Managed Care Cast: Recent Episodes
Managed Care Cast
UPMC and Birth Root Community Doula describe a 4-year partnership addressing food insecurity, housing, and maternal health disparities in Erie, Pennsylvania.
In this episode of Managed Care Cast, Alvin Thomas, PhD, clinical psychologist at the University of Wisconsin-Madison, discusses the mental health challenges facing Black and Latino boys and young men.
published in the July 2026 issue; it examined how new cancer diagnoses affected state Medicaid budgets. He conducted the study with Amanda C. Chen, PhD, of the USC Mann School of Pharmacy and Pharmaceutical Sciences, and David C. Grabowski, PhD, of Harvard Medical School.Kansal explained to AJMC that despite Medicaid's younger population, cancer remains the third-largest source of program spending. Most existing research had focused on commercial and Medicare populations rather than Medicaid specifically. Consequently, using de-identified CMS claims data, he and his team identified new cancer diagnoses, defined as no prior cancer evidence in the preceding 6 months, and compared spending, hospitalizations, and emergency department use between metastatic and non-metastatic cases.Kansal highlighted the core finding, which was that metastatic diagnoses were associated with significantly higher spending than non-metastatic diagnoses across most cancer types. Notably, health care utilization patterns were consistent between fee-for-service and capitated Medicaid states, suggesting that cost drivers stemmed from the disease itself, particularly the shift to systemic therapies once cancer spread, rather than from program administration models.Kansal pointed to the 4 cancer screenings recommended by the US Preventive Services Task Force, namely lung, breast, colorectal, and cervical, as opportunities to reduce late-stage diagnoses and their associated costs while noting that cancers without established screening protocols presented a distinct policy challenge. On balancing innovative treatment access with cost sustainability, he emphasized that Medicaid's state-by-state administration means that no single policy solution applied universally. Still, Kansal emphasized that earlier detection could offer states greater financial flexibility to support innovative therapies for patients with true clinical need.“Intervening earlier is one of the opportunities we might have to really make a difference,” he concluded.
found that nonprofit and system-affiliated hospitals have superior language access. During her conversation with AJMC, she discussed what inspired the research, the study's key findings, and ways to improve equitable access to information about financial assistance, regardless of language.To conclude, Duffy previewed her study to be published in the July 2026 issue of AJMC, which builds on this work by evaluating the readability of financial assistance documents.
Most patients with metabolic dysfunction–associated steatotic liver disease (MASLD) go undiagnosed until significant liver damage has already occurred, despite the availability of simple, guideline-supported screening tools that remain notoriously underused in both primary care and weight management settings. That's according to a conversation between Naim Alkhouri, MD, chief medical officer at Summit Clinical Research and director of the Steatotic Liver Disease Program at the Clinical Research Institute of Ohio, and Chika Anekwe, MD, obesity medicine clinical director at the Massachusetts General Hospital Weight Center and an instructor in medicine at Harvard Medical School.In this episode of Beyond the Silo: Integrated Care Across the CRM Continuum, the third installment in a series examining the cardio-renal-metabolic continuum, Alkhouri and Anekwe discuss why MASLD and its more aggressive form, metabolic dysfunction–associated steatohepatitis (MASH), belong alongside the heart and kidney in conversations about cardiometabolic risk. The pair walk through how Fibrosis-4 Index for Liver Fibrosis calculations can identify high-risk patients before liver damage becomes irreversible, why ownership of screening often falls through the cracks between primary care, obesity medicine, and specialty clinics, and how the recent FDA approvals of resmetirom and semaglutide for MASH have raised the urgency of early detection. The conversation also covers strategies for closing equity gaps in liver disease screening, including the role of telehealth and artificial intelligence in extending care to underserved and rural communities.
Bhatnagar, DO, discusses how the field of acute myeloid leukemia has been fundamentally transformed; what this means for patients in rural, underserved settings; and where hematologic oncology is headed next.
Perry Halkitis, PhD, MS, MPH, dean of the Rutgers School of Public Health, watched epidemics emerge, witnessed governments fail to respond, and seen communities mobilize when institutions would not. From the early days of the AIDS crisis to COVID-19, Ebola, and beyond, he has drawn consistent lessons about what makes public health succeed and what causes it to collapse.
For patients with cancer, diagnosis doesn't just bring a physical battle. It can trigger a trauma response that can linger long after treatment ends, quietly reshaping how people sleep, think, and connect with the world around them.
Early detection of chronic kidney disease (CKD) means little if it does not lead to timely treatment, yet a significant gap persists between when CKD is found and when evidence-based therapies are started. That disconnect is the focus of the second episode of Beyond the Silo: Integrated Care Across the CRM Continuum, a podcast series from The American Journal of Managed Care®, in which Ralph Riello, PharmD, BCPS, leads a conversation with Nihar Desai, MD, MPH, on how to shift CKD care from a reactive, late-stage model to one that is proactive, pathway-driven, and equitable.The discussion builds on the first episode's focus on urine albumin-to-creatinine ratio underutilization, stipulating that screening has occurred and asking what must happen next. You can listen to the first episode here: https://www.ajmc.com/link/89943
On this episode of Managed Care Cast, The American Journal of Managed Care® spoke with Jonathan Wrathall, PhD, a senior advanced analytics consultant at Elevance Health. He authored 2 studies published in the May 2026 issue, both of which centered on food insecurity: “Food Insecurity Identification Modeling for Medicare Enrollees Using Administrative Data” and “Making the Most of Limited Resources: Predicting Food Insecurity.”Throughout the conversation, Wrathall highlighted the motivation behind his studies, key food insecurity predictors, unexpected findings, and gaps in identifying needs across insurance groups. Before concluding, he rounded out the discussion by bringing the findings of both studies together to explain their implications for improving food insecurity detection in health systems.
Psychiatrist and longtime psychedelic researcher Scott Shannon, MD, CEO of the Board of Psychedelic Medicine and Therapies, and founder of Wholeness Center, discusses how a new federal push to accelerate psychedelic therapies could reshape the future of mental health care.
Chronic kidney disease (CKD) affects an estimated 37 million Americans, yet most cases go undiagnosed until the disease has significantly progressed. A urine albumin-to-creatinine ratio (uACR) test can detect kidney damage years before a decline in the estimated glomerular filtration rate (eGFR), but it remains underutilized.In the first episode of Beyond the Silo: Integrated Care Across the CRM Continuum, a podcast series from The American Journal of Managed Care®, Marc P. Bonaca, MD, MPH, moderates a discussion with Josephine Harrington, MD, on why uACR has not yet become a standard of care, how CKD fits into the broader cardio-renal-metabolic (CRM) disease continuum, and what changes are needed across specialties, systems, and workflows. Bonaca is a cardiologist and vascular medicine specialist at the University of Colorado Anschutz and the executive director of CPC Clinical Research. Harrington is also a cardiologist, specializing in advanced heart failure and transplant cardiology at UCHealth’s Heart and Vascular Center at the University of Colorado Hospital.Throughout the conversation, they emphasize that CKD is an early integral part of the CRM continuum, as it is both a driver and consequence of cardiovascular risk, with uACR elevation often appearing before eGFR decline and signaling increased risk even at mild levels. Despite strong guideline support, uACR screening remains underused due to structural barriers. Therefore, the experts explained that the primary barrier is not the test itself but the lack of streamlined workflows that make screening routine and results actionable without adding clinician burden. They concluded that early detection is critical because it enables the timely use of therapies such as SGLT2 inhibitors, glucagon-like peptide-1 receptor agonists, and finerenone, which improve outcomes. To close the gap, the experts noted that uACR should be treated as a routine vital sign for cardiometabolic risk and embedded into health system quality metrics to ensure consistent, accountable use.
found that reducing information barriers for consumers selecting primary care clinics in a tiered network design had only a marginal effect on choice.McDonald and Dowd noted that this suggests informational interventions alone may be insufficient to overcome existing inertia. They added that consumers may already be adequately informed through the tiered benefit design.In AJMC’s conversation with the authors, we discussed how provider- and consumer-oriented payment reforms influence health care efficiency and the role of consumer inertia. We also explored the key findings from their research and the broader implications for patient decision-making.
A clinical pharmacy leader outlines 8 interdependent domains institutions must master to build financially sustainable, patient-accessible CGT programs.
In this episode of Managed Care Cast, Ella Hohmann speaks with Douglas Marks, MD, breast medical oncologist and associate professor at NYU Grossman Long Island School of Medicine, about the role of lifestyle interventions in reducing breast cancer risk. Marks reviews the evidence behind dietary modification, physical activity, and alcohol reduction, and discusses why some of these strategies remain underutilized despite their strong risk-benefit profiles. The conversation also addresses critical gaps in the research, including the underrepresentation of minority populations in clinical and epidemiologic studies, and the socioeconomic barriers that limit real-world uptake of preventive interventions. Looking ahead, Marks shares his perspective on emerging opportunities from GLP-1 receptor agonists to wearable technology and AI-driven monitoring that could transform how clinicians support and track lifestyle change in their patients.
Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO, chief medical officer with the International Myeloma Foundation and professor in the Applied Cancer Research and Drug Discovery Division of the Translational Genomics Research Institute, has spent more than 25 years advancing the treatment of multiple myeloma. In this episode, he breaks down how improved survival, evolving frailty assessments, and the rise of therapies like CAR T and bispecific antibodies are reshaping care for an aging population, and he highlights the growing emphasis on quality of life, caregiver support, and expanding clinical trial access.
On this episode of Managed Care Cast, The American Journal of Managed Care® (AJMC®) was joined by Yubin Park, PhD, and Michael Ellenbogen, MD, authors of research published in the March 2026 issue.Because financial incentives may influence clinical decision-making, their study examined the relationship between industry payments and Medicare beneficiary spending.As reflected in its title, “Industry Payments to Cardiologists Are Associated With Higher Medicare Spending,” their cross-sectional analysis of more than 26,000 cardiologists found that industry payments were associated with increased Medicare costs. Specifically, every $10,000 in payments was linked to an additional $14.10 in beneficiary spending.In AJMC’s conversation with the authors, they discuss what inspired their research, the key findings, and how these results may inform policies and strategies to both better manage physician-industry relationships and control health care spending.
On this episode of Managed Care Cast, I spoke with Dr. Michael Bernstein, an assistant professor in the department of diagnostic imaging at the Warren Alpert Medical School, and Brian Sheppard, a professor of law at Seton Hall Law who focuses on malpractice litigation, to discuss the broader implications of AI becoming more prevalent in health care; understanding its potential impact on legal outcomes and physician liability is essential for providers, risk managers, and policymakers alike.
In January, the CDC announced major revisions to the US childhood immunization schedule, reducing the number of diseases covered by routine vaccines from 17 to 11. The changes followed a December 2025 presidential memorandum directing HHS Secretary Robert F. Kennedy Jr and acting CDC director Jim O’Neill to update the schedule if “superior approaches” were identified abroad.The revisions also come months after Kennedy ended the terms of all 17 Advisory Committee on Immunization Practices members in June 2025 and quickly replaced them with new appointees, some of whom had previously expressed antivaccine views. He said the move was intended to restore public trust in vaccines.To better understand what these developments could mean for vaccine access and coverage, The American Journal of Managed Care® (AJMC®) spoke with Susan Cantrell, the CEO of the Academy of Managed Care Pharmacy, about the managed care pharmacy perspective on the updated recommendations.Throughout her conversation with AJMC, she discussed her reaction to the changes and their implications for pediatric vaccination and public health, as well as the evolving role of managed care pharmacists in supporting vaccine access and addressing vaccine hesitancy.
What Health Inequities Are Really Costing Your Company: Wayne Rawlins, MD by Managed Care Cast
Scalable Strategies Boost Heart Failure Prescription Fills: Weston Blakeslee, PhD by Managed Care Cast
Grocery Card Use Associated With Increased Care Among Dual-Eligible Beneficiaries: Jennifer L. Kowalski, MS by Managed Care Cast
Kristi Martin, a longtime Washington, DC–based policy strategist with deep experience implementing major legislation like the Affordable Care Act and the Inflation Reduction Act, explores how the Orphan Drug Act, passed in 1983 as a bipartisan, patient-driven effort, transformed rare disease treatment by aligning scientific advances, government investment, and market incentives, but that reform may now be necessary—rethinking incentives for blockbuster drugs, refining orphan eligibility, and shifting toward more targeted, evidence-based negotiation.
The American Journal of Managed Care® (AJMC) kicks off its 2026 author podcast series with Nate C. Apathy, PhD, guest editor of AJMC’s 15th Health Information Technology (IT) special issue. He is an assistant professor of health policy and management at the University of Maryland School of Public Health and an affiliated research scientist at the Regenstrief Institute in Indianapolis, Indiana.To set the stage for this milestone issue, Apathy reflects on the most significant health IT advancements of the past 15 years before zeroing in on developments from 2025. He then explores the issue’s central themes, including artificial intelligence (AI) and telehealth.As highlighted in this year’s Health IT issue, Apathy explains that AI has the potential to reduce administrative and clinical burdens and has been rapidly adopted by clinicians. At the same time, AI presents challenges, including maintaining clinical vigilance and managing costs. He also underscores the benefits of telehealth, particularly when tailored to specific clinical contexts. Despite the pace of technological innovation, Apathy emphasizes that success in health IT ultimately depends on building trust and strong relationships, as well as closely aligning solutions with user needs. Looking ahead, he hopes health IT tools will become more intuitive, seamlessly supporting equity, access, and high-quality care while enabling greater personalization.
On this episode of Managed Care Cast, The American Journal of Managed Care® spoke with David Muhlstein, PhD, JD, founder and CEO of Simple Healthcare, about his recent articles highlighting Transparency in Coverage (TIC) files and ghost rates from 119 insurers, including 3 national commercial payers.Aetna, Cigna, and United Healthcare TIC files were more than 90% ghost rates—billing codes for procedures that would never be performed by a specific physician. For example, there were billing codes for heart surgery performed by a psychiatrist, Muhlstein said. These ghost rates increase the size of TIC files, making them difficult to evaluate for consumers, researchers, and analysts. Data files of this size muddle the true aim of the TIC files to provide actual transparency that would allow consumers to compare the prices of health care services and choose more affordable options.
On today’s episode, AJMC® spoke with Dr. Sachin Jain, president and CEO of SCAN Group and Health Plan, about his 10 predictions for the health care industry in 2026. Jain breaks down his predictions and what they could mean in both the short and long term for Americans and how they may shape access, affordability, and accountability across the US health care system.
Her research analyzed Medicare beneficiaries with mental health diagnoses who switched from Medicare Advantage (MA) to traditional Medicare (TM), examining their use of mental health services in the year before and after the switch.In this Managed Care Cast episode, Liu discusses what inspired her research, highlights the key findings, and explores ways to improve equitable access to mental health services for Medicare beneficiaries.
On this episode of Managed Care Cast, we’re talking with the co–editors in chief of The American Journal of Managed Care® (AJMC®), Mark Fendrick, MD, and Michael Chernew, PhD. They look back on the research and news that stood out to them from the past year and discuss what they’re looking forward to in 2026.Check out the dedicated page featuring our efforts to celebrate AJMC’s 30th anniversary: https://www.ajmc.com/anniversary
; explores the characteristics that increase vulnerability to SAD; and covers the effective and unique evidence-based treatment for SAD: bright light therapy.
Today we are bringing you a conversation on the evolving landscape for idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) treatment. Ryan Haumschild, PharmD, MS, MBA, vice president of ambulatory pharmacy atEmory Healthcare and Winship Cancer Institute, spoke with Marilyn Glassberg, MD, the John W. Clarke Professor and Chair of medicine at Loyola University Chicago Stritch School of Medicine; Ayodeji Adegunsoye, MD, MSc, PhD, FACP, FCCP, assistant professor at the University of Chicago; and Janet Pope, MD, MPH, professor of medicine and division member of rheumatology at the University of Western Ontario in Canada.IPF and PPF are increasingly prevalent conditions that pose a growing burden on both patients and health care systems. Despite the availability of FDA-approved antifibrotic therapies, the median survival for patients with IPF and PPF remains less than 5 years after diagnosis—underscoring the critical unmet needs that persist in this field. The panelists discussed the impact these conditions have on patients' lives, evaluated emerging agents, and addressed economic considerations that affect treatment decisions and health care resource allocation.
explores how home health care delivery and patient outcomes differ between 3 plan types: traditional Medicare, episodic Medicare Advantage, and per-visit Medicare Advantage.Throughout the conversation, Prusynski discusses what motivated the research, the study's key findings, and the broader implications for improving the quality and accessibility of future home health care.
On this episode of Managed Care Cast, AJMC spoke with lead CML researcher, Jorge Cortes, MD, to discuss the evolution of the groundbreaking treatment Imatinib and its effect on survial in patients with chronic myelogenous lukiemia.
Donovan Campbell, CEO, and his organization Medbridge are urging CMS to finalize specific refinements to RTM as part of the Calendar Year 2026 Physician Fee Schedule (CMS-1832-P), recognizing that RTM is critical for supporting physical therapy, patient health, and patient engagement. We will explore how this shift provides a crucial financial incentive for organizations, but more importantly, how the successful adoption of RTM enhances the clinical value proposition by improving population health, lowering overall costs, and tackling the problem of access barriers to conservative care.
On today’s episode, Dr. Tabby Khan, senior director of analytics for Komodo Health, spoke about their newest data analysis measuring age and insurance disparities in antibody-drug conjugate, or ADC, treatment rates in patients with metastatic breast cancer. The analysis was in partnership with the Tigerlily Foundation, a national breast cancer advocacy organization, in celebration of the 40th anniversary of Breast Cancer Awareness Month.
Today we are bringing you a conversation on how topical therapies can effectively manage atopic dermatitis. Brian Keegan, MD, PhD, FAAD, a dermatologist with Princeton Dermatology, spoke with Alexa Hetzel, MS, PA-C, physician assistant with Schweiger Dermatology Group; Vikash D. Oza, MD, director of pediatric dermatology at NYU Langone; and Amy Spizuoco, DO, FAOCD, dermatologist and dermatopathologist at True Dermatology.In addition to discussing the clinical benefits and impact on patient outcomes of using topical therapies for atopic dermatitis, the panelists explored how health economics research informs treatment decisions by demonstrating the cost-effectiveness and accessibility of topical therapies. The panel also analyzed the potential health care cost savings and resource optimization achieved through strategic use of topical treatments and atopic dermatitis management.
In this episode of Managed Care Cast, we talk with Barbara Kelley, executive director of the Hearing Loss Association of America. In our conversation, we discuss advocating for hearing loss awareness, breaking down care barriers related to stigma, and empowering individuals through legislation and public policy. Kelley also highlights the importance of early intervention, advancements in hearing technology, and the social and financial challenges faced by individuals with hearing loss, advocating for better hearing health integration into overall wellness.
How is AI transforming breast cancer screening? On this episode of Managed Care Cast, leading radiology expert, Robert NIshikawa, PhD, breaks down the latest advancements in deep-learning models designed to work alongside mammograms—improving accuracy, efficiency, and early detection in breast imaging.
examines the challenges of implementing the Medicare Diabetes Prevention Program (MDPP) from the perspective of program suppliers nationwide.In this conversation, Turk discusses the limited adoption of the MDPP and the inspiration behind her study. She also outlines her key findings and shares next steps for implementing and sustaining the program.
On this episode of Managed Care Cast, The American Journal of Managed Care® spoke with Gen Li, PhD, CEO and cofounder of Phesi, a clinical data company that provides AI-driven insights to sponsors and providers to optimize clinical trial efficacy. A recent analysis from Phesi found over 100 diseases currently being studied using GLP-1 RA therapies. The rapid growth of GLP-1 RA therapies being used across multiple, overlapping conditions creates an incentive for efficient and easily accessible clinical trial data to aid sponsors and researchers in establishing control cohorts using Phesi's Trial Accelerator platform and digital patient profiles.
On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Laxmi Patel, chief strategy officer at Savista, about how the proposed federal Budget Reconciliation Act could reshape Medicaid coverage nationwide. Patel explains why states with large immigrant populations, rural hospital dependence, or provider tax funding could face the most immediate disruptions and what payers can do to prepare. Building on AJMC’s prior discussion with Patel on state-level Medicaid policy changes, this conversation explores how coverage loss, care deserts, and administrative burdens may evolve if these reforms move forward—and what proactive, state-specific strategies can help mitigate the impact.
On this episode of Managed Care Cast, The American Journal of Managed Care® (AJMC®) speaks with Tory M. Wolff, MBA, an author of a study published in the September 2025 issue and managing partner of Recon Strategy, a management consulting firm specializing in health care strategy.His study, "Impact of More Primary Care Visits on Commercial Health Care Costs," found that more frequent routine primary care visits among certain higher-risk commercially insured adults are associated with lower net population-level health care costs. In this conversation, Wolff explores the inspiration behind his research, expands on his findings, and discusses the next steps to better understand the long-term value of routine primary care in commercial populations.
On this episode of Managed Care Cast, expert Mary Catherine Beach, MD, MPH, a professor of medicine at the Johns Hopkins University School of Medicine, discusses the practical implications of bias in electronic health care records.
For National Recovery Month, we are joined by Matthew O. Hurford, MD, vice president, Behavioral Health, UPMC Insurance Services Division, and Michael Lynch, MD, an attending emergency physician and medical toxicologist at UPMC. Among the topics we hit on are the 4 crucial dimensions of recovery; understanding that addiction is a brain disease, not a moral failing; and the challenges and opportunities they encounter in providing behavioral health services to millions of Pennsylvanians.
We discuss the May 16 FDA approval of the first blood test to diagnose Alzheimer disease. This landmark approval marks a significant shift in how Alzheimer disease is identified, moving away from more traditional methods or invasive methods. Our guests, Howard Fillit, the Alzheimer’s Drug Discovery Foundation, and Anthony “Nino” Sireci, MD, MSc, Eli Lilly and Company, help us understand this “huge accomplishment" and how it may be able to transform the diagnostic landscape from one of nihilism to one of hope and early intervention.
Committed to building safe, reliable, and value-driven AI solutions that enhance health care delivery and the member experience, UPMC Health Plan's approach to AI is grounded in strong governance, balancing innovation with critical ethical concerns. In this conversation, we dive into how UPMC Health Plan builds trust with providers and members, discuss challenges of scaling AI effectively, and hear about concrete examples of AI's positive impact.
On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Richard A. Brook, MS, MBA, president of Better Health Worldwide, Inc., and author of a study published in the August 2025 issue.His retrospective analysis, "The Impact of Health Benefit Design on Patients With Infertility," examined how benefit design influences infertility treatment use and pregnancy outcomes. The study found that coverage for infertility treatment was associated with significantly higher use of assisted reproductive technology (ART) medications, more ART procedures performed, and improved pregnancy outcomes.In this conversation, Brook explores the current state of infertility care in the US, the inspiration behind his study, its key findings, and next steps to expand access to ART.
Breast cancer is the second most common cancer among women and the second leading cause of cancer-related deaths among women in the US. In light of Breast Cancer Research Awareness Day, the American Journal of Managed Care® breaks down the most recent advancements in breast cancer prevention, screening, and therapies.
On this episode, Mary Caffrey, Executive Editor of AJMC and Evidence-Based Oncology (EBO), is joined by Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO Chief Medical Officer of the International Myeloma Foundation (IMF), was the primary interviewee and source for a recent EBO article. His insights in that piece highlight how the IMF’s M-Power initiative builds trust and awareness through its 3-pillar approach: community engagement, primary care education, and improving care for patients. During the discussion, Mikael talks about how IMF's M-Power initiative is expanding with the organization's medical student scholars program, using patient narratives to encourage trial participation among Black patients, and navigating today’s political climate around diversity, equity, and inclusion—all while pushing toward a future where lifesaving treatments and cures reach every patient who needs them. Stay tuned for this enlightening discussion on bridging the clinical trial gap.
Heart failure remains one of the most urgent challenges in health care, affecting millions of individuals and imposing a significant burden on families and the broader health system. Although guideline-directed medical therapy (GDMT) has been shown to improve clinical outcomes and reduce hospitalizations, adoption of these therapies remains suboptimal nationwide. Addressing this treatment gap is essential not only for enhancing survival and quality of life but also for mitigating the rising economic impact of heart failure as its prevalence continues to increase. Gluckman also led the session “Addressing Underuse of Guideline-Directed Medical Therapy in Heart Failure” at the July 9 Institute for Value-Based Medicine® (IVBM) event in Garden Grove, CA, where he addressed the need for integrated approaches to drive sustainable, system-level change in cardiovascular care.On this episode of Managed Care Cast, Ty Gluckman, MD, MHA, FACC, FAHA, FASPC—a practicing cardiologist at Providence Heart Institute in Portland, Oregon, and medical director of Providence's Center for Cardiovascular Analytics, Research, and Data Science—discusses strategies to improve GDMT implementation. The conversation explores opportunities for payers and providers, the potential of remote patient monitoring and digital health tools, and the role of value-based care models in supporting optimal therapy. Emphasis is placed on the importance of aligning clinical guidelines with managed care policies to drive meaningful improvements in patient outcomes.
On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Jonathan Gabison, MD, DABOM, and Stephen Lott, PharmD, MS. At the University of Michigan, Gabison is an obesity medicine specialist and family physician, while Lott serves as director of the postgraduate year one managed care residency program and manager of the university's prescription drug plan.Their qualitative study, "Understanding Insurance Coverage Policies for Incretin Mimetics for Weight Management," determined that the high costs associated with these therapies limit insurance coverage and contribute to variation in utilization management strategies aimed at controlling short-term spending.During the conversation, the investigators discuss how high costs, misconceptions about obesity, and inconsistent coverage policies continue to hinder equitable, patient-centered care.
Precision medicine has long guided cancer treatment by matching therapies to tumor mutations, but the emerging field of predictive genomics aims to take this further by factoring in a patient’s genetics, health history, and environment to better predict drug response.
Explore how the Collaborative Care Model enhances mental health access in this episode featuring Anna Bob, executive director of the Path Forward coalition.
Gastropsychiatrist Eva Szigethy, MD, PhD, and Benjamin Cohen, MD, Cleveland Clinic, discuss quality of life improvement in terms of behavioral health and inflammatory bowel disease (IBD).
Delays, denials, and endless paperwork—prior authorization isn’t just a headache for providers; it’s a barrier for patients who need timely care. From shocking patient delays to the surprising role of fax machines in 2025, in this episode, we explore why prior auths are driving burnout, potentially harming outcomes, and what’s being done to streamline the process.
A quick roundup episode of major news and health policy developments from The American Journal of Managed Care.
On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Julia Lucaci, PharmD, MS, the senior director of global health economics and outcomes research at Becton, Dickinson and Company (BD), an international medical technology company.Her commentary, "Should Payers Incentivize Pharmacies to Blister-Package Chronic Medications?" argues that payers should consider offering higher reimbursement rates and/or preferred network status to pharmacies that dispense chronic medications in blister packs to enhance medication adherence and patient outcomes.During the conversation, Lucaci explores the widespread impact of medication nonadherence, the benefits and underutilization of blister packaging in the US, and strategies that could support broader adoption to improve chronic disease management and lower overall health care costs.
A quick roundup episode of major health policy developments, from shifting COVID-19 vaccine guidance and scientific publishing controversies to rising cancer care costs and the impact of oncology biosimilars.
On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Lindsey Leininger, PhD, health policy professor and faculty director of the Center for Health Care at the Tuck School of Business at Dartmouth College, and Allister Chang, MPA, co-founder of Fabric Health, a social-impact startup that aims to improve community well-being by transforming everyday moments in laundromats into opportunities to build trust, support Medicaid recertification, and connect families with health and social services.Their study, "Unmet Health Care and Health-Related Social Needs of Laundromat Users," published in this month's issue, identifies laundromats as a promising community-based setting for Medicaid outreach, with Medicaid enrollees comprising the majority of users and facing disproportionately high levels of unmet needs. During the conversation, Leininger and Chang highlight how engaging with enrollees at laundromats can help foster trust, address unmet social needs, and strengthen Medicaid engagement.
Victor Murray, senior director of Community Engagement and Capacity Building at the Camden Coalition, discusses the evolving role of social workers, emphasizing their expanded scope to include systems change, health equity, and policy work. He highlights the Camden Core Model, which addresses complex health and social needs through trauma-informed care and holistic support.
Explore how employers enhance workplace mental health by fostering a culture of support and engagement, focusing on holistic well-being strategies in this interview with Jim Kinville, University of Pittsburgh Medical Center.
On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Larragem Raines, MS, director of research at the Center for Innovation & Value Research, about her organization's open-source value model for major depressive disorder (MDD). She also defines dynamic pricing and explains how it is incorporated into the MDD value model, topics she expands upon in a recent contributor article.Looking ahead, Raines discusses the potential of artificial intelligence (AI) to improve diagnosis, treatment, and access in the MDD space.
Colleen Ereditario, MPH, RD, LDN, program manager, shares how the “Food as Medicine” approach of Allegheny Health Network (AHN) addresses food insecurity and guides patients to improve their health.
On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Brady Post, PhD, assistant professor at Northeastern University and lead author of a study published in this month's issue.His study, "Impact of Hospital-Physician Integration on Medicare Patient Mix," found no evidence that hospital-employed physicians treated a higher proportion of complex patients, at least among those enrolled in traditional Medicare.During the conversation, Post shares the inspiration behind his research, key findings, and areas for further investigation.
Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes. Overall, their findings show a significant uptick in tirzepatide dispensations, alongside other glucose- and weight-lowering medications, including semaglutide.
Today we are bringing you a conversation the use of continuous glucose monitoring technology and its transformative potential in diabetes care. Davida Kruger, a certified nurse practitioner at Henry Ford in the division of endocrinology, spoke with Jaime Murillo, MD, senior vice president and chief medical officer, medical affairs, United Health Group; Jeremy Wigginton, MD, chief medical officer at a regional Blue plan; Ian Neeland, MD, director of cardiovascular prevention, University Hospitals Harrington Health and Vascular Institute, and associate professor of medicine, Case Western Reserve University School of Medicine; and Ken Cohen, MD, executive director of translational research, Optum Health.The topics of conversation for today’s podcast include how CGM addresses therapeutic inertia, enhances glycemic control, and drives improvements in patient outcomes and health care efficiency, as well as the barriers to adoption, strategies for expanding access, and the cost effectiveness of CGM implementation.
On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.
On this episode of Managed Care Cast, we are speaking with Jai N. Patel, PharmD, the associate director of shared resources management at Atrium Health Wake Forest Baptist Comprehensive Cancer Center.His study, "Medical Policy Determinations for Pharmacogenetic Tests Among US Health Plans," uncovered significant differences in coverage decisions for pharmacogenetic tests across major US health insurers and laboratory benefit managers; pharmacogenetic testing examines how an individual's genetic makeup impacts drug response.In our discussion, Patel shares what motivated this research, key takeaways from his findings, and steps needed to improve consistency in evidence evaluation and pharmacogenetic test coverage.
On this episode of Managed Care Cast, we speak with George Jones, chief operating officer at UpScript Health, an online pioneer of eprescribing 20 years ago, to learn how telemedicine has progressed from asynchronous conferencing to real-time video consultation, enabling the treatment of complex conditions beyond primary care.
On this episode of Managed Care Cast, we speak with Perry N. Halkitis, PhD, MS, MPH, dean of the Rutgers School of Public Health. Our conversation centers on the potential withdrawal of the United States from the World Health Organization, the new directive for the CDC to stop communications with the WHO, and their public health implications. We also touch on the importance of accurate public health information and the role of public health leaders in advocating for science and health.
Today, we're diving deep into a crucial aspect of preventive healthcare: the Annual Wellness Visit. Our guest is Dr. Christopher Wheelock, a clinical transformation physician executive at Highmark Health, responsible for developing payer and provider collaborations to move toward value-based care. In the past, he was heavily involved with developing the workflow, patient scripting and templating for the Annual Wellness Visit when CMS first established it in 2011 as part of the Affordable Care Act.In today’s episode, Dr. Wheelock sheds light on the various elements of the Annual Wellness Visit, including self-assessments of psychosocial issues and screenings for conditions like dementia and incontinence. He also explains the expansion of services in 2025 for Medicare beneficiaries. We also explore the intricacies of coding and billing for these visits, especially if they go beyond the scope of the Annual Wellness Visit; the value they bring to patients, providers, and payers; and the critical role of effective communication and preparation to maximize the benefit of the Annual Wellness Visit.
On this episode of Managed Care Cast, we're talking with Allison Ju-Chen Hu, PhD, a postdoctoral associate in the Department of Population Health Sciences at Weill Cornell Medicine.Her study, "Medicaid Managed Care Network Adequacy Standards and Mental Health Care Access," examined the association between quantitative network adequacy standards (NAS) and mental health care access among adult Medicaid enrollees, including those with mental health conditions.
Joining us for this episode of Managed Care Cast is Robert H. Hopkins, Jr, MD, mnedical director at the National Foundation for Infectious Diseases and NFID liaison to the Advisory Committee on Immunization Practices, who will help separate fact from fiction about avian influenza and discuss what needs to be done to prevent a future escalation.
Today, we do a deep dive into psychedelic-assisted therapy with Jessica Tracy, head of Growth and Partnerships at Enthea. She shares how employers and unions can support mental health and address access barriers to evidence-based ketamine treatments.
March 11, 2025, will mark 5 years since the World Health Organization (WHO) declared COVID-19 a pandemic. Between January 22, 2020, and March 10, 2023, Johns Hopkins University recorded over 676 million confirmed COVID-19 cases worldwide and more than 6.8 million related deaths. In the US alone, it reported over 103 million cases and more than 1 million deaths during this timeframe. Although the WHO declared an end to the public health emergency on May 5, 2023, followed by the CDC on May 11, COVID-19 continues to impact thousands of individuals worldwide. On this episode of Managed Care Cast, we're speaking with Jenny Han, MD, a COVID-19 expert from Emory School of Medicine and Grady Hospital in Atlanta, Georgia. We'll explore the current state of COVID-19, including risk factors, treatments, and the impacts of long COVID. We will also discuss prevention strategies, vaccination efforts, and future steps to improve COVID-19 care and outcomes.
The editors in chief of The American Journal of Managed Care® discuss the key managed care research and news from 2024 and look forward to the journal’s upcoming 30th anniversary.
Today we are bringing you a conversation on treatment with Bruton tyrosine kinase inhibitors for patients with treatment-naïve chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL).Ryan Haumschild, PharmD, MS, MBA, CPEL, vice president of ambulatory pharmacy at Emory Healthcare and Winship Cancer Institute, spoke with 3 experts: Tara Graff, DO, medical oncologist, Mission Cancer and Blood; Jacqueline Barrientos, MD, MS, chief, Hematologic Malignancies, and director, Oncology Research at Mount Sinai Comprehensive Cancer Center; and Matthew Davids, MD, MMSc, director of Clinical Research, Division of Lymphoma, Dana-Farber Cancer Institute, and associate professor of medicine, Harvard Medical School.They covered a wide range of topics including the data on treatment regimens for both CLL and MCL, the cost of treatment, patient-specific considerations during treatment decision making, and the future of treatment.
Rachael Drake, pharmacy technician coordinator, University of Kansas Health System, explains how her team collaborates with insurance companies and providers to support patients with non-Hodgkin lymphoma access treatment.
Among the latest data being presented at the American Society of Hematology Annual Meeting and Exposition, held December 7-10, 2024, in San Diego, California, were 3 abstracts that focused on patient preferences and treatment choices.Sikander Ailawadhi, MD, professor of medicine in the Division of Hematology/Oncology at the Mayo Clinic Florida was a coauthor on all 3 abstracts, covering patient preferences for Bruton tyrosine kinase inhibitors in chronic lymphocytic leukemia and small lymphocytic lymphoma, survivorship burden and patient preferences affecting treatment choices in multiple myeloma, and race/ethnicity-specific sociodemographic and economic factors driving refusal of treatment in multiple myeloma.
Today we are bringing you insights from 3 separate interviews with experts about the treatment, management, and burdens of idiopathic pulmonary fibrosis (IPF).In this podcast, you’ll hear insight from the following individuals: Toby Maher, MD, PhD, professor of clinical medicine, Keck School of Medicine, USC; Martin Kolb, MD, PhD, professor of medicine, McMaster University; and Steven Nathan, MD, FCCP, medical director of the Advanced Lung Disease Program and Lung Transplant Program, Inova Fairfax Hospital, and professor of medicine, University of Virginia.These experts discuss what IPF is, how it impacts patients’ quality of life, barriers to care, and treatments in the pipeline.
On this episode of Managed Care Cast, we're talking with Joanne Armstrong, MD, MPH, the vice president and chief medical officer for women's health and genomics at CVS Health.We explored the progress and persistent challenges in women's health, highlighting topics like care access, the role of technology, maternal health outcomes, and efforts to break the stigma around menopause.
In this special episode of Managed Care Cast, the executive editor of The American Journal of Managed Care, Mary Caffrey, speaks with Tyler Sandahl, PharmD, of Cleveland Clinic, and Michael Byrne, DO, of Tennessee Oncology, about the use of bispecific antibodies to treat patients with multiple myeloma, the importance of caregivers for this regimen, how the entire staff plays a role, the common adverse events patients need to be looking out for, and more.
On this episode of Managed Care Cast, we're talking with Josie Cooper, BA, executive director of the Alliance for Patient Access.Her study, "Utilization Management and Physician Burnout," involved a survey that assessed physician experiences with utilization management and burnout, investigating the potential link between the 2.
Dr Elizabeth Warner, chief medical officer at CDPHP, discusses how Wellness Way's focus on patient experience, community partnerships, and integration of physical and mental health care services sets it apart from traditional hospital-based care.
Prompt care supports mental well-being, as hidradenitis suppurativa is often associated with depression and anxiety due to its physical and social challenges.
On this episode of Managed Care Cast, we're talking with Benjamin Ukert, PhD, of Elevance Health's Public Policy Institute. His study, "Racial and Ethnic Disparities in Prior Authorizations for Patients With Cancer," evaluated prior authorization decisions in cancer care by race and ethnicity for commercially insured patients.
In our conversation with Jeff Giullian, MD, MBA, chief medical officer with DaVita Kidney Care, we dive into 4 important aspects of kidney care: prevention, social support, integrated care, and patient support
On this episode of Managed Care Cast, we're talking with Rick Chapman, PhD, chief science officer of the Center for Innovation & Value Research, formerly known as the Innovation and Value Initiative (IVI).We discussed the Center's Rare Disease project, including the primary goals, key discoveries from Phase 1, and what to expect moving forward.
To help celebrate and recognize National Recovery Month, we have brought you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In this final episode, we speak with Lyndra Bills, MD, senior medical director, and Shari Hutchison, MS, director of program evaluation and outcomes, both with Community Care Behavioral Health Organization.
Delia Orosco, MS, director of Community Wellness Centers at Inland Empire Health Plan (IEHP), shares insight into innovative initiatives like the mobile mammogram clinics.
To recognize National Recovery Month, we are bringing you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In episode 4, Amy Herschell, PhD, associate vice president, Program Implementation and Evaluation, Community Care Behavioral Health Organization, and Jessica Meyers, MSEd, senior advisor for implementation, UPMC Center for High-Value Health Care.
On this episode of Managed Care Cast, we're talking with Simon F. Haeder, PhD, MPA, associate professor of public health at Texas A&M University.His study, "When is a Network Adequate? Consumer Perspectives on Network Adequacy Definitions," explored the factors that consumers consider essential for an adequate provider network, including travel times, inclusive care, and language access.
Chris Barton, senior director of Integrated Systems of Care & Network Innovation at Horizon Blue Cross Blue Shield of New Jersey, discusses how the Youth Behavioral Health Strategy program focuses on addressing the specific needs of youth with mental health and substance use issues through a comprehensive approach
To recognize National Recovery Month, we are bringing you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In episode 3, we speak with Kim MacDonald-Wilson, ScD, CPRP, senior director, Recovery and Wellness Transformation, and Tracy Carney, CPS, CPRP, senior recovery specialist, both at Community Care Behavioral Health Organization, part of the UPMC Insurance Services Division.
To recognize National Recovery Month, we are bringing you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In episode 2, we speak with Rebekah Sedlock, DSW, LCSW, Community Care Behavioral Health Organization, part of the UPMC Insurance Services Division, and Mandy Fauble, PhD, LCSW, UPMC Western Behavioral Health at Safe Harbor.
To recognize National Recovery Month, we are bringing you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In episode 1, we speak with Michael Lynch, MD, associate professor of emergency medicine at the University of Pittsburgh and an attending emergency physician and medical toxicologist at the University of Pittsburgh Medical Center.
On this episode of Managed Care Cast, we're talking with Eden Miller, DO, founder of the Diabetes and Obesity Care clinic in Bend, Oregon, which provides high-level obesity intervention and diabetes treatment and prevention.Her study, "Inadequate Insurance Coverage for Overweight/Obesity Management," reviews the US obesity epidemic and discusses insufficient insurance coverage for obesity management.
On this episode of Managed Care Cast, we're talking with Marge Ciancetta, the product manager of Cotiviti's Star Intelligence solution, which helps health plans and providers improve their Medicare Advantage Star Ratings.We discussed all things Star Ratings, including their importance, how they are calculated, and their impact on plans in 2024. Looking ahead, we also discussed strategies to improve ratings for 2025, especially for smaller plans.
On this episode of Managed Care Cast, we're talking with Sreekanth Chaguturu, MD, chief medical officer of CVS Health; Cathy Moffitt, MD, FAAP, CHIE, chief medical officer of Aetna; and Joneigh Khaldun, MD, MPH, FACEP, chief health equity officer of CVS Health.We discuss various topics, including the current challenges in primary and preventive care engagement, the role of trust in patient-provider relationships, and how community-based approaches and partnerships are improving care access nationwide.
On this episode of Managed Care Cast we speak with Jeffery A. Goad, PharmD, MPH, 2024-2025 president of the National Foundation for Infectious Diseases, on the recent report from the World Health Organization and UNICEF on public immunization rates, with national and global health implications.
On this episode of Managed Care Cast, we're talking with Jason Spangler, MD, MPH, the CEO of the Center for Innovation and Value Research, formerly known as the Innovation and Value Initiative (IVI). We discuss the strengths and limitations of health technology assessment (HTA), one major limitation being its lack of equity. We also touch on IVI's recent rebrand to the Center for Innovation and Value Research on July 16 and how people can get involved.
Melissa Clarke, MD, CMQ, the chief health equity officer at Elevance Health, explains "Health Equity by Design" and how Elevance Health is committed to ensuring a personalized and intentional approach for all its members, regardless of race or ethnicity, sexual orientation, gender identity, disability, and geographic or financial access.
On this episode of Managed Care Cast, we're talking with Jason Shafrin, PhD, the senior managing director of FTI Consulting's Center for Healthcare Economics and Policy and an adjunct professor in the University of Southern California's Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences.His study, "Quantifying the Insurance Value for Rare Diseases: Duchenne Muscular Dystrophy," estimates the insurance value of novel Duchenne muscular dystrophy (DMD) treatment from a survey of individuals planning to have children.
Today we are bringing you a conversation between 3 experts on paroxysmal nocturnal hemoglobinuria (PNH). Ryan Haumschild, PharmD, MS, MBA, vice president of Pharmacy at Emory Healthcare and Winship Cancer Institute, spoke with Jamie Koprivnikar, MD, of John Theurer Cancer Center; David Dingli, MD, PhD, of Mayo Clinic; and Brian P. Mulherin, MD, of American Oncology Network.The topics of conversation for today’s podcast include the pathophysiology of PNH, complement inhibitors, treatment strategies, and the challenges of managing this rare, life-threatening disorder.
On this episode of Managed Care Cast, we're talking with Sreekanth Chaguturu, MD, the chief medical officer of CVS Health. We discuss the impact of recent pharmaceutical innovations, namely glucagon-like peptide-1 (GLP-1) receptor agonists and biosimilars, on patient health outcomes. Also, we explore the role of trust between patients and providers in adopting new medications, along with initiatives used to reduce drug prices and improve access.
Kim Zynn, vice president of UPMC Health Plan's provider network and development relations team, shares how physicians can become LGBTQIA+ affirming providers, which is designated within the health plan.
Douglas Weber, MD, explains how zuranolone has changed the landscape for postpartum depression treatment, addressing a gap in care within the specialty.
Charlie Borowicz, manager of trans and gender diverse health at Allegheny Health Network, shares how the program offers comprehensive patient-first care to those in the LGBTQ and gender diverse community.
On this episode of Managed Care Cast, we're talking with the University of Southern California's Erin Duffy, PhD, MPH, an author of a study published in the June 2024 issue of The American Journal of Managed Care®.Her study, "Deductible Double Jeopardy: Patients May Pay More Out of Pocket When Pregnancy Crosses 2 Years" discusses how annual high-deductible insurance plans may increase maternity care costs when pregnancies cross 2 calendar years, causing patients to hit their cost-sharing limits twice.
In this fifth, and final, special bonus episode of our Pride Month series, we speak with Lauren Albrecht, director of advocacy and organizing, and Layla Orlando, director of health equity and wellness, at Garden State Equality, the largest LGBTQ+ advocacy organization in New Jersey.
In our fourth Pride Month podcast episode, we are speaking with Domenico Ruggerio, executive director of We Are Family, in Charleston, South Carolina, the state's oldest nonprofit, which provides life-affirming and life-saving programs for LGBTQ+ youth.
For June, we are bringing you a limited-edition podcast series to celebrate Pride Month. In our third episode, we speak with Patrick McGovern, CEO of Callen-Lorde since August of 2023 and an outspoken advocate for HIV, LGBTQ+, and community health.
In this interview, we discuss immigrant health with Kheir Mugwaneza, the lead project manager of the Immigrant and Refugee Health Program at Allegheny Health Network.
On this episode of Managed Care Cast, we're talking with Dr Paige Nong, the author of a study published in the Health IT bonus issue. Her study, "Equity and AI Governance at Academic Medical Centers," found that academic medical centers show minimal consideration for equity when developing governance for AI technologies; this highlights the need for health systems and policymakers to prioritize equity literacy and oversight policies.
For June, we are bringing you a limited-edition podcast series to celebrate Pride Month. In our second episode, we speak with Perry Halkitis, PhD, MS, MPH, dean and Hunterdon Professor of Public Health & Health Equity at the Rutgers School of Public Health and founder and director of the Center for Health, Identity, Behavior & Prevention Studies at Rutgers, and James F. Dougherty, MS, VMD, Rutgers’ alumnus, former chairman of the Board of Trustees of the university, and current member of its Board of Governors.
On this episode of Managed Care Cast, we're talking with Kristine Ashcraft, the president and founder of YouScript, a tool that helps to predict adverse drug events and personalize patient care.We discuss the lack of awareness of genetic variants among patients and the recent adoption of biomarker testing legislation in some states. This legislation will increase biomarker testing access, which will help providers to distribute the proper treatments to more patients based on identified genetic variants.
For June, we are bringing you a limited-edition podcast series to celebrate Pride Month. In this, our first episode, we speak with Tiffany Shirley, president of Lancaster Pride.
In this episode of Managed Care Cast, Nihar Desai, MD, MPH, cardiologist and vice chief of Cardiology at the Yale School of Medicine, discusses therapies for cardiovascular conditions as they relate to patient adherence, polypharmacy, and health access.
On this episode of Managed Care Cast, we're talking with Illinois CancerCare's Pankaj Kumar, MD, and Stephanie Parker, PharmD, 2 authors of a commentary published in the May 2024 issue of The American Journal of Managed Care.Their commentary, "Access Denied: CMS’ Action Hurts Patients With Cancer in Rural America," discusses how recent CMS rules restricted the access of rural patients with cancer to medically integrated pharmacies, emphasizing the need for regulatory change.
In the series debut episode of Frameworks for Advancing Health Equity, Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega. We discussed CMS's recent Medicare Part D and Medicare Advantage final rule and how it affects enrollees and health plans.
To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our final episode of this limited series and our conversation with Janine Jelks-Seale, MSPPM, director of health equity at UPMC Health Plan.
On this episode of Managed Care Cast, we're talking with the University of Pennsylvania's Ravi Parikh, MD, MPP, and Aaron Schwartz, MD, PhD, 2 authors of a study published in the April 2024 issue of The American Journal of Managed Care®.Their study, "Trends in Low-Value Cancer Care During the COVID-19 Pandemic," discusses how rates of low-value cancer services among adults with newly diagnosed cancer persisted throughout the COVID-19 pandemic.
To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our third episode and our conversation with Camille Clarke-Smith, EdD, MS, CHES, CPT, program director of quality improvement/Medicare/SNP STARs at UPMC Health Plan, which includes the UPMC for Life Medicare Faith and Wellness Program.
To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our second episode in which we learn all about Freedom House 2.0 and the Pathways to Work Program from its very own Dan LaVallee, senior director, Social Impact, UPMC Health Plan, and Markisha Jones, a Pathways to Work/Freedom House 2.0 graduate.
To help celebrate and recognize National Minority Health Month, we are kicking off a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our first episode, which is all about the Baby Steps Maternity Program and its mission to support women throughout every step of their pregnancy journey.
On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of the American Journal of Accountable Care® and a health policy professor at Penn State University. Topics we are discussing include President Biden's recent prescription drug proposals, prior authorization practices, price transparency, and the potential impact of health policy on the upcoming election.
On this episode of Managed Care Cast, we're talking with the University of Minnesota School of Public Health's Hannah Neprash, PhD; John Mulcahy, a PhD candidate; and Ezra Golberstein, PhD, the authors of a study published in the March 2024 issue of The American Journal of Managed Care®.Their study, "The Extent and Growth of Prior Authorization in Medicare Advantage," discusses how the service-, area-, and carrier-level patterns they identified suggest variation in how Medicare Advantage plans use prior authorization.
On this episode of Managed Care Cast, we're talking with J. Nwando Olayiwola, MD, MPH; Candy Magaña, MPA; and Bereket Kindo, PhD, the lead author, research and project lead, and data scientist of a study published in the February 2024 issue of The American Journal of Managed Care. Their study, "Screening for Health Literacy, Social Determinants, and Discrimination in Health Plans," provides insight on the experiences of patients in a national health plan with 2 structural determinants of health and how those interact with social determinants of health and patient demographics.
In the wake of the 2023 American Society of Hematology Annual Meeting and Exposition, Raymond Thertulien, MD, PhD, of Novant Health, and Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation, discussed health equity research highlights from the meeting and drivers of racial disparities in multiple myeloma outcomes.
The editors in chief of The American Journal of Managed Care® discuss the managed care developments of 2023 and anticipate trends on the horizon.
At the end of 2022, adagrasib received its first FDA approval for the treatment of adults with KRAS G12C-mutated locally advanced or metastatic non–small cell lung cancer. Research is ongoing into adagrasib, a KRAS G12C inhibitor, for other tumors.In today’s episode, we're joined by Jun Gong, MD, associate professor of medicine and the medical director of colorectal cancer in the Division of Medical Oncology at Cedars-Sinai Medical Center. During this interview, he discusses the mechanism of adagrasib, what other diseases it is being studied in, the latest data on adagrasib in colorectal cancer, and the importance of conducting genomic testing.
Justin Bekelman, MD, director of the Penn Center for Cancer Care Innovation, sat with our hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for our final episode of 2023 to discuss the importance of collaboration between academic medicine and community oncology and testing innovative cancer care delivery in these settings.
Today, we bring you a podcast featuring insights from Blue Cross and Blue Shield of North Carolina. Sonny Goyal, chief strategy officer at Blue Cross NC, discusses some top priorities, as well as the insurer’s multiple investments in primary care and the workforce to improve value-based care.
Today we are bringing you a conversation between 3 experts on precision medicine in non–small cell lung cancer (NSCLC).Martin Socinski, MD, executive director of the AdventHealth Cancer Institute, spoke with Martin Dietrich, MD, PhD, medical oncologist of Florida Cancer Specialists and Research Institute, and Joshua Sabari, MD, medical oncologist with NYU Langone Health Perlmutter Cancer Center and assistant progessor in the Department of Medicine at NYU Grossman School of Medicine.The topics of conversation for today’s podcast include how precision medicine in NSCLC for patients with driver mutations, current immunotherapies for patients lacking driver mutations, and more.
