The new Equity Measures in HEDIS 2022

NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS), beginning with the Measurement Year 2022 and ramping up through MY2024, will begin stratifying selected performance measures by race and ethnicity. The idea is that through HEDIS reporting, health plans will be able to identify and address inequities in healthcare and be held accountable for taking these actions.

FDA Under New Leadership: Future Direction

In February 2022, Robert M. Califf was confirmed as the FDA Commissioner for the second time. A seasoned physician and leader who is late in his career, one can expect that his term will be impactful and influential. Advancements in medicine have required a faster approval process from the FDA while at the same time taxing payers financially and demanding robust evidence from manufacturers. 

Future of Gene Therapy Reimbursement Models

Gene therapies bring the prospect of cures once unimaginable. The potential is exciting, but we cannot assume today's healthcare system can accommodate the financial burden expected from the gene therapy pipeline. Innovative therapies come with high manufacturing and delivery costs and target low patient numbers leading to million-dollar price points.

Medicare Advantage Outpaces Traditional Fee-for-Service (FFS) Enrollment: Implications

On June 15, 2022, the Supreme Court of the United States (SCOTUS) ruled in favor of hospitals over Medicare regarding a 340B reimbursement policy instituted in 2018 and unanimously decided that the almost 30% in cuts to Medicare outpatient drug payments for hospitals participating in the 340B drug pricing program was unlawful.