Utilization Management

Over the past week, the issue of utilization management has gained prominence as more middle-aged adults report forgoing medical care due to prohibitive costs, indicating potential challenges for value-based care (VBC) models. The introduction of TrumpRx, a proposed initiative to lower prescription drug prices, aligns with ongoing efforts to enhance patient access but raises questions about its impact on utilization patterns among Medicare beneficiaries. Additionally, stakeholders are discussing the complexities of benefit design in conditions like ATTR-CM, emphasizing the need for innovative strategies in Medicare Advantage plans to balance cost control and quality of care within the context of evolving reimbursement frameworks. For further insight, see [KFF's analysis on rising health costs](https://connect.kff.org/e3t/Ctc/RB+113/c1ThL04/VWfBCp1QSD-zW94ChPY7vThKyW76My975L-_b-N4CDgdq5nR3bW69t95C6lZ3n_W60Tf3L3ZxsyPW5hV4pN653rkfW5_6BBd6NWjc5W3sv8958NGQf6W7-fMHt4YnFsWW3sVkQ696ggzlW17sM214-p0WqW4sRBwf8B-JLhW4V5_L14MKpGLW72prCc2WXq_VW5