Today we are bringing you part 2 of a 2-part podcast series on opportunities for biosimilars, specifically adalimumab biosimilars, in dermatology, gastroenterology, and rheumatology.The discussion was moderated by Ryan Haumschild, PharmD, director of Pharmacy Services at Emory Healthcare and Winship Cancer Institute. The topics of conversation for today’s podcast include implementation of biosimilars in patients with no history of reference biologic use, insights on switching patients from the reference to the biosimilar, auto-substitution, impact of biosimilar utilization on payers and pharmacy benefit managers, and more.
Today we are bringing you part 1 of a 2-part podcast series on opportunities for biosimilars, specifically adalimumab biosimilars, in dermatology, gastroenterology, and rheumatology.The discussion was moderated by Ryan Haumschild, PharmD, director of Pharmacy Services at Emory Healthcare and Winship Cancer Institute. The topics of conversation for today’s podcast include the provider and payer considerations for transitioning patients to biosimliars, challenges associated with biosimilars, approaches to prescribing biosimilars over reference products, and more.
On this episode of Managed Care Cast, Emily Goldberg, MS, CGC, genetic counselor at JScreen, breaks down how genetic screening for breast cancer works and why it is so important to increase awareness and education around these screening tools available to patients who may be at risk for cancer.
Lucio Gordan, MD, president and managing physician of Florida Cancer Specialists & Research Institute, discusses recently updated clinical guidelines from the National Comprehensive Cancer Network (NCCN) in multiple myeloma, which specifically discuss disease staging and risk stratification and advise clinicians on how to address 1q abnormalities.
A biomedical engineer by education, Shah spent the first 5 years of his professional career as practice administrator and business manager at Gettysburg Cancer Center, working with his father, a community oncologist. From there, he moved to Flatiron Health and in July of 2017, helped to found OneOncology. Thyme Care was founded in July of 2020, and in August of this year announced a successful $60 million Series B round of investment capital.Also an angel investor, this entrepreneur in oncology care innovation has been guided by a patient-first mentality and the principal goal of positively changing how patients experience the cancer care system.
On this episode of Managed Care Cast, we speak with the senior author of a study published in the September 2023 issue of The American Journal of Managed Care® on the importance of adequate and effective lung cancer risk factor documentation to determine a patient's eligibility for screening.Farhood Farjah, MD, MPH, FACS, is thoracic surgeon at the University of Washington, and a senior investigator of the study, “Factors Associated With Lung Cancer Risk Factor Documentation.”
In part 2 of this 2-part podcast, a panel of experts discusses challenges with biosimilar uptake, interchangeability studies, patient and provider education.
Florida Cancer Specialists & Research Institute's (FCS') Nathan Walcker, chief executive office at FCS, discusses some key strategic practices and initiatives in providing high quality community-based oncology care he has implemented at FCS.
In part 1 of this 2-part podcast, a panel of experts discusses the clinical manifestations of inflammatory diseases and the potential for biosimilars to treat these diseases.
At this year’s American Society for Preventive Cardiology’s Congress on CVD Prevention, Emelia J. Benjamin, MD, ScM, delivered the Honorary Fellow Award Lecture, “The Imperative to Focus on the Prevention of Atrial Fibrillation,” as the recipient of this year’s Honorary Fellow of the American Society for Preventive Cardiology award—having received the honor for her extraordinary contributions to the field of preventive cardiology.
She stopped by to talk with AJMC while in Arlington, Texas, and our conversation covered everything from just what AFib is to risk factors and prevention strategies to connections between AFib and noncardiovascular health conditions to long-term data on stroke.
Jeff Patton, MD, CEO and board member of OneOncology and executive chairman of Tennessee Oncology, joins hosts Emeline Aviki, MB, MBA, of NYU Langone Perlmutter Cancer Center, and Stephen Schleicher, MD, MBA, ofTennessee Oncology, for our third episode.
Patton, also chairman of the Community Oncology Alliance and a board-certified hematologist and oncologist, highlights of the origins of OneOncology that it was created to protect community oncology, to give other states and communities the opportunity to stay independent in light of large hospital systems, if they wanted to. He also discusses the importance of community clinical trial accrual and of keeping oncological services within the community and not handing them over to large hospital systems, therby driving up the cost of care.
On this episode of Managed Care Cast, we speak with the lead researcher from a study published in the May 2023 issue of The American Journal of Managed Care® about the impact of low-income subsidies on the uptake and equitable use of expensive orally administered antimyeloma therapy.
Shelley Jazowski, PhD, MPH, is a postdoctoral fellow at Vanderbilt University School of Medicine and lead researcher on “Association Between Low-Income Subsidies and Inequities in Orally Administered Antimyeloma Therapy Use."
The authors compared the initiation of and adherence to orally administered antimyeloma therapy between enrollees receiving and not receiving the Medicare Part D low-income subsidy, and examined the association between these subsidies and racial and ethnic barriers to the use of these drugs.
On this episode of Managed Care Cast, we speak with the lead researcher from a study published in the June 2023 issue of The American Journal of Managed Care® about how employers and their employees are utilizing direct-to-consumer (DTC) telehealth to reduce the cost of care.
Krisda Chaiyachati, MD, MPH, is a general internist, primary care physician, and adjunct assistant professor of medicine at the University of Pennsylvania Health System, and the lead author of the study, “Economics of a Health System’s Direct-to-Consumer Telemedicine for Its Employees."
On this episode of Managed Care Cast, Kathy Leyden, vice president of community engagement at Capital District Physicians' Health Plan (CDPHP), discusses key initiatives and areas of focus to address hunger and food insecurity issues across Upstate New York.
On this episode of Oncology Onward, Dr. Debra Patt, executive vice president of policy and strategic initiatives and director of public policy at Texas Oncology joins cohosts Dr Emeline Aviki and Dr Stephen Schleicher for a jam-packed discussion that touches on topics that have never been more timely in the oncology space: the economics behind the current drug shortage, the relationship between pharmacy benefits managers and 340B discounts, and the Inflation Reduction Act.
On this episode of Managed Care Cast, we speak with the lead researcher from a study published in the July 2023 issue of The American Journal of Managed Care® on whether social determinants of health is a predictor for identifying high-cost utilizers among those with commercial health insurance.
On this episode of Managed Care Cast, we’re talking with 2 individuals who were essential in the creation and implementation of the Health Access Initiative for Recovery (HAIR) initiative, launched by Community Care Behavioral Health Organization of Pittsburgh, PA.
On this episode of Managed Care Cast, we feature several leaders in diversity, equity, and inclusion advancing health equity in their respective organization’s policy and practice initiatives.
In part 2 of this 2-part series on health equity in the treatment of psoriasis, Ryan Haumschild, PharmD, and Bryan Buckley, DrPH, discuss how providers can address disparities in psoriasis care, specifically with race, cultural, and ethnic backgrounds in mind.
On this episode of Managed Care Cast, we speak with Bruce W. Sherman, MD, of Case Western Reserve University School of Medicine, about a recent study on wage-level disparities effecting the utilization of mental health resources, for which he was lead investigator; the study articles appear in the April issue of The American Journal of Managed Care®.
On this episode of Managed Care Cast, we feature several leaders in diversity, equity, and inclusion advancing health equity in their respective organization’s policy and practice initiatives.
Shereef Elnahal, MD, MBA, under secretary for health at the Veterans Health Administration, sat for a conversation with our hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, that covered the cancer footprint of the VHA, from work within the newly reinvigorated Cancer Moonshot program and screening for vulnerable communities to the Million Veterans Program, the largest genomic database of its kind in the country and of Black Americans, including information on more than 150,000 Black veterans.
National Public Health Week is observed across the United States each year during the first full week of April, and this year will run from April 3-9. Originally conceived and organized by the American Public Health Association, and now in existence for more than 25 years, the theme this year is, “Centering and Celebrating Cultures in Health.”For National Public Health Week this year, we sat down with Kristen Krause, PhD, MPH, instructor in the Department of Urban-Global Public Health and deputy director, Center for Health, Identity, Behavior and Prevention Studies, Rutgers School of Public Health. Our conversation covered not only her current areas of research focus, but the importance of health equity among traditionally marginalized communities, how the early days of the HIV/AIDS epidemic shaped much of the worldview on public health, the influence of culture on many a health outcome, and lessons learned from past public health emergencies.
In part 1 of this 2-part series on health equity in the treatment of psoriasis, Ryan Haumschild, PharmD, and Bryan Buckley, DrPH, discuss how providers can address disparities in care, specifically with race, cultural, and ethnic backgrounds in mind.
On this episode of Managed Care Cast, we speak with Virginia Wang, PhD, and Matthew L. Maciejewski, PhD, who talk about their recent study on racial disparities in home dialysis, and what more needs to be done to increase uptake and reduce disparities in home dialysis for non-White patients.
On this episode of Managed Care Cast, we feature several leaders in diversity, equity, and inclusion advancing health equity in their respective organization’s policy and practice initiatives.
On this episode of Managed Care Cast, we speak with Jennifer Schneider, MD, co-founder and chief executive officer of Homeward, a value-based care provider aiming to improve access to high-quality care in rural communities through tech-enabled clinical services, partnerships with local physicians and health plans, and community-level demographic data.
On this episode of Managed Care Cast, we speak with Elizabeth Cuevas, MD, division chief of Allegheny Health Network’s Center for Inclusion Health, on prevalent health inequities facing marginalized communities in the Western Pennslyvania region and strategies to identify and address these issues.
For patients to receive timely access to care and for providers to deliver that care on a correspondingly timely basis, the correctness of provider contact information is of utmost importance.However, the results of a new study on the accuracy of mental health provider directories and network adequacy, published in the February issue of The American Journal of Managed Care® and online at AJMC.com, paint a less-than-stellar picture of these data, with implications for the ability of consumers to be able to use mental health care services when they need them.On this episode of Managed Care Cast, we speak with Simon F. Haeder, PhD, MPA, professor of public health at the Texas A&M University School of Public Health, 1 of 3 authors of the article, “Provider Directory Inaccuracy and Timely Access for Mental Health Care.” He and his co-investigators looked at the accuracy of directories of psychiatrists and nonphysician mental health providers for all plans regulated by the California Department of Managed Health Care in 2018 and 2019. Their goals were 2-fold: to decipher the accuracy of these provider directories in California and to see if consumers who need timely access to care can get it from these providers.
Mental health issues and substance use disorder are one of the contributing factors to America’s high maternal mortality rates, in addition to poverty, racism, and lack of access to adequate health care. Last year, the CDC reported that suicide accounts for 9% of the maternal mortality rate 1 year postpartum. Anxiety, perinatal and postpartum depression, and birth-related PTSD are the most common complications of pregnancy and childbirth, affecting 1 in 5 individuals, and for those affect, 75% do not get treatment. Women of color are both more likely to experience these conditions and also also less likely to seek help.On this episode of Managed Care Cast, we speak with Heather Waters, LCSW who leads the maternal health and children’s health services team at Inland Empire Health Plan, a managed care plan serving more than 1.4 million residents on Medi-Cal in California.She tells us about a new maternal mental health program at IEHP aimed at supporting new mothers, both before they give birth and afterwards.
Wanting to provide the best treatment available, help people live their healthiest lives, and alleviate the health care burden on providers, Intermountain Healthcare, a Utah-based not-for-profit system of 33 hospitals in 7 states, and Story Health, a California-based health technology and services company, have partnered to disseminate specialty care for patients living with heart failure in rural areas.Goals of this new partnership include ensuring patients get the care they need in a sustainable manner, increasing health system efficiency by preventing unnecessary hospitalizations, and getting high-quality care from urban population centers to rural patients while saving costs to the health care system and saving patients and their families time and convenience.On this episode of Managed Care Cast, we speak with Tom Stanis, CEO and co-founder of Story Health, and Phillip Wood, Intermountain Ventures program director on how their partnership came about, how it is going so far, and the future of their collaboration.
On this episode of Managed Care Cast, we speak with Reverend Paul Abernathy, chief executive officer of the Neighborhood Resilience Project and board member of UPMC for You, who discusses his experiences in promoting health and resiliency in trauma-affected communities, as well as challenges related to access and accessibility of care and medical mistrust.
To mark the publication of The American Journal of Managed Care®’s 12th annual health IT issue, on this episode of Managed Care Cast, we speak with Christopher M. Whaley, PhD, health care economist at the RAND Corporation, who focuses on health economics issues, including the influence of the COVID-19 pandemic on health care delivery. In particular, he examines how existing technology has pivoted to become a backbone for virtual care delivery while its ongoing evolvement has highlighted inequities in care delivery, making access and lack thereof divisive issues.In their article in the health IT issue, “Differences in Telehealth During COVID-19 Between Commercial and Medicaid Enrollees,” Whaley and his co-authors compare rates of telehealth and in-person evaluation and management visits between individuals with commercial insurance through the California Public Employees’ Retirement System, or CalPERS, and those with publicly funded coverage through the California Medicaid program, with implications for equitable access to telehealth and development of policies to guide its ongoing and future use.
The editors of The American Journal of Managed Care® reflect on the past year and discuss what they’re looking forward to in 2023.
High-deductible health plans (HDHPs) have gained traction in recent years as a means to reduce unnecessary health care spending. The monthly premiums are low, but the high deductibles can lead to higher downstream costs for individuals and families. Potential downsides include the risk of patients deterring or avoiding necessary care.
A team headed by Matthew D. Eisenberg, PhD, from the Johns Hopkins Bloomberg School of Public Health, recently investigated the impact of HDHPs through the lens of the ongoing epidemic of substance use disorder, or SUD, in the United States. The article detailing their study’s findings appears in the October issue of The American Journal of Managed Care®.
On this episode of Managed Care Cast, we speak with Dr Eisenberg on his team’s findings that these plans may have reduced SUD service use through the shifting of costs to their members, thereby exacerbating this already troubling epidemic that has resulted in declines in life expectancy and increases in drug- and alcohol-related deaths.
Teams from the Mass General Brigham health system and the Commonwealth Care Alliance, both in Massachusetts, have collaborated on a value-based care initiative with the principal goals of improving patient clinical outcomes, reducing unnecessary health care utilization, and making care more accessible. iCMP PLUS (Patients Linked to Urgent Support) is an integrated care management program providing intensive, multidisciplinary care to the highest-risk dual-eligible patients with Medicaid ACO coverage who have complex medical needs and high health care costs. Care team members meet patients where they are, demonstrating the effectiveness of community-based care management support programs.
On this episode of Managed Care Cast, we speak with Jack Rowe, MD, MPH, and Lori Tishler, MD, MPH, 2 authors of “Intensive Care Management of a Complex Medicaid Population: A Randomized Evaluation,” published in the September issue of The American Journal of Managed Care®, about their findings on the program’s effectiveness from its early phase of implementation.
The Inflation Reduction Act, signed this month, extends the premium tax credits for health insurance purchased through the health care marketplace for another 2 years. The credits were included in the 2021 American Rescue Plan Act, and were due to expire at the end of this year.
Vicki Fung, PhD, is associate investigator at the Mongan Institute Health Policy Center, Mass General Research Institute, and lead author of “Premium Tax Credits in the American Rescue Plan and Off-Marketplace Enrollees,” published in the August issue of The American Journal of Managed Care®. On this episode of Managed Care Cast, she details how the expanded premium tax credits help individuals purchasing insurance coverage through the marketplace. She also addresses the important ways these plans differ from employee-purchased coverage and the benefits and drawbacks of each and the difficulties involved when deciding whether or not to switch coverage.
As more and more biosimilars enter different markets around the globe, payers and practices will need to consistently evaluate the economics of covering biosimilars and take a stance on whether to support their adoption.
Both payers and practices can play a big role in encouraging biosimilar adoption, and health care institutions that have already begun pushing for more biosimilar use, such as Emory Healthcare, have seen substantial savings.
On this episode of Managed Care Cast, we speak with Ryan Haumschild, PharmD, MS, MBA, the director of pharmacy services at Emory Healthcare and the Winship Cancer Institute. Haumschild is also an Advisory Board member for The American Journal of Managed Care® and its sister site, The Center for Biosimilars®. The interview took place at the The Institute of Value-Based Medicine® (IVBM), hosted by Emory Healthcare, on July 18 in Atlanta, Georgia. Haumschild was chair of the event and gave a presentation on the current pharmacoeconomics of biosimilars and his predictions for how the market will develop in the future.
The episode discussed how the pharmacoeconomics of biosimilars have evolved and different strategies that health care institutions can implement to reap the benefits of biosimilar savings.
We also talked about how stakeholders can collaborate to promote biosimilars and how technology can be used to assist this mission.
Even before the pandemic began in 2020, the number of health care organizations appointing chief health equity officers had started to grow. Is this a role for 1 person only or do initiatives to tackle health care disparities and other issues begin at a higher level? And how can change really be accomplished so there is a measurable effect on health outcomes?
In this episode of Managed Care Cast, we speak with Sachin Jain, MD, MBA, who joined SCAN Group and Health Plan 2 years ago as president and CEO. He discusses an effort, recently described in an article in Harvard Business Review, about how SCAN made 10% of senior managers’ annual bonuses dependent on how well the gap in medication adherence among diverse populations was reduced.
The former CareMore executive shares why executives at the top of organizations need to champion and lead initiatives to reduce health care disparities and do more than “virtue signaling” on health equity issues.
Today we are bringing you part 2 of a 2-part sponsored podcast series discussing treatment goals in insterstitial lung disease (ILD). The discussion was moderated by Ryan Haumschild, PharmD, director of Pharmacy Services at Emory Healthcare and Winship Cancer Institute.
The conversation for today’s podcast includes an in-depth review of treatment landscape of systemic sclerosis ILD as well as a discussion on unmet needs and emerging therapies in ILD.
discusses why the program is needed, the goals of the program, and some of the reasons why children and adolescents are struggling.
We also discuss 988, an upgrade to the National Suicide Prevention Lifeline number coming July 16, 2022. The number will connect individuals with trained counselors, and, if needed, send specially trained responders with the aim of reducing armed law enforcement interventions.
If you or someone you know is in crisis, help is available by calling the the National Suicide Prevention Lifeline toll-free number, which is 988 beginning on July 16, 2022—or call the existing number, 1-800-273-TALK (8255)—to reach your local certified crisis center.
Today we’re highlighting a discussion with a panel of experts in interstitial lung disease moderated by Ryan Haumschild, PharmD, director of Pharmacy Services at Emory Healthcare and Winship Cancer Institute.
The topics of conversation for today’s podcast include treatment goals in patients with ILD and a review of treatment paradigms and standard of care therapies.
On this episode of Managed Care Cast, we speak with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.
In January of this year, entrepreneur and Dallas Mavericks owner Mark Cuban launched a direct-to-consumer pharmacy called the Cost Plus Drug Company, promising savings by eliminating middlemen and charging cost plus 15% and a pharmacy fee. What if Medicare could do the same? On this episode of Managed Care Cast, we speak with a researcher who coauthored a study out this week that looked at the savings to Medicare Part D if the same model had been employed for some of the most used generic drugs.
Hussain S. Lalani, MD, MPH, an internist and one of the coauthors, discussed the findings of the paper, published Monday in the Annals of Internal Medicine. The analysis compared the price paid by Medicare Part D plans in 2020 with the price of 89 generic drugs sold by the pharmacy in 2022.
The researchers, from Brigham and Women’s Hospital and Harvard Medical School, used the price paid by Medicare Part D plans in 2020 and looked at the price of 89 generic drugs sold by the pharmacy in 2022.
After adjusting for changes in drug costs between 2020 and 2022, the researchers found that Medicare paid more on 77 of the 89 generic drugs: $8.1 billion compared with $4.5 billion. Medicare would have saved as much as $3.6 billion over 1 year.
On the After Hours section of Medical World News, we like to show you what scientists, researchers, health care providers, and others are doing in their spare time to relax and recharge. On this episode of Managed Care Cast, we’re highlighting a hobby from a biosimilar expert who says he can make whisky more accessible and affordable through—you guessed it—his own biosimilar whisky.
Sarfaraz K. Niazi, PhD, is an adjunct professor of biopharmaceutical sciences at the University of Illinois and the University of Houston, and a member of the advisory board of The Center for Biosimilars®', a sister site to AJMC.com, the website of The American Journal of Managed Care.
On a recent episode of After Hours, he spoke with Matthew Gavidia, an assistant editor at AJMC.com, about his unusual whiskey-making hobby, the history of the traditional process, and how he distills his own biosimilar version.
The pandemic highlighted deep partisan divisions in the United States over public health measures. Disputes over masking and beliefs about science and vaccines that prevent severe illness and death from infection with SARS-CoV2, the virus that causes COVID-19, affected nearly every area of life. That rancor impacted death rates in counties that voted Republican in the 2020 presidential election, according to a new study out Monday in the journal Health Affairs.
In counties where 70% or more of eligible voters chose the Republican party, there were nearly 73 additional deaths from COVID-19 per 100,000 people compared with Democratic counties (where less than 30% voted Republican).
On today’s episode of Managed Care Cast, we speak with the lead author of the study, Neil J. Sehgal, PhD, MPH, assistant professor of health policy and management in the University of Maryland (UMD) School of Public Health. He discusses the findings of the paper, coauthored with other scholars from UMD, as well as the University of California, Irvine Program in Public Health.
The analysis, which included the majority of US counties, controlled for other characteristics likely to influence COVID-19 transmission and death such as age, race/ethnicity, vaccine uptake, unemployment status, burden of chronic disease, and health care access.
Income inequality is a hot topic in politics today, and while the rising role of social determinants of health is being recognized in care delivery and research, a new study published in Social Science & Medicine aimed to determine to what extent income gaps are associated with Americans’ declining health.
On this episode of Managed Care Cast, we speak with Hui Zheng, PhD, an associate professor in the Department of Sociology at Ohio State University and co-author of “Rising Childhood Income Inequality and Declining Americans’ Health.”
The American Journal of Managed Care® sat down with Zheng to learn more about how income inequality has shifted throughout the 20th and 21st centuries and the potential implications of this shift, along with some solutions to the problem.
Cholangiocarcinoma—or biliary duct cancer—affects about 8000 US patients a year. On this episode of Managed Care Cast, we bring you an excerpt of an interview with Jesper B. Andersen, PhD, associate professor and group leader at the University of Copenhagen and the Biotech Research and Innovation center at the Department of Health.
There have been 3 FDA drug approvals for drugs that treat cholangiocarcinoma, but only for patients that have certain mutations or rearrangements, signifying an unmet need, noted Andersen. And due to the limited number of patients, clinical trials are challenging.
Dr Anderson spoke recently with Brielle Benyon, senior editor of CURE®, a publication by MJH Life Sciences.
You can watch this interview and many others with by Visiting Medicalworldnews.com, where you can get expert insights you won’t find anywhere else.
On this episode of Managed Care Cast, we speak with Tham Le, PhD, MPH, and Linda Wastila, PhD, MSPH, lead and senior authors, respectively, of “Patterns of Opioid Use in Commercially Insured Patients With Cancer,” which was published in the May issue of The American Journal of Managed Care®. They took up their investigation after finding that most previous similar studies of opioid use focused on problems with opioid use among general populations and that patients with cancer are an often overlooked population where opioid use is concerned. They sought a greater understanding of which patients with cancer are at risk for undertreatment and who is at risk for a substance use disorder. Overall, they believe that policies concerning opioid misuse need strengthening while continuing to address the genuine pain needs of patients with cancer and that they need to balance the benefits of opioid prescribing with the risks.
Drug overdose deaths are skyrocketing, with more than 100,000 people dying in 2021, according to the CDC. Obtaining treatment for substance use disorders (SUDs) has never been easy, and this month in Health Affairs, a recent paper examined trends in the use of treatment services to see what, if anything, changed from 2010 to 2019.
Despite an increase in insurance coverage over much of that time period and other policy changes, the results were disappointing, according to one of the authors interviewed about the findings on today’s Managed Care Cast.
Brendan Saloner, PhD, is an associate professor at the Johns Hopkins Bloomberg School of Public Health who specializes in health policy, particularly policies that affect vulnerable populations, including those with drug problems and behavioral or mental health issues.
On this episode of Managed Care Cast, we speak with Dr Joanne Armstrong, vice president and chief medical officer for Women’s Health and Genomics at CVS Health, on the distinct pathophysiology of cardiovascular disease in women, applicability of current screening and care delivery guidelines for heart health in regards to minority populations, and how her own health experiences have influenced her perspective on cardiovascular disease management.
April is Parkinson’s Disease Awareness month, and on this episode of Managed Care Cast, we take a look at the Parkinson's Progression Markers Initiative (PPMI), a study from the Michael J. Fox Foundation for Parkinson's Research (MJFF). The multicenter, international study aims to end Parkinson disease, which is expected to double worldwide by 2040, to more than 14 million people.
The study is investigating the biomarkers and other data collected from a wide range of individuals—those without the disease, those with very early disease, and those with more advanced disease.
Originally launched in 2010, the study is expanding online where it wants to collect information from more than 100,000 people, particularly those with a first-degree relative with Parkinson, those with a genetic mutation for the disease, or those who act out their dreams in their sleep.
Our guest on this episode is Roseanne D. Dobkin, PhD, a clinical psychologist and associate professor of psychiatry at the Robert Wood Johnson Medical School at Rutgers University, and one of the investigators of the study.
In 2018, the FDA approved a record 66 novel drugs. Among them were cancer treatments, orphan drugs for rare diseases, drugs under expedited review, and biosimilars. However, access to each of these drugs for patients covered by different health plans was not uniform. On this episode of Managed Care Cast, we speak with Ari D. Panzer, BS, a master of public policy candidate at Duke University, and lead author of “Patients’ Access to 2018 FDA-Approved Drugs 1 Year Post Approval,” which was published in the April issue of The American Journal of Managed Care®. He delves into why it’s important to ensure patients receive optimal treatment and maximize their outcomes, understanding why health plans vary in their coverage decisions despite having access to the same evidence, and the difficulty of striking the right balance between drug access, cost, and coverage to ensure patients can get the drug therapies they require when appropriate.
Entering its 51st year, the American Kidney Fund has made it its mission to help all patients affected by chronic kidney disease (CKD), which is the fastest-growing noncontagious disease in the United States: from those at risk for chronic kidney disease through patients requiring dialysis and/or transplant. First and foremost is uncovering the primary cause of their kidney failure. Unfortunately, for 14% of low-income patients, the origins of their CKD remain a medical mystery.
In December of 2020, the American Kidney Fund convened the Unknown Causes of Kidney Disease Summit, bringing together government agencies, industry, patients, researchers, and rare disease organizations, hoping that by helping underserved patients get to the root cause of their kidney disease, they could also help solve this mystery for a broader patient population. From this, a roadmap was born for what would become the Unknown Causes of Kidney Disease Project, launched in mid-2021, with goals that include advocating for equitable kidney disease care, educating and empowering patients through culturally competent information, and overcoming financial and communication barriers to treatment.
On this episode of Managed Care Cast, we speak with Mike Spigler, vice president of patient support and education for the American Kidney Fund, who is spearheading the Unknown Causes of Kidney Disease Project. He addresses why patients are the key to all the American Kidney Fund hopes to accomplish, using the organization’s voice to address rare kidney diseases, and emphasizing the necessity of policy change for care coverage support, including for genetic testing.
It’s well known the state of maternal morbidity and mortality in the United States is subpar. From stark racial disparities in maternal deaths to a severe shortage of midwives and doulas, birthing people in the United States face unique challenges not seen in other high-income countries.
Plus, the recent increase in legislation aimed at curbing abortion access throughout the nation may serve to exacerbate these problems, as more women are forced to carry unwanted pregnancies to term.
To better understand how we got here and examine some potential solutions to these problems, The American Journal of Manage Care® sat down with Breana Lipscomb, the senior advisor of Maternal Health & Rights at the Center for Reproductive Rights.
This week also marks Black Maternal Health Week, and on this episode of Managed Care Cast, Lipscomb outlines steps needed to improve care for Black mothers in the US—a demographic that is more than 3 times more likely to have a maternal death compared with their white counterparts.
National Public Health Week, the annual initiative from the American Public Health Association, falls within the first full week of April. On this episode of Managed Care Cast, to mark the conclusion of National Public Health Week this year, which ran from April 4-10, we speak with Perry N. Halkitis, PhD, MS, MPH, dean of the Rutgers School of Public Health, who is also a public health psychologist, infectious disease epidemiologist, applied statistician, researcher, educator, and advocate. He discusses training the next generation of public health professionals, why a paradigm shift is necessary around integrating mental health awareness into public health education, and the importance of activism and advocacy to eliminating health disparities.
In January 2022, Vanderbilt University Medical Center, Meharry Medical College, and the University of Miami Miller School of Medicine announced the receipt of a $12.4 million grant from the National Institutes of Health to develop the Southeast Collaborative for Innovative and Equitable Solutions to Chronic Disease Disparities.
The center’s work aims to reduce disparities seen in the southeast United States, with particular focus on cardiovascular disease, obesity, diabetes, and other related conditions among African Americans and Latino populations.
Currently, over 20% of this region lives in poverty, while racial and ethnic minorities comprise nearly 40% of the population. Southern states also tend to be the least healthy in the nation and account for the majority of Medicaid expansion holdouts under the Affordable Care Act.
To learn more about geographic disparities in chronic disease rates, The American Journal of Managed Care® (AJMC®) sat down with Consuelo Wilkins, MD, MSCI, professor of medicine, senior vice president and senior associate dean for health equity and inclusive excellence at Vanderbilt University Medical Center in Nashville, Tennessee.
On this episode of Managed Care Cast, Wilkins discusses factors that impede progress on chronic disease prevention and outlines the next steps for the Southeast Collaborative.
This episode of Managed Care Cast is part of the new AJMC® Podcast Prevention Series, bringing you the latest news on prevention advancements in disease.
An unprecedented level of detail and robustness around interoperability standards is on its way, and on this episode of Managed Care Cast, we speak with Donald Rucker, MD, the former National Coordinator for Health Information Technology in HHS, about what the opportunities and responsibilities for payers are.
The change is precipitated by 2020 rulemaking regarding the 21st Century Cures Act requirement regarding application programming interfaces. The new requirement will enable access to patient-level data across a patient population, allowing for more analysis that can inform clinical decisions, track those decisions to costs, and even influence future policy.
Rucker, who received his medical degree from the University of Pennsylvania and also has an MBA in business and an MS in medical computer science and informatics from Stanford University, is currently chief strategy officer at 1upHealth.
Within Virginia, one of 13 states that fall within the Appalachian region of the United States, the current overall poverty rate is 10.6%, giving the state a 10th place ranking on a list of the top 10 states with the lowest poverty rates. However, the average poverty rate of the southwest corner of the state, which includes the 6 counties of Buchanan, Dickenson, Russell, Lee, Scott, and Wise, is double that of the state, at 21.9%.
Supported entirely by grants and donations, The Health Wagon has been providing free health care services for the often medically underserved and indigent individuals—who are either underinsured or uninsured—in this part of Virginia for more than 4 decades.
On this episode of Managed Care Cast, we speak with The Health Wagon’s President and CEO Teresa Tyson, DNP, MSN, FNP-BC, FAANP, and Clinical Director Paula Hill-Collins, DNP, MSN, FAANP, to learn more about the often urgent services they provide, to discover how the not-for-profit innovates care through culturally sensitive services for its rural residents, and to discuss the importance of health care equity.
CMS first implemented the Comprehensive Primary Care Plus, or CPC+, Initiative in January 2017. The medical home model is a large-scale redesign effort meant to improve primary care through payer reform and care delivery transformation. However, an interim data analysis of the initiative’s first 3 years among Medicare fee-for-service beneficiaries did not demonstrate improvements in either care continuity or care fragmentation.
On this episode of Managed Care Cast, we speak with Lori Timmins, PhD, senior researcher, and Eugene Rich, MD, senior fellow, both of Mathematica. With their fellow authors, Carol Urato, MA, researcher at Mathematica; Lisa M. Kern, MD, MPH, associate professor of medicine at Weill Cornell Medicine in New York; and Arkadipta Ghosh, PhD, principal researcher at Mathematica, they published their study, “Primary Care Redesign and Care Fragmentation Among Medicare Beneficiaries,” in the March issue of The American Journal of Managed Care®.
Sexual orientation and gender identity change efforts (SOGICE), more commonly known as conversion therapy, is a discredited practice opposed by a number of medical, mental health, and human rights organizations, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry.
Yet annually, the practice’s harms lead to estimated direct and indirect costs of $9.23 billion in the United States, according to a new study published in JAMA Pediatrics.
SOGICE can take the form of individual or group psychotherapy, inpatient treatment, or administration by religious leaders, while many individuals undergo multiple modalities, typically as youths. The practice relies on the false belief that being LGBTQ+ is pathologic, and its enforcers promote sexual and gender identify rejection often to the mental health detriment of recipients.
Currently, 25 states; Washington, DC; and Puerto Rico all have bans in place prohibiting SOGICE for minors. However, unlicensed individuals, like religious practitioners, are not regulated, and all states allow the practice in adults.
As part of the analysis, researchers also investigated the economic and humanistic outcomes of affirmative therapy. Essentially the opposite of SOGICE, affirmative therapy is defined as “psychotherapy validating the positive expression of sexual and gender identities and recognizing the association of macrolevel forces, such as heterosexism and homophobia, with well-being.”
The systematic literature review and economic evaluation was carried out by Cytel, a clinical trial company, and The Trevor Project, a nonprofit dedicated to suicide prevention among LGBTQ+ youths.
On this episode of Managed Care Cast, we speak with lead study author Anna Forsythe, PharmD, MSc, MBA, vice president of value and access at Cytel.
On this episode of Managed Care Cast, we speak with Tim Gronniger, the CEO of Caravan Health, about what to look for as accountable care organizations (ACOs) and policy makers try to encourage more providers to join value-based care arrangements.
Since 1999, nearly 841,000 Americans have died of drug overdoses, according to data from the CDC, while opioids serve as the main driver of these deaths. Synthetic opioids account for 73% of opioid-involved overdose deaths.
The COVID-19 pandemic exacerbated the opioid epidemic as individuals encountered disruptions in routine treatment, alongside steep increases in depression and anxiety rates.
One group of individuals susceptible to opioid use disorder are those with chronic, non-cancer pain. Although interventions such as full mu agonist chronic opioid analgesic therapy (COAT) cessation exist for this population, data show this practice can actually impede vocational and social return to function and to increase length of disability.
In a study published in the October issue of The American Journal of Managed Care® (AJMC®) Marcelina Jasmine Silva DO, and colleagues outlined outcomes from the Focus on Opioid Transitions (FOOT Steps) Program, which was created to help patients with chronic non-cancer pain cease COAT reliance.
On this episode of Managed Care Cast, Silva discusses the findings of this pilot study and elaborates on the success of combining interventions that are typically applied individually.
Human papillomavirus, or HPV, is the most common sexually transmitted infection in the United States and causes the majority of cervical cancer cases in the country.
But screening for HPV can catch the virus early and potentially prevent it from developing into cervical cancer. In addition, safe and effective vaccines against HPV exist, essentially making cervical cancer a preventable disease.
However, uptake of HPV vaccines remains sporadic throughout the United States compared with other nations like the United Kingdom, where cervical cancer is nearly eliminated in young women.
Furthermore, despite its prevalence, an HPV diagnosis gap exists among racial groups in the US, as White women are 3 times more likely to be told they have HPV than Black women.
To dig deeper into racial disparities in HPV, Leslie Cofie, PhD, MPH, an assistant professor of health education and promotion at the College of Health and Human Performance, East Carolina University, conducted a study to understand HPV vaccination uptake among foreign-born Blacks in the US.
Cofie’s most recent area of research focuses on understanding how the social networks, or relationships, of Black immigrants may influence their cancer preventive behaviors, including those related to HPV.
On this episode of Managed Care Cast, Cofie discusses his past research, steps to increase HPV vaccine uptake in the future, and the potentially detrimental impact the COVID-19 pandemic may have on the fight against HPV.
This episode of Managed Care Cast is part of the new AJMC® Podcast Prevention Series, bringing you the latest news on prevention advancements in disease.
Providers who treat high-need, high-cost patients can face challenges to deliver efficient and effective care. Health centers funded by the Health Resources and Services administration (HRSA)—otherwise known as federally qualified health canters or FQHCs— provide care to nearly 30 million Americans, many of whom are uninsured or underinsured.
Because data on these patients’ complexity and utilization patterns are limited, researchers set out to better define these patient populations using information from the 2014 Health Center Patient Survey.
On this episode of Managed Care Cast, we speak with Nadereh Pourat, PhD, MSPH, associate center director and the director of the health economics and evaluation research program at the UCLA Center for Health Policy Research, and Alex Sripipatana, PhD, MPH, director of the division of data and evaluation at HRSA. Pourat, Sripipatant and colleagues recently published the HRSA-funded study “Intersection of Complexity and High Utilization among health center patients aged 18 to 64” in The American Journal of Managed Care®.
HRSA oversees the Health Center Program and works to identify opportunities to better support this program's mission of providing access to high quality and cost-effective care to historically medically underserved communities. This work is part of the administration's goal of enhancing health center quality and performance. Additional health center research articles can be found on HRSA’s Health Center Research and Evaluation webpage.
There is already an enormous amount of concern and worry about the effect of the pandemic on cancer screening; for instance, a recent report from the American Association for Cancer Research found an 87% drop in breast cancer screening, an 84% decline in cervical cancer screening, and an 80% reduction in colon cancer screening.
On this episode of Managed Care Cast, we discuss how health care inequities will make this problem worse, with Monica Soni, MD, associate chief medical officer at New Century Health. Soni, who previously was the director of specialty care for the Los Angeles County Department of Health Services, the nation’s second-largest municipal health system, delves into how racial disparities in health care and social determinants of health hinder preventing cancer in the first place. She also provides some reaction to President Joe Biden’s Cancer Moonshot announcement.
According to the CDC, 37.3 million individuals in the United States currently have diabetes, while of these, 8.5 million are undiagnosed. In addition, more than 1 in 3 Americans currently have prediabetes—or higher than normal blood sugar levels—but 80% of this population is unaware they even have the condition. The American Diabetes Association estimates diagnosed diabetes costs the country $327 billion annually.
Obesity is a key risk factor for type 2 diabetes. Data from 2018 show 42.4% of the United States population is obese, marking a steep increase from the 30.5% reported in the year 2000.
Type 2 diabetes is preventable, and programs like the National Diabetes Prevention Program (DPP) have been proven to lower disease incidence among those at high risk via dietary changes and other lifestyle interventions.
To learn more about how employers are leveraging the DPP to reduce diabetes rates among their workforce, The American Journal of Managed Care® sat down with Jill Hutt, vice president of member services at the Greater Philadelphia Business Coalition on Health (GPBCH).
On this episode of Managed Care Cast, Hutt explains the Coalition’s efforts to reduce diabetes rates through the DPP, the impact of COVID-19 on diabetes prevention, and how employers looking to get involved in the initiative can join.
On January 1, 2022, California law SB-306 went into effect with the aim of reducing soaring sexually transmitted infection (STI) rates in the state. As part of SB- 306, California now requires health insurance to cover at-home STI testing kits and requires syphilis screening during both the first and third trimester of pregnancy, in addition to other mitigation strategies.
Even before the COVID-19 pandemic, US STI rates were reaching crisis levels, with CDC data showing an increase of nearly 20% of chlamydia cases between 2015 and 2019, an increase of more than 50% of gonorrhea cases within this time window, and an over 70% increase in cases of syphilis. All 3 of these conditions are curable, if detected early enough and treated correctly.
To learn more about SB-306, we spoke with Amy Moy, the chief external affairs officer at Essential Access Health, one of the bill’s co-sponsors.
On this episode of Managed Care Cast, Amy outlines what SB-306 does, how it addresses some of the stigma associated with STI testing, and describes what else is needed to improve the STI epidemic in California and the United States as a whole.
This week’s Managed Care Cast conversation took place on the same day President Joe Biden announced the return of the Cancer Moonshot, a program he initiated when he was vice president in the Obama administration. The reinvigorated program aims to cut cancer deaths by 50% over the next 25 years and to increase cancer screening, which has dropped sharply during the pandemic.
This Friday, February 4, is World Cancer Day, an initiative led by the Union for International Cancer Control (UICC), and this year's theme is about closing care gaps. For this episode of Managed Care Cast, we spoke with Meghan Gutierrez, CEO of the Lymphoma Research Foundation, about financial toxicity, how the pandemic has affected patients’ financial needs when they have cancer, health care disparities and care gaps, and more.
Although racism and bias have been long documented issues affecting health equity, findings of a recent study published in Health Affairs indicates these issues may be more embedded in the US health care system than originally thought.
Examining electronic health records (EHRs) from an urban academic medical center, researchers found that negative descriptors were significantly more likely to appear in the records of Black patients compared with White patients. Other factors—such as insurance type, marriage status, and even the COVID-19 pandemic—influenced the odds of having this potentially stigmatizing language appear in a patient’s EHR.
On this episode of Managed Care Cast, we speak with the first author on the study, Michael Sun, a medical student at the Pritzker School of Medicine at the University of Chicago, on the findings, as well as the steps that can be taken to increase awareness among clinicians of these stigmatizing descriptors.
In recent years, predictive models in medicine have become increasingly popular what with the continued integration of artificial intelligence and data technology into health care. However, these models can carry the risk of bias depending on which individuals make up the data sets.
The close relationship between health care and technology also raises a myriad of questions when it comes to regulation, accountability, and model implementation.
In this month’s Health IT issue of the American Journal of Managed Care, Paige Nong, a PhD candidate in public health at the University of Michigan, and colleagues present research on facilitating informed decision making and communicating equity issues when integrating predictive models into care.
On this episode of Managed Care Cast, Nong outlines how the researchers carried out their study, the ethical challenges of combining computer science with health, and next steps for combatting bias in predictive models.
On December 30th, 2021 the No Surprises Act went into effect. Broadly speaking, the act aims to curb surprise bills Americans may incur when they receive care from an out-out-network provider.
In response to the act’s implementation, the American Hospital Association, American Medical Association, and others sued, claiming the law jeopardizes patients’ access to care on the basis that providers and insurers must negotiate these costs when they arise, and if an agreement is not made, an arbitration process for determining fair payment will take place.
On this episode of Managed Care Cast, we speak with Mark Miller, PhD, the executive vice president of health care at Arnold Ventures. In our conversation, Miller lays out how this law came about, its implications for patients, and what might happen if lawsuits against it succeed.
On this episode of Managed Care Cast, we interview the lead author of a paper in the January issue of Health Affairs about what physicians know and don't know regarding their responsibilities to accommodate patients with disabilities when they come in for an office visit.
On this episode of Managed Care Cast, we bring you part 1 of an 8-part video conversation with a payer and a primary health care provider about how they adapted to deliver health care in 2020 and 2021. We sat down with Tunde Sotunde, MD, MBA, the president and CEO of Blue Cross and Blue Shield of North Carolina, the largest insurer in that state covering more than 3.7 million members across all 100 counties, and Alan Story, MD, of Newtown Family Physicians, an independent primary care practice in Catawba County in the western part of the state.
Our conversation, moderated by Allison Inserro, managing editor of AJMC.com, the website of The American Journal of Managed Care®, delves into value-based care, independent care practices, the health care workforce, health equity, and the role of Medicaid.
With key data presented at this year’s 63rd Annual American Society of Hematology Meeting and Exposition showing several CAR T-cell therapies as effective and safe options in the second- and even first-line setting for multiple myeloma and other cancers, discussions on when to best to use these therapies in the real-world setting has garnered increasing attention by payers and providers.
At ASH 2021, we sat down with several key opinion leaders to discuss the use of real-world data for CAR T-cell therapies and its importance in influencing reimbursement and investment strategies by payers.
With key data presented at this year’s 63rd Annual American Society of Hematology Meeting and Exposition showing several CAR T-cell therapies as effective and safe options in the second- and even first-line setting for multiple myeloma and other cancers, discussions on when to best to use these therapies in the real-world setting has garnered increasing attention by payers and providers.
At ASH 2021, we sat down with several key opinion leaders to discuss the use of real-world data for CAR T-cell therapies and its importance in influencing reimbursement and investment strategies by payers.
On this episode of Managed Care Cast, we’re talking with the co-editors-in-chief of The American Journal of Managed Care®, Dr Mark Fendrick and Dr Michael Chernew, and the editor-in-chief of The American Journal of Accountable Care®, Dr Dennis Scanlon. They look back on the past year and discuss the themes and topics they expect to see in the pages of the journals and in the world of health care in 2022.
For more, visit ajmc.com. To get in touch with us, email info@ajmc.com or follow us on Twitter @AJMC_Journal. And if you like the podcast, don’t forget to subscribe and rate us.
When new drugs are approved by the FDA, they can take time to diffuse across the population as clinicians begin to prescribe them. Uptake is not always quick or uniform, due to reasons that can include clinical inertia, provider familiarity, and the cost to patients.
On this episode of Managed Care Cast, we’re talking with the lead author of a study published in our December 2021 issue. The article, “Variation in Early Diffusion of Sacubitril/Valsartan and Implications for Understanding Novel Drug Diffusion,” describes how prescribing of the newly approved heart failure drug spread across the nation. Joining us today is Lauren Gilstrap, MD, MPH, of Dartmouth-Hitchcock Medical Center and The Dartmouth Institute for Health Policy and Clinical Practice.
In addition to shining a light on health disparities, medical misinformation, and public health infrastructure, the COVID-19 pandemic has also propelled calls for the transition to value-based care in the United States.
To discuss this topic, among others, we sat down with Mara McDermott, the executive director of the Value Based Care Coalition, formerly known as the Next Gen ACO Coalition.
On this episode of Managed Care Cast, McDermott discusses the organization’s recent re-brand, how its goals align with the Center for Medicare and Medicaid Innovation’s strategic refresh, and the future of value-based care.
In November, the Pharmacy Quality Alliance (PQA) and Patient Advocate Foundation (PAF) announced a collaboration aimed at developing a patient-centered outcomes research agenda to improve social determinants of health screenings and interventions in pharmacy settings.
The year-long project received funding from the Eugene Washington PCORI Engagement Awards program and will feature an in-person workshop held in conjunction with the PQA Annual Meeting in May.
To learn more about this initiative, why it is needed, and how it will be carried out, The American Journal of Managed Care® (AJMC®) spoke with Melissa Castora-Binkley, PhD, the senior director of research at PQA and Rebekah Angove, PhD, vice president for patient experience at PAF.
In this episode of Managed Care Cast, Castora-Binkley and Angove discuss why pharmacists are in a unique position to help address social determinants of health and the importance of incorporating patients’ perspectives into research agendas.
Are millennial patients with multiple sclerosis (MS) different from older patients? If they are different, is it partly because the MS field has benefitted from new therapeutic options and increased knowledge about the role of diet and exercise and modifiable behaviors, such as smoking?
On a recent episode of Medical World News®, Matt Hoffman, managing editor of Neurology Live®, sat down for a conversation with Mitzi Joi Williams, MD, a board-certified neurologist and MS specialist in Smyrna, Georgia, about the trends she see in younger patients with MS and how they approach treatment decisions and other disease considerations. We invite you to listen to an excerpt of the broadcast here on Managed Care Cast, and you can find a link to the full episode in the show notes. https://www.medicalworldnews.com/view/deep-dive-into-treating-millennials-with-multiple-sclerosis
The Alliance of Community Health Plans (ACHP) recently released its 2021 Report on Affordability. In this episode of Managed Care Cast, we speak with Ceci Connolly, the president and CEO of ACHP, about the steps that its payer members are taking to lower costs through offerings such as virtual-first care, remote patient monitoring, and other new products, some of which were created because of the pandemic.
Proponents of price transparency hope that publishing health care prices can enable patients to shop for their health care services and better understand the bills that they receive. However, little is known about the value of marketwide transparency tools that reveal charges for out-of-network care.
On this episode of Managed Care Cast, we’re talking with an author of a study published in our November 2021 issue. The article, “Assessing Utilization of a Marketwide Price Transparency Tool,” describes how consumers use a shopping tool to research health care prices in their area. Joining us today is Grace Kim, MHA, a PhD student at New York University.
COVID-19’s effects on the body are now known to be far-reaching—and long-lasting in the most severe cases—but when it started spreading across the world in early 2020, initial attention was focused on the lungs. That concern led to worries about the impact of infection for individuals with respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and asthma.
On this episode of Managed Care Cast, we speak with Meilan K. Han, MD, MS, the author of a book released this month called Breathing Lessons: A Doctor’s Guide to Lung Health. Han, a pulmonologist, gives an inside tour of the lungs and how they work, zooms out to examine the drivers of poor respiratory health, and addresses policy changes that are needed to improve lung health.
Han, who started writing the book at the beginning of the pandemic, is a professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan. She also serves on the scientific advisory committees for both the COPD Foundation and the American Lung Association (ALA) and is a spokesperson for the ALA.
On this episode of Managed Care Cast, we speak with Dr Abi Sundaramoorthy, MD, MBA, executive vice president of clinical enterprise at Somatus, a national value-based care company serving patients with underlying kidney disease, on the potential of value-based arrangements to address disparities in chronic kidney disease and promote preventive, effective care.
Fragmented health care is a known issue for patients and providers, and nowhere is the problem as acute as it is in the over-65 population. Studies have shown that patients who have a strong relationship with a primary care provider (PCP) who coordinates their care have better outcomes. But care provided by specialists has expanded over the past 2 decades, and the average PCP has twice as many specialists involved in the care of their fee-for-service Medicare patients as they did 20 years ago, according to research published in Annals of Internal Medicine this week.
On this episode of Managed Care Cast, we speak with one of the coauthors of the study, "Trends in Outpatient Care for Medicare Beneficiaries and Implications for Primary Care, 2000 to 2019," which illustrates the changing trends in a PCP’s panel of Medicare patients and how that translates to an increased workload for primary care doctors.
Michael L. Barnett, MD, MS, an assistant professor in the Department of Health Policy and Management at the Harvard TH Chan School of Public Health, is also an assistant professor of medicine at Brigham and Women’s Hospital in Boston. He earned his medical degree from Harvard Medical School and holds a master of science in health policy and management from the Harvard TH Chan School of Public Health.
The 340 drug pricing program was first established in 1992 and allows participating hospitals to manufacture discounts on drugs used in an outpatient setting. In years since, federal agencies have clarified savings from the program should be directed at improving care for underserved patients. One method of doing this is providing uncompensated care, or charity care and other unreimbursed care, to uninsured or underinsured patients.
In the years since its inception, debates around the program have centered on whether savings actually benefit the underserved as intended.
To determine whether hospital provision of uncompensated care increased following hospital entry into the 340B program, Sunita M. Desai, PhD, and J. Michael McWilliams, MD, PhD, analyzed secondary data on 340B participation and uncompensated care provision from general acute care and critical access hospitals between 2003 and 2015.
Their study “340B Drug Pricing Program and Hospital Provision of Uncompensated Care,” was published in the October issue of The American Journal of Managed Care and is now available online.
On this episode of Managed Care Cast, Desai discusses the study’s findings, what they mean, and next steps for the 340B program.
In this podcast, The American Journal of Managed Care's associate editorial director, Mary Caffrey, speaks with Michelle Afkhami, MD, from City of Hope, about best practices for oncology organizations to leverage molecular/genomic testing, the importance of identifying RET-positive patients early so they can receive targeted treatment, and more.
On this episode of Managed Care Cast, we discuss senior health needs amid the pandemic and how Centerwell Senior Primary Care's holistic, team based approach and value-based care delivery contributed to upticks in senior patient visits despite fears of COVID-19.
As the COVID-19 pandemic continues to take a toll on the nation a year-and-a-half later, public health workers, leaders, and researchers alike are still grappling with ways to convince a large swath of Americans to roll up their sleeves and get vaccinated.
Even as cases and deaths decline nationally, states like Alaska continue to ration care as hospitals struggle with surges of largely unvaccinated patients with COVID-19. Currently, approximately 57% of the nation’s population is fully vaccinated, meaning at least 100 million more individuals have yet to receive the shot.
For these reasons, safety precautions like masking, social distancing and encouraging vaccinations remain crucial to stamp out the virus. In a recent study published in Basic and Applied Social Psychology, researchers sought to increase compliance with coronavirus safety measures using cognitive dissonance as a guide, and their results yielded some promising conclusions.
On this episode of Managed Care Cast, we speak with Logan Pearce, a graduate student at Princeton University and co-author of the study, “Fostering COVID-19 Safe Behaviors Using Cognitive Dissonance.”
