Quality & Performance Metrics

EPA Halts Quantification of Air Quality Health Benefits in Regulatory Analysis

George Padron
State & Federal Regulations, Quality & Performance Metrics, Policy & Legislation | Jan 27, 2026
EPA discontinues assigning dollar values to air pollution health benefits in cost-benefit analyses, complicating healthcare cost projections for managed care organizations.

Dr. Patricia Hayes Discusses Relieving The Pediatric Care Crunch

George Padron
Podcasts, Quality & Performance Metrics, Telehealth & Virtual Care, Care Coordination | Jan 24, 2026
Patricia Hayes, MD, Chief Medical Officer at Imagine Pediatrics, shares her insights on how new partnerships among payers, providers, and virtual care teams are expanding access to care, which is becoming harder to deliver as pediatric inpatient centers shutter.

New Evidence May Inform Coverage Policies for Hormone Therapy in BRCA Carriers

Sonia Reyes
Oncology Care, Quality & Performance Metrics, Real World Evidence, Biomarker & Genomic Testing, Healthcare Headlines, Breast Cancer | Dec 23, 2025
University of Toronto study supports hormone therapy safety for BRCA carriers after preventive surgery, potentially influencing managed care coverage policies.

Cost Plus Drugs Founder Targets Military Pharmacy Spending in PBM Critique

Sonia Reyes
Prior Authorization & Appeals, Cost-Effective Analysis, Quality & Performance Metrics, Healthcare Headlines | Dec 10, 2025
Mark Cuban argues that eliminating PBM intermediaries in military pharmacy benefits could reduce taxpayer costs for TRICARE's eight billion dollar prescription spending.

Revised Obesity Classifications Challenge Current Insurance Coverage Models

George Padron
Prior Authorization & Appeals, Medicare/Medicaid Updates, Quality & Performance Metrics, Real World Evidence | Oct 17, 2025
Revised obesity framework challenges insurance models: half of currently eligible patients may not qualify, while clinical cases face coverage gaps