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Fast-forward through the 1990s and the advent of PBMs — pharmacy benefit management companies — the intermediaries managing drug benefits for healthinsurance plans. Today, the three largest PBMs, processing about 4 in 5 retail prescription claims, are embedded in large healthinsurance companies.
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.
For more insights from the Compliance Institute, download our whitepaper 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 healthinsurance programs.
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