For one cancer center, an outgrowth of the COVID-19 pandemic spurred plans to create an urgent care center for patients with cancer so that they could stay out of the emergency department. The Winship Cancer Institute of Emory University began planning for construction in 2020 after receiving a sizeable donation and broke ground this year. The Rollins Immediate Care Center is expected to open in 2022.
On this episode of Managed Care Cast, we bring you an interview conducted by the editorial director of OncLive®, Gina Mauro, who talks with Charise Gleason, MSN, NP-BC, AOCNP, the advance practice provider chief at Winship Cancer Institute, about how having a dedicated cancer urgent care center will make cancer treatment plans seamless while also helping patients avoid exposure to infectious diseases in emergency waiting rooms.
Migraines plague some 35 million Americans, the majority of them women in their 30s and 40s, and disabling pain and symptoms are linked to lost productivity at work, school, and home. On this episode of Managed Care Cast, we bring you an excerpt of an interview with Deena E. Kuruvilla, MD, FAHS, the medical director of the Westport Headache Institute. She and Matt Hoffman, managing editor of NeurologyLive, another MJH Life Sciences medical news website, had a conversation a few weeks after this year’s American Headache Society Annual Scientific Meeting.
They discuss the obstacles patients with migraine face during the pandemic to getting necessary care, the effect of worsening lifestyle changes over the past year and a half on patients with headaches, the difficulty in finding a clinician who knows about the latest migraine treatments, issues related to prior authorization, and more.
Black Americans are 4 times more likely to develop kidney failure and are diagnosed with chronic kidney disease later and in later stages than White Americans. They are less likely to be deemed eligible for a transplant, instead going on dialysis. Last week a joint report from the American Society of Nephrology (ASN) and the National Kidney Foundation (NKF) recommended the removal of a racially based modifier used in calculating the estimated glomerular filtration rate, which has the effect of making Black patients seem healthier than they really are, leading to care delays.
On this episode of Managed Care Cast, we speak with Susan Quaggin, MD, FASN, a nephrologist and the chief of nephrology/hypertension and director of the Feinberg Cardiovascular and Renal Research Institute at Northwestern University, as well as current president of the ASN. She discusses the recommendations of the National Kidney Foundation (NKF) and ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases and what comes next for laboratories, clinicians, and patients.
On this episode of Managed Care Cast, we speak with Cheryl Mason, director of Content and Informatics for the Health Language solutions team of Wolters Kluwer, who discusses how delays in routine care and other aspects of the pandemic are affecting payer organizations today, and how technology innovations like natural language processing can work to empower key initiatives in population health and beyond.
On this episode of Managed Care Cast, we speak with the lead clinician of a study by the Epic Health Research Network and Kaiser Family Foundation, which found that routine medical care and hospital admissions remained below expected levels in the early months of 2021, marking the second consecutive year for such results.
Trust in health care was eroding even before the COVID-19 pandemic. In a new book, "Re-Engaging in Trust: The Missing Ingredient to Fixing Healthcare," the authors, Jan Berger, MD, MJ, the CEO of Health Intelligence Partners, and Julie Slezak, MSPH, the president of the health care consulting firm, delve into this issue with data from multiple sources and viewed against the backdrop of multiple stakeholders.
Trust among stakeholders—providers, patients, health care organizations and systems, payers, drug companies, and others—is essential, yet it is increasingly fragile, they write. Trust should be measured and improved alongside health care metrics, according to Berger, who discusses the book on this episode of Managed Care Cast.
With COVID-19 continuing to change the way in which health care is perceived and delivered, large employers have been tasked with managing employee health concerns in real time, while also planning for when the pandemic does subside. In the Business Group on Health’s 2022 Large Employers’ Health Care Strategy and Plan Design Survey, employers discussed their perspectives on trends in health care cost and coverage, and how these aspects will influence their benefits strategies and programs in the coming year.
On this episode of Managed Care Cast, we speak with Ellen Kelsay, president and CEO of the Business Group on Health, who discussed 5 major areas of concern spotlighted by employers in the survey, which included health equity and the pandemic’s long-term impact.
The recently released Intergovernmental Panel on Climate Change’s sixth assessment report drove home many of the concerns regarding the detrimental impacts of climate change that many have been warning about for years.
But along with renewed calls for governmental action come doubts that the United States’ and other health care systems are equipped to handle such an influx of increasing medical issues wrought by climate change.
Health systems and personnel have already been tested with the monumental crisis of COVID-19, and with higher rates of diseases expected from increased exposure to pollution, to more emergency responses warranted by frequent natural disasters, health professionals around the world are calling for immediate action to curb current and future ramifications.
On this episode of Managed Care Cast, we speak with Laalitha Surapaneni, MD, MPH, an assistant professor of medicine at the University of Minnesota. Surapaneni discusses her work in mobilizing calls for climate action, the threat of worsened health outcomes due to climate change, and steps health systems can take to better prepare for these challenges.
Co-pay accumulator adjustment programs, or CAAPs, can help incentivize use of lower-cost generics by excluding drug manufacturer assistance from counting toward a patient’s out-of-pocket maximum. However, a rule finalized by HHS last year allows CAAPs to be applied even when no generic alternative is available. If patients are not informed about the implications of these programs, they may be forced to abandon their prescriptions in the face of unaffordable co-pays.
On this episode of Managed Care Cast, we’re talking with an author of a Commentary published in our August 2021 issue. The article, “CAAP Rule and Prescription Drug Prices,” explains the mechanisms of CAAPs and the potential consequences of the new HHS rule. Joining us today is Bryan S. Walsh, JD, of Brigham and Women’s Hospital and Harvard Medical School.
On this episode of Managed Care Cast, we speak with Michael Abrams, managing partner at Numerof & Associates, on persistent barriers to entry for generics entering the pharmaceutical market, the impact of antitrust laws issued by the Biden administration, and further steps that are warranted to address anticompetitive tactics.
Today, we’re bringing you part 1 of a 2-part podcast series discussing multiple sclerosis, or MS. As part of the MS Stakeholder Summit, a panel of experts discusses tailoring treatments to patients with MS, payer considerations, and more.
Vizient recently released its Summer 2021 Pharmacy Market Outlook, which projects pharmaceutical spending for 2022 based on an analysis of its members' data, and on this episode of Managed Care Cast, we talk about some of their findings. The report, which delves into its members’ purchasing patterns, predicts a 3.1% increase in pharmaceutical spending next year, with oncology drugs accounting for about 25% of the increase. The report also discusses increasing competition from biosimilars, including the recent approval of insulin glargine as an interchangeable biosimilar for the treatment of diabetes; the practice of white bagging; and other issues.
On this episode of Managed Care Cast, we speak with Steven Lucio, PharmD, BCPS, senior principal, Pharmacy Solutions, about the report, which also discusses the continued impact of COVID-19 on health care.
August is National Psoriasis Awareness Month, and on this episode of Managed Care Cast, we bring you an excerpt of an interview conducted by Linda Stocum, assistant editor of Dermatology Times, for Medical World News, a new webcast from MJH Life Sciences.
In it, Jerry Bagel, MD, MS, Windsor Dermatology, East Windsor, New Jersey, discusses how psoriasis is now understood to be an inflammatory disease that, if left intreated, can have devastating cardiovascular effects, affecting lifespan and quality of life, especially for young people. He also discusses the many lifestyle changes that some patients will need to make after their skin becomes clear.
Huntington disease is an incurable, progressive neurodegenerative condition that is ultimately fatal, and the field of research into this rare disease saw a setback a few months ago with the end of 2 clinical trials for a type of possible therapy from Roche and Wave Life Sciences.
On this episode of Managed Care Cast, we bring you an excerpt of an interview, originally conducted by Matt Hoffman, senior editor of NeurologyLive, with Daniel Claassen, MD, MS, director, Huntington’s Disease Clinic, and division chief, of Behavioral and Cognitive Neurology, Vanderbilt University Medical Center. Claassen reviews the trial terminations and what that means for patients with this disease, but he also reviews some other candidates in the pharmaceutical pipeline, as well as the need for patient-reported outcomes and the possibility of wearable sensors.
In this episode of Managed Care Cast, the lead author of an article in the July issue of The American Journal of Managed Care® describes the latest research that looks at the power of self-insured employers to negotiate hospital prices and the relationship between employer market power and hospital prices.
Matthew Eisenberg, PhD, and coauthors used the US Census Bureau County Business Patterns data from 2010 to 2016 to estimate employer market power in metropolitan statistical areas (MSAs) and used Truven Health MarketScan commercial claims to estimate mean hospital prices and price ratios at the MSA level.
The paper, "Large Self-insured Employers Lack Power to Effectively Negotiate Hospital Prices," notes a few alternative ways that employers have tried to increase their ability to raise their purchasing power, but the success has been limited.
Eisenberg, an economist and assistant professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, joined Managed Care Cast to discuss these findings.
In a recent paper published in JAMA Network Open, Charlie Wray, DO, MS, and colleagues examined experiences and opinions of nearly 150,000 Americans representing the 5 major forms of health insurance coverage.
Specifically, the researchers used survey data from the 2016-2018 Behavioral Risk Factor Surveillance System and compared access to care, cost of care, and reported satisfaction among those with public or private insurance.
Representing the experiences of over 61 million US adults, respondents included Medicaid and Medicare beneficiaries, those with Veterans Health Administration or military coverage, and those with individually purchased and employer-sponsored coverage.
On this episode of Managed Care Cast, Wray, an assistant professor of medicine at the University of California San Francisco, describes the surprising findings of the teams’ analyses, and offers some solutions to improving the quality of health insurance coverage in the United States.
Social distancing, vigilant sanitizing, and mask wearing required by COVID-19 did more than combat the pandemic—it cut down on flu cases as well as improved respiratory health for some patients. Some studies indicate that the measures also reduced Clostridium difficile, or C difficile, in hospitals and facilities.
A recent set of interviews on Medical World News®, the 24-hour online news program for health care professionals from MJH Life Sciences™, highlighted this development. The interviews, discussing the prospect of these mitigation efforts continuing post pandemic, were conducted by one of our sister sites, HCPLive®, which covered the Digestive Disease Week meeting this spring.
This episode of Managed Care Cast features a few of those interviews: Christie Teigland, PhD, vice president of Advanced Analytics for Avalere Health; Alpesh N. Amin, MD, University of California Irvine School of Medicine; and Brian E. Lacy, MD, PhD, Mayo Clinic.
Today, we’re bringing you part 2 of the MS Stakeholder Summit series. During part 1, which first ran 2 weeks ago, a panel of experts discussed tailoring treatments to patients with multiple sclerosis, payer considerations, and more. In this second part of the series, the same panel of experts continues their talk on MS. They will discuss newer therapies, switching therapies, and more.
Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute, discusses 2 reports on strengthening primary care after the COVID-19 pandemic: one from her own organization and the other from the National Academy of Medicine.
Diabetes care guidelines identify critical points in patients’ care when providers should refer them to diabetes self-management education, or DSME. However, it’s not known whether these clinical indicators of need actually increase the likelihood of receiving a referral.
On this episode of Managed Care Cast, we’re talking with an author of an Original Research article published in our June 2021 issue. The article, “Patient Need and Provider Referrals to Diabetes Self-management Education,” finds that although there is an association between patient need and DSME referral, many patients in need still aren’t being referred.
Joining us today is Brittany Brown-Podgorski, PhD, MPH, who is a postdoctoral fellow at the University of Texas at Austin and will soon be joining the faculty of the University of Pittsburgh.
Gun violence is one of the most prominent public health issues facing America today, and accounted for over 43,500 deaths in 2020 alone—the highest number in decades. But a major driver of gun-related deaths in this country that often goes unmentioned is suicide.
Research shows having access to a firearm significantly increases the risk of suicide via firearm, and during the pandemic, amid an unprecedented surge in firearm purchases, these purchasers appeared far more likely to have experienced suicidal ideation.
To learn more about the intersection between COVID-19, firearm ownership, and suicide, and to mark National Gun Violence Awareness Month, we spoke with Michael D. Anestis, PhD, an associate professor at the Rutgers School of Public Health.
On this episode of Managed Care Cast, Anestis discusses his most recent research on the paramount importance of safe firearm storage, this epidemic’s disproportionate impact on people of color, and future steps needed to help decrease rates of gun-inflicted suicide. Anestis also serves as the executive director of the New Jersey Gun Violence Research Center.
This episode of Managed Care Cast will discuss subjects related to suicide, suicide ideology and gun violence. If you or a loved one is in crisis, please contact the national suicide prevention lifeline at 800-273-8255.
This month, the PwC Health Research Institute (HRI) released its annual Medical Cost Trend report for 2022. Reflecting the impact of the COVID-19 pandemic, the report predicts a 6.5% medical cost trend in 2022, slightly lower than the 7% medical cost trend in 2021 and slightly higher than it was between 2016 and 2020. On this episode of Managed Care Cast, we speak with Trina Tsouderos, who leads HRI, and discuss some of the drivers behind those numbers, as patients who put off care begin to seek services, as workers carry a high burden of mental and emotional stress, and as health care systems invest as they plan ahead for the next crisis.
In this episode of Managed Care Cast, we speak with a coauthor of an article in June’s Health Affairs examining the racial and ethnic composition of beneficiaries in Medicare Advantage plans and the potential implications as the program continues to grow.
On this episode of Managed Care Cast, a research scholar at the Marron Institute of Urban Management at New York University discusses the latest findings in the Health of the Air report, which was presented at the recent American Thoracic Society (ATS) 2021 International Conference.
The COVID-19 pandemic has led to an unprecedented boom in telehealth use, especially when it comes to services provided for mental health. With the combined toll of a global pandemic, economic hardships, and protracted grief, Americans’ mental health has jumped to the forefront of the national conversation.
A recent analysis, published by Blue Cross Blue Shield of Massachusetts, illustrates this seismic shift in care delivery and demand for mental health services. Researchers compiled claims data from March through December of 2019 and compared it with the same time frame in 2020.
To learn more about the report’s findings and to understand the challenges of providing these services to patients during a pandemic, we spoke with Gregory Harris, MD, MPH, DFAPA, the senior medical director for behavioral health at Blue Cross Blue Shield of Massachusetts.
On this episode of Managed Care Cast, Harris describes his experience as a psychiatrist and offers some solutions to meet the growing demand for this field in the months and years following COVID-19.
An author of a study in the May 2021 issue of The American Journal of Managed Care® describes how the COVID-19 pandemic, the aging of America, and already-existing workforce shortages will further threaten the dual-eligible population unless policy makers reform scope-of-practice laws.
Vaccine hesitancy may be one of the contributing factors if the United States does not reach herd immunity to the virus that causes COVID-19. Such hesitancy presents itself in different ways and forms, ranging from outright refusal in conservative rural areas to fears in communities of color, to skepticism of science elsewhere.
On this episode of Managed Care Cast, Patricia Salber, MD, MBA, of The Doctor Weighs In, has a conversation with Abner Mason, the founder and CEO of ConsejoSano, a patient engagement firm working with diverse, multicultural, multilingual populations through at-risk providers, health plans, government programs, employers, and other partners.
The two discuss the importance of relationship building and trust building and understanding where people are coming from when they have the opinions and beliefs that they hold. They also discuss the role of health plans in COVID-19 vaccinations and how payers and partners can work on upstream issues to address other care gaps.
This podcast is brought to you by Insulet.
Today we are bringing you part 2 of a 2-part, sponsored podcast series discussing insulin delivery for patients with diabetes. In part 1, Mary Caffrey, associate editorial director of The American Journal of Managed Care, spoke with Greg Forlenza, MD, a pediatric endocrinologist at the Barbara Davis Center at the University of Colorado, about prepivotal data. In this segment, they conclude the conversation.
With unprecedented pauses in air pollution emissions seen around the world in the spring of 2020 and virus mitigation behaviors being implemented for over a year, the COVID-19 pandemic has presented a unique opportunity to better understand the impact of poor air quality on human health.
In particular, exposure reduction due to mask-wearing and stay-at-home orders has contributed to anecdotal reports of reduced exacerbations among patients with chronic obstructive pulmonary disease (COPD), asthma, allergies and other respiratory conditions.
To learn more about how the pandemic has altered care and disease management among these patients, we spoke with Courtney Blair, MD, an allergist and immunologist in Virginia.
On this episode of Managed Care Cast, Blair who also serves as the president of the Greater Washington Allergy, Asthma, and Immunology Society, discusses factors that may have contributed to improvements in her patients’ respiratory health over the past 15 months.
This podcast is brought to you by Insulet.
Today, we are bringing you part 1 of a 2-part sponsored podcast series discussing insulin delivery for patients with diabetes. In part 1, Mary Caffrey, associate editorial director of The American Journal of Managed Care, speaks to Greg Forlenza, MD, a pediatric endocrinologist, about the evolution of diabetes care technology and standards for automated insulin delivery.
This week, the top managed care news included COVID-19 vaccine eligibility opens to all adults nationwide; a spotlight on payment models and value-based care; barriers to mental health care for children and teenagers.
The United States is now 5 months into its national vaccine rollout. Although hundreds of millions of doses have been successfully administered, the process has hit several snags along the way, including, but not limited to, disparities in administration and a failure to collect racial data on nearly half of those vaccinated at the national level.
But to achieve this feat, health systems have had to adjust to shifting vaccine eligibility requirements, ensure outreach efforts are successful, and combat misinformation within their communities, all the while scheduling appointments and making sure shots get into arms.
In an effort to meet some of the logistical challenges of the rollout, Kyruus works alongside health care organizations and provides search, scheduling, and data management solutions to help connect patients with the right care.
On this episode of Managed Care Cast, we speak with Chris Gervais, the chief technology and security officer at Kyruus, and Erin Jospe, MD, chief medical officer at Kyruus.
The authors of a study in the April 2021 issue of The American Journal of Managed Care® discuss the possible reasons behind the link between care fragmentation and hospitalizations in veterans with diabetes, as well as potential opportunities to address disjointed care in the context of the widespread telehealth uptake seen during the COVID-19 pandemic.
On this episode of Managed Care Cast, we speak with the chief strategy officer for Well Being Trust, one of the authors of a recent report about how well health insurers and state Medicaid programs are covering mental health care for children and compliance with federal law. We discuss the unique challenges that youth face, the health disparities, racism, and community trauma that has been experienced in the past year, and some creative ways that organizations and communities can consider increase access to mental health supports.
This week, the top managed care news included a pause in distribution of J&J’s COVID-19 vaccine; FDA clears first AI device to find possible cancerous hot spots during colonoscopies; lessons from years of public health budgetary neglect.
Neglecting public health in state budgets for more than 10 years created an environment that was ill-suited to deal with the challenges of COVID-19 as well as other issues. On this episode of Managed Care Cast, we speak with one of the authors of a recent paper that examined state funding trends from 2008 to 2018 and discuss what could be done in the future to avoid past mistakes. In an article published this month in Health Affairs, researchers from the Johns Hopkins Bloomberg School of Public Health, the University of Minnesota School of Public Health, and the College of Health Solutions from Arizona State University, took a close look at state spending in 8 categories of public health spending during an 11-year period to understand the extent to which funding has not kept up with pressing and emerging issues.
The stagnation in public health spending occurred during a time of rising mortality in the United States and funding, which was cut during the Great Recession, was not restored. On this episode of Managed Care Cast, we speak with Beth Resnick, DrPH, MPH, a coauthor of the study, a senior scientist in the Department of Health Policy and Management at Johns Hopkins, where she is also the assistant dean for Public Health Practice and Training.
This week, the top managed care news included a European safety committee finding very rare blood clot links with AstraZeneca’s COVID-19 vaccine; new report predicts shifts in the cancer landscape by 2040; the connected nature of type 1 diabetes with other autoimmune diseases.
The Centre for Sexual Health and HIV/AIDS Research Zimbabwe, or CeSHHAR, was founded in 2012 and is headquartered in Harare (hurrahree), Zimbabwe. CeSHHAR conducts evidence-based research related to HIV/AIDS, its prevention, and policy making, along with providing and implementing sexual and reproductive health education and interventions among several at-risk populations.
On this episode of Managed Care Cast, we speak with the executive director of CeSHHAR, Frances Cowan, MD, MSc, MRCP, MBBS, professor of global health at the Liverpool School of Tropical Medicine, about CeSHHAR’s history, its programs, and continuing to make inroads against this 4-decades-old pandemic.
This activity is supported by an educational grant from Boehringer Ingelheim.
Today, we are bringing you part 2 of a 2-part podcast series discussing chronic obstructive pulmonary disease (COPD). In part 2, moderator Neil Minkoff, MD, chief medical officer of Coeus Healthcare, leads a discussion with a panel of experts about personalized approaches to COPD management and treatment efficacy.
This week, the top news in managed care included COVID-19 cases surging as vaccine eligibility expands nationwide; Senate bill seeks to limit use of step therapy in employer health plans; a look into local and global awareness of the ongoing HIV/AIDS epidemic.
Early on in the pandemic, having the ability to predict where outbreaks were going to take place was something to be desired. Cotiviti developed a COVID-19 tracker map using big data models and artificial intelligence (AI) technologies, which can accurately predict where in the United States new COVID-19 outbreaks would occur and show the relative risk of infection for people with underlying health conditions.
On this episode of Managed Care Cast, we speak with Nicole Neumarker, the executive vice president of development and innovation at Cotiviti. Nicole shared Cotiviti’s results with their tracker map at the 2021 AcademyHealth National Health Policy Conference and provided us some insight into what impact this technology could have in the future.
This week, the top managed care news included efficacy data on AstraZeneca’s COVID-19 vaccine questioned; coverage from the NCCN 2021 Virtual Annual Conference; COVID-19 poses risks to children with poorly controlled type 1 diabetes.
Addressing vaccine hesitancy, which may take the form of refusing a vaccine or putting oneself in the “wait and see” camp while thinking it over, has never been more urgent as health authorities race to try and vaccinate as much of the population as possible against the virus that causes COVID-19 in 2021.
On this episode of Managed Care Cast, Pat Salber, MD, MBA, of the Doctor Weighs In, discusses education for patients on the topic of vaccine hesitancy and COVID-19. Her guest is Eve Gaus, who directs the development of interactive, people-centered, multimedia programs for Wolters Kluwer Health. The programs are used by health care systems to address questions raised by patients about the vaccines, how they were approved, how they work, and more.
This week, the top managed care news included AstraZeneca refuting blood clot links to COVID-19 vaccine; 2021 V-BID Summit celebrates 20 years of policy achievements for value-based insurance design; Managed Care Cast discusses 4 strategies payers can use to ensure opioid use disorder care.
The upheaval created by the pandemic over the past year has particularly affected individuals struggling with opioid use disorder (OUD) and other substance use issues in the United States, which set an unfortunate record in the first half of last year. More than 81,000 people died of drug overdoses between June 2019 and May 2020, largely driven by illicit fentanyl, as synthetic opioid overdose deaths increased 38%.
The March issue of The American Journal of Managed Care® includes a commentary about what payers can do to meet the needs of patients who need care for OUD. Chethan Bachireddy, MD, MSc, the chief medical officer for Virginia’s Medicaid program, and coauthor Mishka Terplan, MD, MPH, outline 4 things that payers can do to make sure that patients can get the treatment they need, and what’s at risk if they don’t.
On this episode of Managed Care Cast, Bachireddy discusses the commentary as well as how these strategies are being used in Virginia, where he continues to work one day a week as a primary care physician at Virginia Commonwealth University.
This week, the top news in managed care included CDC guidance on safe activities for fully vaccinated individuals; American Rescue Plan signed into law; new lung cancer screening criteria expand eligibility.
This activity is supported by an educational grant from Boehringer Ingelheim.
Today, we are bringing you part 1 of a 2-part podcast series discussing chronic obstructive pulmonary disease (COPD). In part 1, moderator Neil Minkoff, MD, chief medical officer of Coeus Healthcare, leads a discussion with a panel of experts about the burden of COPD, available treatments, and more.
This week, the top managed care news included President Biden updating production timeline for nationwide vaccine availability; efforts by the National Quality Forum to measure telehealth quality and value; FDA approves first treatment for rare genetic metabolic pediatric disorder.
As the COVID-19 pandemic has led to a nation-wide boom in telehealth use, new questions are emerging regarding reimbursement, accessibility, data protection, and quality measurement. Although the practice has greatly aided in maintaining care for many Americans throughout the past year, several challenges have been reported.
To create a measurement framework linking quality of care delivered by telehealth, health care system readiness, and health outcomes in rural areas specifically, the National Quality Forum (NQF) recently announced a committee of 25 individuals to discuss, update, and enhance NQF’s telehealth framework, first released in 2017. Currently, there are no nationally endorsed telehealth quality measures.
On this episode of Managed Care Cast, we speak with Sheri Winsper, RN, MSN, MHA, the senior vice president for quality measurement at NQF. For the past 20 years, the forum has worked to advance health care quality across the nation by endorsing measures that assess quality of care and value. It also develops specific measurement frameworks for gap areas.
An FDA panel meets to discuss J&J's COVID-19 vaccine ahead of an expected emergency use authorization decision, cemiplimab approved for first-line advanced non–small cell lung cancer with PD-L1 expression, and real-world outcomes contrast cancer clinical trial results in Medicare patients.
On this edition of Managed Care Cast, we present a short excerpt from a January webinar titled “Color and COVID-19: The Virus’ Disproportionate Impact” hosted by the MJH Life Sciences™ COVID-19 Coalition about how the pandemic has had an unequal, devastating impact on communities of color.
This week, the top managed care news included Entresto winning the first FDA nod in a hard-to-treat type of heart failure; President Joe Biden nominates a new CMS administrator; experts discuss the potential for Biden health reforms.
On this episode of Managed Care Cast, we highlight a new feature on AJMC.com, the website of The American Journal of Managed Care (AJMC®) called Clinical Spotlight, where our editors provide a series of interviews with leading experts in certain specialties. Over the past few months, we’ve talked with specialists in chronic obstructive pulmonary disease (COPD), small-cell lung cancer, and chimeric antigen receptor (CAR) T-cell therapy.
The first interview excerpt is with Rose McNulty, editor at AJMC, who speaks with Charles Rudin, MD, chief of the Thoracic Oncology Service at Memorial Sloan Kettering Cancer Center and principal investigator of the National Cancer Institute Small Cell Lung Cancer Consortium. He provides insights into the state of SCLC treatment, clinical trials, and what the future may hold.
The second is with Gianna Melillo, associate editor, who interviews Antonio Anzueto, MD, a professor of medicine at University of Texas Health in San Antonio and a member of the science committee for the Gold Initiative for Chronic Obstructive Lung Disease (GOLD). He discusses the latest updates to the GOLD guidelines for COPD, which pertain to treatment recommendations for patients with coronavirus disease 2019 (COVID-19) as well as the benefits of triple therapy for COPD and adherence issues.
This week, the top managed care news included President Biden’s DOJ reversing course in case seeking to overturn the Affordable Care Act; once-weekly semaglutide and lifestyle changes slashed body weight by 15%; updates on COVID-19 vaccines and treatments.
With the growth of alternative payment models and value-based contracting, policy makers and researchers are looking to other sectors that offer the potential for cooperation with the health care system, including education. Schools and health care organizations are a natural fit to work together to improve outcomes for children, but value-based alignment between the 2 systems will require the development of both contracting mechanisms and a foundation of trust.
On this episode of Managed Care Cast, we’re talking with two coauthors of a commentary published in our February 2021 issue. The commentary, “Achieving Better Value in Pediatric Care: School Systems as Clinical and Financial Partners?”, explains the opportunities for the health care and education systems to cooperate in value-based contracts to improve outcomes for students, as well as how this goal may be affected by the ongoing coronavirus disease 2019 pandemic.
The authors joining us today are Venus Wong, PhD, of the Clinical Excellence and Research Center at Stanford University, and Hoangmai Pham, MD, MPH, of Institute for Exceptional Care.
On this episode of Managed Care Cast, we speak with experts from ChristianaCare, one of the largest health care providers in the mid-Atlantic region, serving patients in Delaware and parts of Maryland, New Jersey, and Pennsylvania.
Hoping to increase the percentage of their patients with diabetes who have a hemoglobin A1C of 9% or lower, in 2019, ChristianaCare implemented a diabetes pilot program at 4 of its primary care sites, partnering each site with an endocrinologist and embedding a behavioral counselor at Primary Care Concord in Chadds Ford, Pennsylvania. With an original goal of growing this patient group by 10% by July of 2019, they instead saw 16% growth.
This week, the top managed care news included nationwide pharmacies to receive vaccine doses; experts issue recommendations for improving health care in 2021; HIV may increase risk of severe COVID-19 infection.
Findings from the latest Quest Diagnostics Health trends study, made in collaboration with The Harris Poll, underscore racial disparities in US health care brought to light by the coronavirus disease 2019 (COVID-19)pandemic.
The online survey, conducted from November 10-12, 2020, found that among over 2000 adult participants, Black and Hispanic/Latinx Americans are nearly 2 times as likely as White Americans to say their access to COVID-19 vaccines, treatments, and health care, once available, is worse than other racial/ethnic groups.
To help combat these disparities, Quest Diagnostics launched the Quest for Health Equity Initiative in August 2020. On this episode of Managed Care Cast, we speak with Harvey Kaufman, MD, the senior medical director at Quest Diagnostics about the Health Trends Study results, the organization’s mission to mitigate testing disparities, and the importance of access to preventive services.
This week, the top managed care news included Biden reopening Affordable Care Act insurance marketplaces; medical claim denial rates highest in initial COVID-19 hotspots; obesity linked with mortality in acute lymphoblastic leukemia.
On this episode, we speak with Andrew Smith, PhD, Huntsman Mental Health Institute at the University of Utah School of Medicine, coauthor of a paper looking at the mental health stressors facing first responders and health care workers during the coronavirus disease 2019 (COVID-19) pandemic. The paper found that a sizable number of these frontline workers are at risk for psychiatric illnesses at severity levels higher than other national disasters, including 9/11 and Hurricane Katrina.
This week, the top managed care news included President Joe Biden's executive orders to reform public health; incoming CDC Director to prioritize communication, coronavirus disease 2019 vaccine rollout; CMS finalizes rule on electronic prior authorization.
The authors of a Clinical research article in the January 2021 Health IT issue of The American Journal of Managed Care® discuss their findings and suggestions for making telehealth access more equitable for all.
This week, the top managed care news included new CDC guidance to base state COVID-19 vaccine supply on administration rates; a report finds record drop in cancer mortality but persistent disparities; Jardiance moves 1 step closer to FDA approval for use in heart failure.
On this episode of Managed Care Cast, we speak with the new chief financial officer of Strive Health, a value-based kidney care company that works with payers and providers to create an integrated care delivery system for chronic kidney disease (CKD) and end stage renal disease (ESRD). We discuss the changes coming to nephrology practices as well as new ways of looking at the whole patient to try and halt the slide to irreversible ESRD.
This week, the top managed care news included FDA advising against changes to vaccine dose schedules; drop in mammography screenings during the first months of the pandemic; first anti-TIGIT therapy granted Breakthrough Therapy designation by the FDA.
This week, the top managed care news included the first coronavirus disease 2019 vaccine shipments arriving nationwide; FDA panel votes to expand use of heart failure drug; efforts to address social determinants of health amid the pandemic.
On this episode of Managed Care Cast, we speak with Bechara Choucair, MD, the chief health officer of Kaiser Permanente, about their social health playbook, which guides clinicians about how to help patients with their social health needs during the pandemic.
As 2020 ends, the last interview in a year-long series running during the 25th anniversary of The American Journal of Managed Care® (AJMC®) is with the journal’s co-editors-in-chief: Michael E. Chernew, PhD, and A. Mark Fendrick, MD.
This episode of Managed Care Cast is a preview of that conversation, which appears in the December issue. Chernew and Fendrick discuss which issues they think President-elect Joe Biden should prioritize, including the sustainability of Medicare, a continued way forward for the Affordable Care Act, and value-based insurance design, particularly as the continued coronavirus disease 2019 pandemic continues to stress every aspect of health care.
Diabetes is an established risk factor for more severe cases of coronavirus disease 2019 (COVID-19). But recently reported cases of COVID-19-related diabetes among those with no preexisting risk factors suggest the 2 conditions may have a bidirectional relationship.
Interested in these rare cases, which don’t appear to fit the typical 2 types of diabetes, Francesco Rubino, MD, a professor of metabolic and bariatric surgery at King’s College London, along with a cohort of clinicians from around the world, devised a global registry of COVID-19-related diabetes to better track and understand this condition.
The CoviDiab Registry was created to establish the extent and characteristics of new-onset, COVID-19-related diabetes, and to investigate its pathogenesis, management and outcomes. On this episode of Managed Care Cast, we speak with Rubino about these new cases, the registry’s progress, and future implications of COVID-19-related diabetes.
Recently released vaccine data from both Pfizer and Moderna indicate encouraging steps forward in the global fight against coronavirus disease 2019 (COVID-19). But both vaccines are still a long way from becoming readily available to the wider public, prompting the question, who should be prioritized once doses become available?
To provide guidance on this front, The National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) requested The National Academies of Science, Engineering, and Medicine (NASEM) to construct a framework assisting US policymakers and global health communities to plan for an equitable allocation of a COVID-19 vaccine.
On this episode of Managed Care Cast, we speak with Jewel Mullen, (MD, MPH) the associate dean for health equity and associate professor of population health and internal medicine at the University of Texas at Austin, Dell Medical School. Mullen is the former principal deputy assistant secretary for health in the U.S. Department of Health and Human Services (HHS) and a member of the National Academies committee which developed the framework for vaccine allocation.
Mullen discusses criteria used to prioritize vaccine recipients, barriers to equitable distribution, and the role of misinformation in the push for an effective COVID-19 vaccine.
Read more: Pfizer Says Vaccine 90% Effective; Biden Team Announces COVID-19 Transition Panel: https://www.ajmc.com/view/pfizer-says-vaccine-90-effective-biden-team-announces-covid-19-transition-panel
Study Backs Decision to Move Forward With Pfizer Vaccine Candidate: https://www.ajmc.com/view/study-backs-decision-to-move-forward-with-pfizer-vaccine-candidate
Moderna SARS-CoV-2 Vaccine Elicits Response in Older Adults: https://www.ajmc.com/view/moderna-sars-cov-2-vaccine-elicits-response-in-older-adults
Dr Maura Abbott: Talk to Your Patients About Their Vaccine Fears: https://www.ajmc.com/view/dr-maura-abbott-talk-to-your-patients-about-their-vaccine-fears
Dr Maura Abbott: COVID-19 Vaccine Development Process Is Safe Despite a Quicker Timeline: https://www.ajmc.com/view/dr-maura-abbott-covid-19-vaccine-development-process-is-safe-despite-a-quicker-timeline
Dr Victoria Smith on Experience Taking Part in a COVID-19 Vaccine Trial: https://www.ajmc.com/view/dr-victoria-smith-on-experience-taking-part-in-a-covid-19-vaccine-trial
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included reports of 2 vaccines’ efficacy against coronavirus disease 2019 (COVID-19); a study finds no risk reduction in cardiac events with fish oil; calls for long-term follow-up to understand effects of lingering COVID-19.
Read more about the stories in this podcast: What We’re Reading: Pfizer Vaccine 95% Effective; At-home COVID-19 Test Approved; Amazon Launches Online Pharmacy: https://www.ajmc.com/view/what-we-re-reading-pfizer-vaccine-95-effective-at-home-covid-19-test-approved-amazon-launches-online-pharmacy
What We're Reading: Vaccines in EUA Process; Alkermes Receives CRL; California Tightens Restrictions: https://www.ajmc.com/view/what-we-re-reading-vaccines-in-eua-process-alkermes-receives-crl-california-tightens-restrictions
Fish Oil Debate Continues as Study Finds No Risk Reduction From Omega-3 Combo: https://www.ajmc.com/view/debate-over-fish-oil-therapy-continues-new-results-find-no-risk-reduction-from-omega-3-combo
Long-term Follow-up Needed to Understand Effects When COVID-19 Lingers, Fauci Says: https://www.ajmc.com/view/long-term-follow-up-needed-to-understand-effects-when-covid-19-lingers-fauci-says
Driving Transparency, Payment Reform in Employer Health Care Coverage: https://www.ajmc.com/view/driving-transparency-payment-reform-in-employer-health-care-coverage
Paper of the Week: Effects of Health Education on Glycemic Control During Holiday Time in Patients with Type 2 Diabetes Mellitus: https://www.ajmc.com/view/jan08-2785p45-51
The coronavirus disease 2019 (COVID-19) pandemic has required health care systems to overhaul their ways of delivering care to patients in order to keep patients, families, and clinicians safe. For medical home visit programs accustomed to visiting patients in person, this task has required creative use of new technologies and relied on regulatory flexibility to facilitate their work.
On this episode of Managed Care Cast, we’re talking with the authors of a Commentary article published in our November issue. The article, “Medical Home Visit Programs During COVID-19 State of Emergency,” describes the experience of reimagining how a home health program can deliver care amid the coronavirus disease 2019 pandemic.
The authors, from Northwell Staten Island University Hospital in Staten Island, New York, are Dr Donna Seminara, Dr Anita Szerszen, Dr John R. Maese, and Dr Zeel Shah.
As the health care industry continues to combat health and cost-related issues exacerbated by the COVID-19 pandemic, employers remain a key figure in the pursuit for higher value care. Recently, the Leapfrog Group partnered with the Health Transformation Alliance, or HTA, to help delineate high-value health care services with a particular focus on transparency and payment reform.
On this episode of Managed Care Cast, we speak with Leah Binder, president and chief executive officer of the Leapfrog Group, about her organization’s partnership with the HTA, the significance of their 20th anniversary this year, and how transparency and employer leverage may shape the transition toward value-based health care.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included the Supreme Court signaling willingness to uphold the Affordable Care Act; Pfizer’s coronavirus disease 2019 vaccine shows 90% efficacy; racial disparities in lung cancer screenings and prescribing biologics.
Read more about the stories in this podcast: Supreme Court Signals Willingness to Uphold ACA: https://www.ajmc.com/view/supreme-court-signals-willingness-to-uphold-aca
Pfizer Says Vaccine 90% Effective; Biden Team Announces COVID-19 Transition Panel: https://www.ajmc.com/view/pfizer-says-vaccine-90-effective-biden-team-announces-covid-19-transition-panel
Lung Cancer Screening Criteria Miss Young, High-Risk Black Smokers: https://www.ajmc.com/view/lung-cancer-screening-criteria-miss-young-high-risk-black-smokers
Black Patients With RA Less Likely Than White Counterparts to Be Prescribed a Biologic: https://www.ajmc.com/view/black-patients-with-ra-less-likely-than-white-counterparts-to-be-prescribed-a-biologic
Lung Cancer Screening Criteria Miss Young, High-Risk Black Smokers: https://www.ajmc.com/view/lung-cancer-screening-criteria-miss-young-high-risk-black-smokers
Bang for the Buck: How Health Care Innovation Affects Life Expectancy and Patient Well-Being: https://www.ajmc.com/view/bang-for-the-buck-how-health-care-innovation-affects-life-expectancy-and-patient-well-being
Paper of the Week—Beyond Black and White: Race/Ethnicity and Health Status Among Older Adults: https://www.ajmc.com/view/beyond-black-and-white-raceethnicity-and-health-status-among-older-adults
As the costs of cancer care continue to rise in the United States, eyes are increasingly turning to payment reform. Research by the Northeast Business Group on Health found that in 2015, employers spent $125 million on cancer care, and since then, cancer therapy costs have increased substantially with greater use of immunotherapy and the introduction of chimeric antigen receptor T-cell therapies that can easily cost half a million dollars for treatment.
The federal government is taking the lead with the Oncology Care Model, which will transition into Oncology Care First in 2022 after a 1-year extension due to the coronavirus disease 2019 pandemic, but commercial payers are also testing payment reform models.
Speakers who participated in the Quality Cancer Care Alliance’s Fall Leadership Summit, weighed in on the payment reform space for cancer care.
Learn more: Speaking of Employers: Purchasers Detail the Challenges of Getting a Handle on Oncology Care Costs https://www.ajmc.com/view/speaking-of-employers-purchasers-detail-the-challenges-of-getting-a-handle-on-oncology-care-costs
Three Ways COVID-19 Makes the Oncology Care First Model More Attractive: https://www.ajmc.com/view/three-ways-covid-19-makes-the-oncology-care-first-model-more-attractive
Infrastructure of OCM Helps Practices Through COVID-19, Chong Says: https://www.ajmc.com/view/infrastructure-of-ocm-helps-practices-through-covid-19-chong-says
A Closer Look at 3 Oncology Payment Reform Projects: https://www.ajmc.com/view/a-closer-look-at-three-oncology-payment-reform-projects
Cancer Does Not Stop for COVID-19, but Reform Becomes a Challenge: https://www.ajmc.com/view/cancer-does-not-stop-for-covid-19-but-reform-becomes-a-challenge
Community Oncology Alliance Payment Reform Brief Details 35 Oncology Payment Models Underway or Planned Across Country: https://communityoncology.org/community-oncology-alliance-coa-payment-reform-brief-details-35-oncology-payment-models-underway-or-planned-across-country/
EDIT: This podcast has been updated as of 11:45 am EST.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top news in managed care included top health care takeaways from the 2020 general election; a Q&A with William Shrank, MD, MSHS, on connecting Medicare Advantage providers and patients; Managed Care Cast discusses balancing evidence with action amid the coronavirus disease 2019 pandemic.
Read more about the stories in this podcast: Top 5 Health Care Takeaways From the 2020 General Election: https://www.ajmc.com/view/top-5-health-care-takeaways-from-the-2020-general-election
Medicare Advantage Providers, Patients Connect Without a Playbook: A Q&A With William H. Shrank, MD, MSHS: https://www.ajmc.com/view/medicare-advantage-providers-patients-connect-without-a-playbook-a-q-a-with-william-h-shrank-md-mshs
Balancing Evidence With Action: Dr Patricia Salber Interviews Dr Denise Basow: https://www.ajmc.com/view/balancing-evidence-with-action-dr-patricia-salber-interviews-dr-denise-basow
Libtayo Accepted for FDA Priority Review in NSCLC With PD-L1 Expression: https://www.ajmc.com/view/libtayo-accepted-for-fda-priority-review-in-nsclc-with-pd-l1-expression
Paper of the Week: Second-line and Third-line Chemotherapy for Lung Cancer: Use and Cost: https://www.ajmc.com/view/may08-3181p297-306
With the coronavirus disease 2019 pandemic, new research is quickly being released as more and more is learned. However, the flood of new research needs to be balanced with appropriate review before action is taken.
In the latest Managed Care Cast, Denise Basow, MD, president and CEO of clinical effectiveness at Wolters Kluwer, speaks with Patricia Salber, MD, MBA, of The Doctor Weighs In, about the onslaught of information, the risk of misinformation, the wide range of information sources available, and more.
Read more: Experts Discuss Myths of COVID-19 and Clarify Misunderstandings: https://www.ajmc.com/view/experts-discuss-myths-of-covid-19-and-clarify-misunderstandings
Study Dispels Misinformation on Contact Lens, Spectacle Use and COVID-19: https://www.ajmc.com/view/study-dispels-misinformation-on-contact-lens-spectacle-use-and-covid19
In Wake of Measles Outbreaks, Another Study Dispels Myths Surrounding MMR Vaccine: https://www.ajmc.com/view/in-wake-of-measles-outbreaks-another-study-dispels-myths-surrounding-mmr-vaccine
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included updates on coronavirus disease 2019 therapies and vaccine candidates; a discussion on keeping physicians independent through value-based care; an overview of the 2020 Community Oncology Alliance Virtual Payer Exchange Summit.
Read more about the stories in this podcast: What We’re Reading: COVID-19 Vaccine Trials to Restart; Record 2-Day Infections; Stress-Reducing Strategies: https://www.ajmc.com/view/what-we-re-reading-astrazeneca-j-j-covid-19-trials-to-restart-record-2-day-infection-stress-reducing-strategies
What We're Reading: Eli Lilly Ends Antibody Trial; Pros, Cons of Telehealth; AAP Issues New Opioid Guidelines: https://www.ajmc.com/view/what-we-re-reading-eli-lilly-ends-antibody-trial-pros-cons-of-telehealth-aap-issue-new-opioid-guidelines
What We’re Reading: Hospitals Strained; Pfizer Trial Enrollment; Variation in Virus Mitigation: https://www.ajmc.com/view/what-we-re-reading-hospitals-strained-pfizer-trial-enrollment-variation-in-virus-mitigation
Researchers Warn of Heightened Risk of HIV With Certain COVID-19 Vaccines: https://www.ajmc.com/view/researchers-warn-of-heightened-risk-of-hiv-with-certain-covid-19-vaccines
Keeping Physicians Independent: Dr Patricia Salber Interviews Dr Farzad Mostashari: https://www.ajmc.com/view/keeping-physicians-independent-dr-patricia-salber-interviews-dr-farzad-mostashari
Community Oncology Alliance Conference Coverage: https://www.ajmc.com/conference/coa
Paper of the Week: Value-Based Insurance Design for Diabetes Mellitus: Approaches to Optimal Pharmacoeconomic Implementation: https://www.ajmc.com/view/a319_10dec_fendrick_s314to22
The company Aledade was created 6 years ago to help physicians stay independent by implementing a value-based care business model. In this episode of Managed Care Cast, Patricia Salber, MD, MBA, of The Doctor Weighs in, speaks with Aledade co-founder, Farzad Mostashari, MD, about what his company has accomplished and why these efforts are important for all stakeholders.
Read more about Aledade, accountable care organizations (ACOs), and value-based care: Mostashari, Gilfillan Highlight the Spillover Effect of ACOs Across the Entire Healthcare System: https://www.ajmc.com/view/mostashari-gilfillan-highlight-the-spillover-effect-of-acos-across-the-entire-healthcare-system
MedPAC's MIPS Vote Meant to Encourage Physicians Into High-Risk Payment Models, Says Aledade's Broome: https://www.ajmc.com/view/medpacs-mips-vote-meant-to-encourage-physicians-into-highrisk-payment-models-says-aledades-broome
ACOs and Healthcare Transformation: Dr Patricia Salber Interviews Travis Broome: https://www.ajmc.com/view/acos-and-healthcare-transformation-dr-patricia-salber-interviews-travis-broome
5 Things About Aledade (and Its ACOs): https://www.ajmc.com/view/5-things-about-aledade-and-its-acos
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included coronavirus disease 2019 (COVID-19) delays in breast cancer surgery; targeted therapies associated with decreased mortality risk for non–small cell lung cancer; an inside look at a patient’s perspective of early-onset Parkinson disease.
Read more about the stories in this podcast:
Cancer Care Delays in COVID-19 Could Lead to Higher Morbidity, Mortality: https://www.ajmc.com/view/cancer-care-delays-in-covid-19-could-lead-to-higher-morbidity-mortality
Propelled by Targeted Therapies, NSCLC Mortality Fell Between 2013 to 2016: https://www.ajmc.com/view/propelled-by-targeted-therapies-nsclc-mortality-fell-between-2013-to-2016
A Patient Perspective on Early-Onset Parkinson Disease: https://www.ajmc.com/view/a-patient-perspective-on-early-onset-parkinson-disease
CHEST 2020 Annual Meeting: https://www.ajmc.com/conference/chest
The Academy of Managed Care Pharmacy Nexus: https://www.ajmc.com/conference/amcp-nexus
The American Society of Nephrology's Kidney Week: https://www.ajmc.com/conference/asn
Paper of the Week: Medical Home Transformation and Breast Cancer Screening: https://www.ajmc.com/view/medical-home-transformation-and-breast-cancer-screening
2020 is the 25th anniversary of The American Journal of Managed Care® and October’s edition of the journal features an interview with Kavita Patel, MD, MS, a nonresident fellow at the Brookings Institution and a primary care physician.
Ten months into the coronavirus disease 2019 (COVID-19) pandemic, some states continue to struggle to keep up with new cases and protect their most vulnerable populations from bearing the brunt of the disease.
However, one state was able to get ahead of the pandemic early on, and, through public private-partnerships, secured immediate care for hundreds of the highest risk individuals within weeks. On this episode of Managed Care Cast, we speak with Susan Mani, MD, the chief population health officer for LifeBridge Health, and Trenor Williams, MD, the chief executive officer and co-founder of Socially Determined.
Together, Dr. Mani and Dr. Williams lay out how Maryland’s COVID-19 task force on vulnerable populations was able to leverage data on social determinants of health and analytics to rapidly pinpoint populations most at risk of severe COVID-19 complications and optimize preventive and treatment measures.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included the first case of coronavirus disease 2019 (COVID-19) reinfection in the United States; a positive side to halting trials to evaluate vaccine safety; a rise in employer-sponsored health insurance premiums for 2020.
Read more about the stories in this podcast: First Case of COVID-19 Reinfection Detected in the US: https://www.ajmc.com/view/first-case-of-covid-19-reinfection-detected-in-the-us
Dr Maura Abbott Explains How Halting Trials to Evaluate Vaccine Safety Is a Good Thing: https://www.ajmc.com/view/dr-maura-abbott-explains-how-halting-trials-to-evaluate-vaccine-safety-is-a-good-thing
KFF Survey Finds Employer-Sponsored Health Insurance Premiums Rose 4% in 2020: https://www.ajmc.com/view/kff-survey-finds-employer-sponsored-health-insurance-premiums-rose-4-in-2020
Dialysis Is on the Ballot Again in California: https://www.ajmc.com/view/dialysis-is-on-the-ballot-again-in-california
CHEST Annual Meeting: https://www.ajmc.com/conference/chest
AMCP Nexus: The Academy of Managed Care Pharmacy Nexus: https://www.ajmc.com/conference/amcp-nexus
Kidney Week: https://www.ajmc.com/conference/asn
Paper of the Week: Improvements in Access and Care Through the Affordable Care Act: https://www.ajmc.com/view/improvements-in-access-and-care-through-the-affordable-care-act
Addressing coronavirus disease 2019 (COVID-19) means addressing racism, wrote Ingrid Katz, MD, assistant professor at Harvard Medical School, and Abraar Karan, MD, MPH, DTM&H, an internist at the Brigham and Women's Hospital and Harvard Medical School, in an opinion piece published in British Medical Journal.
In the latest Managed Care Cast, they speak with Patricia Salber, MD, MBA, of The Doctor Weighs In, about the article, why racism is an issue for doctors to address, and how well medicine is or is not doing with respect to addressing racism in admission to and graduation from medical school, teaching and studying the health impacts of racism in medical teaching, and encouraging more minority medical students to train as medical researchers.
Read the original article by Katz and Karan: https://blogs.bmj.com/bmj/2020/06/05/there-is-no-stopping-covid-19-without-stopping-racism/
Read more about racial and ethnic disparities in health care: Key Steps to Reduce Racial Cancer Disparities Include Supporting Minority Scientists, Diversifying Medical Schools and Clinical Trials: https://www.ajmc.com/view/key-steps-to-reduce-racial-cancer-disparities-include-supporting-minority-scientists-diversifying-medical-schools-and-clinical-trials
Addressing Cancer Disparities Requires Asking Questions and Putting Aside Assumptions: https://www.ajmc.com/view/addressing-cancer-disparities-requires-asking-questions-and-putting-aside-assumptions
Does Intersection of Racial, Gender Biases Affect Heart Failure Treatment Decisions? https://www.ajmc.com/view/does-intersection-of-racial-gender-biases-affect-heart-failure-treatment-decisions
Dr Anthony Fauci on Health Disparities Affecting People of Color: https://www.ajmc.com/view/dr-anthony-fauci-on-health-disparities-affecting-people-of-color
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included President Donald Trump’s discharge from the hospital; a poll finds Americans trust Joe Biden to lead the US health care system; Nobel Prize awarded to scientists who discovered the hepatitis C virus.
