TKG PACT Executive Briefings - 3-Minute Market Insights The Kinetix Group, Powered by Petauri

Send us a Text Message.Laboratory Benefit Managers have emerged over the past decade to fill the need to manage complex and expensive laboratory testing for payers. They have become the new Precision Medicine Gatekeepers. Results from over 14 billion diagnostic tests are estimated to influence 70% of today’s clinical decisions. It’s estimated that there is both overutilization of testing in approximately 20% of cases, and underutilization of testing in approximately 45% of cases. Laborat...

Send us a Text Message.The term therapeutic inertia describes the failure of health care providers to initiate or intensify therapy when it is clearly indicated by established guidelines. The term has largely been applied to the management of blood pressure, blood sugar, and cholesterol, by primary care physicians who recognize the need for their patients to control these conditions but fail to act sufficiently to achieve the guideline recommended therapeutic targets. Despite clearly articula...

Send us a Text Message.Since 2016, 13 states have passed Drug Price Transparency Laws focused on enabling state policymakers to understand opaque drug pricing and payment systems to formulate policy solutions to high prices, while also creating the data infrastructure to realize those policy solutions. Most of these state programs require reporting from manufacturers when they increase the Wholesale Acquisition Cost (WAC) of a drug above a certain threshold or if they introduce a drug wi...

Send us a Text Message.On January 17th, 2024, CMS published the CMS Interoperability and Prior Authorization Final Rule, to improve the electronic exchange of health care data as well as to streamline prior authorization processes. This final rule also adds a new measure for merit-based incentive payment system or MIPS eligible clinicians.Beginning in January 2026, health insurers participating in federal programs including Medicare advantage and Medicaid, must respond to expedited (that's "u...

Send us a Text Message.Today’s topic is the Federal No Surprises Act.The Federal No Surprises Act is intended to protect consumers from unexpected medical bills that occur when a patient unknowingly receives medical services from physicians and other providers who are outside of their health insurance network; in other words, healthcare providers who are not “in network”. The law protects consumers specifically from surprise medical bills in three main scenarios:1. Emergency...

Send us a Text Message.Welcome to our new and revised market insights podcast format, where we have renamed our program the TKG PACT Executive Briefing. The new format will be condensed into 3-minute episodes of market insights, where we highlight one of healthcare’s critical market access issues, policies, challenges, or trends.We hope you enjoy this new “3-Minute Market Insights” format and hope that this resource provides helpful information in smaller, easier to digest, sound bites. Most ...