institutions mitigate risk.). In March of 2022, a New Jersey rheumatologist was convicted by a federal jury for defrauding Medicare and other health insurance programs.

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Why Value-Based Care Requires Value-Based Administration

HIT Consultant

A strong VBC network will often need a sizable technology investment to revise traditionally siloed capabilities, the ability to cater to a spectrum of stakeholders, including accountable care organizations (ACOs), bundled payment programs, full and partial capitation, and the Medicare Shared Savings Program with upside and downside risk.

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Health Provider News

Hall Render

Dunleavy adds $9M to budget to address food stamp, Medicaid backlog New study provides snapshot of increase in maternal deaths in Alaska Mental Health Trust Grants $1.6M doctor talks importance of diversity in health care Illinois hospital CEO dismissed amid board investigation Illinois paid sick leave legislation heading to Gov.

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White House looks to CMMI to test new ways to lower drug prices

C&M Health Law

The EO comes two months after the president signed the Inflation Reduction Act (IRA) which promises to lower the cost of prescription drugs for many Medicare beneficiaries. This is not the first time that the White House will try to leverage CMMI’s testing authority to create models that would lower drug costs in Medicare.