Read more about the stories in this podcast: Trump to Be Discharged From Hospital Despite Continued COVID-19 Treatments: https://www.ajmc.com/view/trump-to-be-discharged-from-hospital-for-covid-19-symptoms
More Americans Trust Biden to Lead US Health Care System, West Health-Gallup Poll Finds: https://www.ajmc.com/view/more-americans-trust-biden-to-lead-us-health-care-system-west-health-gallup-poll-finds
Discovery of Hepatitis C Virus Brings Nobel Prize: https://www.ajmc.com/view/discovery-of-hepatitis-c-virus-brings-nobel-prize
Study Highlights Persistent Racial Disparities in Insulin Pump Use Among Children With T1D: https://www.ajmc.com/view/study-highlights-persistent-racial-disparities-in-insulin-pump-use-among-children-with-t1d
Migraine Trust International Symposium Conference Coverage: https://www.ajmc.com/conference/mtis
Paper of the Week: A Way Out of the Dismal Arithmetic of Hepatitis C Treatment: https://www.ajmc.com/view/a-way-out-of-the-dismal-arithmetic-of-hepatitis-c-treatment
Metastatic breast cancer is the most advanced stage of breast cancer; it is treatable but not curable. Men with breast cancer comprise less than 1% of all patients with the disease, and most of their treatments are based on study results seen among female patients. This year alone, experts predict that 276,480 women and 2620 men will receive a breast cancer diagnosis.
The American Journal of Managed Care® spoke recently with Kirby Lewis of West Virginia. Kirby was a stage 2 breast cancer survivor, for which he had a mastectomy in 2012, prior to receiving a diagnosis of metastatic breast cancer (MBC) in 2016. He is 1 of 9 patient faces participating in “Facing MBC Together” from Athenex Oncology.
In this interview, he talks about what sustains him and his mission to spread awareness about male MBC.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included the president testing positive for coronavirus disease 2019 (COVID-19); progress in diabetes technology coverage and access for Medicare beneficiaries; an inside look into how colleges and universities addressed the COVID-19 pandemic.
Read more about the stories in this podcast: Trump, First Lady Test Positive for Coronavirus; Trump Enters Hospital: https://www.ajmc.com/view/trump-first-lady-test-positive-for-coronavirus
How Have Colleges, Universities Addressed the COVID-19 Pandemic? https://www.ajmc.com/view/how-have-colleges-universities-addressed-the-covid-19-pandemic-
Patient-Centered Oncology Care: https://www.ajmc.com/conference/pcoc
Moderna SARS-CoV-2 Vaccine Elicits Response in Older Adults: https://www.ajmc.com/view/moderna-sars-cov-2-vaccine-elicits-response-in-older-adults
Referral Management and the Care of Patients With Diabetes: https://www.ajmc.com/view/feb04-1712p137-143
Despite decades of experimentation, there have not been large increases in health care quality in the United States. What will move the needle?
In this week’s Managed Care Cast, Elizabeth McGlynn, PhD, speaks with Patricia Salber, MD, MBA, of The Doctor Weighs In, about health care quality in the United States, quality measurement and incentives, what the United States can do to drive quality improvement, how social determinants fit into the picture, and more.
McGlynn serves as Kaiser Permanente Bernard J. Tyson School of Medicine’s Interim Senior Associate Dean for Research and Scholarships and as a professor. She is an internationally known expert on methods for evaluating the appropriateness and quality of health care delivery.
Read more about health care quality in the United States: Can Healthcare Quality Measures Benefit Patient Health https://www.ajmc.com/view/can-healthcare-quality-measures-benefit-patient-health
Dr Kerin Adelson Discusses Evolution in Physician Response to Quality Care Initiatives: https://www.ajmc.com/view/dr-kerin-adelson-discusses-evolution-in-physician-response-to-quality-care-initiatives
Can Accountable Care Divert the Sources of Hospitalization https://www.ajmc.com/view/can-accountable-care-divert-the-sources-of-hospitalization
Healthcare Needs Bipartisan Support to Benefit Patients, Stabenow Says: https://www.ajmc.com/view/healthcare-needs-bipartisan-support-to-benefit-patients-stabenow-says
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included a Supreme Court vacancy that could shape the fate of the Affordable Care Act; the pandemic’s effects on access to care; a look at the opportunities presented by the virtual format of Patient-Centered Oncology Care® 2020.
Read more about the stories in this podcast: How a Supreme Court Vacancy Can Shape the Fate of the ACA, Reproductive Rights: https://www.ajmc.com/view/how-a-supreme-court-vacancy-can-shape-the-fate-of-the-aca-reproductive-rights
Access to Parkinson Disease Medication Affected in Low-Income Countries: https://www.ajmc.com/view/access-to-parkinson-disease-medication-affected-in-low-income-countries
ACR Survey Reveals Patients Struggle to Maintain Access to Care During COVID-19 Pandemic: https://www.ajmc.com/view/acr-survey-reveals-patients-struggle-to-maintain-access-to-care-during-covid-19-pandemic
Patient-Centered Oncology Care: https://www.ajmc.com/conference/pcoc
FDA Accepts Anti-BCMA Ide-cel for MM for Priority Review: https://www.ajmc.com/view/fda-accepts-anti-bcma-ide-cel-for-mm-for-priority-review
Incorporating Value Into Physician Payment and Patient Cost Sharing: https://www.ajmc.com/view/incorporating-value-into-physician-payment-and-patient-cost-sharing
Allison Brennan, MPP, senior vice president of government affairs at the National Association of Accountable Care Organizations (NAACOS) discusses legislation that would impact ACOs, the impact coronavirus disease 2019 had on ACOs, and the fall NAACOS meeting.
Learn more: NAACOS Partner Page on AJMC.com: https://www.ajmc.com/partners/naacos
NAACOS Fall 2020 Conference Agenda: https://www.naacos.com/fall-agenda
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included the effects of wildfires and the pandemic on health; a conversation on Ochsner Health’s Connected Maternity Online Monitoring Program; a preview of discussions at Patient-Centered Oncology Care® 2020.
Read more about the stories in this podcast: Concurrent Wildfire, Pandemic Hazards Test US Mental, Physical Health: https://www.ajmc.com/view/concurrent-wildfire-pandemic-hazards-test-us-mental-physical-health
Dr Joseph Biggio Discusses Ochsner Health's Connected MOM Program, COVID-19 Pregnancy Challenges: https://www.ajmc.com/view/dr-joseph-biggio-discusses-ochsner-health-s-connected-mom-program-covid-19-pregnancy-challenges
Patient-Centered Oncology Care 2020 Pre-Conference Videos: https://www.ajmc.com/conference/pcoc
Patient-Centered Oncology Care 2020 Registration: https://event.ajmc.com/event/a8831e3f-8e98-4837-88fc-780d4f4eca61/regProcessStep1
Pain 1 of 3 in a Cluster of Symptoms Affecting Men After Prostate Cancer: https://www.ajmc.com/view/pain-1-of-3-in-a-cluster-of-symptoms-affecting-men-after-prostate-cancer
ECTRIMS: European Committee for Research and Treatment in Multiple Sclerosis Conference Coverage: https://www.ajmc.com/conference/ectrims
Long-term Cost Effects of Collaborative Care for Late-life Depression: https://www.ajmc.com/view/feb08-2835p095-100
As the coronavirus disease 2019 (COVID-19) continues to spread throughout the country, practices and health systems are transforming care to limit exposure to those who may be at greater risk of severe complications. At Ochsner Health, the largest non-profit academic healthcare system in Louisiana, providers are leveraging the system’s Connected Maternity Online Monitoring (MOM) digital medicine program to minimize expectant mothers’ risks of contracting COVID-19.
To learn more about this program, we spoke with Joseph Biggio Jr. MD, MS, the system co-chair of Women’s Services and system chair for Maternal-Fetal Medicine at Ochsner Health. Dr. Biggio, an obstetrician gynecologist, specializes in provision of high-risk pregnancy care and has been involved with provision of care related to women with medical complications, obstetric complications, and fetal complications in pregnancy.
On this episode of Managed Care Cast, Dr. Biggio explains how the Connected MOM program functions and lays out the challenges expectant mothers face during a pandemic.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included identification of insomnia as a risk factor for type 2 diabetes; a look at the growth of telehealth during coronavirus disease 2019; an overview of the speakers who will appear at Patient-Centered Oncology Care 2020.
Read more about the stories in this podcast:
Study Finds Insomnia as New Risk Factor for Type 2 Diabetes: https://www.ajmc.com/view/study-finds-insomnia-as-new-risk-factor-for-type-2-diabetes
The Growth of Telehealth During COVID-19 and Its Future After: Dr Patricia Salber Interviews Dr Joseph Kvedar: https://www.ajmc.com/view/the-growth-of-telehealth-during-covid-19-and-its-future-after-dr-patricia-salber-interviews-dr
PCOC 2020: Cancer Care Transformation Continues During COVID-19: https://www.ajmc.com/view/pcoc-2020-cancer-care-transformation-continues-during-covid-19
Equity in Care Delivery Still at Top of PCOC 2020 Agenda, Amid “Undue Burden”: https://www.ajmc.com/view/equity-in-care-delivery-still-at-top-of-pcoc-2020-agenda-amid-undue-burden
PCOC20 registration: https://event.ajmc.com/event/a8831e3f-8e98-4837-88fc-780d4f4eca61/regProcessStep1
FDA Clears Targeted Therapy, Diagnostic for Metastatic RET Fusion-Positive NSCLC: https://www.ajmc.com/view/fda-clears-targeted-therapy-diagnostic-for-metastatic-ret-fusion-positive-nsclc
The Promise and Perils of Big Data in Healthcare: https://www.ajmc.com/view/the-promise-and-perils-of-big-data-in-healthcare
Telehealth has been around for years in the United States, but it was not until the coronavirus disease 2019 (COVID-19) pandemic that it became regularly used. The growth of telehealth was fueled by the inability to see patients in person at the beginning of the pandemic and a move by the government to temporarily relax regulations.
Joseph Kvedar, MD, president of the American Telemedicine Association, professor of Dermatology at Harvard Medical School, co-chair of the American Medical Association's Digital Medicine Payment Advisory Group, and editor-in-chief of npj Digital Medicine, explained that some of those relaxations might continue on after the pandemic passes, but some may get rolled back.
In conversation with Patricia Salber, MD, MBA, of The Doctor Weighs In, Kvedar also discussed how breakthroughs in technology have helped make virtual visits possible, the future of telehealth, and more.
Learn more: Contributor: Telehealth Claim Lines Increased 4132% Nationally From June 2019 to June 2020: https://www.ajmc.com/view/contributor-telehealth-claim-lines-increased-4132-nationally-from-june-2019-to-june-2020
Continuation of Routine Screenings, Care Is Crucial During COVID-19 Pandemic: https://www.ajmc.com/view/continuation-of-routine-screenings-care-is-crucial-during-covid19-pandemic
ACR Position Statement Supports Use of Telemedicine After COVID-19 Crisis: https://www.ajmc.com/view/acr-position-statement-supports-use-of-telemedicine-after-covid19-crisis
Which Telehealth Changes Will Become Permanent? Hints May Come Next Month: https://www.ajmc.com/view/which-telehealth-changes-will-become-permanent-hints-may-come-next-month
In-person Visits Are Invaluable, but Telehealth Is Here to Stay: https://www.ajmc.com/view/inperson-visits-are-invaluable-but-telehealth-is-here-to-stay
In this episode of Managed Care Cast, we talk with Michael N. Abrams, a cofounder and managing partner of Numerof & Associates, about the fifth annual report on the state of population health.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included HHS defending a CDC change limiting coronavirus disease 2019 (COVID-19) testing for asymptomatic people; an inside look at the Facing Metastatic Breast Cancer Together campaign; a conversation with Kashyap Patel, MD, on his new book.
Read more about the stories in this podcast: Amid Controversy, HHS Defends Change in COVID-19 Testing Guidance: https://www.ajmc.com/view/amid-controversy-hhs-defends-change-in-covid-19-testing-guidance Being Each Other’s Hero: Facing MBC Together: https://www.ajmc.com/view/being-each-others-hero-facing-mbc-together When the Topic Is Dying: A Conversation With Kashyap Patel, MD: https://www.ajmc.com/view/when-the-topic-is-dying-a-conversation-with-kashyap-patel-md How Virtual Care, Back-to-School Support, Health Inequities Are Influencing Employer Action: https://www.ajmc.com/view/how-virtual-care-back-to-school-support-health-inequities-are-influencing-employer-action After FDA Approval, EMA Accepts Marketing Authorization Application for First Oral SMA Therapy: https://www.ajmc.com/view/after-fda-approval-ema-accepts-marketing-authorization-application-for-first-oral-sma-therapy Forgotten Patients: ACO Attribution Omits Those With Low Service Use and the Dying: https://www.ajmc.com/view/forgotten-patients-aco-attribution-omits-those-with-low-service-use-and-the-dying
If there is any issue that has encapsulated the gravity of social determinants of health (SDOH) better than the coronavirus disease 2019 (COVID-19) pandemic, you'd probably be hard pressed to find a public health official able to name one. On this episode of Managed Care Cast, we share a little bit of our interview with the head of the American Public Health Association, which will appear in the September issue of The American Journal of Managed Care®.
As schoolchildren, teachers, essential workers and others try to adjust to the changes wrought by this novel infectious disease this year, Georges C. Benjamin, MD, speaks about the "need to have a new societal compact for health."
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week in managed care, the top news includes survival improves among wait-listed heart transplant candidates, the Trump administration offers a progress report on its kidney care initiative, and panelists say choice is vital to the biosimilar savings picture.
Read more about the stories in this podcast: Survival Improves Among Wait-listed Heart Transplant Candidates: https://www.ajmc.com/view/survival-improves-among-wait-listed-heart-transplant-candidates Administration Offers Progress Report on Kidney Care Initiative: https://www.ajmc.com/view/administration-offers-progress-report-on-kidney-care-initiative Choice Is Vital to Biosimilar Savings Picture, Panelists Say: https://www.ajmc.com/view/choice-is-vital-to-biosimilar-savings-picture-panelists-say Do ICD-10 Codes Accurately Reflect COVID-19 Symptoms? https://www.ajmc.com/view/do-icd-10-codes-accurately-reflect-covid-19-symptoms For Short Bouts of Acute Pain, Avoid Opioids, Guidelines Caution: https://www.ajmc.com/view/for-short-bouts-of-acute-pain-avoid-opioids-guidelines-caution Population Targeting and Durability of Multimorbidity Collaborative Care Management: https://www.ajmc.com/view/population-targeting-and-durability-of-multimorbidity-colloborative-care-management
The coronavirus disease 2019 (COVID-19)pandemic has created one of the most rapidly changing environments to ever hit health care. The pandemic has put a strain on hospitals and staff, but people are also worried about the impact COVID-19 is having on preventive care and the management of chronic illness.
Scott Hayworth, MD, president and CEO of New York-based CareMount Medical, discussed how his medical group handled the pandemic in what had been the epicenter of the US outbreak back in the spring, as well as what changes the group has made that will permanently alter the way it delivers care, during a conversation with Patricia Salber, MD, MBA, of The Doctor Weighs In.
Learn more: Continuation of Routine Screenings, Care Is Crucial During COVID-19 Pandemic: https://www.ajmc.com/view/continuation-of-routine-screenings-care-is-crucial-during-covid19-pandemic Cancer Care in the Age of COVID-19: Dr Patricia Salber Interviews Dr Bobby Reddy: https://www.ajmc.com/view/cancer-care-in-the-age-of-covid-19-dr-patricia-salbers-interviews-dr-bobby-reddy
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week in managed care, the top news included all-cause mortality disparities among Black and White men in rural areas; vaping as a risk factor for COVID-19 in young adults; how the pandemic presents an opportunity for value-based care delivery.
Read more about the stories in this podcast: All-Cause Mortality Disparities Persist Among Black, White Men Living in Rural US: https://www.ajmc.com/view/all-cause-mortality-disparities-persist-among-black-white-men-living-in-rural-us
Vaping a Risk Factor for COVID-19 in Teens, Young Adults: https://www.ajmc.com/view/vaping-a-risk-factor-for-covid-19-in-teens-young-adults
How Can the COVID-19 Pandemic Enhance Value-Based Health Care Delivery? https://www.ajmc.com/view/how-can-the-covid-19-pandemic-enhance-value-based-health-care-delivery
FDA Clears clonoSEQ to Detect MRD in Chronic Lymphocytic Leukemia: https://www.ajmc.com/view/fda-clears-cloneseq-to-detect-mrd-in-chronic-lymphocytic-leukemia
Racial Disparities in African Americans With Diabetes: Process and Outcome Mismatch: https://www.ajmc.com/view/racial-disparities-in-african-americans-with-diabetes-process-and-outcome-mismatch
In the world of drug development, it is typically the outcomes of phase 3 clinical trials that get the most attention. With the possibility of game-changing treatments for a myriad of diseases, they garner the most headlines, especially as the world waits on vaccines and effective treatment for the coronavirus disease 2019 pandemic.
But what happens during the early phase of testing? On today’s episode of Managed Care Cast, we speak with Jill A. Fisher, PhD, author of a new book, Adverse Events: Race, Inequality, and the Testing of New Pharmaceuticals. Her research took her inside clinical testing sites for phase 1 drug studies, a veiled world where healthy participants agree to spend days or weeks in a locked facility receiving an active ingredient or placebo. She interviewed participants, research staff, and others, and delves into the societal and economic forces that compel people—typically Black men in their 20s, 30s and 40s—to enroll repeatedly in phase 1 studies.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included CMS updates on telehealth and more; COVID-19 vaccine developments and remaining challenges; a study examines the impact of state policies on life expectancy.
Read more about the stories in this podcast: CMS Releases E&M Updates, Expands Telehealth, Makes ACO Changes: https://www.ajmc.com/view/cms-releases-e-and-m-updates-expands-telehealth-makes-aco-changes Experts Highlight COVID-19 Vaccine Developments and Remaining Challenges: https://www.ajmc.com/view/experts-highlight-covid-19-vaccine-developments-and-remaining-challenges How Do State Policies Impact Life Expectancy? https://www.ajmc.com/view/how-do-state-policies-impact-life-expectancy Tafasitamab Combination Approved for Adults With R/R DLBCL: https://www.ajmc.com/view/tafasitamab-combination-approved-for-adults-with-r-r-dlbcl The Correlation of Family Physician Work With Submitted Codes and Fees: https://www.ajmc.com/view/the-correlation-of-family-physician-work-with-submitted-codes-and-fees
On this episode of Managed Care Cast, we speak with Krisda H. Chaiyachati, MD, MPH, MSHP, about the study he co-wrote entitled “Economic Outcomes of Insurer-Led Care Management for High-Cost Medicaid Patients.” In the study, Chaiyachati and co-authors aim to evaluate the impact of the Community-Based Care Management program on total costs of care and utilization among adult high-need, high-cost patients enrolled in a Medicaid managed care organization. The program included teams of community health care workers and nurses who coordinated care for this cohort.
Dr. Chaiyachati is an assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine and a clinical innovation manager at Penn Medicine’s Center for Healthcare Innovation
The study was published in the July edition of The American Journal of Manage Care ®.
While there remain a lot of unknowns about coronavirus disease 2019 (COVID-19) and the risk of infection patients with cancer face, it is known that when they do contract the virus, they are at a higher risk of mortality, explained Sandeep “Bobby” Reddy, MD, an oncologist at Harbor-UCLA Medical Center and chief medical officer of NantHealth, during an interview with Patricia Salber, MD, MBA, of The Doctor Weighs In.
Reddy discussed the clinical care of cancer patients in the age of COVID-19, including how care has changed as a result of the pandemic; best practices at treatment centers to protect patients and staff; recommendations for patients, whether they are in the middle of treatment, haven’t yet started treatment, or have discovered something worrisome but haven’t yet been diagnosed; and more.
Read about related stories: Diagnostic Delays From COVID-19 May Increase Cancer-Related Deaths, UK Studies Say: https://www.ajmc.com/view/diagnostic-delays-from-covid19-may-increase-cancerrelated-deaths-uk-studies-say COVID-19 and Cancer: NCI's Sharpless Says COVID-19 Could Halt Streak of US Cancer Mortality Gains: https://www.ajmc.com/view/covid19-and-cancer-ncis-sharpless-says-covid-19-could-halt-streak-of-us-cancer-mortality-gains Continuation of Routine Screenings, Care Is Crucial During COVID-19 Pandemic: https://www.ajmc.com/view/continuation-of-routine-screenings-care-is-crucial-during-covid19-pandemic Don't Delay Cancer Care During COVID-19 Crisis: https://www.ajmc.com/view/dont-delay-cancer-care-during-covid19-crisis
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included top pharmaceutical executives refuse to attend a Trump meeting after executive orders on costs; a survey shows concerns about reopening schools, toll of COVID-19 split by party lines, background; a review of 20 years of data concludes vaccines are "remarkably safe."
Read more about the stories in this podcast: Trump Signs 4 Executive Orders in Effort to Carry Out Promise to Lower Drug Prices: https://www.ajmc.com/view/trump-signs-4-executive-orders-in-effort-to-carry-out-promise-to-lower-drug-prices What We're Reading: Pharma Execs Refuse to Attend Trump Meeting; Kodak Lands $765M US Loan; Persistent COVID-19 Symptoms: https://www.ajmc.com/view/what-were-reading-pharma-execs-refuse-to-attend-trump-meeting-kodak-lands-765m-us-loan-persistent-covid19-symptoms Concerns About Reopening Schools, Toll of COVID-19 Split by Party Lines, Background: https://www.ajmc.com/view/concerns-about-reopening-schools-toll-of-covid19-split-by-party-lines-background Review of 20 Years of Data Concludes Vaccines Are "Remarkably Safe": https://www.ajmc.com/view/review-of-20-years-of-data-concludes-vaccines-are-remarkably-safe FDA Gives Truvian Emergency OK for Rapid COVID-19 Antibody Test: https://www.ajmc.com/view/fda-gives-truvian-emergency-ok-for-rapid-covid19-antibody-test Effects of a Community-Based Care Management Model for Super-Utilizers: https://www.ajmc.com/view/effects-of-a-communitybased-care-management-model-for-superutilizers
On this episode of Managed Care Cast, we speak with the senior vice president of Network Payment Innovation and Contract Management for Blue Cross Blue Shield of Massachusetts, which is launching new value-based payment approach for independent primary care practices. The pilot project will reward practices for keeping patients healthy while providing extra support during the pandemic.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included states suing the Trump administration over an HHS rule on nondiscrimination; experimental vaccines show promise against coronavirus disease 2019 (COVID-19) in healthy subjects; diagnostic delays from COVID-19 may increase cancer-related deaths.
Read more about the stories in this podcast: States Sue Trump Administration for Changing Nondiscrimination Provisions of ACA: https://www.ajmc.com/newsroom/states-sue-trump-administration-for-changing-nondiscrimination-provisions-of-aca Experimental Vaccines Show Promise Against COVID-19 in Healthy Subjects: https://www.ajmc.com/newsroom/experimental-vaccines-show-promise-against-covid19-in-healthy-subjects Diagnostic Delays From COVID-19 May Increase Cancer-Related Deaths, UK Studies Say: https://www.ajmc.com/focus-of-the-week/diagnostic-delays-from-covid19-may-increase-cancerrelated-deaths-uk-studies-say Cancer Organizations Ask Trump Administration to Maintain Relationship With WHO: https://www.ajmc.com/newsroom/cancer-organizations-ask-trump-administration-to-maintain-relationship-with-who Merck Gets Priority Review in NDA for Vericiguat: https://www.ajmc.com/newsroom/merck-gets-priority-review-in-nda-for-vericiguat Leveraging Remote Behavioral Health Interventions to Improve Medical Outcomes and Reduce Costs: https://www.ajmc.com/journals/issue/2015/2015-vol21-n2/leveraging-remote-behavioral-health-interventions-to-improve-medical-outcomes-and-reduce-costs
On today’s episode of Managed Care Cast, we feature a short excerpt of an upcoming interview in the August issue of The American Journal of Managed Care® with Mandy K. Cohen, MD, MPH, North Carolina's secretary of the Department of Health and Human Services, as part of our yearlong Q&A series. We discussed the state's upcoming transition to Medicaid managed care, the pandemic, her advice to public health workers in the face of criticism, and how what is learned from the pandemic can help inform the future of managed care going forward.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included states facing COVID-19 spikes reporting health coverage losses; new COVID-19 data protocol raises concerns; and experts discuss key steps to reduce racial inequities in cancer care.
Learn more about the stories in this podcast: States Facing COVID-19 Spikes Report Greatest Health Insurance Coverage Losses: https://www.ajmc.com/focus-of-the-week/states-facing-covid19-spikes-report-greatest-health-insurance-coverage-losses New COVID-19 Hospital Data Protocol Raises Concerns: https://www.ajmc.com/newsroom/new-covid19-hospital-data-protocol-raises-concerns Key Steps to Reduce Racial Cancer Disparities Include Supporting Minority Scientists, Diversifying Medical Schools and Clinical Trials: https://www.ajmc.com/interviews/key-steps-to-reduce-racial-cancer-disparities-include-supporting-minority-scientists-diversifying-medical-schools-and-clinical-trials PrEP Use Has Changed Following Implementation of Social Distancing Measures: https://www.ajmc.com/focus-of-the-week/prep-use-has-changed-following-implementation-of-social-distancing-measures Roche Invests in Blueprint Medicines, Maker of RET Inhibitor Pralsetinib: https://www.ajmc.com/newsroom/roche-invests-in-blueprint-medicines-maker-of-ret-inhibitor-pralsetinib Impact of a Pharmacy-Based Transitional Care Program on Hospital Readmissions: https://www.ajmc.com/journals/issue/2017/2017-vol23-n3/impact-of-a-pharmacy-based-transitional-care-program-on-hospital-readmissions
Routine preventive screenings and vaccination rates have decreased due to the coronavirus disease 2019 (COVID-19) pandemic, while the Director of the National Cancer Institute recently warned delays in cancer screenings are likely to result in thousands of excess deaths. At the same time, a recent study found the pandemic could create losses of up to $15 billion for primary care practices.
To find out what can be done about these setbacks, and to learn why it is so critical to continue screenings during the pandemic, we spoke with Andrea Gelzer, MD, senior vice president and corporate chief medical officer for AmeriHealth Caritas.
On this episode of Managed Care Cast, Dr. Gelzer discusses the vital role telehealth has played during the pandemic, and how providers and payers can work together to encourage patients to continue routine care.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included CMS planning to pay more for at-home dialysis equipment; ACR supports continued use of telemedicine after the COVID-19 pandemic passes; coverage of AIDS 2020, the 23rd International AIDS Conference.
Read more about the stories in this podcast: CMS Seeks Incentives for At-Home Dialysis in Wake of COVID-19: https://www.ajmc.com/newsroom/cms-seeks-incentives-for-athome-dialysis-in-wake-of-covid19 ACR Position Statement Supports Use of Telemedicine After COVID-19 Crisis: https://www.ajmc.com/newsroom/acr-position-statement-supports-use-of-telemedicine-after-covid19-crisis Telehealth Growth in April Suggests Continuing Impact of COVID-19: https://www.ajmc.com/contributor/robin-gelburd-jd/2020/07/telehealth-growth-in-april-suggests-continuing-impact-of-covid19 Study Results Show Possible Link Between Medicaid Expansion, Drop in Advanced Breast Cancer: https://www.ajmc.com/newsroom/study-results-show-possible-link-between-medicaid-expansion-drop-in-advanced-breast-cancer- AIDS 2020: Virtual: https://www.ajmc.com/conferences/aids-2020 A Timeline of COVID-19 Developments in 2020: https://www.ajmc.com/focus-of-the-week/a-timeline-of-covid19-developments-in-2020 Physician and Patient Tools to Improve Chronic Kidney Disease Care: https://www.ajmc.com/journals/issue/2018/2018-vol24-n4/physician-and-patient-tools-to-improve-chronic-kidney-disease-care
Medication access barriers and nonadherence significantly impact medication underuse in the United States. This issue is estimated to cost the country’s healthcare system between $100 billion to $290 billion annually, as patients who underuse medication are more likely to have complications, which can result in costly health care utilization.
Recently, The Pharmacy Quality Alliance (PQA) and National Pharmaceutical Council (NPC) announced 2 research grants funding studies of patients’ real-world medication access barriers. Leveraging the framework devised by the PQA and NPC released in March 2019, researchers at The Johns Hopkins Hospital and University of Rhode Island will investigate this problem and release their findings in 2021.
Oral anticancer therapies have become popular alternatives to more traditional care, such as chemotherapy. However, research shows that adherence to oral anti-cancer therapies can range from 20% to 100%. Several factors contribute to medication non-adherence and access barriers. To learn more, we spoke with Ami Vyas, PhD, an assistant professor of pharmacy practice, specializing in health outcomes research, at The University of Rhode Island.
The last decade has brought great strides in diabetes care. Better insulins and better technology can allow people with diabetes—both type 1 and type 2—to keep their blood sugar from rising and falling in ways that cause long-term damage to their eyesight and vascular systems. New classes of drugs for patients with type 2 diabetes have been shown to cut the risk of heart and renal failure, and more widespread use could help some patients avoid dialysis.
But the good news is not felt by everyone. Amid this progress, the rate of amputations rose 50% between 2009 and 2015. African American patients lose limbs at triple the rate of other groups. The mission of the Affordable Care Act—spend more to prevent disease and complications, and save money later—has bypassed many of these patients for one reason: they lack access to care. Fourteen states have not expanded Medicaid, including several Deep South states where diabetes and obesity rates are highest.
The result of these state-level policy decisions is becoming clear. Research presented at the recent meeting of the American Diabetes Association found a 17% decrease in the risk of amputation when patients lived in states that expanded Medicaid. What’s more, the number of hospital admissions for diabetic foot ulcers plummeted in states that expanded Medicaid, while rising 21% in states that rejected expansion.
None of this is news to Foluso Fakorede, MD, who treats patients at risk of limb loss in the Mississippi Delta. Fakorede spoke with The American Journal of Managed Care® about his work in Mississippi, through his practice, Cardiovascular Solutions of Central Mississippi.
Read more: Diabetes Shouldn't Cost Patients Their Legs: https://www.ajmc.com/contributor/bret-weichmann/2020/01/diabetes-shouldnt-cost-patients-their-legs Understanding Diabetes Risks Can Save Your Limbs: https://www.ajmc.com/contributor/gerald-niedzwiecki/2019/12/understanding-diabetes-risks-can-save-your-limbs Heart Failure Coverage Success Seen in Medicaid Expansion States: https://www.ajmc.com/focus-of-the-week/heart-failure-coverage-success-seen-in-medicaid-expansion-states
The significant effect of the COVID-19 pandemic on mental health was spotlighted in a recent collaborative study conducted by the National Alliance of Healthcare Purchaser Coalitions, Total Brain, and One Mind. Compared with before the pandemic began, study findings indicate stark increases in rates of depression, anxiety, and stress, with women shown to be at a greater risk.
On this episode of Managed Care Cast, we speak with Michael Thompson, president and CEO of the National Alliance, and Louis Gagnon, CEO of Total Brain, on their findings and how employers can optimize how they monitor and support mental health in their respective workforce.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included CMS proposing rules for value-based contracting in Medicaid; claims data highlighting racial disparities in COVID-19 effects; an interview with Anthony Fauci, MD, on the progress made against HIV.
Read more about the stories in this podcast: CMS Issues Rules to Promote Value-Based Contracting, Pay for High-Cost Therapies in Medicaid: https://www.ajmc.com/newsroom/cms-issues-rules-to-promote-valuebased-contracting-pay-for-highcost-therapies-in-medicaid Medicare Claims Data Further Highlight Pandemic's Toll on Racial Minorities: https://www.ajmc.com/focus-of-the-week/medicare-claims-data-further-highlight-pandemics-toll-on-racial-minorities What Is Being Done to Assess the Disproportionate Effect of COVID-19 on Minority, Rural Communities? https://www.ajmc.com/focus-of-the-week/what-is-being-done-to-assess-the-disproportionate-effect-of-covid19-on-minority-rural-communities Fauci: Countless Lives Have Been Saved, but an HIV Vaccine and Cure Remain Elusive: https://www.ajmc.com/interviews/fauci-countless-lives-have-been-saved-but-a-vaccine-and-cure-remain-elusive PwC Provides 3 Spending Scenarios to Address Implications of COVID-19 on the 2021 Medical Cost Trend: https://www.ajmc.com/focus-of-the-week/pwc-provides-3-spending-scenarios-to-address-implications-of-covid19-on-the-2021-medical-cost-trend Infectious Diseases and Anemia in a Sample of Out-of-Treatment Drug Users: https://www.ajmc.com/journals/issue/1998/1998-09-vol4-n9/sep98-1074p1257-1264
Older and poorer Americans are disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. In this episode of Managed Care Cast, we speak with Richard Shinto, MD, MBA, president and CEO of InnovaCare Health, about the company’s care of their Medicare Advantage and Medicaid beneficiaries in Puerto Rico during the COVID-19 pandemic. He last spoke with us in 2018 about the effect that Hurricane Maria had on the organization and its members. In today’s podcast, he shares how coping with the aftermath of the 2017 hurricane assisted them with the pandemic.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included more details about the COVID-19 vaccine process; attempts to reinforce social distancing amid reopening; a recap of the American Diabetes Association 2020 Virtual Scientific Sessions.
Read more about the stories in this podcast: US Releases More Details About COVID-19 Vaccine Process, Says Some Doses Will Be Free: https://www.ajmc.com/newsroom/us-releases-more-details-about-covid19-vaccine-process-says-some-doses-will-be-free With States Reopening, CDC Tries to Reinforce Social Distancing Guidance: https://www.ajmc.com/newsroom/with-states-reopening-cdc-tries-to-reinforce-social-distancing-guidance American Diabetes Association 2020 Virtual Scientific Sessions: https://www.ajmc.com/conferences/ada-2020 What We're Reading: Drug Price TV Ruling Upheld; WHO Ends Hydroxychloroquine Study; Caution Issued on Rally Attendance: https://www.ajmc.com/newsroom/what-were-reading-drug-prices-not-required-in-tv-ads-who-ends-study-of-hydroxychloroquine-caution-issued-on-rally-attendance- FDA Approves Second Biomarker-Based Indication for Pembrolizumab: https://www.ajmc.com/newsroom/fda-approves-second-biomarkerbased-indication-for-pembrolizumab Effectiveness and Cost-Effectiveness of Diabetes Prevention Among Adherent Participants: https://www.ajmc.com/journals/issue/2013/2013-1-vol19-n3/effectiveness-and-cost-effectiveness-of-diabetes-prevention-among-adherent-participants
The ramifications of the COVID-19 pandemic has caused uncertainty among employers nationwide adjusting to this new normal. Notably, viable health care coverage has emerged as an essential necessity, with employees seeking favorable benefits. A recent analysis by Willis Towers Watson indicates that individual markets, once characterized as volatile, have emerged as an option now associated with stability and growth.
On this episode of Managed Care Cast, we speak with John Barkett, MBA, senior director of Policy Affairs in Benefits Delivery and Administration for Willis Towers Watson, on the current outlook of individual markets in private exchange solutions amid the pandemic.
In this episode of Managed Care Cast, we speak with the lead author of a study in the June issue of The American Journal of Managed Care® about the nationwide dearth of suppliers of the Medicare Diabetes Prevention Program, which aims to reach older adults with prediabetes. Natalie D. Ritchie, associate research scientist in the Denver Health and Hospital Authority Office of Research and an assistant professor at the University of Colorado School of Medicine and College of Nursing, discussed her thoughts on why not enough suppliers are offering the program. The study ("Medicare Diabetes Prevention Program: Where Are the Suppliers?") can be found at ajmc.com/link/4659.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included HHS distributing COVID-19 funds to Medicaid and CHIP providers; the National Kidney Foundation issues a statement on health disparities and racial violence; a preview of our coverage of the American Diabetes Association 2020 Virtual Scientific Sessions.
Read more about the stories in this podcast: HHS to Send COVID-19 Funds to Medicaid, CHIP, Safety Net Hospitals: https://www.ajmc.com/newsroom/hhs-to-send-covid19-funds-to-medicaid-chip-safety-net-hospitals National Kidney Foundation Issues Statement on Health Disparities, Racial Violence: https://www.ajmc.com/newsroom/national-kidney-foundation-issues-statement-on-health-disparities-racial-violence American Diabetes Association 2020 Virtual Scientific Sessions: https://www.ajmc.com/conferences/ada-2020 Diabetes Educators Release Updated Report on DSMES Accessibility, Usage: https://www.ajmc.com/focus-of-the-week/diabetes-educators-release-updated-report-on-dsmes-accessibility-usage Paper of the Week—Provider Behavior and Treatment Intensification in Diabetes Care: https://www.ajmc.com/journals/issue/2015/2015-vol21-n6/provider-behavior-and-treatment-intensification-in-diabetes-care
Chronic musculoskeletal pain costs the United States hundreds of billions of dollars each year. Now, with the coronavirus disease 2019 (COVID-19) pandemic, healthcare providers are tasked with providing optimal care to patients while minimizing human contact as much as possible.
On this episode of Managed Care Cast, we speak with Jeffrey Krauss, MD, chief medical officer of Hinge Health and Stanford Clinical assistant professor. In a study Dr. Krauss co-wrote entitled “Digital care for chronic musculoskeletal pain: 10,000 participant longitudinal cohort study,” researchers evaluated the efficacy of a 12-week digital care program aimed to reduce lower back and knee pain in a real-world population.
According to authors, the results support the prospect for digital care programs to serve the overwhelming number of musculoskeletal pain sufferers worldwide.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, top managed care stories included an additional setback for Medicaid work rules; another study finding more benefits from SGLT2 inhibitors; researchers finding unwanted end-of-life care causes stress.
Read more about the stories in this podcast: OCM, Other APM Timelines Extended Due to COVID-19: www.ajmc.com/focus-of-the-week/ocm-other-apm-timelines-extended-due-to-covid-19 Racial Disparities Shift in Observation Status in Hospital Admissions for Avoidable Conditions: www.ajmc.com/focus-of-the-week/racial-disparities-shift-in-observation-status-in-hospital-admissions-for-avoidable-conditions Study Finds Nonprofit Hospitals Did Not Direct Medicaid Expansion Savings Into Communities: www.ajmc.com/focus-of-the-week/study-finds-nonprofit-hospitals-did-not-direct-medicaid-expansion-savings-into-communities- ASCO 2020 Annual Meeting: www.ajmc.com/conferences/asco-2020 Improving Quality of Care in Oncology Through Healthcare Payment Reform: www.ajmc.com/journals/issue/2018/2018-vol24-n3/improving-quality-of-care-in-oncology-through-healthcare-payment-reform
In this episode of Managed Care Cast, we speak with the lead author of a study in the May issue of The American Journal of Managed Care® about the shift in new accountable care organizations (ACOs) from being led by hospital systems to being led by physician groups, and the accompanying policy shifts that are needed. David Muhlestein, the chief strategy and chief research officer at Leavitt Partners, also discussed his thoughts on the affect of coronavirus disease 2019 on ACOs. The study is titled "Accountable Care Organizations Are Increasingly Led by Physician Groups Rather Than Hospital Systems."
Amid COVID-19, patients with Parkinson disease have had to adjust to the physical and mental challenges precipitated by the pandemic. Notably, those with Parkinson disease, who are already linked with heightened feelings of stress and anxiety, may be further at risk.
On this episode of Managed Care Cast, we speak with Rachel Dolhun, MD, vice president of Medical Communications at The Michael J. Fox Foundation for Parkinson Research, about recent innovations by The Michael J. Fox Foundation to assist patients and families of patients with Parkinson disease in adjusting to this new normal.
In a prior study, nearly 7 in 10 employees indicated in a survey that the COVID-19 pandemic is the most stressful time of their entire professional career. Researchers from Lyra Health, an employee behavioral health provider, recently conducted a study examining the efficacy, in real-world circumstances, of a structured, cognitive behavioral coaching program delivered through video or telephone.
On this episode of Managed Care Cast, we speak with Connie Chen, MD, chief medical officer at Lyra Health, about the study “Effectiveness of a Cognitive Behavioral Coaching Program Delivered Via Video in Real World Settings.”
Against a backdrop of the health care and cost concerns stemming from the COVID-19 pandemic, the April issue of The American Journal of Managed Care® features an interview with Dr. Sherry Glied, health economist and dean of New York University’s Robert F. Wagner Graduate School of Public Service, about the Affordable Care Act and Medicaid, as well as the vital role that public service leadership plays in navigating a crisis of this scale.
The 2020 Community Oncology Conference, hosted by the Community Oncology Alliance (COA), will take place virtually on April 23 and April 24. The American Journal of Managed Care® (AJMC®) is bringing you a series of previews so you can learn more about what to expect when you attend this virtual meeting. In this interview we speak with Debra Patt, MD, MPH, MBA, executive vice president of policy and strategy at Texas Oncology who is presenting on applied informatics in oncology at the virtual meeting.
The 2020 Community Oncology Conference, hosted by the Community Oncology Alliance (COA), takes place virtually on April 23 and April 24. The American Journal of Managed Care® (AJMC®) is bringing you a series of previews so you can learn more about what you'll hear when you attend this virtual meeting. In this interview we're speaking with Lee Schwartzberg, MD, FACP, the chief medical director of West Cancer Center and the chief medical officer of OneOncology, and who is moderating a stakeholder panel discussion on genomic profiling in cancer.
Complex care management programs aim to improve health outcomes of high-cost, high-need patients through coordinating medical and social services. In general, Medicaid patients have high rates of chronic conditions and often utilize preventable acute care, leading to avoidable spending. To determine the impact complex care management programs can have on Medicaid beneficiaries, researchers conducted a study at CareMore Health in Memphis, Tennessee.
On this episode of Managed Care cast, we speak with Farhad Modarai, DO, on a recent paper he co-wrote, entitled, "Impact of Complex Care Management on Spending and Utilization for High-Need, High Cost Medicaid Patients." The study can be found in the February issue of The American Journal of Managed Care®.
Efforts to ensure that veterans have timely access to healthcare include community partnerships and the Veterans Choice Program, but new research suggests that women veterans may be receiving less care, particularly those who report unstable housing or mental/behavioral health issues,
On this episode of Managed Care Cast, we speak with Laurel A. Copeland, PhD, about the paper “Gender Differences in Newly Separated Veterans’ Use of Healthcare.” The study can be found in the March issue of The American Journal of Managed Care®.
Prior authorizations play a key role in checking on the safety and appropriateness of medical treatments among patients, but when they take too long, efficiency of care suffers.
On this episode of Managed Care Cast, we speak with April Todd, senior vice president, CORE and Explorations for CAQH, on CAQH CORE’s recent approval of a 2-day rule for health plans in requesting additional supporting information from providers and making final determinations on prior authorization requests. CAQH CORE is a multi-stakeholder collaboration aimed at creating healthcare operating rules for electronic administrative transactions and establishing a common foundation for the operational components of value-based payment.
This week, top managed care stories included an additional setback for Medicaid work rules; another study finding more benefits from SGLT2 inhibitors; researchers finding unwanted end-of-life care causes stress.
When implemented as intended, preventive drug lists (PDLs) can help high-deductable health plan members save money by covering preventive medications at lower or no costs. However, after conducting a series of interviews, researchers found this is not always the case among patients with asthma who have PDLs. Some patients were unaware their plans had PDLs, while other PDLs did not cover the cost of asthma medication.
On this episode of Managed Care cast, we speak with Melissa B. Gilkey, PhD, and Alison A. Galbraith, MD, MPH, about their paper, "Preventive Drug Lists as Tools for Managing Asthma Medication Costs." The study can be found in the February issue of The American Journal of Managed Care®.
Although genomic testing is recognized in national oncology guidelines as key to determining the right therapy for metastatic colorectal cancer (MCC), overall biomarker testing rates remain poor. On this episode of Managed Care Cast, we speak with one of the authors of a recent study about this issue published in JCO Precision Oncology. Stuart Goldberg, MD, a hematologist oncologist at the John Theurer Cancer Center at Hackensack University Medical Center, discusses real-world testing of biomarkers in MCC by mining electronic health records.
Goldberg is also the hospital’s first chief of the Division of Outcomes and Value Research, and the episode also discusses the relationship between value-based medicine and precision medicine and the promise of delivering improved outcomes at lower costs by avoiding ineffective therapies through the use of specialized testing and diagnostics.
On this episode of Managed Care Cast, we speak with John Showalter, MD, chief product officer at Jvion and an internal medicine physician, and Soy Chen, MS, director of data science at Jvion and part of their data science team. We discuss their research about using applied machine learning to predict healthcare utilization based on social determinants of health, appearing in the January 2019 Health IT issue of The American Journal of Managed Care®.
Nearly 75% of Americans will consider healthcare a main factor when they vote in the 2020 presidential election, according to a survey published by Wolters Kluwer late last year. The survey, called Mending HealthCare in America 2020: Consumers & Cost, showed alignment and deep divisions among patients and providers, with issues around transparency, cost, and care variability causing concern. On this episode of the podcast, we speak with Peter Bonis, MD, chief medical officer, Clinical Effectiveness, Wolters Kluwer, Health.
On this episode of Managed Care Cast, we speak with Kashyap Patel, MD, the chief executive officer of Carolina Blood and Cancer Care Associates—a leading OCM practice—and associate editor of Evidence-Based Oncology™ (EBO), as well as Tennessee Oncology’s Stephen M. Schleicher, MD, MBA, to discuss Oncology Care First.
On this Managed Care Cast, we speak with a health policy researcher who got the idea for a study about medical billing appearing in the December 2019 issue of The American Journal of Managed Care® after she received one that was unexpected. While efforts to abate surprise medical billing, such as the kind that come from out-of-network emergency department visits, are currently being debated in Washington, DC, the kind of billing discussed here occurs when patients struggle to understand the difference between preventive health services, which are covered at no cost under the Affordable Care Act, and billing for services at a doctor’s visit for an illness, condition, or injury.
Katie Schmitz, a graduate student pursuing a master’s degree in health communication from Purdue University, is one of the coauthors of "Preventive/Office Visit Patient Knowledge and Their Insurance Information Gathering Perceptions."
Read the full paper: https://www.ajmc.com/journals/issue/2019/2019-vol25-n12/preventiveoffice-visit-patient-knowledge-and-their-insurance-information-gathering-perceptions
On this episode of KOL Corner, Amy Ellis, director of quality and value-based care at Northwest Medical Specialties, talks with Amanda Hodges, BSN, RN, OCN, the director of implementation of ReVital Cancer Implementation.
In today’s Managed Care Cast, we bring you portions of the panel discussion during the the last Institute for Value-Based Medicine® (IVBM®) event for 2019, where oncologists and others shared their thoughts, successes, and frustrations with the current Oncology Care Model, as well as the question and answer session.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included research that may hold the key to slowing progression of multiple sclerosis; Humana says it is saving billions of dollars through value-based care; the challenges of rural healthcare delivery.
Read more about the stories in this podcast: Researchers May Have Identified How to Slow the Progression of MS: https://www.ajmc.com/newsroom/researchers-may-have-identified-how-to-slow-the-progression-of-ms Humana Saves $3.5B, Drives Down Hospital Use Through Value-Based Care in Medicare Advantage: https://www.ajmc.com/focus-of-the-week/humana-saves-35b-drives-down-hospital-use-through-valuebased-care-in-medicare-advantage Tackling Rural Health Challenges During Rural Health Month and Beyond: https://www.ajmc.com/contributor/kelly-munson/2019/11/tackling-rural-health-challenges-during-rural-health-month-and-beyond Hope and Some Skepticism Whether Oncology Payment Models Will Work: https://www.ajmc.com/focus-of-the-week/hope-and-some-skepticism-whether-oncology-payment-models-will-work
Women in the United States suffer from maternal mortality rates not seen elsewhere in developed countries, and nowhere is that more true than in patients served by Medicare. Although it is a national epidemic, inadequate maternal care disproportionately affects minority women and the 43% of US births financed by Medicaid. On this episode, we speak with an executive vice president of Avia Health Solutions, which is trying to address this issue in conjunction with 30 healthcare systems.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included research that shows stents may offer no more value than drugs for some heart patients; a ban on flavored tobacco products gains momentum; a survey finds most American families struggle with social factors that impact health.
Read more about the stories in this podcast: In Stable Heart Disease, Study Finds Stents Might Be No Better Than Drugs: https://www.ajmc.com/conferences/aha-2019/in-stable-heart-disease-study-finds-stents-might-be-no-better-than-drugs American Heart Association Scientific Sessions 2019: https://www.ajmc.com/conferences/aha-2019 What We're Reading: Vaping Ban Bill; Anal Cancer Rates; Medical Bill Protections: https://www.ajmc.com/newsroom/what-were-reading-vaping-ban-bill-anal-cancer-rates-medical-bill-protections Social Factors of Health Impacting Majority of US Families, Survey Says: https://www.ajmc.com/focus-of-the-week/social-factors-of-health-impacting-majority-of-us-families-survey-says Patients Need More Education Regarding the Purpose of Precision Medicine Trials: https://www.ajmc.com/focus-of-the-week/patients-need-more-education-regarding-the-purpose-of-precision-medicine-trials One Size Does Not Always Fit All in Value Assessment: https://www.ajmc.com/journals/issue/2019/2019-vol25-n11/one-size-does-not-always-fit-all-in-value-assessment Value Assessment and Heterogeneity: Another Side to the Story: https://www.ajmc.com/journals/issue/2019/2019-vol25-n11/value-assessment-and-heterogeneity-another-side-to-the-story The American Journal of Managed Care—November 2019: https://www.ajmc.com/journals/issue/2019/2019-vol25-n11
Healthcare is changing due to a combination of technological improvements and rising costs. For instance, more than half of surgical procedures now take place in an outpatient environment, but, as with many things in healthcare, there isn’t a lot of transparency. Today on Managed Care Cast, we speak with Michael Abrams, managing partner of Numerof & Associates, about patient safety and outpatient settings.
Chronic disease affects most employees in the United States, and today, on World Diabetes Day, Managed Care Cast speaks with the lead author of a study about chronic disease that appears in the November issue of The American Journal of Managed Care®. Author Maren S. Fragala, PhD, CSCS.D, talks about how employer-sponsored health screenings can help identifiy previously undiagnosed disease, enabling early detection and treatment, and help keep workers healthier.
During this week’s podcast, we sit down with Mark Lewis, MD, a gastrointestinal oncologist at Intermountain Healthcare. In addition to being a practicing oncologist, Lewis has been living with cancer himself with a hereditary tumor syndrome that’s been passed down in his family, giving him a unique experience that has driven his approach to treating his own patients. During the interview, Lewis discusses his personal history with cancer, how he’s seen the cancer landscape change over the last 2 decades, and his experience with treating neuroendocrine tumors.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included CMS started planning for life after the Oncology Care Model; a judge blocked a rule requiring immigrants to have health coverage; Election Day brought news for Medicaid work rules.
Read more about the stories in this podcast: CMS, CMMI Seek Feedback on Oncology Care First, Successor to OCM: https://www.ajmc.com/newsroom/cms-cmmi-seek-feedback-on-oncology-care-first-successor-to-ocm Electronic PROs a Proposed Feature of Successor Model in Oncology Care: https://www.ajmc.com/focus-of-the-week/electronic-pros-a-proposed-feature-of-successor-model-in-oncology-care What We're Reading: Trump's Immigrant Health Insurance Rule Blocked; Tips to Choose a Health Plan; FDA Advises Zantac Recalls: https://www.ajmc.com/newsroom/what-were-reading-trumps-immigrant-health-insurance-rule-blocked-tips-to-choose-a-health-plan-fda-advises-zantac-recalls What We're Reading: Democrats Win With Medicaid Work Rule Promise; Trump Says No to Pelosi Plan; UnitedHealthcare Biosimilar Switching: https://www.ajmc.com/newsroom/what-were-reading-democrats-win-with-medicaid-work-rule-promise-trump-says-no-to-pelosi-plan-unitedhealthcare-biosimilar-switching Final ICER Report Finds Empagliflozin More Cost Effective Than Oral Semaglutide for Type 2 Diabetes: https://www.ajmc.com/focus-of-the-week/final-icer-report-finds-empagliflozin-more-costeffective-than-oral-semaglutide-for-type-2-diabetes UnitedHealthcare Patients Will Switch to Biosimilar Epoetin Alfa in 2020: https://www.centerforbiosimilars.com/news/unitedhealthcare-patients-will-switch-to-biosimilar-epoetin-alfa-in-2020
In 2002, Bill Allman, working for Washington State, heard from a widow with a $75,000 bill from Medicaid, which was incurred as part of his long-term care costs. Like Allman, the man was a veteran. On this episode of Managed Care Cast, we learn how Allman, who is retiring at the end of 2019, launched a program to connect veterans to health benefits they didn't know they had, and in the process, figured out that states could reduce Medicaid spending.
In 2018, the Ochsner Accountable Care Network was able to reduce expected costs of care by more than $12.78 million for its Medicare beneficiaries, and it increased its savings 12% over 2017. This comes amidst research and claims that accountable care organizations may not be successful at reducing costs while improving outcomes.
David Carmouche, MD, president of the Ochsner Health Network and executive director of the Ochsner Accountable Care Network, explains how the Ochsner accountable care organization (ACO) was able to find success and how other ACOs can get over the learning curve to achieve savings.
Learn more about Ochsner https://www.ajmc.com/partners/ochsner
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included the average Affordable Care Act premiums falling 4%; the FDA approving a triple combination treatment for cystic fibrosis; House Republicans releasing part 1 of their healthcare plan.
Read more about the stories in this podcast: While Waiting for ACA Decision, HHS Says 2020 Benchmark Plan Premiums Mostly Lower: https://www.ajmc.com/newsroom/while-waiting-for-aca-decision-hhs-says-2020-benchmark-plan-premiums-mostly-lower FDA Approves Novel Triple Combination Therapy for Cystic Fibrosis: https://www.ajmc.com/newsroom/fda-approves-novel-triple-combination-therapy-for-cystic-fibrosis What We're Reading: Republicans Release Health Plan; J&J's Talc Problems; House Panel to Consider Vape Tax: https://www.ajmc.com/newsroom/what-were-reading-republicans-release-health-plan-jjs-talc-problems-house-panel-to-consider-vape-tax Blood Supply Falls Short of Need in Most Countries, Study Finds: https://www.ajmc.com/newsroom/blood-supply-falls-short-of-need-in-most-countries-study-finds Black Patients With Diabetes May Have Greater Hospital Readmission Risk, Study Finds: https://www.ajmc.com/newsroom/black-patients-with-diabetes-may-have-greater-hospital-readmission-risk-study-finds Patient-Centered Oncology Care®—Innovation and Quality: New Directions in Value-Based Care: https://www.ajmc.com/pcoc-philadelphia-2019-11-08
Healthcare is increasingly trying to use big data and clinical pharmacists are no exception. On today's episode of Managed Care Cast, we talk with an assistant professor at Geisinger’s Center for Pharmacy Innovation and Outcomes about his work with big data.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included a new guide that balances curbs on opioid abuse with the needs of patients with chronic pain; HHS proposed reforming antikickback rules to help boost value-based care; a report found flaws with Medicaid work requirements.
Who will care for America's growing aged population in the coming decades? Today on the podcast, we're speaking with PHI, a New York-based nonprofit organization that works to improve long-term services and care for the elderly and those with disabilities by focusing on the job quality of those providing day-to-day hands-on care—low-paid home health care aides and nursing assistants.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week.
This week, the top managed care news included an effort by the Trump administration to bolster Medicare Advantage; an abortion case from Louisiana reached the Supreme Court; the study of adapting to changing oxygen levels wins the Nobel Prize.
Read more about the stories in this podcast: Trump Executive Order Bolsters Medicare, MA to Compete Against "Medicare for All" Proposals: https://www.ajmc.com/newsroom/trump-executive-order-bolsters-medicare-ma-to-compete-against-medicare-for-all-proposals What We're Reading: Abortion Access Appeal; Trump to Suspend Visas for Uninsured Immigrants; Vape Ban in Oregon: https://www.ajmc.com/newsroom/what-were-reading-abortion-access-appeal-trump-to-suspend-visas-for-uninsured-immigrants-vape-ban-in-oregon Nobel Prize Honors 3 Who Showed How Cells Adapt to Oxygen Levels: https://www.ajmc.com/focus-of-the-week/nobel-prize-honors-3-who-showed-how-cells-adapt-to-oxygen-levels California Becomes First State to Make HIV Prevention Medication Accessible Without a Prescription: https://www.ajmc.com/newsroom/california-becomes-first-state-to-make-hiv-prevention-medication-accessible-without-a-prescription- Psych Congress 2019: https://www.ajmc.com/conferences/psychcongress-2019
This month’s issue of The American Journal of Managed Care® took a look at differences in coverage of orphan and nonorphan drugs to get insight into variation in orphan drug coverage across the largest commercial plans in the United States. The study, which analyzed a data set of private health plan coverage decisions for specialty drugs in 3 ways, found that health plans restrict access to orphan drugs about one-third of the time and that restrictions vary across plans. To get more insight into the findings, and the reasons behind these trends, we sat down with James Chambers, PhD, associate professor of medicine at Tufts Medical Center Institute for Clinical Research and Health Policy Studies.
Exploring the Rise of Obesity-Related Cancers: A Conversation With Dr Debra Patt by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included Medicare cuts hospital payments over readmissions; a second-generation chimeric antigen receptor T-cell therapy shows promise; a diabetes drug is approved to prevent kidney failure for the first time.
Read more about the stories in this podcast: What We're Reading: Medicare Issues Readmission Penalties; Virginia Abortion Law Ruling; Vitamin A's Role in Skin Cancer: https://www.ajmc.com/newsroom/what-were-reading-medicare-issues-readmission-penalties-virginia-abortion-law-ruling-vitamin-as-role-in-skin-cancer- PwC Report Urges Action to Tackle Social Determinants of Health: https://www.ajmc.com/focus-of-the-week/pwc-report-urges-action-to-tackle-social-determinants-of-health Researchers Say Second-Generation CAR T-Cell Therapy Proves Successful in Early Studies, Human Trial Planned: https://www.ajmc.com/newsroom/researchers-say-secondgeneration-car-proves-successful-in-early-lab-studies-human-trial-planned FDA Approves Canagliflozin to Prevent Kidney Failure, Hospitalization for Heart Failure: https://www.ajmc.com/focus-of-the-week/fda-approves-canagliflozin-to-prevent-kidney-failure-hospitalization-for-heart-failure What We're Reading: DEA Authorized Opioid Production Surge; Georgia Abortion Law Blocked; Drone Deliveries for Healthcare: https://www.ajmc.com/newsroom/what-were-reading-dea-authorized-opioid-production-surge-georgia-abortion-law-blocked-drone-deliveries-for-healthcare Patient-Centered Oncology Care—Innovation and Quality: New Directions in Value-Based Care: https://www.ajmc.com/pcoc-philadelphia-2019-11-08
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included state and federal crackdowns on vaping that forced out the president of Juul; FDA approved a groundbreaking diabetes treatment; Medicare Advantage premiums will decline for 2020.
Read more about the stories in this podcast: What We're Reading: Walmart Removes E-Cigs; Sutter Health Antitrust Case; Sanders Proposes Medical Debt Elimination: https://www.ajmc.com/newsroom/what-were-reading-walmart-removes-ecigs-sutter-health-antitrust-case-sanders-proposes-medical-debt-elimination What We're Reading: Heartburn Medication Recall; Juul Labs CEO Steps Down; Amazon Launches Virtual Health Clinic: https://www.ajmc.com/newsroom/what-were-reading-heartburn-medication-recall-juul-labs-ceo-steps-down-amazon-launches-virtual-health-clinic Flavored E-Cigarettes Linked With Worsening Severity of Asthma in Mice: https://www.ajmc.com/newsroom/flavored-ecigarettes-linked-with-worsening-severity-of-asthma-in-mice FDA Approves Novo Nordisk's Oral Semaglutide, First GLP-1 in Pill Form: https://www.ajmc.com/newsroom/fda-approves-novo-nordisks-oral-semaglutide-first-glp1-in-pill-form MA Premiums to Decline as Enrollment Is Expected to Continue Climbing in 2020: https://www.ajmc.com/focus-of-the-week/ma-premiums-to-decline-as-enrollment-is-expected-to-continue-climbing-in-2020 Physician Shortage Likely to Impact OB/GYN Workforce in Coming Years: https://www.ajmc.com/newsroom/physician-shortage-likely-to-impact-obgyn-workforce-in-coming-years The Center for Biosimilars®: https://www.centerforbiosimilars.com/ Evidence-Based Diabetes Management—September 2019: https://www.ajmc.com/journals/evidence-based-diabetes-management/2019/september-2019
Now 3 years into the Oncology Care Model, practices participating in the episode-based model have recently received results from performance period 4, representing care delivered in the first half of 2018. Results from the previous 2 performance periods have some practices concerned because there was little improvement; During both performance period 2 and 3 approximately 30% of practices achieved savings.
With performance period 4 results out now, it’s a transformative point in the model in which practices that have not yet achieved a performance-based payment have to either enter 2-sided risk or leave the model. To dive into the most recent results and their implications, we spoke with Charles Saunders, MD, chief executive officer of Integra Connect.
Read more about the Oncology Care Model performance period results: Lessons From the Field: How Practices Are Succeeding Under OCM: https://www.ajmc.com/focus-of-the-week/lessons-from-the-field-how-practices-are-succeeding-under-ocm Mike Fazio: Practices Are Happier With PP4 Results in the OCM: https://www.ajmc.com/conferences/qcca-fall-2019/mike-fazio-practices-are-happier-with-pp4-results-in-the-ocm COA Submits OCM 2.0 Proposal: https://www.ajmc.com/newsroom/coa-submits-ocm-20-proposal COA Urges Delay in Downside Risk Deadline for OCM: https://www.ajmc.com/newsroom/coa-urges-delay-in-downside-risk-deadline-for-ocm
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included Purdue Pharma filing for bankruptcy; new data showing the number of people who get screened for HIV at least once falls far short of what CDC recommends; findings that most US hospital markets are now highly concentrated.
Read more about the stories in this podcast: What We're Reading: Purdue Pharma Files for Bankruptcy; Rise in Uninsured Immigrants; Spiked CBD in Maryland: https://www.ajmc.com/newsroom/what-were-reading-purdue-pharma-files-for-bankruptcy-rise-in-uninsured-immigrants-spiked-cbd-in-maryland How Many People Actually Get Screened for HIV? https://www.ajmc.com/newsroom/how-many-people-actually-get-screened-for-hiv Nearly 75% of US Hospital Markets Highly Concentrated, HCCI Report Shows: https://www.ajmc.com/newsroom/nearly-75-of-us-hospital-markets-highly-concentrated-hcci-report-shows What We're Reading: Fast Track Designation for Dapagliflozin; California Advocates Against Vaping; Measles Cases Fading: https://www.ajmc.com/newsroom/what-were-reading-fast-track-designation-for-dapagliflozin-california-advocate-against-vaping-measles-cases-fading- Amgen Posts Updates on Triplet Therapy Using Carfilzomib: https://www.ajmc.com/newsroom/amgen-posts-updates-on-triplet-therapy-using-carfilzomib Managed Care for Long-Stay Nursing Home Residents: An Evaluation of Institutional Special Needs Plans: https://www.ajmc.com/journals/issue/2019/2019-vol25-n9/managed-care-for-long-stay-nursing-home-residents-an-evaluation-of-institutional-special-needs-plans
Exploring Reference-Based Pricing as a Method for Lowering Healthcare Costs by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included a report showing the US uninsured rate rose in 2018; the Trump administration indicating it will ban all flavors of e-cigarettes except for tobacco; new research showing the prevalence of hemophilia is 3 times larger than originally believed.
Read more about the stories in this podcast: Despite Strong Economy, Census Report Says Uninsured Rate Rose in 2018: https://www.ajmc.com/focus-of-the-week/despite-strong-economy-census-report-says-uninsured-rate-rose-in-2018 What We're Reading: FDA Investigating Juul; Sutter Health Handed Lawsuit; European Doctor Sues FDA: https://www.ajmc.com/newsroom/what-were-reading-fda-investigating-juul-sutter-health-handed-lawsuit-european-doctor-sues-fda Trump Administration Seeks to Rid Market of Flavored e-Cigarettes: https://www.ajmc.com/newsroom/trump-administration-seeks-to-rid-market-of-flavored-ecigarettes Prevalence of Hemophilia Worldwide Is Triple That of Previous Estimates, New Study Says: https://www.ajmc.com/focus-of-the-week/prevalence-of-hemophilia-worldwide-is-triple-that-of-previous-estimates-new-study-says- Employers Recognize Need to Improve Employee Health Experience: https://www.ajmc.com/newsroom/employers-recognize-need-to-improve-employee-health-experience Patient-Centered Oncology Care: Innovation and Quality—New Directions in Value-Based Care: https://www.ajmc.com/pcoc-philadelphia-2019-11-08
To date, most alternative payment models (APMs) that have emerged in the shift toward value-based care have been initiated by payers and focused on primary care providers. However, there has recently been a new wave of payment reform in which providers, mostly specialists, are designing and implementing their own APMs in their practices. A study published in the September issue of The American Journal of Managed Care analyzed some of these new payment models to gain insight into what providers are prioritizing in their APMs. To get more insight into the study and its findings, we spoke with study author Suhas Gondi, BA, of Harvard Medical School.
Relationships in healthcare are important and trust is crucial to those relationships. However, it has been on the decline in the United States. We speak with the executive vice president of the ABIM Foundation and representatives from the 8 winning organizations of the foundation's Trust Practice Challenge about the programs they implemented to rebuild trust.
Read more: ABIM Foundation Trust Practice Challenge: https://abimfoundation.org/what-we-do/rebuilding-trust-in-health-care/trust-practice-challenge 5 Things About Medical Mistrust: www.ajmc.com/newsroom/5-things-about-medical-mistrust From the Editorial Board: Daniel B. Wolfson, MHSA: www.ajmc.com/journals/issue/2019/2019-vol25-n5/from-the-editorial-board-daniel-b-wolfson-mhsa
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included a diabetes drug showing positive results in treating heart failure; new lipid guidelines promoting the use of proprotein convertase subtilisin/kexin type 9 inhibitors; and a study finding doctors are more likely to prescribe opioids if they are in a hurry.
Read more about the stories in this podcast: Dapagliflozin Cuts Risk of CV Death, Worsening of Heart Failure 26%, Whether Diabetes Present or Not: https://www.ajmc.com/newsroom/dapagliflozin-cut-risk-of-cv-death-worsening-of-heart-failure-26-whether-diabetes-present-or-not New Guidelines Supported by Lipid-Lowering Therapy Studies, Indicating Benefit of PCSK9 Inhibitors: https://www.ajmc.com/focus-of-the-week/new-guidelines-supported-by-lipidlowering-therapy-studies-indicating-benefit-of-pcsk9-inhibitors Providers More Likely to Prescribe Opioids as the Day Progresses or If They're Running Late: https://www.ajmc.com/focus-of-the-week/providers-more-likely-to-prescribe-opioids-as-the-day-progresses-if-theyre-running-late Large European Study Links Soda Consumption to Greater Risk of Mortality, Including From Parkinson: https://www.ajmc.com/newsroom/large-european-study-links-soda-consumption-to-greater-risk-of-mortality-including-from-parkinson IVBM: The Future of Oncology Value-Based Care: https://www.ajmc.com/meetings/ivbm-nashville-2019-10-24 Advancing Oncology Quality Through Value-Based Care: https://www.ajmc.com/meetings/ivbm-philadelphia-2019-09-19
On this episode of Managed Care Cast, we speak with the author of a new book that discusses the price and cost of American healthcare. Martin Makary, MD, MPH, a surgical oncologist and chief of the Johns Hopkins Islet Transplant Center, talked about what he found while writing The Price We Pay: What Broke American Health Care—and How to Fix It. Makary discusses spurious billing practices, overtreatment, and the opioid issue, as well as efforts by some providers and employers to reshape primary care.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included a huge ruling against one opioid maker and a settlement offer from another; an expert panel calling for broader screening for hepatitis C; a review showing there are more fatal events linked to a multiple sclerosis drug than previously known.
Read more about the stories in this podcast: What We're Reading: Purdue Pharma Settlement; HCV Screening; Medicare for All Support: https://www.ajmc.com/newsroom/what-were-reading-purdue-pharma-settlement-hcv-screening-medicare-for-all-support Fatal AEs Associated With Alemtuzumab for MS May Occur More Frequently Than Previously Thought: https://www.ajmc.com/newsroom/fatal-aes-associated-with-alemtuzumab-for-ms-may-occur-more-frequently-than-previously-thought FDA Grants Fast Track Designation for Dapagliflozin to Prevent Kidney Failure: https://www.ajmc.com/newsroom/fda-grants-fast-track-designation-for-dapagliflozin-to-prevent-kidney-failure- 5 Things to Look for at the European Society of Cardiology 2019 Congress: https://www.ajmc.com/newsroom/5-things-to-look-for-at-the-european-society-of-cardiology-2019-congress Keeping Glucose in Range, With the Right Tools and Treatment for Management: https://www.ajmc.com/focus-of-the-week/keeping-glucose-in-range-with-the-right-tools-and-treatment-for-management IVBM: Advancing Oncology Quality Through Value-Based Care: https://www.ajmc.com/meetings/ivbm-philadelphia-2019-09-19
As advocates for addressing social determinants of health (SDOH) look to get buy in from stakeholders, there's a need for building evidence base to show that initiatives addressing these determinants work.
To discuss the importance of both quantifying and communicating the return on investment of these initiatives, we spoke with Susan Mani, MD, vice president of Clinical Transformation and Ambulatory Quality at LifeBridge Health.
Read more about building an evidence base for SDOH initiatives Building the Evidence Base to Quantify, Communicate the ROI of SDOH Initiatives: www.ajmc.com/conferences/whcc-2019/building-the-evidence-base-to-quantify-communicate-the-roi-of-sdoh-initiatives
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week in managed care, the top news included outcomes results in treating heart failure; US prevention experts said more women should get BRCA testing; the American Heart Association offered an advisory on treating high triglycerides with prescription omega-3 fatty acids.
Read more about the stories in this podcast: AstraZeneca's Dapagliflozin Meets Primary End Point in Heart Failure Trial: https://www.ajmc.com/newsroom/astrazenecas-dapagliflozin-meets-primary-end-point-in-heart-failure-trial FDA's Fast Track Designation for Empagliflozin in Heart Failure Points to New Paradigm: https://www.ajmc.com/newsroom/fdas-fast-track-designation-for-empagliflozin-in-heart-failure-points-to-new-paradigm More Women May Be Screened for BRCA Mutations Following USPSTF Guideline Update: https://www.ajmc.com/newsroom/more-women-may-be-screened-for-brca-mutations-following-uspstf-guideline-update Evidence-Based Oncology - August 2019: https://www.ajmc.com/journals/evidence-based-oncology/2019/august-2019 Prescription Omega-3 Fatty Acids Effectively Reduce Triglycerides, AHA Says in Advisory: https://www.ajmc.com/focus-of-the-week/prescription-omega-3-fatty-acids-effectively-reduce-triglycerides-aha-says-in-advisory Neighborhood Characteristics Linked to Premature Mortality Rates: https://www.ajmc.com/focus-of-the-week/neighborhood-characteristics-linked-to-premature-mortality-rates Costs, Quality, Access, and More: The Challenges of Providing Healthcare to Employees: https://www.ajmc.com/managed-care-cast/costs-quality-access-and-more-the-challenges-of-providing-healthcare-to-employees Employers Compendium: https://www.ajmc.com/compendium/employers
Employers are the single largest provider and purchaser of healthcare insurance in the United States and they represent a potential force for change in the US healthcare system. In order to control costs and provide better care to their employees, employers have been banding together through local coalitions. Many coalitions across the country have coalesced under the National Alliance of Healthcare Purchaser Coalitions.
At the National Alliance’s recent Leadership Summit, held at the end of June in Pittsburgh, we spoke with some of the leaders about key issues facing employers in healthcare and how those top concerns may have changed over the past few years.
Read more: Employers Compendium: https://www.ajmc.com/compendium/employers National Alliance of Healthcare Purchaser Coalitions partner page: https://www.ajmc.com/partners/national-alliance Greater Philadelphia Business Coalition on Health partner page: https://www.ajmc.com/partners/gpbch National Alliance of Healthcare Purchaser Coalitions’ 2019 Leadership Summits conference page: https://www.ajmc.com/conferences/leadership-summits-2019
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included the Trump administration looking to bar legal immigrants from using public benefits; a study in The American Journal of Managed Care® finding that a law to limit surprise medical bills is working; data on Affordable Care Act enrollment showing the effect of subsidies.
Read more about the stories in this podcast: Trump Administration Publishes Final Rule Aimed at Legal Immigrants Using Public Benefits: https://www.ajmc.com/newsroom/trump-administration-publishes-final-rule-aimed-at-legal-immigrants-using-public-benefits Influence of Out-of-Network Payment Standards on Insurer–Provider Bargaining: California’s Experience: https://www.ajmc.com/journals/issue/2019/2019-vol25-n8/influence-of-outofnetwork-payment-standards-on-insurer-provider-bargaining-californias-experience What We're Reading: Ebola Vaccine Victory; ACA Numbers Mixed; Scientists Repurpose Old Drugs: https://www.ajmc.com/newsroom/what-were-reading-ebola-vaccine-victory-aca-numbers-mixed-scientists-reurpose-old-drugs Researchers Say They Developed an Approach to Further Suppress HIV Infection: https://www.ajmc.com/newsroom/researchers-say-they-developed-an-approach-to-further-suppress-hiv-infection Evidence-Based Oncology - August 2019: https://www.ajmc.com/journals/evidence-based-oncology/2019/august-2019
On this episode of Managed Care Cast, we’re bringing you a portion of a panel discussion about the Oncology Care Model, held in July 2019 during a meeting of The Institute for Value-Based Medicine (IVBM), an initiative of The American Journal of Managed Care®. At IVBM events, we gather thought leaders to share best practices across medicine, pharmacy, and management in regional locations around the country. This podcast is taken from our meeting focusing on Innovation and Quality in Oncology Care.
Read previous coverage of IVBM events: Managing Costs in Diabetes Means Intervening Early to Avoid Complications Later, Experts Say: www.ajmc.com/journals/evidence-based-diabetes-management/2019/june-2019/managing-costs-in-diabetes-means-intervening-early-to-avoid-complications-later-experts-say Even With Room for Improvement, OCM Practices Agree: They Would Participate Again; and Practice Transformations Improve Access, Increase Communication in the Shift to Value-Based Cancer Care: www.ajmc.com/journals/evidence-based-oncology/2019/june-2019/institute-for-valuebased-medicine As Comorbidities Pile Up, True Diabetes Cost Measured by More Than Insulin, Panel Says: www.ajmc.com/newsroom/as-comorbidities-pile-up-true-diabetes-cost-measured-by-more-than-insulin-panel-says-
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included CMS giving chimeric antigen receptor T-cell payments a boost; a US task force announcing that those at risk for pancreatic cancer should be screened; FDA revealing Novartis withheld data about a high-cost gene therapy.
Read more about the stories in this podcast: CMS Gives CAR T Payments Short-term Boost, Adjusts Hospital Wage Index: https://www.ajmc.com/focus-of-the-week/cms-gives-car-t-payments-shortterm-boost-adjusts-hospital-wage-index Still No Call for Widespread Screening for Pancreatic Cancer, but USPSTF Says Yes for Those With Known Risk: https://www.ajmc.com/focus-of-the-week/still-no-call-for-widespread-screening-for-pancreatic-cancer-but-uspstf-says-yes-for-those-with-known-risk What We're Reading: FDA Says Novartis Hid Data; Judge Halts Ark. Abortion Rules; New Phase in Opioid Suits: https://www.ajmc.com/newsroom/what-were-reading-fda-says-novartis-hid-data-judge-halts-ark-abortion-rules-new-phase-in-opioid-suits One Dose of HPV Vaccine Effective in Preventing Cervical Cancer Compared With Multiple Doses, Researchers Say: https://www.ajmc.com/newsroom/one-dose-of-hpv-vaccine-effective-in-preventing-cervical-cancer-compared-with-multiple-doses-researchers-say "Not So Different": The Biosimilars Council Says Patent Abuses Are Costing Biosimilar Savings: https://www.centerforbiosimilars.com/podcast/not-so-different-the-biosimilars-council-says-patent-abuses-are-costing-biosimilar-savings
Transitioning to value-based care is a marathon, not a race, and should be viewed as a mission and a culture, Jeff Hunnicutt, chief executive officer at Highlands Oncology Group, told Amy Ellis, director of quality and value-based care at Northwest Medical Specialties. In order to successfully transform a practice, there needs to be a clear message and set values ingrained in the mindset of staff at the frontline of patient care.
As a progressive disease diabetes presents an ongoing challenge for physicians to provide adequate control of patients’ diabetes, and new agents with novel mechanisms of action help reduce the burden in the management of diabetes.
In a recent Peer Exchange discussion, Dr Peter Salgo, of Columbia University College of Physicians and Surgeons and NewYork-Presbyterian Hospital, led a discussion on novel agents and their role in treating patients with and with cardiovascular disease. On the panel was Dr. Om Ganda of Joslin Diabetes Center; Jim Kenney of JTKenney, a managed care consulting practice; and Dr Helena Rodbard, past president of the American College of Endocrinology and past president of the American Association of Clinical Endocrinologists.
Listen to the full discussion: https://www.ajmc.com/peer-exchange/new-classes-for-treatment-of-type-2-diabetes/
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included HHS laying out a plan for importing certain prescription drugs from other countries; a potential new standard of care for chronic lymphocytic leukemia; 3 insulin makers get subpoenaed over their pricing practices.
Read more about the stories in this podcast: HHS, FDA Outline Foundation for Importing Certain Drugs From Other Countries: https://www.ajmc.com/newsroom/hhs-fda-outline-foundation-for-importing-certain-drugs-from-other-countries CMS Testing Pilot to Give FFS Medicare Providers Historical Claims Data on Patients: https://www.ajmc.com/newsroom/cms-testing-pilot-to-give-ffs-medicare-providers-historical-claims-data-on-patients Ibrutinib–Rituximab Improves Survival Compared With Current Treatment for Chronic Lymphocytic Leukemia: https://www.ajmc.com/newsroom/ibrutinibndashrituximab-improves-survival-compared-with-current-treatment-for-chronic-lymphocytic-leukemia What We're Reading: Democrats Debate Medicare for All; Insulin Makers Questioned; Best Hospital Rankings: https://www.ajmc.com/newsroom/what-were-reading-democrats-debate-medicare-for-all-insulin-makers-questioned-best-hospital-rankings Bipartisan Senate Bill Seeks to Roll Back a Decade's Worth of Insulin Price Hikes: https://www.ajmc.com/focus-of-the-week/bipartisan-senate-bill-seeks-to-roll-back-a-decades-worth-of-insulin-price-hikes Lilly to Launch Half-Price Version of Humalog: https://www.ajmc.com/newsroom/lilly-to-launch-halfprice-version-of-humalog Sanofi Offer Sets Monthly Price of $99 for Insulin Supply: https://www.ajmc.com/newsroom/sanofi-offers-set-monthly-price-of-99-for-insulin-supply IVBM: Advancing Oncologu Quality Through Value-Based Care: https://www.ajmc.com/meetings/ivbm-philadelphia-2019-09-19
While precision medicine has started to inch its way to becoming a norm in healthcare, there are still barriers holding back widespread implementation amomg providers and organizations. From reimbursement challenges to primary use in oncology to proving the return on investment of implementing a precision medicine program, addressing these barriers could open the door to more providers and oragnizations embracing precision medicine in their practice.
To discuss these challenges and ways to mitigate them, we sat down with Joel Diamond, MD, a practicing physician, adjunct associate professor of Biomedical Informatics at the University of Pittsburgh, and cofounder and chief medical officer of 2bPrecise.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included bipartisan Senate bills taking aim at drug prices, especially insulin; a study linking payer refusal to pay for proprotein convertase subtilisin/kexin type 9 inhibitors with heart attacks and deaths; and a former FDA commissioner visiting The American Journal of Managed Care®.
Read more about the stories in this podcast: Senate Finance Committee Unveils Bipartisan Bill to Lower Drug Costs: https://www.ajmc.com/newsroom/senate-committee-unveils-bipartisan-bill-to-lower-drug-costs Bipartisan Senate Bill Seeks to Roll Back a Decade's Worth of Insulin Price Hikes: https://www.ajmc.com/focus-of-the-week/bipartisan-senate-bill-seeks-to-roll-back-a-decades-worth-of-insulin-price-hikes Rejected, Unfilled PCSK9 Inhibitor Prescriptions Linked to Higher Risk of Cardiovascular Events: https://www.ajmc.com/focus-of-the-week/rejected-unfilled-pcsk9-inhibitor-prescriptions-linked-to-higher-risk-of-cardiovascular-events Impact of a Co-pay Accumulator Adjustment Program on Specialty Drug Adherence: https://www.ajmc.com/journals/issue/2019/2019-vol25-n7/impact-of-a-copay-accumulator-adjustment-program-on-specialty-drug-adherence Consuming Riboflavin Through Diet May Reduce Migraine Occurrence: https://www.ajmc.com/newsroom/consuming-riboflavin-through-diet-may-reduce-migraine-occurrence
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included CMS pushing for bundled payments in radiation oncology; reports detailing deficiencies in hospice care; a study finding widening disparities in life expectancy among white Americans.
Read more about the stories in this podcast: CMS Proposes Bundled Payments for Radiation Oncology: https://www.ajmc.com/newsroom/cms-proposes-bundled-payments-for-radiation-oncology OIG Reports Find Deficiencies in Hospice Care and Resulting Harms to Patients: https://www.ajmc.com/focus-of-the-week/oig-reports-find-deficiencies-in-hospice-care-and-resulting-harms-to-patients Study Reveals Declining Life Expectancy Among White Americans That Defies Easy Answers: https://www.ajmc.com/focus-of-the-week/study-reveals-declining-life-expectancy-among-white-americans-that-defies-easy-answers Systolic, Diastolic BP Both Predict Cardiovascular Events, Kaiser Permanente Study Finds: https://www.ajmc.com/newsroom/systolic-diastolic-bp-both-predict-cardiovascular-events-kaiser-permanente-study-finds Number of Manufacturers and Generic Drug Pricing From 2005 to 2017: https://www.ajmc.com/journals/issue/2019/2019-vol25-n7/number-of-manufacturers-and-generic-drug-pricing-from-2005-to-2017
Pharmaceutical manufacturers sought to improve patient access to treatments through the use of co-payment assistance cards. But, while these cards reduce the out-of-pocket cost for enrollees, employers worry that they could result in increased medication use and associated expenditures, thus negating efforts made with benefit designs. To mitigate the issue, pharmacy benefit managers have introduced co-pay accumulator adjustment programs, which prevent pharmaceutical manufacturer subsidies put toward a patient’s out-of-pocket costs from counting toward the deductible. As a result, high-deductible health plan enrollees could face a sharp spike in out-of-pocket costs when the manufacturer subsidy limits are reached, but the patient has not reached their deductible.
Despite the lack of data around how these programs affect patient outcomes, they have become popular among employers.
Bruce Sherman, MD, FCCP, chief medical officer of the National Alliance of Healthcare Purchasers Coalition, discusses the findings of a paper in the July issue of The American Journal of Managed Care® on the impact of co-pay accumulator adjustment programs on specialty drug use.
Read the paper: https://www.ajmc.com/journals/issue/2019/2019-vol25-n7/impact-of-a-copay-accumulator-adjustment-program-on-specialty-drug-adherence
Just halfway through the year, and 2019 has been busy for biosimilars with new guidance and approvals, but the loss of a big advocate of biosimilars from the FDA. In this episode of Managed Care Cast, Kelly Davio, senior editor of The Center for Biosimilars®, a sister site of The American Journal of Managed Care®, discusses new approvals, what the loss of Scott Gottlieb, MD, as FDA commissioner means, the reality of pay-for-delay deals, and more.
Learn more about biosimilars at centerforbiosimilars.com.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included uncertainty surrounding the fate of the Affordable Care Act's individual mandate; a study finding Medicare beneficiaries may be paying more for some generics than brand-name drugs; the Trump administration proposing 5 new payment models to transform kidney disease care.
Read more about the stories in this podcast: Appeals Court Shows Uncertainty Over Constitutionality of ACA's Individual Mandate: https://www.ajmc.com/focus-of-the-week/appeals-court-shows-uncertainty-over-constitutionality-of-acas-individual-mandate Medicare Beneficiaries May Pay More for Some Generics Than Brand-Name Drugs: https://www.ajmc.com/focus-of-the-week/medicare-beneficiaries-may-pay-more-for-some-generics-than-brandname-drugs Despite Growth, Uptake of Downside Risk in ACO Contracts Remains Low: https://www.ajmc.com/focus-of-the-week/despite-growth-uptake-of-downside-risk-in-aco-contracts-remains-low HHS Unveils 5 New Payment Models to Transform Kidney Disease Care: https://www.ajmc.com/newsroom/hhs-unveils-5-new-payment-models-to-transform-kidney-disease-care Evidence-Based Diabetes Management—June 2019: https://www.ajmc.com/journals/evidence-based-diabetes-management/2019/june-2019
While many women in healthcare report experiencing subtle or not-so-subtle bias and microaggressions at work, a recently published study sought to determine how healthcare professionals associate men and women with career and family, and also how surgeons associate men and women with surgery and family medicine. In this podcast, we speak with the lead author, Arghavan Salles, MD, PhD, about the findings, as well as other issues affecting women in healthcare.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, we recap the top managed care news from the first half of 2019, including outcomes from some of the biggest diabetes trials, research into the annual Medicare wellness visit, and an experimental treatment in Parkinson disease.
Read more about the stories in this podcast: Medicare Annual Wellness Visit Association With Healthcare Quality and Costs: https://www.ajmc.com/journals/issue/2019/2019-vol25-n3/medicare-annual-wellness-visit-association-with-healthcare-quality-and-costs Cardiovascular Prevention Guidelines Call for Less Aspirin, More SGLT2s, GLP-1s for Type 2 Diabetes: https://www.ajmc.com/conferences/acc-2019/cardiovascular-prevention-guidelines-call-for-less-aspirin-more-sglt2s-glp-1s-for-type-2-diabetes New Treatment May Have the Potential to Slow, Stop, or Reverse Parkinson Disease: https://www.ajmc.com/newsroom/new-treatment-may-have-the-potential-to-slow-stop-or-reverse-parkinson-disease Oral Semaglutide Meets CV Safety Mark, Reduces Events in High-Risk T2D Patients: https://www.ajmc.com/conferences/ada-2019/oral-semaglutide-meets-cv-safety-mark-reduces-events-in-highrisk-t2d-patients Novo Nordisk Seeks Oral Semaglutide Approval, CV Indications on New Drug and Injectable: https://www.ajmc.com/newsroom/novo-nordisk-seeks-oral-semaglutide-approval-cv-indications-on-new-drug-and-injectable- CREDENCE: Canagliflozin Cuts Risk of Renal Failure, Death 30% in Patients With Type 2 Diabetes, CKD: https://www.ajmc.com/newsroom/credence-canagliflozin-cuts-risk-of-renal-failure-death-30-in-patients-with-type-2-diabetes-ckd
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included President Trump issuing an executive order for more healthcare transparency; provisional data indicating that overdose deaths may be falling; the Supreme Court agreeing to hear insurers' Affordable Care Act lawsuit.
Read more about the stories in this podcast: Trump Issues Executive Order Intended to Require Disclosure of Negotiated Rates Between Insurers, Hospitals: https://www.ajmc.com/newsroom/trump-issues-executive-order-intended-to-require-disclosure-of-negotiated-rates-between-insurers-hospitals Provisional Data Predict Overdose Death Rates Will Fall for First Time in Decades: https://www.ajmc.com/newsroom/provisional-data-predict-overdose-death-rates-will-fall-for-first-time-in-decades What We're Reading: Supreme Court to Hear ACA Suit; Missouri Abortion Clinic; City of Hope Investment: https://www.ajmc.com/newsroom/what-were-reading-supreme-court-to-hear-aca-suit-missouri-abortion-clinic-city-of-hope-investment Nearly 5.4 Million Cancer Survivors Suffer From Chronic Pain: https://www.ajmc.com/focus-of-the-week/nearly-54-million-cancer-survivors-suffer-from-chronic-pain MIT Group Brings Together Stakeholders to Brainstorm How to Pay for Curative Therapies Over Time: https://www.ajmc.com/journals/evidence-based-oncology/2019/june-2019/mit-group-brings-together-stakeholders-to-brainstorm-how-to-pay-for-curative-therapies-over-time- Two-Sided Risk in the Oncology Care Model: https://www.ajmc.com/journals/evidence-based-oncology/2019/june-2019/twosided-risk-in-the-oncology-care-model NCCN's Putnam Serving as Point of Contact for Payers, Employers to Keep Cancer Care "Accessible": https://www.ajmc.com/journals/evidence-based-oncology/2019/june-2019/nccns-putnam-serving-as-point-of-contact-for-payers-employers-to-keep-cancer-care-accessible Evidence-Based Oncology—June 2019: https://www.ajmc.com/journals/evidence-based-oncology/2019/june-2019
Today on Managed Care Cast, we speak with Benjamin Isgur, leader of PwC’s Health Research Institute, about their latest report, Medical Cost Trend Report 2020: Beyond the Numbers. We talk about what is making the medical cost trend start to move upwards and what employers are trying to do about it.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included a report finding slow progress in reducing low-value care; a study finding savings by accountable care organizations may be overstated; CMS proposing a rule to allow for electronic prior authorization in Part D drugs.
Read more about the stories in this podcast: Analysis Finds Progress in Reducing Spending on Low-Value Services Positive but Sluggish: https://www.ajmc.com/focus-of-the-week/analysis-finds-progress-in-reducing-spending-on-lowvalue-services-positive-but-sluggish Savings of MSSP ACOs May Be Overstated, Annals Study Finds: https://www.ajmc.com/newsroom/savings-of-mssp-acos-may-be-overstated-annals-study-finds CMS Proposes Electronic Prior Authorization for Part D Drugs: https://www.ajmc.com/newsroom/cms-proposes-electronic-prior-authorization-for-part-d-drugs FDA Approves Liraglutide for Youth With Type 2 Diabetes: https://www.ajmc.com/newsroom/fda-approves-liraglutide-for-youth-with-type-2-diabetes What We're Reading: Texas' Surprise Medical Bill Protection; Student Nicotine Testing; WIC Program Lowered Childhood Obesity: https://www.ajmc.com/newsroom/what-were-reading-texas-surprise-medical-bill-protection-student-nicotine-testing-wic-program-lowered-childhood-obesity Seema S. Sonnad Emerging Leader in Managed Care Research Award: https://www.ajmc.com/about/ajmc/sss-elmcr-award
Value-based care has been a big prerogative of CMS for the last decade, and it's not going away, Brian Kern, a lawyer with Frier Levitt, told Amy Ellis, director of quality and value-based care at Northwest Medical Specialties. The government programs, such as the Bundled Payments for Care Improvement, Medicare Shared Savings Program, and Oncology Care Model, are important because practices learn from them and hopefully take these similar models to private payers, which transform healthcare.
Through these value-based care programs, data analytics is crucial to help physicians understand cost, improve outcomes, and increase patient satisfaction.
Today we’re speaking with Dr Mark Simon, the chief medical officer of OB Hospitalist Group. OB Hospitalist contracts with hospitals across the United States to create OB emergency departments. The group employs more than 600 experienced OBs who are available 24 hours a day, 7 days a week to ensure that an OB is always in the hospital, rather than on call. OB Hospitalist also works with hospitals to reduce costs by being an outsourced provider of obstetricians.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the Community Oncology Alliance submitting an alternative to the Oncology Care Model; more study results demonstrating diabetes drugs can prevent renal failure; US task force recommending pre-exposure prophylaxis for HIV prevention.
Read more about the stories in this podcast: COA Submits OCM 2.0 Proposal: https://www.ajmc.com/newsroom/coa-submits-ocm-20-proposal DECLARE Shows Diabetes Drug Farxiga Prevented Renal Decline, Even for Those With Good Kidney Health: https://www.ajmc.com/conferences/ada-2019/declare-shows-diabetes-drug-farxiga-prevented-renal-decline-even-for-those-with-good-kidney-health More CV, Renal Outcomes at ADA: CREDENCE, CARMELINA, CAROLINA: https://www.ajmc.com/conferences/ada-2019/more-cv-renal-outcomes-at-ada-credence-carmelina-carolina Oral Semaglutide Meets CV Safety Mark, Reduces Events in High-Risk T2D Patients: https://www.ajmc.com/conferences/ada-2019/oral-semaglutide-meets-cv-safety-mark-reduces-events-in-highrisk-t2d-patients 79th Scientific Sessions of the American Diabetes Association: https://www.ajmc.com/conferences/ada-2019 USPSTF Issues Recommendation Statements on PrEP, Screening for HIV: https://www.ajmc.com/newsroom/uspstf-issues-recommendation-statements-on-prep-screening-for-hiv Teaching Hospitals Have Similar or Lower Costs of Care as Nonteaching Hospitals for Medicare Patients: https://www.ajmc.com/focus-of-the-week/teaching-hospitals-have-similar-or-lower-costs-of-care-as-nonteaching-hospitals-for-medicare-patients Dr David Blumenthal Tells Employers to Get Tough, Get Smart, Get Informed on Healthcare: https://www.ajmc.com/newsroom/dr-david-blumenthal-tells-employers-to-get-tough-get-smart-get-informed-on-healthcare
The rate of innovation in oncology has been impressive, with novel therapies, such as chimeric antigen receptor T-cell therapies, and new diagnostics that make it easier to understand which patients will benefit from certain targeted therapies. With all of these innovations coming to market and being tested in clinical trials, it might make sense that some people are ready to move on from the treatments of the past.
In a new commentary published in the June issue of The American Journal of Managed Care®, Bruce Feinberg, DO, of Cardinal Health, explains why people shouldn’t count out chemotherapy just yet. In the latest podcast interview, Feinberg explains his views on chemotherapy and how important it still is in cancer care.
Reports of the Demise of Chemotherapy Have Been Greatly Exaggerated: www.ajmc.com/journals/issue/2019/2019-vol25-n6/reports-of-the-demise-of-chemotherapy-have-been-greatly-exaggerated
Phase 3 TAILORx Results Confirm Chemotherapy Unnecessary in 70% of Women With Early-Stage Breast Cancer: https://www.ajmc.com/conferences/asco-2018/phase-3-tailorx-results-confirm-chemotherapy-unnecessary-in-70-of-women-with-earlystage-breast-cancer
TAILORx Results May Mitigate Financial Toxicity: https://www.ajmc.com/contributor/molly-macdonald/2018/06/tailorx-results-may-mitigate-financial-toxicity
The burden of medical expenses, whether incurred through a catastrophic illness or surprise medical bills, affects the uninsured and insured alike. A 5-year-old charity called RIP Medical Debt buys medical debt incurred, so far, by more than 250,000 Americans. We talk to one of the cofounders and coauthors of "End Medical Debt," the book they wrote about the issue.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the American Society of Clinical Oncology discussing drug pricing; community oncologists seeking a delay in taking on downside risk in the Oncology Care Model; CDC finding a drop in new diabetes cases in the United States.
Read more about the stories in this podcast: ASCO Town Hall Brings Tense Conversation About Drug Pricing: https://www.ajmc.com/conferences/asco-2019/asco-town-hall-brings-tense-conversation-about-drug-pricing Cannabis Risks and Benefits in Cancer Symptom Management: Much Remains Unknown: https://www.ajmc.com/conferences/asco-2019/cannabis-risks-and-benefits-in-cancer-symptom-management-much-remains-unknown American Society of Clinical Oncology Annual Meeting 2019: https://www.ajmc.com/conferences/asco-2019 COA Urges Delay in Downside Risk Deadline for OCM: https://www.ajmc.com/newsroom/coa-urges-delay-in-downside-risk-deadline-for-ocm Data Show New US Diabetes Cases Are Taking a Dip: https://www.ajmc.com/newsroom/data-show-new-us-diabetes-cases-are-taking-a-dip American Diabetes Association 2019: https://www.ajmc.com/conferences/ada-2019 Seema Verma Envisions a US Health System That Shares Data, Is Truly Value-Based: https://www.ajmc.com/focus-of-the-week/seema-verma-envisions-a-us-health-system-that-shares-data-is-truly-valuebased
We sit down with David Smith, the executive director of the Medicaid Transformation Project, to get an update about the integration challenges health systems are facing, including system issues, infrastructure issues, coding and payment issues, and more.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the FDA's approval of a $2.1 million gene therapy; a study revealing that the worldwide need for palliative care will nearly double by 2060; the FDA granting priority review to Amarin’s Vascepa for a cardiovascular indication.
Read more about the stories in this podcast: FDA Approves Gene Therapy With $2.1M Price Tag for Spinal Muscular Atrophy in Pediatric Patients: https://www.ajmc.com/newsroom/fda-approves-gene-therapy-with-21m-price-tag-for-spinal-muscular-atrophy-in-pediatric-patients Serious Health-Related Suffering to Nearly Double by 2060, Highlighting Need to Ramp Up Palliative Care Efforts: https://www.ajmc.com/focus-of-the-week/serious-healthrelated-suffering-to-nearly-double-by-2060-highlighting-need-to-ramp-up-palliative-care-efforts What We're Reading: FDA Grants Priority Review for Amarin's Vascepa; HHS Rule Challenged; Military Mental Health Proposal: https://www.ajmc.com/newsroom/what-were-reading-fda-grants-priority-review-for-amarins-vascepa-hhs-rule-challenged-military-mental-health-proposal Amarin's High-Dose Fish Oil Pill Cuts Total CV Event Risk 30% in Study: https://www.ajmc.com/conferences/acc-2019/amarins-highdose-fish-oil-pill-cuts-total-cv-event-risk-30-in-study The American Journal of Managed Care—May 2019: https://www.ajmc.com/journals/issue/2019/2019-vol25-n5 Open Doors to Primary Care Should Add a “Screen” to Reduce Low-Value Care: https://www.ajmc.com/journals/issue/2019/2019-vol25-n5/open-doors-to-primary-care-should-add-a-ldquoscreenrdquo-to-reduce-lowvalue-care American Society of Clinical Oncology Annual Meeting 2019: https://www.ajmc.com/conferences/asco-2019
In the first of a series of interviews with key opinion leaders, Amy Ellis, director of quality and value-based care at Northwest Medical Specialties, discusses practice transformation with Jess Quiring, a patient navigator at New Mexico Cancer Center.
During the converation, Quiring explained how her practice modified the depression and distress screening tools for the different populations it treated. For instance, it changed the language based on what was more acceptable to Native Americans receiving treatment. She also explained the various programs the practice offers to patients, such as yoga, an art workshop, and meal preparation assistance, as well as several support groups.
Exploring the Increased Prevalence, Evolving Role of Physician Assistants by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included a study questioning the Hospital Readmissions Reduction Program; FDA issuing a warning about do-it-yourself artificial pancreas systems; measles cases reach the highest level since 1994.
Read more about the stories in this podcast: Study Questions Penalizing, Incentivizing PCPs for Readmission Rates: https://www.ajmc.com/focus-of-the-week/study-questions-penalizing-incentivizing-pcps-for-readmission-rates FDA Issues Warning on Do-It-Yourself Artificial Pancreas: https://www.ajmc.com/newsroom/fda-issues-warning-on-do-it-yourself-artificial-pancreas What We're Reading: Tobacco Age Legislation; Most Measles Cases Since 1994; Hidden Dangers of Heart Device: https://www.ajmc.com/newsroom/what-were-reading-tobacco-age-legislation-most-measles-cases-since-1994-hidden-dangers-of-heart-device Alkermes' Novel Schizophrenia Drug Shows Less Weight Gain, Addressing Top Patient Complaint: https://www.ajmc.com/conferences/apa-2019?rel=0/alkermes-novel-schizophrenia-drug-shows-less-weight-gain-addressing-top-patient-complaint Adam Simmons on Patient Preferences When Taking Antipsychotic Medications: https://www.ajmc.com/conferences/apa-2019/adam-simmons-on-patient-preferences-when-taking-antipsychotic-medications American Psychiatric Association 2019 Annual Meeting: https://www.ajmc.com/conferences/apa-2019 Panelists Debate the Role of ICER: Useful Overseer of Prices, or Oppressor of Choice? https://www.ajmc.com/conferences/ispor-2019/panelists-debate-the-role-of-icer-useful-overseer-of-prices-or-oppressor-of-choice- ISPOR 2019 Annual Meeting: https://www.ajmc.com/conferences/ispor-2019
As the cost of healthcare continues to rise, employers are getting more involved in their employees’ health and identifying ways they can intervene to help get employees who have chronic conditions healthy or access to care they need and also keep employees who are already healthy from getting sick.
At the Midwest Business Group on Health (MBGH)’s 39th annual conference, Cheryl Larson, president and chief executive officer of MBGH, and Denise Giambalvo, vice president of MBGH, discussed a range of topics affecting employers, including trust with employees, popular initiatives, the cost of specialty drugs, and various proposals and policies from the Trump administration, such as getting rid of drug rebates and including drug prices in TV ads.
Read coverage from the Midwest Business Group on Health’s annual conference: https://www.ajmc.com/conferences/mbgh-2019
Patients with Parkinson disease can suffer complications in the hospital if the individualized, highly structured care plans that manage their disease are not followed. We interviewed neurologist Hooman Azmi, MD, the co-author of Parkinson's Disease for the Hospitalist: Managing the Complex Care of a Vulnerable Population, about what it takes to improve patient care for this population. He is the director of the Division of Movement Disorders at Hackensack University Medical Center and is also a member of the neuro-oncology team at the John Theurer Cancer Center at Hackensack UMC.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included 44 states suing drug makers for price fixing; Gilead pledging to donate pre-exposure prophylaxis for up to 200,000 people for up to 11 years; Philadelphia soda tax reduced consumption of sugary drinks.
Read more about the stories in this podcast: What We're Reading: Drug Makers Accused of Price-Fixing; Washington State Public Option Insurance; Vaccine Exemptions Stall: https://www.ajmc.com/newsroom/what-were-reading-drug-makers-accused-of-pricefixing-washington-state-public-option-insurance-vaccine-exemptions-stall Reactions Are Mixed as Gilead Announces PrEP Donations, Early Launch of Generic: https://www.ajmc.com/newsroom/reactions-are-mixed-as-gilead-announces-prep-donations-early-launch-of-generic Sales of Sweetened Drinks Fell 38% After Philadelphia Beverage Tax: https://www.ajmc.com/newsroom/sales-of-sweetened-drinks-fell-38-after-philadelphia-beverage-tax Chemotherapy Demand Will Rise Significantly by 2040, and Workforce Will Need to Expand With It: https://www.ajmc.com/focus-of-the-week/chemotherapy-demand-will-rise-significantly-by-2040-and-workforce-will-need-to-expand-with-it ISPOR 2019 (Coverage starting May 20): https://www.ajmc.com/conferences/ispor-2019 Sign up: ISPOR 2019—On Location Interviews, Day 1: https://www.ajmc.com/onlocation/2019/ispor-2019-on-location-interviews-day-1 Sign up: ISPOR 2019—On Location Interviews, Day 2: https://www.ajmc.com/onlocation/2019/ispor-2019-on-location-interviews-day-2 Sign up: ISPOR 2019—On Location Interviews, Day 3: https://www.ajmc.com/onlocation/2019/ispor-2019-on-location-interviews-day-3 American Psychiatric Association 2019 Annual Meeting (Coverage starting May 19): https://www.ajmc.com/conferences/apa-2019 Newsletter Sign-up: https://www.ajmc.com/email-profile
Do Machine-Readable Directories Improve Provider Directory Accuracy? by Managed Care Cast
Outcomes for patients with cancer are continuously improving, but the increasingly complex healthcare system, new payment and delivery models that place more risk on practices, and rising costs of therapies has made it difficult for independent oncology practices to thrive and survive. However, independent practices present an important part of cancer care, delivering care to patients who are not near large hospital-based systems at lower costs.
Sibel Blau, MD, explains how Quality Cancer Care Alliance is bringing together independent practices and helping them succeed by providing them with best business models, practice efficiencies, and financial advantages.
Read more about the stories in this podcast: Data and Collaboration Are Key for Value-Based Care Success: https://www.ajmc.com/journals/evidence-based-oncology/2018/december-2018/data-and-collaboration-are-key-for-valuebased-care-success Strategies for Fighting Consolidation in Community Oncology: https://www.ajmc.com/conferences/coa-2019/strategies-for-fighting-consolidation-in-community-oncology Dr Ray Page Details Using Triage Pathways and Scaling Them Across Multiple Practices: https://www.ajmc.com/interviews/dr-ray-page-details-using-triage-pathways-and-scaling-them-across-multiple-practices Barry Russo on How Community Oncology Practices Can Work Together and Learn From Each Other: https://www.ajmc.com/interviews/barry-russo-on-how-community-oncology-practices-can-work-together-and-learn-from-each-other
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included HHS announcing a finalized rule requiring the disclosure of drug prices in television ads; a report finding high satisfaction with employer health coverage despite the cost; a study finding heart failure is surging among young adults.
Read the articles in this podcast: HHS Finalizes Rule Requiring Disclosure of Drug Prices in TV Ads: https://www.ajmc.com/newsroom/hhs-finalizes-rule-requiring-disclosure-of-drug-prices-in-tv-ads High Satisfaction With Employer Coverage, but Financial Challenges Persist: https://www.ajmc.com/focus-of-the-week/high-satisfaction-with-employer-coverage-but-financial-challenges-persist Amgen, Syapse Join Forces for Precision Medicine in Oncology: https://www.ajmc.com/newsroom/amgen-syapse-join-forces-for-precision-medicine-in-oncology What We're Reading: Medicaid Fraud Settlement; Heart Failure in Young Adults; FDA Investigates Sunscreen: https://www.ajmc.com/newsroom/what-were-reading-medicaid-fraud-settlement-heart-failure-in-young-adults-fda-investigates-sunscreen Managing Costs in Diabetes Means Intervening Early to Avoid Complications Later, Experts Say: https://www.ajmc.com/focus-of-the-week/managing-costs-in-diabetes-means-intervening-early-to-avoid-complications-later-experts-say Dr Rebekah Gee Offers an Inside Look at Louisiana's Subscription Payment Model for HCV Drugs: https://www.ajmc.com/managed-care-cast/dr-rebekah-gee-offers-an-inside-look-at-louisianas-subscription-payment-model-for-hcv-drugs
The Louisiana Department of Health and Corrections announced in March 2019 their selection of Asegua Therapeutics, a subsidiary arm of Gilead Sciences, as their pharmaceutical partner for the state’s subscription model for hepatitis C virus treatment.
The alternative payment model, the first of its kind in the United States, was first announced in August 2018 by the Louisiana Department of Health, who explained that HCV infections are a public health crisis within the state. Though highly effective antiviral treatment exists that can largely cure patients with HCV, the price of the treatments remains high, and Medicaid patients and the Department of Corrections population are unable to access the therapies.
Under this model, instead of paying for each prescription individually, the state would pay a subscription fee to the drug company whereby the state would then receive unlimited access to the drug, similar to how consumers pay a monthly fee to stream unlimited television shows and movies.
Today, we’re speaking with Dr Rebekah Gee, secretary of the Louisiana Department of Health and one of the key leaders in bringing this alternative payment model to fruition.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included CMS Administrator Seema Verma calling for more disruption to the healthcare system; former FDA Commissioner Scott Gottlieb, MD, reflecting on the agency’s record of innovation; liraglutide demonstrating promise for youth with type 2 diabetes.
Read more about the stories in this podcast: CMS' Verma: Upend the Status Quo to Move to Value-Based Care: https://www.ajmc.com/conferences/naacos-spring-2019/cms-verma-upend-the-status-quo-to-move-to-valuebased-care National Association of ACOs Spring 2019: https://www.ajmc.com/conferences/naacos-spring-2019 In First Speech Since Stepping Down as FDA Commissioner, Gottlieb Reflects on Agency's Push for Innovation: https://www.ajmc.com/conferences/whcc-2019/in-first-speech-since-stepping-down-as-fda-commissioner-gottlieb-reflects-on-agencys-push-for-innovation World Health Care Congress 2019: https://www.ajmc.com/conferences/whcc-2019 Liraglutide Lowers A1C in Youth With Type 2 Diabetes, Phase 3 Study Finds: https://www.ajmc.com/focus-of-the-week/liraglutide-lowers-a1c-in-youth-with-type-2-diabetes-phase-3-study-finds/ Study: Oncotype DX-Guided Treatment May Cut Breast Cancer Care Costs by $50 Million in US: https://www.ajmc.com/newsroom/study-oncotype-dxguided-treatment-may-cut-breast-cancer-care-costs-by-50-million-in-us Why Patients Seek Out Medical Cannabis: https://www.ajmc.com/managed-care-cast/why-patients-seek-out-medical-cannabis
Heard at COA: Improving Cancer Care in Community Practices With OneOncology by Managed Care Cast
Earlier this year a paper published in Health Affairs discussed the reasons why patients seek out medical cannabis. We spoke with one of the authors, Kevin F. Boehnke, PhD, a researcher in anesthesiology, about the findings that chronic pain accounted for the majority of all patient-reported qualifying conditions under which US patients sought medical marijuana.
We also discuss other topics related to medical cannabis in the United States, as well as the kinds of future research that would be helpful to understanding this issue.
Today we’re speaking with Dr. Steven Goldberg, the vice president of medical affairs, population health, and chief health officer at Quest Diagnostics. He is also a co-author of a recent peer-reviewed case study that analyzed a benefits and wellness program designed by a self-insured employer. The employer, Quest Diagnostics, covers nearly 60,000 lives. The analysis of the program showed that it was able to reduce costs while maintaining program quality and promoting population health. According to the study findings, through proactive changes, physician executive leadership, health plan collaboration, disease-specific population health initiatives, and plan design, Quest Diagnostic's annual healthcare cost trend steadily improved from a year-over-year trend of 5.7% from 2014 to 2015, to 4.6% from 2015 to 2016, to -1.0% for 2016 to 2017, and most recently, 0.3% in the 2017 to 2018 year.
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included a study demonstrating that diabetes drug canagliflozin cuts the risk of renal failure and death; the FDA approving the first targeted therapy for metastatic bladder cancer; approximately half of all cancer deaths are attributable to modifiable risk factors.
Read more about the stories in this podcast: CREDENCE: Canagliflozin Cuts Risk of Renal Failure, Death 30% in Patients With Type 2 Diabetes, CKD: https://www.ajmc.com/newsroom/credence-canagliflozin-cuts-risk-of-renal-failure-death-30-in-patients-with-type-2-diabetes-ckd FDA Approves Erdafitinib, First Targeted Therapy for Metastatic Bladder Cancer: https://www.ajmc.com/newsroom/fda-approves-erdafitinib-first-targeted-therapy-for-metastatic-bladder-cancer Nearly Half of Cancer Deaths Attributable to Modifiable Risk Factors: https://www.ajmc.com/newsroom/nearly-half-of-cancer-deaths-attributable-to-modifiable-risk-factors Panelists Offer an Insider Perspective of the Unstable Future of Genetic Testing Reimbursement: https://www.ajmc.com/conferences/flasco-2019/panelists-offer-an-insider-perspective-of-the-unstable-future-of-genetic-testing-reimbursement FLASCO Spring Session 2019: https://www.ajmc.com/conferences/flasco-2019 Deaths Among Opioid Users: Impact of Potential Inappropriate Prescribing Practices: https://www.ajmc.com/journals/issue/2019/2019-vol25-n4/deaths-among-opioid-users-impact-of-potential-inappropriate-prescribing-practices The American Journal of Managed Care—April 2019: https://www.ajmc.com/journals/issue/2019/2019-vol25-n4
Understanding the Impact of Inappropriate Opioid Prescribing Practices by Managed Care Cast
As the prevalence of burnout among healthcare providers has increased over the last few years, it has raised attention to the issue. Burnout includes overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and a lack of accomplishment. Among physicians, common drivers include excessive workloads, clerical burdens, organizational structures, and leadership culture.
Greater attention to the issue, and the impact it can have on patient outcomes, has led to more organizations to implement interventions to address and alleviate burnout in healthcare. Bernadette Melnyk, PhD, RN, APRN-CNP, FAANP, FNAP, FAAN, vice president for health promotion, chief wellness officer and professor and dean of the college of nursing at The Ohio State University, highlighted the need for a chief wellness officer, same as healthcare has chief technology and quality officers, and some interventions being implemented.
Learn more about burnout: Making The Case For The Chief Wellness Officer In America’s Health Systems: A Call To Action: https://www.healthaffairs.org/do/10.1377/hblog20181025.308059/full/ Physicians Are Pessimistic About Future of Healthcare, Highlight Extent of Social Determinants: https://www.ajmc.com/focus-of-the-week/physicians-are-pessimistic-about-future-of-healthcare-highlight-extent-of-social-determinants Physician Burnout Associated With Poorer Patient Outcomes: https://www.ajmc.com/focus-of-the-week/physician-burnout-associated-with-poorer-patient-outcomes Dr W. Clay Jackson Discusses Identifying, Addressing Clinician Burnout: https://www.ajmc.com/conferences/psychcongress2018/dr-w-clay-jackson-discusses-identifying-addressing-clinician-burnout Will HHS' Strategy to Address Health IT–Related Physician Burden Provide Relief for Providers? https://www.ajmc.com/focus-of-the-week/will-hhs-strategy-to-address-health-itndashrelated-physician-burden-provide-relief-for-providers After Increasing for Several Years, Physician Burnout Shows Modest Decline: https://www.ajmc.com/newsroom/after-increasing-for-several-years-physician-burnout-shows-modest-decline
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included CDC clarifying its opioid guidelines for chronic pain; pharmacy benefit managers testifying before a Senate committee; Sanofi expanding its insulin savings program starting in June.
Read more about the stories in this podcast: Oncologists, Hematologists Welcome CDC Clarification on Opioid Therapy for Chronic Pain: https://www.ajmc.com/newsroom/oncologists-hematologists-welcome-cdc-clarification-on-opioid-therapy-for-chronic-pain PBM Executives Tout Value Before Senate Finance Committee: https://www.ajmc.com/newsroom/pbm-executives-tout-value-before-senate-finance-committee Sanofi Offer Sets Monthly Price of $99 for Insulin Supply: https://www.ajmc.com/newsroom/sanofi-offers-set-monthly-price-of-99-for-insulin-supply Doctors More Likely to Overprescribe Antibiotics for Children During Telemedicine Visits: https://www.ajmc.com/focus-of-the-week/doctors-more-likely-to-overprescribe-antibiotics-for-children-during-telemedicine-visits Diabetes Management: Advances in Treatment and Management to Reduce Cost and Improve Outcomes: https://www.ajmc.com/meetings/ivbm-la-2019-04-17
As a former chief operating officer for a national diabetes supply, education, and support company, Tom Milam created programs for people with diabetes that served more than 100,000 members nationwide. His experience also includes a federal appointment providing advisory service to Medicare. His extensive experience and knowledge within the diabetes space allows Tom to offer us an expert view of CMS’ Competitive Bidding Program.
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included courts rejecting multiple health initiatives from the Trump administration; Congress heard more about rising insulin prices; a new agreement seeks standards for reporting social determinants of health.
Read more about the stories in this podcast: Federal Judge Strikes Down Medicaid Work Rules in Kentucky, Arkansas: https://www.ajmc.com/newsroom/federal-judge-strikes-down-medicaid-work-rules-in-kentucky-arkansas Judge Rules Trump's DOL Tried to Create "End Run" Around ACA With Association Health Plans: https://www.ajmc.com/newsroom/judge-rules-trumps-dol-tried-to-create-end-run-around-aca-with-association-health-plans Healthcare Availability, Affordability Most Pressing Worry, Gallup Poll Says: https://www.ajmc.com/newsroom/healthcare-availability-affordability-most-pressing-worry-gallup-poll-says House Subcommittee Hears About Impact of Rising Insulin Prices: https://www.ajmc.com/newsroom/house-subcommittee-hears-about-impact-of-rising-insulin-prices House Subcommittee Hears Insulin Concerns as FDA Advances Biosimilar Transition: https://www.centerforbiosimilars.com/news/house-subcommittee-hears-insulin-concerns-as-fda-advances-biosimilar-transition Senate Committee Discusses the Burden of High Drug Prices and Potential Solutions: https://www.ajmc.com/newsroom/senate-committee-discusses-the-burden-of-high-drug-prices-and-potential-solutions AMA, UnitedHealthcare Announce Collaboration to Better Identify, Address SDOH Through Data: https://www.ajmc.com/newsroom/ama-unitedhealthcare-announce-collaboration-to-better-identify-address-sdoh-through-data Louisiana Chooses Asegua to Partner for "Netflix" Subscription Model for HCV Treatment: https://www.ajmc.com/focus-of-the-week/louisiana-chooses-asegua-to-partner-for-netflix-subscription-model-for-hcv-treatment Evidence-Based Diabetes Management—March 2019: https://www.ajmc.com/journals/evidence-based-diabetes-management/2019/march-2019 Three Years After Advocates Report Flaws, Medicare Diabetes Test Strip Bidding Program Nears Collapse: https://www.ajmc.com/journals/evidence-based-diabetes-management/2019/march-2019/three-years-after-advocates-report-flaws-medicare-diabetes-test-strip-bidding-program-nears-collapse From the Editor-in-Chief: Halt the Glucose Test Strip Bidding Program Until It Can Be Fixed: https://www.ajmc.com/journals/evidence-based-diabetes-management/2019/march-2019/from-the-editorinchief-halt-the-glucose-test-strip-bidding-program-until-it-can-be-fixed
Dr. Elizabeth Mynatt, the executive director of the Institute for People and Technology and a professor in the College of Computing at the Georgia Institute of Technology discusses an app she and her team developed called MyPath that uses artificial intelligence to help guide a patient’s cancer journey.
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the Department of Justice siding with a federal judge in striking down the Affordable Care Act; FDA Commissioner Scott Gottlieb, MD, calling for stricter oversight of electronic health records; and a study finding that healthy eating in Medicare and Medicaid is cost effective.
Read more about the stories in this podcast: DOJ Reverses Course, Sides With Judge Striking Down ACA: https://www.ajmc.com/focus-of-the-week/doj-reverses-course-sides-with-judge-striking-down-aca House Democrats Unveil Bill Aimed at Shoring Up ACA Patient Protections, Affordability: https://www.ajmc.com/newsroom/house-democrats-unveil-bill-aimed-at-shoring-up-aca-patient-protections-affordability What We're Reading: EHR Oversight; Medicaid Expansion and CRC; Arkansas Work Requirements: https://www.ajmc.com/newsroom/what-were-reading-ehr-oversight-medicaid-expansion-and-crc-arkansas-work-requirements In Scott Gottlieb's Final Weeks as FDA Commissioner, Tying Up Loose Ends: https://www.ajmc.com/focus-of-the-week/in-scott-gottliebs-final-weeks-as-fda-commissioner-tying-up-loose-ends Incentivizing Healthy Eating in Medicare, Medicaid Is Cost Effective, Study Finds: https://www.ajmc.com/focus-of-the-week/incentivizing-healthy-eating-in-medicare-medicaid-is-cost-effective-study-finds PD-L1 Testing "Name of the Game" in First-Line Treatment of NSCLC: https://www.ajmc.com/conferences/nccn-2019/pdl1-testing-name-of-the-game-in-firstline-treatment-of-nsclc National Comprehensive Cancer Network Annual Conference 2019: https://www.ajmc.com/conferences/nccn-2019 Keeping an Eye on Increasing Competition in the Specialty Drug Pipeline: https://www.ajmc.com/conferences/amcp-2019/keeping-an-eye-on-increasing-competition-in-the-specialty-drug-pipeline The Academy of Managed Care Pharmacy 2019: https://www.ajmc.com/conferences/amcp-2019
In this week’s bonus podcast, we have a conversation from the Association of Community Cancer Centers (ACCC) 45th Annual Meeting & Cancer Center Business Summit, which was held March 21-22 in Washington, DC. The meeting marked the end of Tom Gallo’s year as president and the beginning of the yearlong presidency of Ali McBride, PharmD.
At the meeting, Gallo and McBride sat down to discuss how ACCC’s members feel about the state of cancer delivery, as well as recent trends that were highlighted in an annual report and their presidential themes.
Related articles: Envisioning the Future of Cancer Care: https://www.ajmc.com/conferences/accc-2019/envisioning-the-future-of-cancer-care Digital Health Lessons From Around the World: https://www.ajmc.com/conferences/accc-2019/digital-health-lessons-from-around-the-world Different Vantage Points, but Similar Goals of High-Value Care, Patient Satisfaction: https://www.ajmc.com/conferences/accc-2019/different-vantage-points-but-similar-goals-of-highvalue-care-patient-satisfaction ACCC 2019: On Location Interviews, Day 1: https://www.ajmc.com/onlocation/2019/accc-2019--on-location-interviews ACCC 2019: On Location Interviews, Day 2: https://www.ajmc.com/onlocation/2019/accc-2019-on-location-interviews-day-2
The presence of loneliness among older patients is significant and has gained the attention of healthcare stakeholders, with some warning that it could become and epidemic. Growing research has pointed to loneliness as a risk factor for adverse health outcomes, and stakeholders around the coutnry have taken on the challenge of addressing the issue. In 2017, CareMore Health introduced their Togetherness Program to focus on these patients’ psychological, social, and physical health.
During this podcast, we sit down with Sachin Jain, MD, president of CareMore Health, to find out more about the health effects of loneliness and how their togetherness program is impacting seniors.
Related articles: Efforts to Target Loneliness Reap Health Benefits, CareMore Finds: https://www.ajmc.com/focus-of-the-week/efforts-to-target-loneliness-reap-health-benefits-caremore-finds CareMore's Prescription for Loneliness Removes Barriers to Togetherness: https://www.ajmc.com/focus-of-the-week/caremores-prescription-for-loneliness-removes-barriers-to-togetherness CareMore's Togetherness Program Addresses a Symptom of Living With Chronic Illness: Loneliness: https://www.ajmc.com/journals/evidence-based-oncology/2018/august-2018/caremores-togetherness-program-addresses-a-symptom-of-living-with-chronic-illness-loneliness
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included new primary prevention guidelines that could increase the use of some diabetes drugs; the FDA expanded criteria for which patients can take part in clinical trials; a summit on value-based insurance design showed the need for tough conversations with stakeholders.
Read more about the stories in this podcast: Cardiovascular Prevention Guidelines Call for Less Aspirin, More SGLT2s, GLP-1s for Type 2 Diabetes: https://www.ajmc.com/conferences/acc-2019/cardiovascular-prevention-guidelines-call-for-less-aspirin-more-sglt2s-glp-1s-for-type-2-diabetes Giant Study Suggests Apple Watch Accurately Catches Atrial Fibrillation: https://www.ajmc.com/conferences/acc-2019/giant-study-suggests-apple-watch-accurately-catches-afib DECLARE: Dapagliflozin Offers Benefits for Diabetes Patients With Heart Failure: https://www.ajmc.com/conferences/acc-2019/declare-dapagliflozin-offers-benefits-for-diabetes-patients-with-heart-failure Amarin's High-Dose Fish Oil Pill Cuts Total CV Event Risk 30% in Study: https://www.ajmc.com/conferences/acc-2019/amarins-highdose-fish-oil-pill-cuts-total-cv-event-risk-30-in-study American College of Cardiology 2019: https://www.ajmc.com/conferences/acc-2019 FDA Expands Patient Inclusion Criteria for Cancer Clinical Trials: https://www.ajmc.com/focus-of-the-week/fda-expands-patient-inclusion-criteria-for-cancer-clinical-trials- Dr Janice Mehnert Discusses Including Patients With Comorbidities in Cancer Clinical Trials: https://www.ajmc.com/interviews/dr-janice-mehnert-discusses-including-patients-with-comorbidities-in-cancer-clinical-trials Reducing Low-Value Care May Mean Tough Conversations With Stakeholders: https://www.ajmc.com/conferences/vbid-summit-2019/reducing-lowvalue-care-may-mean-tough-conversations-with-stakeholders V-BID Summit 2019: https://www.ajmc.com/conferences/vbid-summit-2019 Participation in Community Groups Found to Increase Awareness of PrEP: https://www.ajmc.com/newsroom/participation-in-community-groups-found-to-increase-awareness-of-prep Newsletter Signup: https://www.ajmc.com/email-profile ACCC Annual Meeting & Cancer Center Business Summit: https://www.ajmc.com/conferences/accc-2019 National Comprehensive Cancer Network Annual Conference 2019: https://www.ajmc.com/conferences/nccn-2019
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the 2020 budget plan proposing a mix of healthcare spending cuts and increases; the FDA approving the first immunotherapy regimen for breast cancer; and researchers uncovering how sodium glucose co-transporter-2 inhibitors work.
Read more about the stories in this podcast: Proposed 2020 White House Budget Includes Block Grants, Medicaid Work Rules, Increased HIV Funding: https://www.ajmc.com/focus-of-the-week/proposed-2020-white-house-budget-includes-block-grants-medicaid-work-rules-increased-hiv-funding FDA Approves Atezolizumab Combination for Triple-Negative Breast Cancer: https://www.ajmc.com/newsroom/fda-approves-atezolizumab-combination-for-triplenegative-breast-cancer SGLT2 Inhibitors Work by Inducing Fasting State, Joslin Center Scientist Says: https://www.ajmc.com/newsroom/sglt2-inhibitors-work-by-inducing-fasting-state-joslin-center-scientist-says e-Cigarettes Boost Heart Attack Risk, Emotional Stress, Findings Show: https://www.ajmc.com/newsroom/ecigarettes-boost-heart-attack-risk-emotional-stress-findings-show
Understanding Barriers to Accessing Specialty Care Under Medicaid Expansion by Managed Care Cast
The federal government has been releasing a number of policies and proposals that will affect care delivery and are aimed at rising costs of care and prescription drugs.
Ted Okon, executive director of the Community Oncology Alliance (COA), sat down with Managed Care Cast to discuss a number of policies affecting COA’s members, including proposals around chimeric antigen receptor T-cell therapies, pharmacy benefit managers, and the Oncology Care Model.
Read more about the stories in this podcast: CMS Proposes That Patients Be Enrolled in Studies to Get Coverage for CAR T-Cell Therapy: https://www.ajmc.com/newsroom/cms-proposes-that-patients-be-enrolled-in-studies-to-get-coverage-for-car-tcell-therapy Ted Okon on Policy Priorities for COA in 2019: https://www.ajmc.com/conferences/coapayersummit2018/ted-okon-on-policy-priorities-for-coa-in-2019 COA's OCM 2.0: Moving Toward a Universal Payment Model: https://www.ajmc.com/conferences/coapayersummit2018/coas-ocm-20-moving-toward-a-universal-payment-model More Than 300 Groups Seek Halt to CMS' Plans for Global Drug Pricing Index: https://www.ajmc.com/newsroom/more-than-300-groups-seek-halt-to-cms-plans-for-global-drug-pricing-index Trump Proposes Allowing Medicare to Base Drug Prices on What Other Countries Pay: https://www.ajmc.com/newsroom/trump-proposes-allowing-medicare-to-base-drug-prices-on-what-other-countries-pay HHS Proposes to End Drug Rebates in Medicare, Medicaid Managed Care: https://www.ajmc.com/newsroom/hhs-proposes-to-end-drug-rebates-in-medicare-medicaid-managed-care
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included Scott Gottlieb, MD, resigning as FDA commissioner; Eli Lilly offering a discounted version of Humalog; another study dispels the myths around autism and the measles, mumps, and rubella vaccine.
Read more about the stories in this podcast: Dr Scott Gottlieb to Resign as FDA Commissioner: https://www.ajmc.com/newsroom/dr-scott-gottlieb-to-resign-as-fda-commissioner-reports-say Lilly to Launch Half-Price Version of Humalog: https://www.ajmc.com/newsroom/lilly-to-launch-halfprice-version-of-humalog What We're Reading: HIV Cured in Second Patient; Patients Question FDA; China Creating Ethics Committee: https://www.ajmc.com/newsroom/what-were-reading-hiv-cured-in-second-patient-patients-question-fda-china-creating-ethics-committee HIV Compendium: https://www.ajmc.com/compendium/hiv In Wake of Measles Outbreaks, Another Study Dispels Myths Surrounding MMR Vaccine: https://www.ajmc.com/newsroom/in-wake-of-measles-outbreaks-another-study-dispels-myths-surrounding-mmr-vaccine HIV, Vaccine Refusal, Delays Among Greatest Threats to Global Health, Says WHO: https://www.ajmc.com/newsroom/hiv-vaccine-refusal-delays-among-greatest-threats-to-global-health-says-who The American Journal of Managed Care—March 2019: https://www.ajmc.com/journals/issue/2019/2019-vol25-n3 Common Elements in Opioid Use Disorder Guidelines for Buprenorphine Prescribing: https://www.ajmc.com/journals/issue/2019/2019-vol25-n3/common-elements-in-opioid-use-disorder-guidelines-for-buprenorphine-prescribing
Realigning Accountability to Improve Population Healthcare Delivery Under MIPS by Managed Care Cast
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included pharmaceutical executives appearing before a Senate drug pricing hearing; HHS finalizing a Title X rule change; and an analysis that found travel and wait times for healthcare services come with a high price.
Read more about the stories in this podcast: Senate Committee Discusses the Burden of High Drug Prices and Potential Solutions: https://www.ajmc.com/newsroom/senate-committee-discusses-the-burden-of-high-drug-prices-and-potential-solutions Pharma Executives Call for Reforms to Medicare, Rebate System in Senate Hearing: https://www.ajmc.com/focus-of-the-week/pharma-executives-call-on-reforms-to-medicare-rebate-system-in-senate-hearing HHS Rule Bars Clinics That Perform Abortion, Make Referrals From Receiving Title X Funds: https://www.ajmc.com/newsroom/hhs-rule-bars-clinics-that-perform-abortion-make-referrals-from-receiving-title-x-funds HPV Vaccines Cut Cervical Cancer Rates, Study Shows: https://www.ajmc.com/newsroom/hpv-vaccination-safeguarding-against-cervical-cancer Travel, Wait Times for Healthcare Services Cost $89 Billion Annually: https://www.ajmc.com/focus-of-the-week/travel-wait-times-for-healthcare-services-cost-89-billion-annually American Academy of Allergy, Asthma and Immunology 2019: https://www.ajmc.com/conferences/aaaai-2019
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included CMS' proposal to cover chimeric antigen receptor T-cell therapy; a study faulting the FDA’s handling of fentanyl oversight; and breast surgeons calling for genetic testing for all patients with breast cancer.
Read more about the stories in this podcast: CMS Proposes That Patients Be Enrolled in Studies to Get Coverage for CAR T-Cell Therapy: https://www.ajmc.com/newsroom/cms-proposes-that-patients-be-enrolled-in-studies-to-get-coverage-for-car-tcell-therapy Study Criticizes FDA Safety Oversight of Rapid-Release Fentanyl: https://www.ajmc.com/newsroom/study-criticizes-fda-safety-oversight-of-rapidrelease-fentanyl Breast Surgeons Seek Genetic Testing for All Patients With Breast Cancer: https://www.ajmc.com/newsroom/breast-surgeons-seek-genetic-testing-for-all-patients-with-breast-cancer Greater Diet Drink Consumption Heightens Stroke Risk in Postmenopausal Women: https://www.ajmc.com/newsroom/greater-diet-drink-consumption-heightens-stroke-risk-in-postmenopausal-women Advancing Quality Oncology Care in the Evolving Value-Based Care Landscape: https://www.ajmc.com/ivbm-dallas
Improving Care While Reducing Costs Through ACOs and Other Value-Based Efforts by Managed Care Cast
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included increased demand for long-acting contraception since President Trump took office; a payer decision on an insulin pump alarmed diabetes advocates; and despite being involved in cancer treatment decisions, many primary care providers don't feel prepared to do so.
Read more about the stories in this podcast: Demand for Long-Acting Contraception Increased in Wake of Concerns About Birth Control Access: https://www.ajmc.com/focus-of-the-week/demand-for-longacting-contraception-increased-in-wake-of-concerns-about-birth-control-access JDRF Alarmed by Extension of UnitedHealthcare-Medtronic Pact to Youth With Type 1 Diabetes: https://www.ajmc.com/focus-of-the-week/jdrf-alarmed-by-extension-of-unitedhealthcaremedtronic-pact-to-youth-with-type1diabetes Despite Being Involved in Cancer Treatment Decisions, PCPs Lack Knowledge, Confidence: https://www.ajmc.com/focus-of-the-week/despite-being-involved-in-cancer-treatment-decisions-pcps-lack-knowledge-confidence Examining New Payment Ideas for Curative Therapies: https://www.ajmc.com/newsroom/examining-new-payment-ideas-for-curative-therapies Evidence-Based Oncology - February 2019: https://www.ajmc.com/journals/evidence-based-oncology/2019/february-2019 Rutgers' Janice Mehnert, MD, on Biomarkers, Being Inclusive in Clinical Trials, and Taking Time to Weigh the Options: https://www.ajmc.com/journals/evidence-based-oncology/2019/february-2019/rutgers-janice-mehnert-md-on-biomarkers-being-inclusive-in-clinical-trials-and-taking-time-to-weigh-the-options
Does Providing Women With Cesarean Delivery Rate Comparison Data Influence Hospital Choice? by Managed Care Cast
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included President Trump's State of the Union address highlighting healthcare; HHS Secretary Alex Azar taking on drug rebates; physicians asking Congress to fully implement the HITECH Act.
Read more about the stories in this podcast: Trump Highlights New Initiatives for Childhood Cancer, HIV in State of the Union: https://www.ajmc.com/newsroom/trump-highlights-new-initiatives-for-childhood-cancer-hiv-in-state-of-the-union Azar Promotes Efforts to Tackle Rebate System: https://www.ajmc.com/conferences/academyhealth-2019/azar-promotes-efforts-to-tackle-rebate-system AcademyHealth 2019 National Health Policy Conference: https://www.ajmc.com/conferences/academyhealth-2019 Campaign Seeks Push to Improve Usability of EHRs: https://www.ajmc.com/focus-of-the-week/campaign-seeks-push-to-improve-usability-of-ehrs Getting Ready for the Use of Real-World Evidence: https://www.ajmc.com/focus-of-the-week/getting-ready-for-the-use-of-realworld-evidence Does Comparing Cesarean Delivery Rates Influence Women’s Choice of Obstetric Hospital? https://www.ajmc.com/journals/issue/2019/2019-vol25-n2/does-comparing-cesarean-delivery-rates-influence-womens-choice-of-obstetric-hospital
Overheard at AcademyHealth: Health Policy, Social Determinants, and Data by Managed Care Cast
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included House and Senate hearings on the cost of prescription drugs; a study finding patients with diabetes can be safely switched to cheaper insulin; and the first non-chemotherapy combination being approved for the treatment of chronic lymphocytic leukemia.
Read more about the stories in this podcast: Senate Committee Discusses the Burden of High Drug Prices and Potential Solutions: https://www.ajmc.com/newsroom/senate-committee-discusses-the-burden-of-high-drug-prices-and-potential-solutions Medicare Patients With Type 2 Diabetes Safely Switched From Analog to Human Insulin, JAMA Study Finds: https://www.ajmc.com/newsroom/medicare-patients-with-type-2-diabetes-safely-switched-from-analog-to-human-insulin-ijamai-study-finds FDA Approves Ibrutinib Combination as Frontline Treatment for CLL: https://www.ajmc.com/newsroom/fda-approves-ibrutinib-combination-as-frontline-treatment-for-cll What Do Americans Think About Medicare for All? It Depends on What They Hear: https://www.ajmc.com/focus-of-the-week/what-do-americans-think-about-medicare-for-all-it-depends-on-what-they-hear Congress Doubles Down on High Drug Prices, but Is It More Talk Than Action? https://www.ajmc.com/focus-of-the-week/congress-doubles-down-on-high-drug-prices-but-is-it-more-talk-than-action The Drug Price Iceberg: More Than Meets the Eye: https://www.ajmc.com/journals/issue/2019/2019-vol25-n2/the-drug-price-iceberg-more-than-meets-the-eye
Discussing the Continuing Decline in Overall Cancer Mortality in the United States by Managed Care Cast
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the Institute for Clinical and Economic Review investigating rising drug prices; CMS expanding value-based insurance design; and researchers using a blood test to detect preclinical Alzheimer disease.
Read more about the stories in this podcast: What's Driving US Healthcare Costs? Stakeholders Weigh In: https://www.ajmc.com/focus-of-the-week/whats-driving-us-healthcare-costs-stakeholders-weigh-in ICER Will Review If Drug Price Hikes Are Supported by New Evidence: https://www.ajmc.com/newsroom/icer-will-review-if-drug-price-hikes-are-supported-by-new-evidence Report: Increasing Drug Prices, Shortages Causing Hospitals to Cut Staff, Putting Patient Safety at Risk: https://www.ajmc.com/focus-of-the-week/report-increasing-drug-prices-shortages-causing-hospitals-to-cut-staff-putting-patient-safety-at-risk What We're Reading: Insulin Costs Double; PhRMA's Record Spending; Causes of Liver Transplants: https://www.ajmc.com/newsroom/what-were-reading-insulin-costs-double-phrmas-record-spending-causes-of-liver-transplants CMS Expands VBID in Medicare Advantage, Increases Risk Sharing in Part D: https://www.ajmc.com/newsroom/cms-expands-vbid-in-medicare-advantage-increases-risk-sharing-in-part-d Researchers Use Blood Test to Detect Preclinical Alzheimer Disease Signs: https://www.ajmc.com/newsroom/researchers-use-blood-test-to-detect-preclinical-alzheimer-disease-signs Improving Care for Patients With Metastatic Breast Cancer: https://www.ajmc.com/peer-exchange/advances-metastatic-breast-cancer/improving-care-for-patients-with-metastatic-breast-cancer
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included a new investigation into drug prices; FDA Commissioner Scott Gottlieb, MD, provided updates on how the government shutdown is impacting FDA work; research found comorbidities impede clinical trial participation for patients with cancer.
Read more about the stories in this podcast: Biologics, Diabetes, Cancer Drugs on House Oversight Probe List: https://www.ajmc.com/newsroom/biologics-diabetes-cancer-drugs-on-house-oversight-probe-list HHS Medicare Drug Shift Plan Could Reduce Costs Overall but Raise Them for Some, Researchers Say: https://www.ajmc.com/newsroom/hhs-medicare-drug-shift-plan-could-reduce-costs-overall-but-raise-them-for-some-researchers-say What We're Reading: FDA Resumes Some Inspections; Walmart Leaves CVS' PBM Networks; Flu Season: https://www.ajmc.com/newsroom/what-were-reading-fda-resumes-some-inspections-walmart-leaves-cvss-pbm-networks-flu-season Comorbidities Impede Clinical Trial Participation Among Patients With Cancer: https://www.ajmc.com/focus-of-the-week/comorbidities-impede-clinical-trial-participation-among-patients-with-cancer Understanding What Drives Health Information Exchange Use During Postacute Care Transitions: https://www.ajmc.com/managed-care-cast/understanding-what-drives-health-information-exchange-use-during-postacute-care-transitions The American Journal of Managed Care—January 2019, Health IT Issue: https://www.ajmc.com/journals/issue/2019/2019-vol25-n1
Understanding What Drives Health Information Exchange Use During Postacute Care Transitions by Managed Care Cast
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the FDA commissioner discussing boosting drug competition; BMS offering details on its acquisition of Celgene; and cancer mortality rates declining for the 25th consecutive year.
Read more about the stories in this podcast: FDA's Scott Gottlieb, MD, Highlights Biosimilars Initiatives in J.P. Morgan Keynote Address: https://www.centerforbiosimilars.com/conferences/jp-morgan-2019/fdas-scott-gottlieb-md-highlights-biosimilars-initiatives-in-jp-morgan-keynote-address BMS, Celgene Discuss $74 Billion Acquisition During JP Morgan Healthcare Conference: https://www.ajmc.com/newsroom/bms-celgene-discuss-74-billion-acquisition-during-jp-morgan-healthcare-conference Cancer Mortality Rate Drops for the 25th Consecutive Year, but Socioeconomic Gap Widens: https://www.ajmc.com/focus-of-the-week/cancer-mortality-rate-drops-for-the-25th-consecutive-year-but-socioeconomic-gap-widens Rise of Marijuana Cries Out for Research, Regulation, Physicians Say: https://www.ajmc.com/focus-of-the-week/rise-of-marijuana-cries-out-for-research-regulation-physicians-say CVS Health CEO Outlines How Aetna Deal Will Benefit Customers: https://www.ajmc.com/newsroom/cvs-health-ceo-outlines-how-aetna-deal-will-benefit-customers
Last year was a big year for biosimilars in the United States with the number of FDA-approved biosimilars nearly doubling and major policy and regulatory developments taking place in 2018.
Kelly Davio, senior editor of AJMC's The Center for Biosimilars, highlights recent progress, how the US market compares with Europe, and what remains to be seen.
Read more: The Center for Biosimilars: https://www.centerforbiosimilars.com/ Stakeholders Weigh In on the Key Biosimilar Developments of 2018: https://www.centerforbiosimilars.com/news/stakeholders-weigh-in-on-the-key-biosimilar-developments-of-2018 Coherus Confirms That It Has Launched Its Pegfilgrastim Biosimilar, Udenyca: https://www.centerforbiosimilars.com/news/coherus-confirms-that-it-has-launched-its-pegfilgrastim-biosimilar-udenyca FDA Releases Biosimilar Action Plan: https://www.centerforbiosimilars.com/news/fda-releases-biosimilar-action-plan Pfizer Launches Epoetin Alfa Biosimilar, Retacrit, at 33.5% Discount to Reference Epogen: https://www.centerforbiosimilars.com/news/pfizer-launches-epoetin-alfa-biosimilar-retacrit-at-335-discount-to-reference-epogen Pfizer Becomes Latest to Settle With AbbVie Over Humira: https://www.centerforbiosimilars.com/news/pfizer-becomes-latest-to-settle-with-abbvie-over-humira
Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included a government shutdown affects healthcare; Democrats take control of the House; and AJMC® names its most influential person in healthcare.
Read more about the stories in this podcast: How the Partial Government Shutdown Will Affect Healthcare: https://www.ajmc.com/newsroom/how-the-partial-government-shutdown-will-affect-healthcare House Democrats Return to Power, Plan Hearings on ACA, Climate Change, Immigration Health: https://www.ajmc.com/newsroom/house-democrats-return-to-power-plan-hearings-on-aca-climate-change-immigration-health Readers Choose the Most Influential Person in Healthcare in 2018: https://www.ajmc.com/newsroom/readers-choose-the-most-influential-person-in-healthcare-in-2018 Trump Offers Blueprint to Drive Down Prescription Drug Prices; Targets Rebates, "Middlemen": https://www.ajmc.com/newsroom/-trump-offers-blueprint-to-drive-down-prescription-drug-prices-targets-rebates-middlemen 5 Things to Know About the FDA's Biosimilar Action Plan: https://www.ajmc.com/newsroom/5-things-to-know-about-the-fdas-biosimilar-action-plan FDA Takes Steps to Prevent Access to Flavored Tobacco Products, Ban Menthol Cigarettes: https://www.ajmc.com/newsroom/fda-takes-steps-to-prevent-access-to-flavored-tobacco-products-ban-menthol-cigarettes What We're Reading: ACA to Remain in Place During Appeal; Cigarette Ban in Pharmacies; Judge Blocks 340B Cuts: https://www.ajmc.com/newsroom/what-were-reading-aca-to-remain-in-place-during-appeal-cigarette-ban-in-pharmacies-judge-blocks-340b-cuts Evidence-Based Diabetes Management—December 2018: https://www.ajmc.com/journals/evidence-based-diabetes-management/2018/december-2018
To start 2019, Managed Care Cast, the podcast of The American Journal of Managed Care® is taking a look back at 2018. At the end of the year AJMC® had polled readers on 5 big news stories from the year to gauge which one they thought was the most important. Here, Laura Joszt, associate editorial director, and Jaime Rosenberg, assistant editor, discuss these healthcare news stories and reveal which one was named the most important of 2018.
Read more about the papers and news events mentioned: 5 Healthcare-Related Ballot Measures From the 2018 Midterm Elections: https://www.ajmc.com/newsroom/5-healthcarerelated-ballot-measures-from-the-2018-midterm-elections Tracking Medicaid Expansion: https://www.ajmc.com/newsroom/tracking-medicaid-expansion Advocates Lambast Growing Number of Uninsured in Arkansas Due to Work Rules: https://www.ajmc.com/newsroom/advocates-lambast-growing-number-of-uninsured-in-arkansas-due-to-work-rules CMS Will Allow Medicare Advantage Plans to Use Step Therapy to Negotiate Drug Prices: https://www.ajmc.com/newsroom/cms-will-allow-medicare-advantage-plans-to-use-step-therapy-to-negotiate-drug-prices Trump Administration Finalizes Rule for Short-Term, Limited Duration Health Plans: https://www.ajmc.com/newsroom/trump-administration-finalizes-rule-for-shortterm-limited-duration-health-plans As ACA Enrollment Begins, What's Included in Some Short-Term Insurance Plans? https://www.ajmc.com/newsroom/as-aca-enrollment-begins-whats-included-in-some-shortterm-insurance-plans Federal Judge Strikes Down Affordable Care Act: https://www.ajmc.com/newsroom/federal-judge-strikes-down-affordable-care-act In the Wake of ACA Ruling, the Only Thing Certain Is Uncertainty: https://www.ajmc.com/focus-of-the-week/in-the-wake-of-aca-ruling-the-only-thing-certain-is-uncertainty Looking Back and Ahead: AJMC®'s Editors-in-Chief Recap 2018 and Make Predictions for 2019: https://www.ajmc.com/managed-care-cast/looking-back-and-ahead-iajmcisupregsups-editorsinchief-recap-2018-and-make-predictions-for-2019 CDC Data: Life Expectancy Decreases as Deaths From Suicide, Drug Overdose Increase: https://www.ajmc.com/focus-of-the-week/cdc-data-life-expectancy-decreases-as-deaths-from-suicide-drug-overdose-increase
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, we recapped the top news from 2018 with a look at policy changes, new research, decisions at the polls, and more.
Read more about the stories in this podcast: As ACA Enrollment Begins, What's Included in Some Short-Term Insurance Plans? https://www.ajmc.com/newsroom/as-aca-enrollment-begins-whats-included-in-some-shortterm-insurance-plans Federal Judge Strikes Down Affordable Care Act: https://www.ajmc.com/newsroom/federal-judge-strikes-down-affordable-care-act Tracking Medicaid Expansion: https://www.ajmc.com/newsroom/tracking-medicaid-expansion CDC Data: Life Expectancy Decreases as Deaths From Suicide, Drug Overdose Increase: https://www.ajmc.com/focus-of-the-week/cdc-data-life-expectancy-decreases-as-deaths-from-suicide-drug-overdose-increase Praluent Cuts Deaths by 29% for Those With Highest Cholesterol Levels, ODYSSEY Finds: https://www.ajmc.com/conferences/acc-2018/praluent-cuts-deaths-by-29-for-those-with-highest-cholesterol-levels-odyssey-finds Phase 3 TAILORx Results Confirm Chemotherapy Unnecessary in 70% of Women With Early-Stage Breast Cancer: https://www.ajmc.com/conferences/asco-2018/phase-3-tailorx-results-confirm-chemotherapy-unnecessary-in-70-of-women-with-earlystage-breast-cancer Choosing Wisely Clinical Decision Support Adherence and Associated Inpatient Outcomes: https://www.ajmc.com/journals/issue/2018/2018-vol24-n8/choosing-wisely-clinical-decision-support-adherence-and-associated-inpatient-outcomes
As 2018 draws to a close, The American Journal of Managed Care® (AJMC®)'s co-editors-in-chief, A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan, and Michael E. Chernew, PhD, director of the Healthcare Markets and Regulation Lab at Harvard Medical School, recapped their favorite AJMC® papers published in 2018, identified events from the year that are likely to impact future research in the journal, and looked ahead to 2019 with healthcare and health policy predictions.
Read more about the papers and news events mentioned: Financial Burden of Healthcare Utilization in Consumer-Directed Health Plans: https://www.ajmc.com/journals/issue/2018/2018-vol24-n4/financial-burden-of-healthcare-utilization-in-consumer-directed-health-plans A Randomized, Pragmatic, Pharmacist-Led Intervention Reduced Opioids Following Orthopedic Surgery: https://www.ajmc.com/journals/issue/2018/2018-vol24-n11/a-randomized-pragmatic-pharmacistled-intervention-reduced-opioids-following-orthopedic-surgery Overall US Healthcare Spending Growth Slowed for Second Year, CMS Says: https://www.ajmc.com/focus-of-the-week/overall-us-healthcare-spending-growth-slows-for-second-year-cms-says Levers to Reduce Use of Unnecessary Services: Creating Needed Headroom to Enhance Spending on Evidence-Based Care: https://www.ajmc.com/journals/issue/2018/2018-vol24-n8/levers-to-reduce-use-of-unnecessary-services-creating-needed-headroom-to-enhance-spending-on-evidencebased-care Addressing Low-Value Care and a Better Benefit Design at the V-BID Summit: https://www.ajmc.com/managed-care-cast/addressing-lowvalue-care-and-a-better-benefit-design-at-the-vbid-summit Federal Judge Strikes Down Affordable Care Act: https://www.ajmc.com/newsroom/federal-judge-strikes-down-affordable-care-act In the Wake of ACA Ruling, the Only Thing Certain Is Uncertainty: https://www.ajmc.com/focus-of-the-week/in-the-wake-of-aca-ruling-the-only-thing-certain-is-uncertainty
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included a federal judge ruling that the Affordable Care Act is unconstitutional; new diabetes standards address cardiovascular risk; efforts targeting loneliness show improved health outcomes.
Read more about the stories in this podcast: Federal Judge Strikes Down Affordable Care Act: https://www.ajmc.com/newsroom/federal-judge-strikes-down-affordable-care-act ADA Embraces CV Risk Calculator, Calls for Using GLP-1s Before Insulin in Type 2 Diabetes: https://www.ajmc.com/newsroom/ada-embraces-cv-risk-calculator-calls-for-using-glp1s-before-insulin-in-type-2-diabetes Efforts to Target Loneliness Reap Health Benefits, CareMore Finds: https://www.ajmc.com/focus-of-the-week/efforts-to-target-loneliness-reap-health-benefits-caremore-finds CareMore's Togetherness Program Addresses a Symptom of Living With Chronic Illness: Loneliness: https://www.ajmc.com/journals/evidence-based-oncology/2018/august-2018/caremores-togetherness-program-addresses-a-symptom-of-living-with-chronic-illness-loneliness Report Assesses Degree of Alignment Between ASCO, ESMO Oncology Frameworks: https://www.ajmc.com/newsroom/report-assesses-degree-of-alignment-between-asco-esmo-oncology-frameworks Increased Healthcare Utilization and Expenditures Associated With Chronic Opioid Therapy: https://www.ajmc.com/journals/ajac/2018/2018-vol6-n4/increased-healthcare-utilization-and-expenditures-associated-with-chronic-opioid-therapy
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included a report that found uninsured rates were on the rise in 2017; an analysis of rising health insurance costs for families; predictions for cardiology trends in 2019.
Read more about the stories in this podcast: Rate of Uninsured Increased in 2017 for the First Time Since 2014: https://www.ajmc.com/newsroom/rate-of-uninsured-increased-in-2017-for-the-first-time-since-2014 Health Insurance Cost Burden Increased Sharply in 2017 for Families: https://www.ajmc.com/focus-of-the-week/health-insurance-cost-burden-increased-sharply-in-2017-for-families What We're Reading: ACA Sign-Ups Surge; Zika Developmental Delays; Breastfeeding and Liver Disease: https://www.ajmc.com/newsroom/what-were-reading-aca-signups-surge-zika-developmental-delays-breastfeeding-and-liver-disease Cardiologists See More Direct Oral Anticoagulants, Value Discussion of PCSK9s, and Technology in 2019: https://www.ajmc.com/newsroom/cardiologists-see-more-direct-oral-anticoagulants-value-discussion-of-pcsk9s-and-technology-in-2019 Evidence-Based Oncology—December 2018: https://www.ajmc.com/journals/evidence-based-oncology/2018/december-2018 The Future of Cancer Care: https://www.ajmc.com/journals/evidence-based-oncology/2018/december-2018/the-future-of-cancer-care
Using Cost Variation to Identify Savings Opportunities Under the OCM by Managed Care Cast
Who sets the price for medications and other supplies used in hospitals and why are there shortages of some of these items? Martin Makary, MD, MPH, a surgical oncologist and chief of the Johns Hopkins Islet Transplant Center as well as executive director of Choosing Wisely, discussed this issue and its ramifications for healthcare costs.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included a CDC report that found life expectancy in the United States declined again; telemedicine use among physicians remains low; another study added to the debate over who should take statins.
Read more about the stories in this podcast: CDC Data: Life Expectancy Decreases as Deaths From Suicide, Drug Overdose Increase: www.ajmc.com/focus-of-the-week/cdc-data-life-expectancy-decreases-as-deaths-from-suicide-drug-overdose-increase Report Uncovers Rising Death Rates Among Whites at Midlife, Citing Addiction, Suicide, and Pain: www.ajmc.com/focus-of-the-week/report-uncovers-rising-death-rates-among-whites-at-midlife-citing-addiction-suicide-and-pain Telemedicine Use Among Physicians Remains Relatively Low: https://www.ajmc.com/focus-of-the-week/telemedicine-use-among-physicians-remains-relatively-low New Study Adds to Debate Over Statin Use to Prevent CVD: https://www.ajmc.com/newsroom/new-study-adds-to-debate-over-statin-use-to-prevent-cvd Real-World Evidence With Axicabtagene Ciloleucel CAR T Treatment Similar to ZUMA-1 Trial Findings: https://www.ajmc.com/conferences/ash-2018/realworld-evidence-with-axicabtagene-ciloleucel-car-t-treatment-similar-to-zuma1-trial-findings Length of Hospital Stay Key Driver of Costs Associated With CRS Following CAR T Treatment: https://www.ajmc.com/conferences/ash-2018/length-of-hospital-stay-key-driver-of-costs-associated-with-crs-following-car-t-treatment Dr Theresa Keegan: AYAs Continue to Be Underrepresented in Clinical Trials: https://www.ajmc.com/conferences/ash-2018/dr-theresa-keegan-ayas-continue-to-be-underrepresented-in-clinical-trials American Society of Hematology Annual Meeting & Exposition: https://www.ajmc.com/conferences/ash-2018 The American Journal of Accountable Care—December 2018: https://www.ajmc.com/journals/ajac/2018/2018-vol6-n4 Mental Health and Diabetes Control Among Vulnerable Primary Care Patients: https://www.ajmc.com/journals/ajac/2018/2018-vol6-n4/mental-health-and-diabetes-control-among-vulnerable-primary-care-patients
Attention deficit hyperactivity disorder, or ADHD, is one of the most common conditions in childhood and is often treated by primary care providers. Earlier this year, the Agency for Healthcare Research and Quality published a comparative effectiveness review called Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents.
The lead author of the report, Alex R. Kemper, MD, MPH, MS, discussed the key findings with Managed Care Cast. Kemper, a board-certified pediatrician and chief of the division of ambulatory pediatrics at Nationwide Children’s Hospital, talked about what doctors and families need to know in order to understand the best treatment options.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included a CMS plan for changes in drug coverage that brought a wave of criticism; a government task force recommended more people at risk for HIV take pre-exposure prophylaxis, known as PrEP; the American College of Cardiology issued an Expert Consensus Pathway on treatment of patients with type 2 diabetes and atherosclerotic cardiovascular disease.
Read more about the stories in this podcast: CMS Aims at Drug Prices Through Part D, MA Step Therapy, Pharmacy Rebates: https://www.ajmc.com/newsroom/cms-aims-at-drug-prices-through-part-d-ma-step-therapy-pharmacy-rebates CMS Finalizes New Structure to Move Home Health to Value-Based Payment: https://www.ajmc.com/newsroom/cms-finalizes-new-structure-to-move-home-health-to-valuebased-payment USPSTF Recommends Clinicians Prescribe HIV PrEP to All High-Risk Patients: https://www.ajmc.com/newsroom/uspstf-recommends-clinicians-prescribe-hiv-prep-to-all-highrisk-patients ACC Pathway Finds Empagliflozin "Preferred" SGLT2 Therapy for Patients With Type 2 Diabetes, ASCVD: https://www.ajmc.com/newsroom/acc-pathway-finds-empagliflozin-preferred-sglt2-therapy-for-patients-with-type-2-diabetes-ascvd American Society of Hematology Annual Meeting & Exposition: https://www.ajmc.com/conferences/ash-2018 Twitter: @EBOncology: https://twitter.com/eboncology
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included HHS Secretary Alex Azar hinting that the government may get more involved in addressing social needs impacting health; work rules in Arkansas cost thousands their Medicaid coverage; research finds a shorter course of hepatitis C treatment may be just as effective as the full course of treatment.
Read more about the stories in this podcast: Azar: CMMI Will Get More Involved in Addressing Social Needs Driving Health Issues: www.ajmc.com/focus-of-the-week/azar-cmmi-will-get-more-involved-in-addressing-social-needs-driving-health-issues Advocates Lambast Growing Number of Uninsured in Arkansas Due to Work Rules: www.ajmc.com/newsroom/advocates-lambast-growing-number-of-uninsured-in-arkansas-due-to-work-rules Shortening Treatment Time Maintains Efficacy, Saves Costs in Hepatitis C: www.ajmc.com/newsroom/shortening-treatment-time-maintains-efficacy-saves-costs-in-hepatitis-c Stricter Blood Pressure Guidelines Could Prevent Cardiovascular Events, but Debate Continues: www.ajmc.com/focus-of-the-week/stricter-blood-pressure-guidelines-could-prevent-cardiovascular-events-but-debate-continues The American Journal of Managed Care® Names Dr Erin Trish as the 2018 Recipient of the Seema S. Sonnad Emerging Leader in Managed Care Research Award: www.ajmc.com/press-release/the-american-journal-of-managed-careisupregsup-names-dr-erin-trish-as-the-2018-recipient-of-the-seema-s-sonnad-emerging-leader-in-managed-care-research-award AMA's McAneny Calls for Real-time Oncology Payment Model Led by Physicians: www.ajmc.com/conferences/pcoc2018/mcaneny-calls-for-realtime-oncology-payment-model-led-by-physicians Patient-Centered Oncology Care 2018: www.ajmc.com/conferences/pcoc2018
A lot of healthcare is simply exchange of information, but the current healthcare system doesn’t allow for that exchange to happen in a convenient way. The Network for Excellence in Health Innovation (NEHI) has released a new roadmap that reinvents healthcare in the United States through the use of technology.
Susan Dentzer, president and CEO of NEHI, discusses the Health Care Without Walls model of care, how it would improve care, as well as physician work satisfaction, and what it would take to implement such a system.
Read more about NEHI and telehealth: NEHI Recommends Implementing Value-Based Contracts With High-Cost Oncology Treatments: https://www.ajmc.com/newsroom/nehi-recommends-implementing-valuebased-contracts-with-highcost-oncology-treatments- Getting Telehealth Right: Engaging Patients and Providers: https://www.ajmc.com/conferences/acr-2016/getting-telehealth-right--engaging-patients-and-providers-virtually-in-health-wellness-and-treatment More Patients Willing to Switch to Telehealth Providers: https://www.ajmc.com/newsroom/more-patients-willing-to-switch-to-telehealth-providers Telemedicine: The Cost-Effective Future of Healthcare: https://www.ajmc.com/contributor/john-rehm/2016/12/telemedicine-the-cost-effective-future-of-healthcare Telehealth Use Limited in Some Federal Health Programs, GAO Finds: https://www.ajmc.com/focus-of-the-week/telehealth-use-limited-in-some-federal-health-programs-gao-finds
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included research that showed cancer surpassed cardiovascular disease to be the leading cause of death in high-income counties; HHS Secretary Alex Azar announced a new mandatory payment model is coming to oncology; a policy change could make mental health treatment more available.
Read more about the stories in this podcast: Cancer Surpasses CVD as Leading Cause of Death in High-Income Counties: https://www.ajmc.com/focus-of-the-week/cancer-surpasses-cvd-as-leading-cause-of-death-in-highincome-counties Azar Announces Mandatory Oncology Payment Model Is Coming: https://www.ajmc.com/newsroom/azar-announces-mandatory-oncology-payment-model-is-coming HHS Lifting IMD Exclusion for Medicaid Payment for Inpatient Mental Health Treatment: https://www.ajmc.com/newsroom/hhs-lifting-imd-exclusion-for-medicaid-payment-for-inpatient-mental-health-treatment Gallup-Sharecare Report Shows How Diabetes Ranks Grew Across the US: https://www.ajmc.com/newsroom/gallupsharecare-report-shows-how-diabetes-ranks-grew-across-the-us The American Journal of Managed Care—November 2018: https://www.ajmc.com/journals/issue/2018/2018-vol24-n11
Using Community-Based Care Management to Lower Service Use, Spending Among High-Risk Patients by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included Medicaid expansion wins at the ballot box; new melanoma guidelines that promote recommended treatments and discuss genetic testing; research found high blood pressure in young adults predicts future cardiovascular events.
Read more about the stories in this podcast: What We're Reading: Midterm Elections, Healthcare Edition—Medicaid Expansion, Ballot Measures, Single Payer: https://www.ajmc.com/newsroom/what-were-reading-midterm-elections-healthcare-edition-medicaid-expansion-ballot-measures-single-payer New Melanoma Guidelines Identify Recommended Treatments, Weigh in on Genetic Testing: https://www.ajmc.com/focus-of-the-week/new-melanoma-guidelines-identify-recommended-treatments-weigh-in-on-genetic-testing High Blood Pressure in Young Adults Indicative of CVD Events Later in Life: https://www.ajmc.com/focus-of-the-week/high-blood-pressure-in-young-adults-indicative-of-cvd-events-later-in-life Elizabeth Stringer Explains Veterans' Risk of Opioid Abuse: https://www.ajmc.com/interviews/elizabeth-stringer-explains-veterans-risk-of-opioid-abuse Deploying Data to Prevent Opioid Abuse in At-Risk Patients: https://www.ajmc.com/focus-of-the-week/deploying-data-to-prevent-opioid-abuse-in-atrisk-patients Patient-Centered Oncology Care®: https://www.ajmc.com/pcoc2018
Heard at Psych Congress: Clinical Impacts of Stigma Surrounding Mental Illness by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care new included a proposal to allow Medicare to pay the same prices for certain drugs as what other countries pay; President Donald Trump signed a law to fight the opioid crisis; an FDA advisory panel voted narrowly to retain a 10-year-old guidance for safety trials for diabetes drugs.
Read more about the stories in this podcast: Trump Proposes Allowing Medicare to Base Drug Prices on What Other Countries Pay: https://www.ajmc.com/newsroom/trump-proposes-allowing-medicare-to-base-drug-prices-on-what-other-countries-pay Will Bipartisan US Opioid Law Go Far Enough to Save Lives? https://www.ajmc.com/newsroom/will-bipartisan-us-opioid-law-go-far-enough-to-save-lives Narrow Vote Calls for Keeping Drug Safety Trials, but Many See Changes: https://www.ajmc.com/focus-of-the-week/narrow-vote-calls-for-keeping-drug-safety-trials-but-many-see-changes Survivors of Head and Neck Cancers Have an Elevated Risk for Suicide: https://www.ajmc.com/focus-of-the-week/survivors-of-head-and-neck-cancers-have-an-elevated-risk-for-suicide Community Oncology Alliance (COA) Payer Exchange Summit 2018: https://www.ajmc.com/conferences/coapayersummit2018
Recently, Barbara McAneny, MD, the current president of the American Medical Association (AMA), visited The American Journal of Managed Care® (AJMC®)’s office for a wide-ranging discussion on new payment models, transforming care, and the work of the AMA.
McAneny is an oncologist who has been at the forefront of transforming care for patients with cancer. In 2012 she and her organization, Innovative Oncology Business Solutions, received a $19.76 million grant by the Center for Medicare and Medicaid Innovation to develop a community oncology medical home model. The model was implemented in 7 practices and aimed to improve patient care, outcomes, and satisfaction, while reducing costs.
She will be the keynote speaker November 16 in Philadelphia at Patient-Centered Oncology Care®, AJMC®’s annual multistakeholder meeting featuring payers, providers, and patient advocates.
Read more: The Future of Oncology? COME HOME, the Oncology Medical Home: https://www.ajmc.com/journals/evidence-based-oncology/2013/2013-1-vol19-sp1/the-future-of-oncology-come-home-the-oncology-medical-home/ AMA Chooses Oncologist Dr Barbara McAneny to Lead as President-Elect: https://www.ajmc.com/newsroom/ama-chooses-oncologist-dr-barbara-mcaneny-to-lead-as-president-elect Patient-Centered Oncology Care®: www.ajmc.com/pcoc2018 Implications of OCM Reports and the Future of the Program: https://www.ajmc.com/newsroom/implications-of-ocm-reports-and-the-future-of-the-program The Price of Innovation When Improving Cancer Care Delivery: https://www.ajmc.com/conferences/accc-2018/the-price-of-innovation-when-improving-cancer-care-delivery
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the Trump administration giving governors the power to overhaul section 1332 waivers under the Affordable Care Act (ACA); CMS disclosed a breach in the portal that agents and brokers use to assist consumers signing up for health coverage under the ACA; about one-third of all US healthcare payments in 2017 were tied to alternative payment models.
Read more about the stories in this podcast: Trump Administration Gives States More Power to Alter ACA Exchange Offerings: https://www.ajmc.com/newsroom/trump-administration-gives-states-more-power-to-alter-aca-exchange-offerings CMS Reports Data Breach in ACA Agent and Broker Portal: https://www.ajmc.com/focus-of-the-week/cms-reports-data-breach-in-aca-agent-and-broker-portal CMS Cuts Budget for ACA Marketing to $10 Million for 2019 Plan Year: https://www.ajmc.com/newsroom/cms-cuts-budget-for-aca-marketing-to-10-million-for-2019-plan-year Payments Are Increasingly Tied to Value, but More Risk-Based Models Needed: https://www.ajmc.com/newsroom/payments-are-increasingly-tied-to-value-but-more-riskbased-models-needed Drug Market to See More Competition, Launch of Biosimilars in 2019: https://www.ajmc.com/conferences/amcpnexus2018/drug-market-to-see-more-competition-launch-of-biosimilars-in-2019 The Academy of Managed Care Pharmacy Nexus 2018: https://www.ajmc.com/conferences/amcpnexus2018 Psych Congress 2018: https://www.ajmc.com/conferences/psychcongress2018 Dr Barbara McAneny Discusses the Effect of OCM's Second Performance Period Results: https://www.ajmc.com/interviews/dr-barbara-mcaneny-discusses-the-effect-of-ocms-second-performance-period-results Patient-Centered Oncology®: https://www.ajmc.com/pcoc2018
A survivor of chronic lymphocytic leukemia who participated in the first CAR T trial in 2010 looks back at his experience and also discusses his views on how patient-reported outcomes (PROs) should be used, if at all, by the Centers for Medicare and Medicaid (CMS).
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the Trump administration unveiling plans to include drug prices in television ads; CMS touted Medicare Advantage at the beginning of open enrollment for Medicare; research found Medicare beneficiaries who live in housing with support services stay out of the hospital.
Read more about the stories in this podcast: Trump Officials Outline Plan to Put Drug Prices in TV Ads: https://www.ajmc.com/newsroom/trump-officials-outline-plan-to-put-drug-prices-in-tv-ads Verma Talks Up Medicare Advantage Growth at Insurance Industry Meeting: https://www.ajmc.com/newsroom/verma-talks-up-medicaid-advantage-growth-at-insurance-industry-meeting CMS Will Allow Medicare Advantage Plans to Use Step Therapy to Negotiate Drug Prices: https://www.ajmc.com/newsroom/cms-will-allow-medicare-advantage-plans-to-use-step-therapy-to-negotiate-drug-prices UnitedHealthcare Names 3 Biosimilars Preferred Treatments in 2019 MA Plans: https://www.centerforbiosimilars.com/news/unitedhealthcare-names-3-biosimilars-preferred-treatments-in-2019-ma-plans What We're Reading: Promoting Pediatric Cancer Research; Mystery Paralysis; Cost of Being Sick: https://www.ajmc.com/newsroom/what-were-reading-promoting-pediatric-cancer-research-mystery-paralysis-cost-of-being-sick Affordable Housing With Supportive Services Leads to Reduced Hospital Use Among Seniors: https://www.ajmc.com/focus-of-the-week/affordable-housing-with-supportive-services-leads-to-reduced-hospital-use-among-seniors Evidence-Based Oncology—October 2018: https://www.ajmc.com/journals/evidence-based-oncology/2018/october-2018
Examining Health-Related Challenges Puerto Rico Still Faces a Year After Hurricane Maria by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the Department of Justice giving the green light for the CVS–Aetna merger; premiums for employer insurance plans are on the rise; and the new North American trade deal includes protections for drug makers that will hurt biosimilars.
Read more about the stories in this podcast: Justice Department Clears $68 Billion CVS–Aetna Merger: https://www.ajmc.com/newsroom/justice-department-clears-68-billion-cvsndashaetna-merger Premiums for Employer-Sponsored Family Insurance Increased 5% in 2018: https://www.ajmc.com/focus-of-the-week/premiums-for-employersponsored-family-insurance-increased-5-in-2018 What We're Reading: HealthCare.gov Maintenance; USMCA Drug Exclusivity; Medicare Telemedicine Proposal: https://www.ajmc.com/newsroom/what-were-reading-healthcaregov-maintenance-usmca-drug-exclusivity-medicare-telemedicine-proposal Food Insecurity, Unaffordable Care Linked With Widening Disparities in Cancer Deaths: https://www.ajmc.com/focus-of-the-week/food-insecurity-unaffordable-care-linked-with-widening-disparities-in-cancer-deaths National Association of ACOs Fall 2018: https://www.ajmc.com/conferences/naacos-fall2018
As healthcare costs continue to increase, health systems are trying to better understand resource utilization among providers. The use of feedback reports can document physician practice patterns and increase accountability for resource use to prevent overuse and misuse.
A new paper in the October issue of The American Journal of Managed Care measured changes in ordering rates for 4 resource use measures before and after dissemination of physician feedback reports. Lead author Eva Chang, PhD, of RTI International, discussed the findings and how the impact of the feedback reports varied depending on physician experience.
Read the study and related research: Primary Care Physician Resource Use Changes Associated With Feedback Reports: https://www.ajmc.com/journals/issue/2018/2018-vol24-n10/primary-care-physician-resource-use-changes-associated-with-feedback-reports The American Journal of Managed Care—October 2018: https://www.ajmc.com/journals/issue/2018/2018-vol24-n10 Tackling Antibiotic Prescribers' Behaviors for Respiratory Infections at the VA: https://www.ajmc.com/newsroom/tackling-antibiotic-prescribers-behaviors-for-respiratory-infections-at-the-va Impact of Weekly Feedback on Test Ordering Patterns: https://www.ajmc.com/journals/issue/2015/2015-vol21-n11/impact-of-weekly-feedback-on-test-ordering-patterns
CMS’ accountable care organization program, the Medicare Shared Savings Program, could potentially be undergoing some big changes. During the recent fall 2018 meeting of the National Association of ACOs, the proposed changes were top of mind. Attendees were most concerned about how the faster timeline to taking on risk would impact participation, but were pleased with changes to the benchmark and risk adjustment.
In this episode of Managed Care Cast, stakeholders at accountable care organizations (ACOs) and policy experts discuss the proposed changes and what impact they believe they will have on ACO participation.
Read more about the stories in this podcast: CMS Plans to Overhaul MSSP Program to Force More Risk on ACOs: https://www.ajmc.com/newsroom/cms-plans-to-overhaul-mssp-program-to-force-more-risk-on-acos Proposed Rule for Medicare ACOs Includes Notable Changes for Rural Providers: https://www.ajmc.com/contributor/caravan-health/2018/09/proposed-rule-for-medicare-acos-includes-notable-changes-for-rural-providers CMS Proposal Is a Start for Making Risk More Appealing to ACOs: https://www.ajmc.com/contributor/travis-broome/2018/08/cms-proposal-is-a-start-for-making-risk-more-appealing-to-acos MSSP Proposal Better Measures Risk With Changes to the Benchmark Methodology: https://www.ajmc.com/contributor/travis-broome/2018/09/mssp-proposal-better-measures-risk-with-changes-to-the-benchmark-methodology MSSP Changes Present Opportunities, but Likely to Decrease Number of ACOs, NAACOS Says: https://www.ajmc.com/newsroom/mssp-changes-present-opportunities-but-likely-to-decrease-number-of-acos-naacos-says Physician ACOs Associated With Growing MSSP Savings Over 3 Years: https://www.ajmc.com/newsroom/physician-acos-associated-with-growing-mssp-savings-over-3-years
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the Nobel Prize in Medicine was awarded to 2 people for research into immunotherapy; physician-run accountable care organizations bring savings for Medicare; research highlights the health impacts of sexual harassment and assault.
Read more about the stories in this podcast: Nobel Prize Recognizes Discoveries With T Cells in Immunotherapy: https://www.ajmc.com/focus-of-the-week/nobel-prize-recognizes-discoveries-with-t-cells-in-immunotherapy The Long Road: Nobel Prize Winner James Allison Highlights the Value of Research: https://www.ajmc.com/newsroom/the-long-road-nobel-prize-winner-james-allison-highlights-the-value-of-research Physician ACOs Associated With Growing MSSP Savings Over 3 Years: https://www.ajmc.com/newsroom/physician-acos-associated-with-growing-mssp-savings-over-3-years What We're Reading: Demand for Antibiotics; FDA Inspects Juul; Fast Food Consumption: https://www.ajmc.com/newsroom/what-were-reading-demand-for-antibiotics-fda-inspects-juul-fast-food-consumption Sexual Assault, Harassment Raise Women's Risk for Physical and Mental Health Issues: https://www.ajmc.com/focus-of-the-week/sexual-assault-harassment-raise-womens-risk-for-physical-and-mental-health-issues Evidence-Based Diabetes Management—September 2018: https://www.ajmc.com/journals/evidence-based-diabetes-management/2018/september-2018
Employers may not look forward to purchasing healthcare, but they are in the position to transform the market. Key opinion leaders like Suzanne Delbanco, PhD, MPH, of Catalyst for Payment Reform; Brian Marcotte of the National Business Group on Health; and Judy Berger of Southwest Airlines, discuss how employers are getting more involved in healthcare by championing alternative payment models and other more services to their employees.
Learn more about the most recent news and updates in Medicaid: Employers Play an Increasingly Important Role in the Move to Value-Based Care: www.ajmc.com/conferences/acdc-spring-2018/employers-play-an-increasingly-important-role-in-the-move-to-valuebased-care Employer Support Is Needed to Help Payment Reform Succeed: www.ajmc.com/newsroom/employer-support-is-needed-to-help-payment-reform-succeed Percent of Employers Offering Health Coverage Increases for First Time Since 2008: www.ajmc.com/focus-of-the-week/percent-of-employers-offering-health-coverage-increases-for-first-time-since-2008 Employers Actively Exploring, Offering New Ways of Delivering Healthcare to Employees: www.ajmc.com/newsroom/employers-actively-exploring-offering-new-ways-of-care-delivering-healthcare-to-employees When Employee Healthcare Costs Move Stocks: www.ajmc.com/contributor/joseph-andelin/2018/09/when-employee-healthcare-costs-move-stocks
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included comments to several proposals from CMS; Medicare advocates say voters will be motivated by healthcare cost concerns during the midterm elections; research showed diabetes drug dapagliflozin, an SGLT2 inhibitor, reduces risks of major cardiovascular events.
Read more about the stories in this podcast: Hospital Groups, Others Raise Concerns Over CMS Payment Proposal: https://www.ajmc.com/newsroom/hospital-groups-others-raise-concerns-over-cms-payment-proposal Senate Votes 98-2 to Ban Pharmacist Gag Clauses: https://www.ajmc.com/newsroom/senate-votes-982-to-ban-pharmacist-gag-clauses What We're Reading: Safety-Net Readmissions; Gag Clause Bill to Trump; CREATES Impact on Drug Spend: https://www.ajmc.com/newsroom/what-were-reading-safetynet-readmissions-gag-clause-bill-to-trump-creates-impact-on-drug-spend Medicare Advocates Call for Keeping Program as It Is, Cite Voter Concerns About Costs: https://www.ajmc.com/newsroom/medicare-advocates-call-for-keeping-program-as-it-is-cite-voter-concerns-about-costs Diabetes Drug Farxiga Cuts Heart Risks in Topline Results: https://www.ajmc.com/newsroom/diabetes-drug-farxiga-cuts-heart-risks-in-topline-results CVD-REAL Results in More Diverse Countries Link SGLT2s to Lower Risk of Death, Heart Attack, Stroke: https://www.ajmc.com/conferences/acc-2018/cvdreal-results-in-more-diverse-countries-link-sglt2s-to-lower-risk-of-death-heart-attack-stroke Patient-Centered Oncology Care®: https://www.ajmc.com/pcoc2018
Medicaid Transformation Project: Addressing Health, Social Needs of Vulnerable Populations by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the Senate overwhelmingly voting to ban pharmacist gag clauses; a study found the current vaccine pipeline for HIV, tuberculosis, and malaria may fall short; an expert noted a trend of healthcare cost data seeping into nonhealthcare companies’ earnings calls.
Read more about the stories in this podcast: Senate Votes 98-2 to Ban Pharmacist Gag Clauses: https://www.ajmc.com/newsroom/senate-votes-982-to-ban-pharmacist-gag-clauses Launch of Highly Efficacious HIV, Tuberculosis, and Malaria Vaccines Unlikely, Study Says: https://www.ajmc.com/newsroom/launch-of-highly-efficacious-hiv-tuberculosis-and-malaria-vaccines-unlikely-study-says When Employee Healthcare Costs Move Stocks: https://www.ajmc.com/contributor/joseph-andelin/2018/09/when-employee-healthcare-costs-move-stocks A Multidisciplinary Approach to Managing Complexities in Cancer Care: https://www.ajmc.com/managed-care-cast/a-multidisciplinary-approach-to-managing-complexities-in-cancer-care Patient-Centered Oncology Care: https://www.ajmc.com/pcoc2018
A Multidisciplinary Approach to Managing Complexities in Cancer Care by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included medical groups asking CMS to halt or slow down its plans to cut physician reimbursement for evaluation and management services; the Senate weighs a package of bills to combat the opioid epidemic; new research shows the Affordable Care Act pushed the uninsured rate down to 10%.
Read more about the stories in this podcast: Medical Groups Tell CMS to Stand Down From Linking Reimbursement to Paperwork Burdens: https://www.ajmc.com/newsroom/medical-groups-tell-cms-to-stand-down-from-linking-reimbursement-to-paperwork-burdens What We're Reading: Senate Opioid Bills; Michigan's Medicaid Work Requirements; Missouri Abortion Ruling: https://www.ajmc.com/newsroom/what-were-reading-senate-opioid-bills-michigans-medicaid-work-requirements-missouri-abortion-ruling ACA Pushed Uninsured Rate Down to 10% in 2016, Even More So in Medicaid Expansion States: https://www.ajmc.com/newsroom/aca-pushed-uninsured-rate-down-to-10-in-2016-even-more-so-in-medicaid-expansion-states Prescription Drug Coverage Improved Survival for Patients With MM: https://www.ajmc.com/newsroom/prescription-drug-coverage-improved-survival-for-patients-with-mm Future Perspectives on Oncology Value Based Care: https://www.ajmc.com/ivbm-nyc
The September issue of The American Journal of Managed Care® highlighted research into social determinants of health and ways to address social determnants in the health system.
In a commentary, Dhruv Khullar, MD, MPP, and Rainu Kaushal, MD, MPH, both of the Weill Cornell Department of Health Policy and Research, outlined how health systems can utilize data-sharing networks to deliver targeted care to high-need, high-cost patients. In this interview, Khullar outlines the idea of precision health, challenges the industry faces when trying to share data, and what steps can be taken to implement such care.
Learn more about drug prices in the United States and efforts to lower them: “Precision Health” for High-Need, High-Cost Patients: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/precision-health-for-highneed-highcost-patients Language Barriers and LDL-C/SBP Control Among Latinos With Diabetes: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/language-barriers-and-ldlcsbp-control-among-latinos-with-diabetes Food Insecurity, Healthcare Utilization, and High Cost: A Longitudinal Cohort Study: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/food-insecurity-healthcare-utilization-and-high-cost-a-longitudinal-cohort-study Health Literacy, Preventive Health Screening, and Medication Adherence Behaviors of Older African Americans at a PCMH: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/health-literacy-preventive-health-screening-and-medication-adherence-behaviors-of-older-african-americans-at-a-pcmh
Going Below the Surface of Healthcare Cost Discussions With Dr Bobby Dubois by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included a study on the impact physician burnout is having on care quality; the latest Affordable Care Act showdown took place in a Texas courtroom; the share of employers offering health coverage increased for the first time since 2008.
Read more about the stories in this podcast: Physician Burnout Associated With Poorer Patient Outcomes: https://www.ajmc.com/focus-of-the-week/physician-burnout-associated-with-poorer-patient-outcomes What We're Reading: Co-Pay Accumulators; GOP Pre-Existing Conditions Bill; Supervised Injection Sites: https://www.ajmc.com/newsroom/what-were-reading-copay-accumulators-gop-preexisting-conditions-bill-supervised-injection-sites Texas Hearing Against ACA Wraps Up as Senators Tie Issue to Kavanaugh: https://www.ajmc.com/newsroom/texas-hearing-against-aca-wraps-up-as-senators-tie-issue-to-kavanaugh Percent of Employers Offering Health Coverage Increases for First Time Since 2008: https://www.ajmc.com/focus-of-the-week/percent-of-employers-offering-health-coverage-increases-for-first-time-since-2008 High-Touch Care Leads to Better Outcomes and Lower Costs in a Senior Population: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/hightouch-care-leads-to-better-outcomes-and-lower-costs-in-a-senior-population
Bringing Virtual Tumor Boards, Real-Time Data to the Point of Care by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included encouraging results from the Next Generation Accountable Care Organization model; concerns that CMS' new billing rules will hurt the sickest patients; a study confirms the value of daily aspirin for patients with diabetes.
Read more about the stories in this podcast: Next Generation ACO Model Saves $62 Million in First Year: https://www.ajmc.com/focus-of-the-week/next-generation-aco-model-saves-62-million-in-first-year Patient, Provider Groups Tell CMS Proposed E/M Service Cuts Will Hurt Sickest Patients: https://www.ajmc.com/newsroom/patient-provider-groups-tell-cms-proposed-em-service-cuts-will-hurt-sickest-patients ASCEND Results Confirm Aspirin Prevents Primary Vascular Events in Diabetes: https://www.ajmc.com/focus-of-the-week/ascend-results-confirm-aspirin-prevents-primary-vascular-events-in-diabetes- Senate Moves Forward With Drug Price Transparency Amendment: https://www.ajmc.com/focus-of-the-week/senate-moves-forward-with-drug-price-transparency-amendment The Financial Impact of the Sequester Cut to Medicare Part B Drug Reimbursement in Community Oncology: https://www.ajmc.com/contributor/coa/2018/08/the-financial-impact-of-the-sequester-cut-to-medicare-part-b-drug-reimbursement-in-community-oncology
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included a panel mostly endorsed the use of patient-reported outcomes for coverage of chimeric antigen receptor T-cell therapy; the US Preventive Services Task Force released new recommendations for cervical cancer screening; research found accountable care organization penetration may be changing how physicians work.
Read more about the stories in this podcast: Many Questions to Ask in Setting National Coverage for CAR T Therapies: https://www.ajmc.com/focus-of-the-week/many-questions-to-ask-in-setting-national-coverage-for-cart-therapies MEDCAC Panel Mostly Endorses PROs for CAR T Therapies: https://www.ajmc.com/newsroom/medcac-panel-mostly-endorses-pros-for-car-t-therapies USPSTF Updates Cervical Cancer Screening Recommendations: https://www.ajmc.com/newsroom/uspstf-updates-cervical-cancer-screening-recommendations ACO Penetration Linked to Decreased Work Hours, Less Self-Employment: https://www.ajmc.com/focus-of-the-week/aco-penetration-linked-to-decreased-work-hours-less-selfemployment Substituting Brand-Name Combinations for Generics Could Have Saved Medicare $925 Million in 2016: https://www.ajmc.com/focus-of-the-week/substituting-brandname-combinations-for-generics-could-have-saved-medicare-925-million-in-2016 Payment Reform Reveals Value of Diabetes Educators in Driving Down Healthcare Costs, Joslin's Gabbay Says: https://www.ajmc.com/conferences/aade2018/payment-reform-reveals-value-of-diabetes-educators-in-driving-down-healthcare-costs-joslins-gabbay-says American Association of Diabetes Educators 2018: https://www.ajmc.com/conferences/aade2018 Evidence-Based Oncology—August 2018: https://www.ajmc.com/journals/evidence-based-oncology/2018/august-2018
Currently, 30 million people in the United States have diabetes and the American Diabetes Association estimates that the total economic cost of disease was $327 billion in 2017. An additional 84 million American adults have prediabetes, and 90% of them don’t know they have it, according to the CDC.
Given the high cost of treating diabetes and the large population with prediabetes, which puts them at an increased risk of developing type 2 diabetes, prevention has become a point of focus. At the annual meeting of the American Association of Diabetes Educators, held August 17 to 20, prevention and delay of type 2 diabetes was one of the 2018 priority topics.
Today, we’re taking a look back to 2017, when The American Journal of Managed Care® convened a panel of experts to discuss diabetes prevention and the use of technology.
Read more about the stories in this podcast: Peer Exchange—Technology in Diabetes Care: From Prevention to Disease Management: https://www.ajmc.com/peer-exchange/technology-in-diabetes-care-from-prevention-to-disease-management American Association of Diabetes Educators 2018 coverage: https://www.ajmc.com/conferences/aade2018 CDC—Prediabetes: Your Chance to Prevent Type 2 Diabetes: https://www.cdc.gov/diabetes/basics/prediabetes.html American Diabetes Association—Statistics About Diabetes: http://www.diabetes.org/diabetes-basics/statistics/ How Technology Can Make CMS' Diabetes Prevention Program Viable: https://www.ajmc.com/journals/evidence-based-diabetes-management/2018/march-2018/how-technology-can-make-cms-diabetes-prevention-program-viable April 1 Brings Day One of the Medicare Diabetes Prevention Program, and Challenges for Health Plans: https://www.ajmc.com/newsroom/april-1st-brings-day-one-of-the-medicare-diabetes-prevention-program-and-challenges-for-health-plans
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included CMS outlining a plan to encourage Medicare accountable care organizations to take on more risk, faster; a study found substantial growth in Medicaid managed care enrollment; an analysis showed nearly 1 in 5 inpatient hospital stays includes a claim from an out-of-network provider.
Read more about the stories in this podcast: CMS Plans to Overhaul MSSP Program to Force More Risk on ACOs: https://www.ajmc.com/newsroom/cms-plans-to-overhaul-mssp-program-to-force-more-risk-on-acos CMS Proposal Is a Start for Making Risk More Appealing to ACOs: https://www.ajmc.com/contributor/travis-broome/2018/08/cms-proposal-is-a-start-for-making-risk-more-appealing-to-acos Medicaid Managed Care Grew Substantially From 1999 to 2012: https://www.ajmc.com/focus-of-the-week/medicaid-managed-care-grew-substantially-from-1999-to-2012 Nearly 1 in 5 Inpatient Admissions Includes a Claim From an Out-of-Network Provider: https://www.ajmc.com/focus-of-the-week/nearly-1-in-5-inpatient-admissions-includes-a-claim-from-an-outofnetwork-provider CVS Will Rely on ICER Data as It Seeks to Curb Costs, Implement "Zero-Dollar Drug List": https://www.centerforbiosimilars.com/news/cvs-will-rely-on-icer-data-as-it-seeks-to-curb-costs-implement-zerodollar-drug-list What We're Reading: Ark. Work Requirements Lawsuit; CVS' Cost Savings Plan; Kavanaugh and Healthcare: https://www.ajmc.com/newsroom/what-were-reading-ark-work-requirements-lawsuit-cvs-cost-savings-plan-kavanaugh-and-healthcare Choosing Wisely Clinical Decision Support Adherence and Associated Inpatient Outcomes: https://www.ajmc.com/journals/issue/2018/2018-vol24-n8/choosing-wisely-clinical-decision-support-adherence-and-associated-inpatient-outcomes
Optimizing Number and Timing of Doctor's Appointment Reminders: An Interview With Dr John F. Steiner by Managed Care Cast
Health centers have been delivering comprehensive, high-quality preventive and primary healthcare to the country’s most vulnerable populations for more than 50 years.
While health centers started out as a primary care safety net, they are increasingly taking a holistic approach. Kristina Wharton, of the Department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine, explained that these centers quickly branched out into mental health services and dentistry.
Read more about the stories in this podcast: Ensuring Access to Prescription Medications in the Post-ACA Healthcare Access Landscape: The Essential Role of FQHCs in the Safety Net for the Underinsured: https://www.ajmc.com/journals/supplement/2018/the-patient-assistance-safety-net-how-many-need-help-how-many-are-helped/ensuring-access-to-prescription-medications-in-the-postaca-healthcare-access-landscape-the-essential-role-of-fqhcs-in-the-safety-net-for-the-underinsured Celebrating America’s Health Centers: Our Healthcare Heroes: https://www.hhs.gov/blog/2018/08/13/celebrating-americas-health-centers-our-healthcare-heroes.html Health Centers Key in Addressing Opioid Epidemic, and Medicaid Is Crucial, Kaiser Finds: https://www.ajmc.com/newsroom/health-centers-key-in-addressing-opioid-epidemic-and-medicaid-is-crucial-kaiser-finds Public Health Alarms Raised Over Possible Change in Immigration Policy: https://www.ajmc.com/focus-of-the-week/public-health-alarms-raised-over-possible-change-in-immigration-policy
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included, CMS allowing step therapy in Medicare Advantage plans in a bid to allow for drug price negotiation; larger practices with more resources, technology and care management processes have higher readmission rates than smaller practices; studies find that empagliflozin also reduces liver fat in patients with diabetes and nonalcoholic fatty liver disease.
Read more about the stories in this podcast: CMS Will Allow Medicare Advantage Plans to Use Step Therapy to Negotiate Drug Prices: https://www.ajmc.com/newsroom/cms-will-allow-medicare-advantage-plans-to-use-step-therapy-to-negotiate-drug-prices CMS Approves Extra Payments for CAR T, Increases Other Payments in Final Rule: https://www.ajmc.com/newsroom/cms-approves-extra-payments-for-car-t-increases-other-payments-in-final-rule Larger Practices Spend More on, Have Higher Readmission Rates for Medicare Beneficiaries: https://www.ajmc.com/focus-of-the-week/larger-practices-spend-more-on-have-higher-readmission-rates-for-medicare-beneficiaries Liquid Biopsy Identifies Patients More Likely to Benefit From Immunotherapy in NSCLC: https://www.ajmc.com/newsroom/liquid-biopsy-identifies-patients-more-likely-to-benefit-from-immunotherapy-in-nsclc Studies Point to Empagliflozin as First Choice for Fatty Liver Disease in T2D: https://www.ajmc.com/newsroom/studies-point-to-empagliflozin-as-first-choice-for-fatty-liver-disease-in-t2d Discussing Increased Prevalence of NAFLD and NASH, and the Current Lack of Treatments: https://www.ajmc.com/managed-care-cast/discussing-increased-prevalence-of-nafld-and-nash-and-the-current-lack-of-treatments
One of the most common causes of liver disease in the United States is nonalcoholic fatty liver disease, affecting between 30% and 40% of adults, according to the National Institute of Diabetes, and Digestive and Kidney Diseases. It’s a condition in which excess fat is stored in the liver—a buildup that is not caused by heavy alcohol use.
Despite how common nonalcoholic fatty liver disease (NAFLD) is, there are currently no approved medications on the market. In this podcast, we talk to a clinician involved with a program that uses lifestyle management and a patient advocate, who is trying to shape policy to help patients with NAFLD and its more extreme version, nonalcoholic steatohepatitis (NASH).
Read more about NAFLD and NASH: Studies Point to Empagliflozin as First Choice for Fatty Liver Disease in T2D: https://www.ajmc.com/newsroom/studies-point-to-empagliflozin-as-first-choice-for-fatty-liver-disease-in-t2d Drug Approvals That Dr Aimee Tharaldson Is Keeping an Eye on for 2019: https://www.ajmc.com/conferences/amcp-2018/drug-approvals-that-dr-aimee-tharaldson-is-keeping-an-eye-on-for-2019 Analyzing the Near-Term Pipeline for Specialty Drugs: https://www.ajmc.com/conferences/amcp-2017/analyzing-the-near-term-pipeline-for-specialty-drugs Dr Aimee Tharaldson: We're Keeping an Eye on Future NASH Treatments: https://www.ajmc.com//conferences/amcp-2017/dr-aimee-tharaldson-were-keeping-an-eye-on-future-nash-treatments
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included a report that found quality issues and fraud in Medicare’s hospice program; the Trump administration expanded short-term health plans; cancer screening rates are falling short of targets.
Read more about the stories in this podcast: Report Finds Medicare Hospice Program Beset With Quality, Care Issues: https://www.ajmc.com/newsroom/report-finds-medicare-hospice-program-beset-with-quality-care-issues Trump Administration Finalizes Rule for Short-Term, Limited Duration Health Plans: https://www.ajmc.com/newsroom/trump-administration-finalizes-rule-for-shortterm-limited-duration-health-plans What We're Reading: Part D Premiums; US Healthcare Spending; Consequences of Sudden Inactivity: https://www.ajmc.com/newsroom/what-were-reading-part-d-premiums-us-healthcare-spending-consequences-of-sudden-inactivity Cancer Screening Rates in the US Fall Short of Healthy People 2020 Targets: https://www.ajmc.com/focus-of-the-week/cancer-screening-rates-in-the-us-fall-short-of-healthy-people-2020-targets FDA Approves Freestyle Libre CGM With 14-Day Sensor: https://www.ajmc.com/newsroom/fda-approves-freestyle-libre-cgm-with-14day-sensor Review Finds VBID Programs Improved Adherence at No Added Cost: https://www.ajmc.com/contributor/vbid-center/2018/08/review-finds-vbid-programs-improved-adherence-at-no-added-cost
Advancing Precision Oncology With the Syapse Precision Medicine Council by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included CMS reversing its decision to suspend the risk adjustment payment program; out-of-pocket costs and copayment accumulators put an HIV prevention drug out of reach for patients; research finds geography can determine posttreatment imaging for women with breast cancer.
Read more about the stories in this podcast: What We're Reading: Resuming Risk Adjustment Program; New Endometriosis Drug; Lilly Denounces Drug Imports: https://www.ajmc.com/newsroom/what-were-reading-resuming-risk-adjustment-program-new-endometriosis-drug-lilly-denounces-drug-imports PrEP for HIV Prevention: Essential for Ending the Epidemic, but Out of Reach for Many: https://www.ajmc.com/focus-of-the-week/prep-for-hiv-prevention-essential-for-ending-the-epidemic-but-out-of-reach-for-many Geography Influences Type of Posttreatment Imaging Received After Early Breast Cancer: https://www.ajmc.com/newsroom/geography-influences-type-of-posttreatment-imaging-received-after-early-breast-cancer FDA Releases Biosimilar Action Plan: https://www.centerforbiosimilars.com/news/fda-releases-biosimilar-action-plan The Center for Biosimilars®: https://www.centerforbiosimilars.com/
Nurse Practitioners: Taking on New Roles as Physician Shortage Grows by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included patient advocates, providers, payers, and pharma commenting on the Trump administration's drug pricing plan; a survey that found physicians and payers believe progress toward value-based care is slowing; a study that questions the standards of evidence for breakthrough therapy approvals.
Read more about the stories in this podcast: From Patient Advocates to Pharma, Groups Weigh in on Trump Blueprint for Drug Costs: https://www.ajmc.com/newsroom/from-patient-advocates-to-pharma-groups-weigh-in-on-trump-blueprint-for-drug-costs Novartis Will Freeze Drug Prices Through End of 2018, CEO Says: https://www.ajmc.com/newsroom/novartis-will-freeze-drug-prices-through-end-of-2018-ceo-says What We're Reading: 340B Lawsuit to Be Refiled; Digging Into Breakthrough Approvals; Screen Time and ADHD: https://www.ajmc.com/newsroom/what-were-reading-340b-lawsuit-to-be-refiled-digging-into-breakthrough-approvals-screen-time-and-adhd Pause in Risk Adjustment Payments Announced, CMS Blames District Court's Decision: https://www.ajmc.com/newsroom/pause-in-risk-adjustment-payments-announced-cms-blames-district-courts-decision Doctors, Payers Think Transition to Value-Based Care Has Slowed, Survey Says: https://www.ajmc.com/newsroom/doctors-payers-think-transition-to-valuebased-care-has-slowed-survey-says Do Breakthrough Therapies Need More Rigorous Evaluation? https://www.ajmc.com/newsroom/do-breakthrough-therapies-need-more-rigorous-evaluation- Evidence-Based Oncology - July 2018: https://www.ajmc.com/journals/evidence-based-oncology/2018/july-2018
There are concerns that cancer care costs may increase as the site of provider-administers cancer drugs shifts from physician officers to hospital outpatient departments. Researchers in the July issue of The American Journal of Managed Care examined chemotherapy-related spending in Medicare Part B after controlling for patient characteristics, such as cancer type, and explored differences in chemotherapy utilization patterns between the 2 settings.
In this interview, lead author Yamini Kalidindi, a research assistant at Pennsylvania State University and a graduate student in the department of health policy and administration, explains why the findings of her study differ from previous research and highlights the importance of considering patient characteristics such as cancer type.
Read the paper in the July issue: Differences in Spending on Provider-Administered Chemotherapy by Site of Care in Medicare: https://www.ajmc.com/journals/issue/2018/2018-vol24-n7/differences-in-spending-on-provideradministered-chemotherapy-by-site-of-care-in-medicare
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included additional moves by the Trump administration to unravel the Affordable Care Act; Pfizer canceled a round of drug price increases after speaking to the president; advocates for 340B sound the alarm on efforts to reform the program.
Read more about the stories in this podcast: Pause in Risk Adjustment Payments Announced, CMS Blames District Court's Decision: https://www.ajmc.com/newsroom/pause-in-risk-adjustment-payments-announced-cms-blames-district-courts-decision CMS Cuts Budget for ACA Marketing to $10 Million for 2019 Plan Year: https://www.ajmc.com/newsroom/cms-cuts-budget-for-aca-marketing-to-10-million-for-2019-plan-year What We're Reading: Pfizer Halts Price Increases; Azar's Attention Is Split; VA Pick Clears First Hurdle: https://www.ajmc.com/newsroom/what-were-reading-pfizer-halts-price-increases-azars-attention-is-split-va-pick-clears-first-hurdle 340B Health Says Changing Hospital Eligibility Will Slash Program: https://www.ajmc.com/newsroom/340b-health-says-changing-hospital-eligibility-will-slash-program Highmark Reaches Value-Based Contract for Empagliflozin, Fixed-Dose Combinations: https://www.ajmc.com/newsroom/highmark-reaches-valuebased-contract-for-empagliflozin-fixeddose-combinations
Providing an open channel of communication between pharmacists and patients, medication therapy management (MTM) allows pharmacists to optimize medications for their patients and patients to take an active role in their healthcare. As MTM services help pharmacists better understand how different medications interact with each other, MTM has been recommended as a way to identify and prevent opioid misuse.
In an effort to provide greater incentive for Part D sponsors to use MTM programs, the Center for Medicare and Medicaid Innovation launched in January 2017 the 5-year Part D Enhanced Medication Therapy Management (eMTM) Model. The model is assessing whether incentives, such as payment and regulatory flexibilities, will result in enhancements in the MTM program, ultimately leading to improved patient outcomes and reduced costs.
In this podcast, we speak with Brian Litten, JD, chief strategic officer, Tabula Rasa HealthCare; and Calvin Knowlton, BScPharm, MDiv, PhD, chief executive officer and founder of Tabula Rasa HealthCare, to get more insight into MTM and the eMTM model.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included a federal judge blocking Kentucky’s Medicaid work requirements; CMS announced it would launch a demonstration to encourage Medicare Advantage providers to take on more risk; and researchers identify racial disparities in HIV incidence and recommended a 5-part plan of action.
Read more about the stories in this podcast: Federal Judge Blocks Kentucky's Medicaid Work Requirements: https://www.ajmc.com/newsroom/federal-judge-blocks-kentuckys-medicaid-work-requirements Kentucky Cuts Medicaid Vision, Dental Benefits Following Block to Work Requirements: https://www.ajmc.com/newsroom/kentucky-cuts-medicaid-vision-dental-benefits-following-block-to-work-requirements CMS Will Waive MIPS for Doctors Who Agree to More Medicare Advantage Risk: https://www.ajmc.com/newsroom/cms-will-waive-mips-for-doctors-who-agree-to-more-medicare-advantage-risk Health Organizations Urge HHS to Recognize MA Providers in MACRA: https://www.ajmc.com/newsroom/health-organizations-urge-hhs-to-recognize-ma-providers-in-macra Researchers Highlight Disproportionate HIV Incidence Among African Americans, Recommend Plan of Action: https://www.ajmc.com/newsroom/researchers-highlight-disproportionate-hiv-incidence-among-african-americans-recommend-plan-of-action Feedback on the Direction, Challenges of the OCM: https://www.ajmc.com/focus-of-the-week/feedback-on-the-direction-challenges-of-the-ocm Implementing Alternative Payment Models for Improved Population Health: Experiences From the OCM: https://www.ajmc.com/interactive-tools/experiences-from-the-ocm
Health disparities stemming from social, economic, and environmental factors have become a growing target in healthcare with payers, providers, and policy makers turning their attention on how to address those nonmedical factors that impact an individual’s overall health and health outcomes outside of the medical setting.
While the importance of addressing social determinants of health is becoming more clear, there are still challenges for this new field—delving into the arena can be daunting for health systems and there is not much evidence yet on best practices for screening patients and getting them to the right resouces.
In this podcast, we talk to Clifford Goodman, PhD, of The Lewin Group; Shantanu Agrawal, MD, MPhil, of National Quality Forum; and Rachel Gold, PhD, MPH, of the Kaiser Permanente Center for Health Research.
Read more about the stories in this podcast: Doctors Talk About How Social Determinants Affect Their Work With Patients: https://www.ajmc.com/focus-of-the-week/doctors-talk-about-how-social-determinants-affect-their-work-with-patients Physicians Call for Action on Social Determinants of Health: https://www.ajmc.com/newsroom/physicians-call-for-action-on-social-determinants-of-health Humana's "Bold Goal" Update Finds More Healthy Days for Medicare Members in 4 Cities: https://www.ajmc.com/focus-of-the-week/humanas-bold-goal-update-finds-more-healthy-days-for-medicare-members-in-4-cities A Health Plan's Investigation of Healthy Days and Chronic Conditions: https://www.ajmc.com/journals/issue/2017/2017-vol23-n10/a-health-plans-investigation-of-healthy-days-and-chronic-conditions Dr Shantanu Agrawal: Bringing Together the Community to Tackle Social Determinants of Health: https://www.ajmc.com/conferences/aco-fall2017/dr-shantanu-agrawal-bringing-together-the-community-to-tackle-social-determinants-of-health Dr Shantanu Agrawal Highlights Progress Being Made to Address Health Inequities: https://www.ajmc.com/conferences/aco-fall2017/dr-shantanu-agrawal-highlights-progress-being-made-to-address-health-inequities Data Necessary to Appropriately Address Social Determinants of Health: https://www.ajmc.com/conferences/acdc-spring-2018/data-necessary-to-appropriately-address-social-determinants-of-health
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week in managed care, the top stories included HHS Secretary Alex Azar appearing before the Senate Committee on Finance to discuss the administration's plan to drive down prescription drug prices; FDA Commissioner Scott Gottlieb, MD, calling on payers to share data to aid drug innovation; and CMS calling for stricter oversight of Medicaid.
Read more about the stories in this podcast: Azar Appears Before Senate Committee on Finance to Discuss Drug Innovation, Affordability: https://www.ajmc.com/focus-of-the-week/azar-appears-before-senate-committee-on-finance-to-discuss-drug-innovation-affordability Gottlieb Calls on Payers to Share Data to Aid Drug Innovation: https://www.ajmc.com/focus-of-the-week/gottlieb-calls-on-payers-to-share-data-to-aid-drug-innovation CMS Unveiling Stricter Oversight of Medicaid Due to Program Expansion: https://www.ajmc.com/newsroom/cms-unveiling-stricter-oversight-of-medicaid-due-to-program-expansion What We're Reading: SCOTUS Abortion Ruling; Use of HDHPs Grows; More Seniors Die at Home: https://www.ajmc.com/newsroom/what-were-reading-scotus-abortion-ruling-use-of-hdhps-grows-more-seniors-die-at-home Dr Robert A. Gabbay Highlights the Development of Joslin Diabetes Center's Clinical Guidelines: https://www.ajmc.com/interviews/dr-robert-a-gabbay-highlights-the-development-of-joslin-diabetes-centers-clinical-guidelines Evidence-Based Diabetes Management—June 2018: https://www.ajmc.com/journals/evidence-based-diabetes-management/2018/june-2018
Exploring the Current State of Precision Medicine at the ASCO Annual Meeting by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week in managed care, the top stories included Atul Gawande, MD, being named the CEO of the Amazon–Berkshire Hathaway–JPMorgan Chase healthcare venture; the Trump administration finalized rules for creating association health plans; an analysis found some cancer types are represented more than others in the Oncology Care Model.
Read more about the stories in this podcast: Amazon, Berkshire Hathaway, JPMorgan Chase Announce CEO of Joint Health Company: https://www.ajmc.com/newsroom/amazon-berkshire-hathaway-jpmorgan-chase-announce-ceo-of-joint-health-company New Rule Allows Creation of Association Health Plans That Skirt ACA Regulations, Protections: https://www.ajmc.com/newsroom/new-rule-allows-creation-of-association-health-plans-that-skirt-aca-regulations-protections Participation in OCM May Transform Care for Certain Cancer Types More Quickly Than Others: https://www.ajmc.com/newsroom/participation-in-ocm-may-transform-care-for-certain-cancer-types-more-quickly-than-others Implementing Alternative Payment Models for Improved Population Health: Experiences from the OCM: https://www.ajmc.com/webcast/experiences-from-the-ocm UpWell Health Survey: 45% of Those With Diabetes Skip Care Due to Costs: https://www.ajmc.com/newsroom/upwell-health-survey-45-of-those-with-diabetes-skip-care-due-to-costs A Retrospective on the Oncology Care Model: https://www.ajmc.com/journals/evidence-based-oncology/2018/june-2018/a-retrospective-on-the-oncology-care-model Perspective: FDA/CMS Parallel Review Advances Coverage for Cancer Comprehensive Genomic Profiling: https://www.ajmc.com/journals/evidence-based-oncology/2018/june-2018/perspective-fdacms-parallel-review-advances-coverage-for-cancer-comprehensive-genomic-profiling Evidence-Based Oncology—June 2018: https://www.ajmc.com/journals/evidence-based-oncology/2018/june-2018
Center for HOPE: Addressing Health Needs and Cancer Disparities Among Underserved Populations by Managed Care Cast
Lowering Costs And Readmission Rates Through a Meal Delivery Program by Managed Care Cast
This Week In Managed Care—Medicare Part A is Running Out and Other Health News by Managed Care Cast
Health literacy in the United States is low to begin with, and health financial literacy is even lower. The changing health insurance system is partly to blame. A few decades ago, health insurance covered everything. Now, patients have a lot more financial responsibility, and they don’t always understand it. In cancer, health financial literacy is particularly important since treatment can be so costly.
This episode of Managed Care Cast includes conversations with a few experts in the field: Yousuf Zafar, MD, MHS, of the Duke Cancer Institute; Clara Lambert, BBA, OPN-CG, chair of the Association of Community Cancer Centers Financial Advocacy Network Advisory Committee; Todd Yezefski, MD, senior fellow in the Clinical Research Division at the Fred Hutchinson Cancer Research Center and Division of Medical Oncology at the University of Washington; and Michele McCourt, senior director of the CancerCare Co-Payment Assistance Foundation.
Read more: A Descriptive Study of Patients Receiving Foundational Financial Assistance Through Local Specialty Pharmacies: www.ajmc.com/journals/supplement/2018/the-patient-assistance-safety-net-how-many-need-help-how-many-are-helped/a-descriptive-study-of-patients-receiving-foundational-financial-assistance-through-local-specialty-pharmacies Impact of Trained Oncology Financial Navigators on Patient Out-of-Pocket Spending: www.ajmc.com/journals/supplement/2018/the-patient-assistance-safety-net-how-many-need-help-how-many-are-helped/impact-of-trained-oncology-financial-navigators-on-patient-outofpocket-spending Policy Improvement Areas to Reduce Financial Hardship: www.ajmc.com/conferences/pan-2018/policy-improvement-areas-to-reduce-financial-hardship Addressing Financial Concerns at the Outset to Improve Patient Outcomes: www.ajmc.com/conferences/pan-2018/addressing-financial-concerns-at-the-outset-to-improve-patient-outcomes
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories include Senator Bill Cassidy's new plan to lower healthcare costs; policy recommendations from the American Diabetes Association on how to lower insulin prices; and coverage from the American Society of Clinical Oncology annual meeting.
Read more about the stories in this podcast: Senator Cassidy Unveils Proposal to Lower Healthcare Costs: www.ajmc.com/newsroom/senator-cassidy-unveils-proposal-to-lower-healthcare-costs
ADA Issues Recommendations Designed to Fix Insulin Pricing, Accessibility Crisis: http://www.ajmc.com/newsroom/ada-issues-recommendations-designed-to-fix-insulin-pricing-accessibility-crisis
Persephone Trial: Cutting Trastuzumab Duration by Half Safer, Efficacious in HER2-Positive Breast Cancer: http://www.ajmc.com/conferences/asco-2018/persephone-trial-cutting-trastuzumab-duration-by-half-safer-efficacious-in-her2positive-breast-cancer-
Remote Monitoring Can Reduce Radiation-Related Symptoms in Head and Neck Cancer: http://www.ajmc.com/conferences/asco-2018/remote-monitoring-can-reduce-radiationrelated-symptoms-in-head-and-neck-cancer
2018 American Society of Clinical Oncology Annual Meeting: http://www.ajmc.com/conferences/asco-2018
Pembrolizumab Improved OS, PFS as First-Line Treatment in NSCLC: http://www.ajmc.com/newsroom/pembrolizumab-improved-os-pfs-as-firstline-treatment-in-nsclc
What We're Reading: WellCare–Meridian Deal; Virginia Set to Expand Medicaid; High Court Rebuffs Planned Parenthood: http://www.ajmc.com/newsroom/what-were-reading-wellcarendashmeridian-deal-virginia-set-to-expand-medicaid-high-court-rebuffs-planned-parenthood
Seema S. Sonnad Emerging Leader in Managed Care Research Award: http://www.ajmc.com/about/ajmc/sss-elmcr-award
With healthcare costs in the United States rising, employers have been trying to find a way to get a handle on these costs by improving employee health and well-being. Workplace wellness programs have been around for decades, but they received a boost in 2010 with the Affordable Care Act allowing companies to offer financial incentives to get employees to participate in the programs.
However, the research on these wellness programs has been mixed, to say the least, with more recent research finding that these programs don’t really work. But more than just the unclear health benefits of these programs, there are real data and privacy concerns for employees. In this podcast, Al Lewis, a famed opponent of workplace wellness programs, provides insight on just why he’s so confident these programs don’t work, and Deborah Peel, MD, outlines her privacy concerns in the age of data sharing.
Read more: Do Wellness Outcomes Reports Systematically and Dramatically Overstate Savings? www.ajmc.com/contributor/al-lewis-jd/2017/01/do-wellness-outcomes-reports-systematically-and-dramatically-overstate-savings Workplace Wellness Can Be Hazardous to Your Health: www.ajmc.com/contributor/al-lewis-jd/2018/05/workplace-wellness-can-be-hazardous-to-your-health NBER's Invalidation of Wellness: Behind the Headlines: www.ajmc.com/contributor/al-lewis-jd/2018/03/nbers-invalidation-of-wellness-behind-the-headlines Boosting Workplace Wellness Programs With Financial Incentives: www.ajmc.com/journals/issue/2017/2017-vol23-n10/boosting-workplace-wellness-programs-with-financial-incentives Employer-Sponsored Wellness Programs Attract Already Fit and Healthy Individuals: www.ajmc.com/newsroom/employersponsored-wellness-programs-attract-already-fit-and-healthy-individuals
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories include the finding that new guidelines will mean the number of people with hypertension will soar; research finds that most diabetes apps don’t lower glycated hemoglobin; and a health plan announced its plan to fight housing instability.
Read more about the stories in this podcast: Under 2017 Guideline, More Than 105 Million Americans Have Hypertension: www.ajmc.com/focus-of-the-week/under-2017-guideline-over-105-million-americans-have-hypertension AHRQ Finds Very Few Diabetes Apps Improve A1C Levels: www.ajmc.com/newsroom/ahrq-finds-very-few-diabetes-apps-improve-a1c-levels Kaiser Permanente Investing $200 Million to Address Housing Instability, Improve Health: www.ajmc.com/newsroom/kaiser-permanente-investing-200-million-to-adress-housing-instability-improve-health FDA Expands Indication for PrEP to Reduce Risk of HIV in Adolescents: www.ajmc.com/newsroom/fda-expands-indication-for-prep-to-reduce-risk-of-hiv-in-adolescents Rucaparib May Have Potential Clinical Benefit for Advanced Pancreatic Cancer: www.ajmc.com/newsroom/rucaparib-may-have-potential-clinical-benefit-for-advanced-pancreatic-cancer What Is and Is Not in Trump's Drug Pricing Plan: An Interview With Dr Michael Chernew: www.ajmc.com/managed-care-cast/what-is-and-is-not-in-trumps-drug-pricing-plan-an-interview-with-dr-michael-chernew
Creators of President Donald Trump’s blueprint to control drug prices, American Patients First, say it represents real reform. Critics see a pulled punch to the pharmaceutical industry.
Mary Caffrey, the managing editor of The American Journal of Managed Care’s Evidence-Based series, spoke with Harvard healthcare economist Michael E. Chernew, PhD, who is the co-editor in chief of AJMC, to discuss elements of the Trump administration proposal to control drug prices. Chernew is also a former vice chair of the Medicare Payment Advisory Commission.
Read more: Trump Offers Blueprint to Drive Down Prescription Drug Prices; Targets Rebates, "Middlemen": www.ajmc.com/newsroom/-trump-offers-blueprint-to-drive-down-prescription-drug-prices-targets-rebates-middlemen Azar Stumps for Plan to Hold Down Prescription Drug Costs: www.ajmc.com/focus-of-the-week/azar-stumps-for-plan-to-hold-down-prescription-drug-costs Trump Targets Drug Prices, Right-to-Try in State of the Union: www.ajmc.com/newsroom/trump-targets-drug-prices-righttotry-in-state-of-the-union Will Trump Take Steps to Rein in Drug Prices?: www.ajmc.com/focus-of-the-week/will-trump-take-steps-to-rein-in-drug-prices
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included President Donald Trump's plan to drive down drug prices; the FDA approved the first biosimilar of the year; a study found rapid uptake of PD-1 agents after FDA approval.
Read more about the stories in this podcast: Trump Offers Blueprint to Drive Down Prescription Drug Prices; Targets Rebates, "Middlemen": www.ajmc.com/newsroom/-trump-offers-blueprint-to-drive-down-prescription-drug-prices-targets-rebates-middlemen
Azar Stumps for Plan to Hold Down Prescription Drug Costs: www.ajmc.com/focus-of-the-week/azar-stumps-for-plan-to-hold-down-prescription-drug-costs
FDA Approves Epoetin Alfa Biosimilar for Anemia: www.ajmc.com/newsroom/fda-approves-epoetin-alfa-biosimilar-for-anemia
Study Finds Rapid Uptake of Anti–PD-1 Agents Following FDA Approval: www.ajmc.com/newsroom/study-finds-rapid-uptake-of-anti8211pd1-agents-following-fda-approval
Researcher Details Microbiome Mysteries Connecting the Gut, Brain: www.ajmc.com/conferences/sobp-2018/researcher-details-microbiome-mysteries-connecting-the-gut-brain
Society of Biological Psychiatry 73rd Annual Scientific Convention: www.ajmc.com/conferences/sobp-2018
American Thoracic Society 2018 International Conference: www.ajmc.com/conferences/ats-2018
ISPOR Annual Conference: http://www.ajmc.com/conferences/ispor-2018
Newsletter Signup: www.ajmc.com/email-profile
The Scope of Physician Burnout: Symptoms, Impacts, and Efforts to Address It by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included another report that shows uninsured rates are rising; FDA confirms shortages of the EpiPen, but the manufacturer insists the delay will be short; a Senate panel examines the need for transparency in insulin pricing.
Read more about the stories in this podcast: No States Reported a Decline in the Uninsured Rate From 2016 to 2017: www.ajmc.com/focus-of-the-week/no-states-reported-a-decline-in-the-uninsured-rate-from-2016-to-2017 FDA Confirms Short-Term Shortages of EpiPen: www.ajmc.com/newsroom/fda-confirms-shortterm-shortages-of-epipen ADA's Cefalu Calls for Transparency Across Supply Chain to Address Insulin Costs: www.ajmc.com/newsroom/adas-cefalu-calls-for-transparency-across-supply-chain-to-address-insulin-costs Daratumumab Approved as Frontline Treatment in Newly Diagnosed Multiple Myeloma: www.ajmc.com/newsroom/daratumumab-approved-as-frontline-treatment-in-newly-diagnosed-multiple-myeloma Single-Payer System Is the Solution for Mental Health Care, Panelists Say: www.ajmc.com/conferences/apa-2018/singlepayer-system-is-the-solution-for-mental-health-care-panelists-say American Psychiatric Association 2018 Annual Meeting: www.ajmc.com/conferences/apa-2018
Accountable care organizations are incentivized to reduce spending and improve quality of care. One way they have tried to do achieve these goals is by establishing control over a patient’s full continuum of care by minimizing the care patients receive from other providers outside of the ACO, including specialists.
Michael Barnett, MD, and J. Michael McWilliams, MD, PhD, have a paper in the May issue of The American Journal of Managed Care® on leakage of specialty care among ACOs and the changes in specialty care leakage and use associated with the Medicare Shared Savings Program.
Read the paper: http://www.ajmc.com/journals/issue/2018/2018-vol24-n5/changes-in-specialty-care-use-and-leakage-in-medicare-accountable-care-organizations
Patients who get care at a hospital often receive bills that are bigger than they were expecting. In the case of Medicare, this can happen when a beneficiary receives care at a hospital for several days but was never formally admitted to the hospital. The result is higher out-of-pocket expenses and fewer Medicare benefits—the biggest being the qualification of a nursing home stay after being discharged from a hospital. While hospitals must now inform Medicare recipients when they are being held under observation status, the use of observation still places an undue burden on seniors.
Andria Jacobs, chief operating officer for PCG Software, discusses the impact of being held in observation, what CMS has done to try to alleviate the situation, and what else needs to be done.
Read Andria's past articles: http://www.ajmc.com/contributor/andria-jacobs-rn-ms-cen-cphq
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included a report that insurance coverage gains are reversing; a deal to lower the cost of Praluent for Express Scripts members; findings that synthetic opioids are playing a bigger role in overdose deaths.
Increases in Insurance Coverage Rates From ACA Beginning to Reverse: www.ajmc.com/focus-of-the-week/increases-in-insurance-coverage-rates-from-aca-beginning-to-reverse Sanofi, Regeneron to Cut Praluent Prices Under Exclusive Express Scripts Deal That Ends Prior Approval Delays: www.ajmc.com/newsroom/sanofi-regeneron-to-cut-praluent-prices-under-exclusive-express-scripts-deal-that-ends-prior-approval-delays Dr Jay Edelberg on Safety, Efficacy of Praluent and Remaining Payment Challenges: www.ajmc.com/conferences/aha-2017/dr-jay-edelberg-on-safety-efficacy-of-praluent-and-remaining-payment-challenges Synthetic Opioids Overtake Prescription Opioids as Driver of Overdose Deaths in 2016: www.ajmc.com/newsroom/synthetic-opioids-overtake-prescription-opioids-as-driver-of-overdose-deaths-in-2016 FDA Approves CAR T-Cell Treatment Kymriah for Adult B-Cell Lymphoma: www.ajmc.com/newsroom/fda-approves-cart-cell-treatment-kymriah-for-adult-bcell-lymphoma Verma Highlights CMS Initiatives to Empower Patients and Promote Competition: www.ajmc.com/conferences/whcc-2018/verma-highlights-cms-initiatives-to-empower-patients-and-promote-competition Former HHS Secretary Price Identifies a Path to Moving Forward in Healthcare Reform: www.ajmc.com/conferences/whcc-2018/former-hhs-secretary-price-identifies-a-path-to-moving-forward-in-healthcare-reform 15th Annual World Health Care Congress: www.ajmc.com/conferences/whcc-2018
Low-Value Services: Their Impact and Challenges With Addressing Them by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included an announcement from CMS of creating direct provider contracting, plus a broad set of proposed rules for health information technology; new recommendations to improve postpartum care; a look at future competition among specialty drugs.
Read more about the stories in this podcast: CMS: "Meaningful Use" Is Out, "Interoperability" Is In: www.ajmc.com/newsroom/cms-meaningful-use-is-out-interoperability-is-in Humana Launches Bundled Payment Model to Improve Maternity Outcomes and Cost: www.ajmc.com/newsroom/humana-launches-bundled-payment-model-to-improve-maternity-outcomes-and-cost What We're Reading: VA Pick's Hearing Delayed; Hospital Profits Fall; Re-Imagining Postpartum Care: www.ajmc.com/newsroom/what-were-reading-va-picks-hearing-delayed-hospital-profits-fall-reimagining-postpartum-care ACOG Annual Clinical and Scientific Meeting: www.ajmc.com/conferences/acog-2018 Newsletter Sign-up: www.ajmc.com/email-profile Specialty Drug Pipeline Review Focuses on Competition, Cancer Drugs: www.ajmc.com/conferences/amcp-2018/specialty-drug-pipeline-review-focuses-on-competition-cancer-drugs Dr Aimee Tharaldson Discusses Key Market Trends in Specialty Pharmacy: www.ajmc.com/conferences/amcp-2018/dr-aimee-tharaldson-discusses-key-market-trends-in-specialty-pharmacy The Academy of Managed Care Pharmacy (AMCP) 2018: www.ajmc.com/conferences/amcp-2018
At the beginning of the year, The American Journal of Managed Care® convened a panel of experts in infectious disease and managed care to discuss management of HIV, including the need for individualized care the role for newer treatments options. Here, we provide some of that conversation.
Watch the full discussion: Special Considerations in HIV Management: www.ajmc.com/peer-exchange/special-considerations-in-hiv-management/
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included a new bill in Congress to tackle the opioid epidemic; an analysis that warns against including drug costs in bundled payment models; the FDA commissioner shares ideas to improve innovation and access to next-generation sequencing.
Read more about the stories in this podcast: Congress, Medical Societies Move on Ways to Attack Opioid Problem: www.ajmc.com/newsroom/congress-medical-societies-move-on-ways-to-attack-opioid-problem Bundled Payments That Include Drug Costs Would Penalize Practices Based on Patient Mix: www.ajmc.com/newsroom/bundled-payments-that-include-drug-costs-would-penalize-practices-based-on-patient-mix FDA Finalizes Guidances to Accelerate Development of Next-Generation Sequencing Tests: www.ajmc.com/newsroom/fda-finalizes-guidances-to-accelerate-development-of-next-generation-sequencing-tests Commissioner Gottlieb Updates Community Oncologists on the FDA's Mission to Improve Access: www.ajmc.com/conferences/coa-2018/commissioner-gottlieb-updates-community-oncologists-on-the-fdas-mission-to-improve-access 2018 Community Oncology Conference: www.ajmc.com/conferences/coa-2018 Keytruda results: http://www.mrknewsroom.com/news-release/oncology/mercks-keytruda-pembrolizumab-plus-pemetrexed-alimta-and-platinum-chemotherapy Evidence-Based Oncology—April 2018: www.ajmc.com/journals/evidence-based-oncology/2018/april-2018
Current policies being employed to limit spending can have serious consequences for patients. In the April issue of The American Journal of Managed Care, A. Mark Fendrick, MD, co-authored a paper that examined the relationship between consumer cost sharing for branded antidepressants and the initiation of branded therapy among patients who were filling a prescription for a generic medication to treat major depressive disorder.
Read the paper: Cost Sharing and Branded Antidepressant Initiation Among Patients Treated With Generics: www.ajmc.com/journals/issue/2018/2018-vol24-n4/cost-sharing-and-branded-antidepressant-initiation-among-patients-treated-with-generics
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included President Donald Trump signing an executive order requiring the poor to get jobs or lose food and healthcare benefits; a CMS report found ethnic, racial, and gender disparities in Medicare Advantage plans; CDC highlighted the impact of HIV on America's youth.
Read more about the stories in this podcast: What We're Reading: Trump Signs Executive Order; VA Staffing Crisis; Texas Hospital Firm Draws Scrutiny: www.ajmc.com/newsroom/what-were-reading-trump-signs-executive-order-va-staffing-crisis-texas-hospital-firm-draws-scrutiny- CMS Creates New ACA Penalty Mandate Exemptions, Including Opposition to Abortion: www.ajmc.com/newsroom/cms-creates-new-aca-penalty-mandate-exemptions-including-opposition-to-abortion CMS Report Details Extent of Medicare Advantage Racial, Gender Disparities: www.ajmc.com/newsroom/cms-report-details-extent-of-medicare-advantage-racial-gender-disparities Sanofi to Start Offering Discounts on Two Insulin Products: www.ajmc.com/newsroom/sanofi-to-start-offering-discounts-on-2-insulin-products National Youth HIV/AIDS Awareness Day: Highlighting the Impact of Disease on the Age Group: www.ajmc.com/newsroom/national-youth-hivaids-awareness-day-highlighting-the-impact-of-disease-on-the-age-group With the Oncology Care Model, "Everyone Has to Be Engaged," Including Patients: www.ajmc.com/newsroom/with-the-oncology-care-model-everyone-has-to-be-engaged-including-patients
With the cost of healthcare rising, consumers are being asked to shoulder more of the financial burden and make more cost-conscious decisions regarding their healthcare. One method to do this is through the use of consumer-directed health plans, which are high-deductible health plans coupled with a health savings account or a health reimbursement arrangement. Neeraj Sood, PhD, co-authored a paper in the April issue of The American Journal of Managed Care (AJMC) evaluating the impact of enrollment in consumer-directed health plans on financial burden associated with healthcare utilization.
Read Sood's paper “Financial Burden of Healthcare Utilization in Consumer-Directed Health Plans” in the April issue of AJMC: http://www.ajmc.com/journals/issue/2018/2018-vol24-n4/financial-burden-of-healthcare-utilization-in-consumer-directed-health-plans
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included final numbers for 2018 enrollment in Affordable Care Act plans; an increase in Medicare Advantage payments; National Public Health Week highlighted the importance of community relationships in improving health.
Read more about the stories in this podcast: What We're Reading: 2018 ACA Enrollment; Spread of Rare Superbug; Off-the-Shelf CAR T Therapies: www.ajmc.com/newsroom/what-were-reading-2018-aca-enrollment-spread-of-rare-superbug-offtheshelf-car-t-therapies CMS Final Rule Lowers Maximum Co-Payment Amount for Biosimilars: www.centerforbiosimilars.com/news/cms-final-rule-lowers-maximum-copayment-amount-for-biosimilars CMS Raises Medicare Advantage Payments, Tweaks Opioid Language for Patients With Pain: www.ajmc.com/newsroom/cms-raises-medicare-advantage-payments-tweaks-opioid-language-for-pain-patients Strong Community Relationships Key to Improving Health, Said Speakers at National Public Health Week Forum: www.ajmc.com/newsroom/strong-community-relationships-key-to-improving-health-said-speakers-at-national-public-health-week-forum What We're Reading: 2018 ACA Enrollment; Spread of Rare Superbug; Off-the-Shelf CAR T Therapies: www.ajmc.com/newsroom/what-were-reading-2018-aca-enrollment-spread-of-rare-superbug-offtheshelf-car-t-therapies Guidance That Allows for Higher A1C Misses the Mark: www.ajmc.com/journals/evidence-based-diabetes-management/2018/march-2018/guidance-that-allows-for-higher-a1c-misses-the-mark Evidence-Based Diabetes Management—March 2018: www.ajmc.com/journals/evidence-based-diabetes-management/2018/march-2018
Locations, Types, and Characteristics of Data Breaches in Hospitals by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included another insurer announcing it would pass on drug rebates to consumers; FDA approved a new continuous glucose monitor and created a new medical device class; new guidelines address how to treat people with both HIV and cancer.
Read more about the stories in this podcast: What We're Reading: Accidental Medicaid Enrollment; Cracking Down on Opioids; Passing on Drug Rebates: www.ajmc.com/newsroom/what-were-reading-accidental-medicaid-enrollment-cracking-down-on-opioids-passing-on-drug-rebatesUnitedHealthcare to Pass Drug Company Rebates Back to Consumers: www.ajmc.com/newsroom/unitedhealthcare-to-pass-drug-company-rebates-back-to-consumers Out-of-Pocket Costs for Insulin Are a Problem. Litigants in Case Disagree on Who Is at Fault: www.ajmc.com/newsroom/out-of-pocket-costs-for-insulin-are-a-problem-litigants-in-case-disagree-on-who-is-at-fault Brenda Schmidt Discusses Getting Ready for the Launch of Medicare DPP: www.ajmc.com/interviews/brenda-schmidt-discusses-getting-ready-for-the-launch-of-medicare-dpp FDA Approves Dexcom G6, Streamlines Review for Similar Interoperable CGMs: www.ajmc.com/newsroom/fda-approves-dexcom-g6-streamlines-review-for-similar-interoperable-cgms NCCN's New Guidelines Promote Better Cancer Care for People With HIV: www.ajmc.com/conferences/nccn-2018/nccns-new-guidelines-promote-better-cancer-care-for-people-with-hiv Institute for Value-Based Medicine—Advancing Quality in Oncology Care: www.ajmc.com/ivbm-registration
As the country searches a new way to address cost of care, value-based insurance design (VBID), is gaining traction as one way of encouraging the use of high-value services and discouraging the use of low-value services. VBID would give patients access to treatments and services with high clinical value at reduced or no cost sharing. Currently, health plans tend to value all treatments and services as equal in clinical value to all patients, even though this is not the reality.
On March 14, the University of Michigan’s V-BID Center hosted its annual VBID Summit with discussions on aligning around value, how public payers are adopting VBID principles, addressing the use of low-value care services, and creating a smarter high-deductible health plan.
Read coverage of the panels from the V-BID Summit: The Challenge of Addressing Low-Value Care Once It's Identified: www.ajmc.com/conferences/v-bid-summit-2018/the-challenge-of-addressing-lowvalue-care-once-its-identified How Public Payers Are Adopting VBID Principles Despite Constraints: www.ajmc.com/conferences/v-bid-summit-2018/how-public-payers-are-adopting-vbid-principles-despite-constraints Aligning Around Value: Challenges With Quality Measures and Implementing Clinical Nuance: www.ajmc.com/conferences/v-bid-summit-2018/aligning-around-value-challenges-with-quality-measures-and-implementing-clinical-nuance Path to a Smarter High-Deductible Plan Includes Flexibility, Disruptive Innovation: www.ajmc.com/conferences/v-bid-summit-2018/path-to-a-smarter-highdeductible-plan-includes-flexibility-disruptive-innovation
On March 14, advocates for community cancer centers took to Capitol Hill to speak with legislators and advocate for the issues important to them and their patients. At the Association of Community Cancer Centers' (ACCC) 44th Annual Meeting and Cancer Business Summit, Blaire Burnett of ACCC, George Spurlock of Southern Cancer Center, and Randall Oyer, MD, of Lancaster General Health, discussed their experiences with Capitol Hill Day and what issues they discussed with legislators.
For coverage of sessions and interviews with speakers from the ACCC 44th Annual Meeting and Cancer Business Summit, visit our conference page: http://www.ajmc.com/conferences/accc-2018.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included changes to the Next Generation ACO Model caused 7 accountable care organizations to leave the model; a report highlights how quickly hospital acqusition of physician practices is occurring; CMS finalizes coverage for Next-Generation Sequencing tests.
Read more about the stories in this podcast: Seven ACOs Exit Next Generation Model, Blaming CMS for "Unilateral" Changes: www.ajmc.com/newsroom/seven-acos-exit-next-generation-model-blaming-cms-for-unilateral-changes Accountable Care Delivery Congress: www.ajmc.com/acdcongress Hospital Acquisition of Independent Physician Practices Continues to Increase: www.ajmc.com/focus-of-the-week/hospital-acquisition-of-independent-physician-practices-continues-to-increase First-of-a-Kind Companion Test for Cancer Gene Profiling Gets FDA Approval: www.ajmc.com/newsroom/firstofakind-companion-test-for-cancer-gene-profiling-gets-fda-approval CMS Finalizes Coverage for Next-Generation Sequencing Tests: www.ajmc.com/newsroom/cms-finalizes-coverage-for-next-generation-sequencing-tests Incorporating Value Into Physician Payment and Patient Cost Sharing: www.ajmc.com/journals/issue/2018/2018-vol24-n3/incorporating-value-into-physician-payment-and-patient-cost-sharing National Comprehensive Cancer Network 23rd Annual Conference: www.ajmc.com/conferences/nccn-2018 Society of Gynecologic Oncology 2018 Annual Meeting on Women’s Cancer: www.ajmc.com/conferences/sgo-2018
As the US healthcare system searches for a way to address the poor health and high healthcare costs of American, one concept has risen to the top and received a lot of attention: social determinants of health. These are the conditions in which people are born, live, and work that impact their health. And they are mostly responsible for health inequities.
There are a number of conditions that are considered social determinants of health, including access to educational, economic, and job opportunities; transportation options; public safety; and housing.
In this podcast, we focus on the issue of housing, and how communities are working to get people into housing so their health can improve.
Learn more about social determinants of health: Program Nets Substantial Savings by Housing Homeless Individuals With Health Issues http://www.ajmc.com/focus-of-the-week/program-nets-substantial-savings-by-housing-homeless-individuals-with-health-issues
Developing State-Level Programs for Care of Complex Populations www.ajmc.com/focus-of-the-week/developing-statelevel-programs-for-care-of-complex-populations
Food, Housing Focus of NQF Medicaid Report About Social Determinants of Health www.ajmc.com/focus-of-the-week/food-housing-focus-of-nqf-medicaid-report-about-social-determinants-of-health-
Successful Interventions, Positive Outcomes: Understanding the Impact of Social Determinants of Health www.ajmc.com/contributor/medecision/2018/01/successful-interventions-positive-outcomes-understanding-the-impact-of-social-determinants-of-health
Cross-Sector Partnerships to Address Health-Related Social Needs www.ajmc.com/focus-of-the-week/crosssector-partnerships-to-address-healthrelated-social-needs
More Healthcare Execs Accounting for Social Determinants of Patients' Lives, Survey Finds www.ajmc.com/focus-of-the-week/more-healthcare-execs-accounting-for-social-determinants-of-patients-lives-survey-finds
The Essential Facts of Life Are the Foundation of Health www.ajmc.com/contributor/adam-sharp/2018/02/the-essential-facts-of-life-are-the-foundation-of-health
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included Sanofi offering a deal to payers for its cholesterol drug; a “right-to-try” bill is defeated in the House; and a forum of oncology pharmacists discusses “health insurance” versus “healthcare.”
Read more about the stories in this podcast: With ODYSSEY Results in Hand, Talks With Payers Begin to Jump Start Praluent Sales: www.ajmc.com/conferences/acc-2018/with-odyssey-results-in-hand-talks-with-payers-begin-to-jump-start-praluent-sales "Right-to-Try" Legislation Defeated in House Amid Doubts About Its Necessity: www.ajmc.com/newsroom/right-to-try-legislation-headed-for-a-vote-as-doubts-about-its-necessity-remain Coverage of the American College of Cardiology’s 67th Annual Scientific Session & Expo: www.ajmc.com/conferences/acc-2018 Rep. Doug Collins: Providing Healthcare vs Health Insurance: www.ajmc.com/conferences/ncoda-spring-forum-2018/rep-doug-collins-providing-healthcare-vs-health-insurance National Community Oncology Dispensing Association 2018 Spring Forum: www.ajmc.com/conferences/ncoda-spring-forum-2018 Pembrolizumab Granted Priority Review for Treatment of Cervical Cancer: www.ajmc.com/newsroom/pembrolizumab-granted-priority-review-for-treatment-of-cervical-cancer Association of Community Cancer Centers' 44th annual meeting: www.ajmc.com/conferences/accc-2018
As hospitals are increasingly held accountable for what happens outside the hospital walls, they need access to better claims data. In a recent study published in November issue of The American Journal of Managed Care®, researchers with the Michigan Value Collaborative found that it is possible to derive episode-level utilization from claims data and it provides a level of postdischarge care precision that is superior to medical records that hospitals have access to.
Read the study: Validation of a Claims-Based Algorithm to Characterize Episodes of Care: www.ajmc.com/journals/issue/2017/2017-vol23-n11/validation-of-a-claimsbased-algorithm-to-characterize-episodes-of-care
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included Cigna's deal to buy Express Scripts; Seema Verma, Alex Azar, and Scott Gottlieb, MD, made the rounds at health conferences; an analysis finds FDA's accelerated approval pathway has been a success with hematology and oncology drugs.
Read more about the stories in this podcast: Healthcare Mergers Continue With Deal for Cigna to Acquire Express Scripts: www.ajmc.com/newsroom/cigna-to-acquire-express-scripts-in-67-billion-deal What We're Reading: Verma on Health Data; More Medicaid Work Requirements; NJ Individual Mandate: www.ajmc.com/newsroom/what-were-reading-verma-on-health-data-more-medicaid-work-requirements-nj-individual-mandate Azar Tells Insurance Industry Patients Must Be in Charge of Their Own Data: www.ajmc.com/newsroom/azar-tells-insurance-industry-patients-must-be-in-charge-of-their-own-data FDA's Gottlieb Blames Rebates, Reimbursement Issues for Holding Back Biosimilar Market: www.ajmc.com/newsroom/fdas-gottlieb-blames-rebates-reimbursement-issues-for-holding-back-biosimilar-market What We're Reading: Azar to Announce Healthcare Actions; Opposition to CMS Opioid Limits; Diabetes Disagreement: www.ajmc.com/newsroom/what-were-reading-azar-to-announce-healthcare-actions-opposition-to-cms-opioid-limits-diabetes-disagreement Expedited Approval Is Successful for Cancer Therapies, FDA Says: www.ajmc.com/focus-of-the-week/expedited-approval-is-successful-for-cancer-therapies-fda-says The Shift From Episodic to Continuous Care: Wearable Technology and Telemedicine in Cardiology: www.ajmc.com/managed-care-cast/the-shift-from-episodic-to-continuous-care-wearable-technology-and-telemedicine-in-cardiology American College of Cardiology’s 67th Annual Scientific Session & Expo: www.ajmc.com/conferences/acc-2018
The Shift From Episodic to Continuous Care: Wearable Technology and Telemedicine in Cardiology by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included a bipartisan group of governors releasing an outline for health reform; a report finds value-based contracts brings down prescription drug co-pays; 20 states file a lawsuit over the constitutionality of the Affordable Care Act.
Read more about the stories in this podcast: Bipartisan Group of Governors Unveils Blueprint to Reform Health System: www.ajmc.com/focus-of-the-week/bipartisan-group-of-governors-unveils-blueprint-to-reform-health-system Value-Based Contracts Significantly Decrease Price of Co-Pays for Medications: www.ajmc.com/newsroom/valuebased-contracts-significantly-decrease-price-of-copays-for-medications Twenty States Allege ACA Is Unconstitutional in Federal Lawsuit: www.ajmc.com/newsroom/twenty-states-allege-aca-is-unconstitutional-in-federal-lawsuit NCCN Releases Guidelines to Address Treatment Gaps for People With HIV and Cancer: www.ajmc.com/newsroom/nccn-releases-guidelines-to-address-treatment-gaps-for-people-with-hiv-and-cancer Evidence-Based Oncology – Patient Centered Oncology Care 2017: www.ajmc.com/journals/evidence-based-oncology/2018/patient-centered-oncology-care-2017
This week, the top managed care stories included the Trump administration proposed extending the duration of short-term health plans; a report found that CAR T-cell therapies are worth their high price tags; the new issue of Evidence-Based Oncology® examined current issues in immunotherapy.
Read more about the stories in this podcast: Trump Administration Proposes Extending Short-Term Health Plans to 12 Months: www.ajmc.com/newsroom/trump-administration-proposes-extending-shortterm-health-plans-to-12-months
What We're Reading: Cost of Healthcare Bills; Albertsons Buying Rite Aid; Pediatric Cancer Therapies: www.ajmc.com/newsroom/what-were-reading-cost-of-healthcare-bills-albertsons-buying-rite-aid-pediatric-cancer-therapies
ICER Report: Costs of Approved CAR T-Cell Therapies Aligned With Clinical Benefit: www.ajmc.com/newsroom/icer-report-costs-of-approved-car-tcell-therapies-aligned-with-clinical-benefit
Evidence-Based Oncology® – February 2018: www.ajmc.com/journals/evidence-based-oncology/2018/february-2018
In healthcare, digital care and telemedicine efforts are mostly viewed as an add-on to US healthcare, but that mindset should be flipped, argued Sean Duffy, CEO of Omada Health, in a piece written for The New England Journal of Medicine, titled “In-Person Healthcare as Option B.”
Duffy and Patricia Salber, MD, MBA, discuss the future of virtual visits, making decisions about when virtual visits are more appropriate than in-person visits, payment for virtual care, and more.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included a report from CMS that found healthcare spending will rise 5.5% over the next 8 years; the budget deal passed by Congress included a number of provisions with long-term health impact; a study found eating a low-carb could help reverse type 2 diabetes.
Read more about the stories in this podcast: By 2026, National Health Spending Will Climb to 19.7% of Economy, Report Says: www.ajmc.com/newsroom/by-2026-national-health-spending-will-climb-to-197-of-economy-report-says- Proposed Bipartisan Bill, 2018 Budget Deal Provide Positive Implications for VBID: www.ajmc.com/focus-of-the-week/proposed-bipartisan-bill-2018-budget-deal-provide-positive-implications-for-vbid Congress Includes Language Protecting the Rights of Diabetes Patients in Budget Deal: www.ajmc.com/newsroom/congress-includes-language-protecting-the-rights-of-diabetes-patients-in-budget-deal ASCO Review Finds Clinical Pathway Programs Adhere to Guidelines: www.ajmc.com/newsroom/asco-review-finds-clinical-pathway-programs-adhere-to-guidelines After a Year, Low-Carb Diet Helps Many Patients Reverse Type 2 Diabetes, Lose Weight, and Stop Insulin: www.ajmc.com/focus-of-the-week/after-a-year-low-carb-diet-helps-many-patients-reverse-type-2-diabetes-lose-weight-and-stop-insulin Medicare Accountable Care Spending Patterns: Shifting Expenditures Associated With Savings: www.ajmc.com/journals/ajac/2018/2018-vol6-n1/medicare-accountable-care-spending-patterns-shifting-expenditures-associated-with-savings
In a new letter published in the February issue of The American Journal of Managed Care, Martin Makary, MD, a professor of surgery at Johns Hopkins University, and his coauthors assessed price markup variation by hospital and by oncology specialty to better understand the financial hardships patients can face when charges for the same service vary widely across hospitals.
The United States healthcare system is about to undergo some changes. The proposed cross-sector merger between CVS Health and Aetna created some waves and it was followed by an even bigger surprise: the partnership between Amazon, JP Morgan Chase, and Berkshire Hathaway to create a new healthcare company.
Rita Numerof, PhD, the co-founder and president of Numerof & Associates, and Patricia Salber, MD, MBA, of The Doctor Weighs In, discuss the changes and the underlying factors that have led to so many attempts to shake up healthcare.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managedcare stories included Indiana being approved as the second state to implement work requirements in Medicaid; research found 5-year survival rates for cancer are increasing; coverage from the American Society of Clinical Oncology's 2018 Genitourinary Symposium.
Read more about the stories in this podcast: Indiana Joins Kentucky as Second State With Medicaid Work Requirements: www.ajmc.com/newsroom/indiana-joins-kentucky-as-second-state-with-medicaid-work-requirements What We're Reading: Flu Vaccine Protection; Ind. Drops Medicaid Enrollees; Global Outbreak Prevention: www.ajmc.com/newsroom/what-were-reading-flu-vaccine-protection-ind-drops-medicaid-enrollees-global-outbreak-prevention What We're Reading: Adherence Pilot; Va. Work Requirement; Disease Linked to Flint Water: www.ajmc.com/newsroom/what-were-reading-adherence-pilot-va-work-requirement-disease-linked-to-flint-water 5-Year Survival Rates for Patients With Cancer Worldwide: www.ajmc.com/newsroom/5year-survival-rates-for-patients-with-cancer-worldwide Cancer Mortality Statistics and Disparities in the US: Dr Patricia Salber Interviews Dr Otis Brawley: www.ajmc.com/managed-care-cast/cancer-mortality-statistics-and-disparities-in-the-us-dr-patricia-salber-interviews-dr-otis-brawley Risk-Sharing Contracts Can Potentially Decrease Drug Prices: www.ajmc.com/newsroom/risksharing-contracts-can-potentially-decrease-drug-prices Genitourinary Cancers Symposium: www.ajmc.com/conferences/gu-symposium-2018
There has been some good news regarding cancer: a decline in the death rate and in new cancer diagnoses for men. However, the latest findings also highlight what still needs to be worked on, according to Otis W. Brawley, MD, MACP, FASCO, FACE, chief medical and scientific officer for the American Cancer Society.
In the latest Managed Care Cast, Brawley and Patricia Salber, MD, MBA, of The Doctor Weighs In, discuss the decline in cancer rates for men, concerns with vaping, weighing the risks and benefits of certain screening procedures, and more.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included President Donald Trump vowing to lower drug prices during his State of the Union address; 3 corporate giants joined forces on healthcare; and CAR T-cell therapy was named the cancer advance of the year.
Read more about the stories in this podcast: Trump Targets Drug Prices, Right-to-Try in State of the Union: www.ajmc.com/newsroom/trump-targets-drug-prices-righttotry-in-state-of-the-union CDC Chief Resigns After Trading in Tobacco Stocks: www.ajmc.com/newsroom/cdc-chief-resigns-after-trading-in-tobacco-stocks Amazon, JPMorgan Chase, Berkshire Hathaway: We'll Tackle Employee Health Costs With New Firm: www.ajmc.com/newsroom/amazon-jpmorgan-chase-berkshire-hathaway-well-tackle-employee-health-costs-with-new-firm Prime Therapeutics, Boehringer-Ingelheim Reach Outcomes-Based Contract for Jardiance: www.ajmc.com/newsroom/prime-therapeutics-boehringeringelheim-reach-outcomesbased-contract-for-jardiance CAR T-Cell Therapy Named ASCO's Advance of the Year: www.ajmc.com/newsroom/car-tcell-therapy-named-ascos-advance-of-the-year Evidence-Based Oncology—January 2018: www.ajmc.com/journals/evidence-based-oncology/2018/january-2018
Using Health IT to Increase Medication Adherence and Enhance Precision Medicine by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included Senate confirming Alex Azar as the new HHS Secretary; a report found that healthcare prices rose in 2016; the accountable care organization movement continued to expand.
Read more about the stories in this podcast: Senate Confirms Alex Azar as HHS Secretary: www.ajmc.com/newsroom/senate-confirms-alex-azar-as-hhs-secretary Kentucky Medicaid Recipients Sue HHS Over Work Requirements: www.ajmc.com/newsroom/kentucky-medicaid-recipients-sue-hhs-over-work-requirements Americans Used Less Care in 2016 but Healthcare Costs Still Soared, Report Says: www.ajmc.com/newsroom/americans-used-less-care-in-2016-but-healthcare-costs-still-soared-report-says 561 ACOs Participating in Medicare Shared Savings Program in 2018: www.ajmc.com/focus-of-the-week/561-acos-participating-in-medicare-shared-savings-program-in-2018 ODYSSEY Outcomes Results for Sanofi's Praluent to Lead Off ACC Meeting: www.ajmc.com/focus-of-the-week/odyssey-outcomes-results-for-sanofis-praluent-to-lead-off-acc-meeting Patients Prefer End-of-Life Care in Their Location of Choice: www.ajmc.com/newsroom/patients-prefer-endoflife-care-in-their-location-of-choice Implementing the Merit-Based Incentive Payment System for Improved Population Health: www.ajmc.com/webcast/mips
The introduction of biosimilars to the US market has led to an unprecedented amount of uncertainty as stakeholders try to understand the implications of their arrival. In the following Peer Exchange discussion from the Center for Biosimilars, held in September 2017, industry experts discuss regulation, policy, and litigation issues in the world of biosimilars.
The Center for Biosimilars, a sister site of The American Journal of Managed Care, serves as an online resource that brings together the worlds of clinical, business, regulatory, policy, and economic outcomes of biosimilars.
For more insight into the world of biosimilar therapies, visit centerforbiosimilars.com.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week in managed care, the top stories included the announcement that Kentucky is the first state approved to require patients work to receive Medicaid benefits; FDA Commissioner Scott Gottlieb, MD, reveals a new program to improve clinical trial transparency; research finds the worst cases of attention-deficit/hyperactivity disorder could lower life expectancy.
Read more about the stories in this podcast: Kentucky First State Approved for Medicaid Work Requirements: www.ajmc.com/newsroom/kentucky-first-state-approved-for-medicaid-work-requirements FDA Launches Pilot Program to Improve Transparency of Clinical Trial Information: www.ajmc.com/focus-of-the-week/fda-launches-pilot-program-to-improve-transparency-of-clinical-trial-information- FDA Approves Olaparib for Breast Cancer With a BRCA Gene Mutation: www.ajmc.com/newsroom/fda-approves-olaparib-for-breast-cancer-with-a-brca-gene-mutation Psychologist Barkley Says Life Expectancy Slashed in Worst Cases for Those With ADHD: www.ajmc.com/conferences/apsard-2018/psychologist-barkley-says-life-expectancy-slashed-in-worst-cases-for-those-with-adhd American Professional Society of ADHD and Related Disorders: www.ajmc.com/conferences/apsard-2018 January 2018 Health IT Issue: http://www.ajmc.com/journals/issue/2018/2018-vol24-n1
The Electronic Health Record Landscape: An Interview With Dr Jacob Reider by Managed Care Cast
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included CMS unveiling a new voluntary bundled payment model; coverage from the JP Morgan Healthcare Conference, including immunotherapy's impact on HIV treatment and biosimilars; and news that 2 key diabetes devices will be covered by Medicare.
Read more about the stories in this podcast: CMS Tells States How to Require Work for Medicaid: www.ajmc.com/newsroom/cms-tells-states-how-to-require-work-for-medicaid Kentucky First State Approved for Medicaid Work Requirements: www.ajmc.com/newsroom/kentucky-first-state-approved-for-medicaid-work-requirements MedPAC Votes a Resounding "No" to MIPS, Recommends Voluntary Value Program: www.ajmc.com/newsroom/medpac-votes-a-resounding-no-to-mips-recommends-voluntary-value-program CMS Unveils New Voluntary Bundled Payment Model: www.ajmc.com/newsroom/cms-unveils-new-voluntary-bundled-payment-model 5 Things From the 36th Annual JP Morgan Healthcare Conference: www.ajmc.com/newsroom/5-things-from-the-36th-annual-jp-morgan-healthcare-conference Dexcom Works to Bring CGM to the Medicare Population, and More: www.ajmc.com/newsroom/dexcom-works-to-bring-cgm-to-the-medicare-population-and-more Abbott's Freestyle Libre CGM Gains Medicare Coverage: www.ajmc.com/newsroom/abbotts-freestyle-libre-cgm-gains-medicare-coverage Study Shows the Impact Synchronization Programs Have on Medication Adherence: www.ajmc.com/newsroom/study-shows-the-impact-synchronization-programs-have-on-medication-adherence
Healthcare could be improved if policy makers, leaders, and administrators thought more about the role of medical professionalism and the intrinsic motivations of physicians, said Richard J. Baron, MD, MACP, president and CEO of the American Board of Internal Medicine and the ABIM Foundation, during an interview with Patricia Salber, MD, MBA, of The Doctor Weigns In.
During their discussion, Baron and Salber touched upon professional, social justice in healthcare, burnout in medicine, and more.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included an analysis of how healthcare spending has changed in the United States; a study finds people willing to try e-cigarettes smoke less and are more likely to quit; and a new cholesterol test that doesn't require fasting gives more accurate results.
Read more about the stories in this podcast: How US Spending on Healthcare Has Changed Over Time: www.ajmc.com/focus-of-the-week/how-us-spending-on-healthcare-has-changed-over-time Smokers Willing to Try E-Cigarettes More Successful at Smoking Less, Study Says: www.ajmc.com/newsroom/smokers-willing-to-try-ecigarettes-more-successful-at-smoking-less-study-says New Cholesterol Test More Accurate Than Old Test That Requires Fasting: www.ajmc.com/newsroom/new-cholesterol-test-more-accurate-than-old-test-that-requires-fasting Perspectives of a Lipidologist: LDL Cholesterol Testing, PCSK9 Inhibitors: www.ajmc.com/journals/evidence-based-diabetes-management/2017/december-2017/perspectives-of-a-lipidologist-ldl-cholesterol-testing-pcsk9-inhibitors Study Suggests Screening Patients With Fibromyalgia Syndrome for ADHD: www.ajmc.com/newsroom/study-suggests-screening-patients-with-fibromyalgia-syndrome-for-adhd- Implementing the Merit-Based Incentive Payment System for Improved Population Health: www.ajmc.com/webcast/mips
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included a road map to develop state-level programs to care for complex populations; the Physician-focused Payment Technical Advisory Committee backed 2 new alternative payment models; a new cancer gene profiling test may open doors to new targeted therapies.
Read more about the stories in this podcast: Developing State-Level Programs for Care of Complex Populations: www.ajmc.com/focus-of-the-week/developing-statelevel-programs-for-care-of-complex-populations
Renee Murray Explains How Hotspotting Is Used: www.ajmc.com/conferences/aco-fall2016/renee-murray-explains-how-hotspotting-is-used
What We're Reading: Hospital Penalization; New APMs; EHR Challenges: www.ajmc.com/newsroom/what-were-reading-hospital-penalization-new-apms-ehr-challenges
Cancer Gene Profiling Test Can Open Doors to New Targeted Therapies: www.ajmc.com/newsroom/cancer-gene-profiling-test-can-open-doors-to-new-targeted-therapies
5 Events in the Nation's Capital That Drove Managed Care News in 2017: www.ajmc.com/newsroom/5-events-in-nations-capital-that-drove-managed-care-news-in-2017
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included the elimination of the Affordable Care Act's individual mandate; a new gene therapy for inherited vision loss that could cost $1 million; and a study found that social isolation can increase the risk of type 2 diabetes.
Read more about the stories in this podcast: What We're Reading: GOP Tax Bill Passes; Healthcare Deals; Discussing High Drug Prices: www.ajmc.com/newsroom/what-were-reading-gop-tax-bill-passes-healthcare-deals-discussing-high-drug-prices
FDA Approves Gene Therapy for Inherited Vision Loss: www.ajmc.com/newsroom/fda-approves-gene-therapy-for-inherited-vision-loss
What We're Reading: GOP Tax Bill Passes; Healthcare Deals; Discussing High Drug Prices: www.ajmc.com/newsroom/what-were-reading-gop-tax-bill-passes-healthcare-deals-discussing-high-drug-prices
Links Between Social Isolation, Type 2 Diabetes Show Need for Friendships: www.ajmc.com/newsroom/links-between-social-isolation-type-2-diabetes-show-need-for-friendships
Evidence-Based Oncology—December 2017: www.ajmc.com/journals/evidence-based-oncology/2017/december-2017
Are cancer drug costs a problem? Of course, and oncologists can do more to impact them, said Dr. Michael Kolodziej, who was the keynote speaker at The American Journal of Managed Care’s annual Patient-Centered Oncology Care® (PCOC®) meeting, which was held in November in Philadelphia. Dr Kolodziej is the current vice president and chief innovation officer at ADVI. Prior to his current position, he worked for Flatiron Health and spent 3 years at Aetna.
In this interview, recorded at the end of the first day of PCOC, Torrie Fields, senior program manager at Blue Shield of California, and Dr Kolodziej discuss the move to value-based care in oncology, what practices need to do to be successful, and the role of team-based care.
See coverage from PCOC: http://www.ajmc.com/conferences/pcoc-2017
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included coverage from the 59th American Society of Hematology Annual Meeting and Exposition; recommendations on the use of diabetes drugs with cardiovascular indications; and a new study found that despite changes in insurance plans to give consumers more clout, unnecessary medical spending remains a problem.
Read more about the stories in this podcast: What We're Reading: Medical Device Approval; Medical Laboratories Sue Government; ACA Sign-Up Deadline: www.ajmc.com/newsroom/what-were-reading-medical-device-approval-medical-laboratories-sue-government-aca-signup-deadline
CAR T Progress: Global Submissions for Kymriah, 42% Ongoing Response With Yescarta in ZUMA-1 Patients: www.ajmc.com/conferences/ash-2017/car-t-progress-global-submissions-for-kymriah-42-ongoing-response-with-yescarta-in-zuma1-patients-
Dr Stephen Schuster Outlines CAR T Results Seen in Leukemia, Lymphoma, and Myeloma: www.ajmc.com/conferences/ash-2017/dr-stephen-schuster-outlines-car-t-results-seen-in-leukemia-lymphoma-and-myeloma
American Society of Hematology coverage: www.ajmc.com/conferences/ash-2017
ADA 2018 Standards Address Drugs With CV Benefits, Hold Firm on Blood Pressure: www.ajmc.com/newsroom/ada-2018-standards-address-drugs-with-cv-benefits-hold-firm-on-blood-pressure
Impact of Consumer-Directed Health Plans on Low-Value Healthcare: www.ajmc.com/journals/issue/2017/2017-vol23-n12/impact-of-consumerdirected-health-plans-on-lowvalue-healthcare
Overuse of medical services has been a costly issue in US healthcare for decades. Now in its fifth year, the Choosing Wisely initiative from ABIM Foundation seeks to increase conversations between physicians and patients to help them make wise decisions about appropriate care and reduce the use of low-value services.
Learn more about Choosing Wisely: http://www.choosingwisely.org/
Choosing Wisely Brings Lots of Energy, but No Growth in Awareness: www.ajmc.com/focus-of-the-week/choosing-wisely-brings-lots-of-energy-but-no-growth-in-awareness
Physician Perceptions of Choosing Wisely and Drivers of Overuse: www.ajmc.com/journals/issue/2016/2016-vol22-n5/physician-perceptions-of-choosing-wisely-and-drivers-of-overuse
Despite efforts by Republicans to scale back the Affordable Care Act, there is another movement to push the healthcare industry further left and into a single-payer system.
In the latest Managed Care Cast, Donald M. Berwick, MD, MPP, FRCP, president emeritus and senior fellow of the Institute for Healthcare Improvement and a former administrator of CMS, and Patricia Salber, MD, MBA, of The Doctor Weighs In, discuss the idea of single-payer system and misconceptions about the concept, such as that is means the government will run healthcare. Some countries have chosen government-run healthcare in addition to a single-payer system, but the United States has been discussing a single-payer environment, which is a discussion around payment, not care delivery.
They also speculate on the steps of getting from the current multipayer system in the United States to single-payer system and what individual states are doing to investigate the possibility of setting up a single-payer system.
This week, the top managed care news included a new proposal from CMS that insurers warn will cause confusion; a new review examines the prevalence and cost of chronic conditions in Medicaid; and a study finds 42% of all new US cancer cases in 2014 were due to potentially modifiable exposures.
Read more about the stories in this podcast: Health Insurers to CMS: Your Changes Will Confuse Consumers, Hurt Markets: www.ajmc.com/newsroom/health-insurers-to-cms-your-changes-will-confuse-consumers-hurt-markets
Identifying the Most Prevalent and Costly Chronic Conditions in Medicaid: www.ajmc.com/newsroom/identifying-the-most-prevalent-and-costly-chronic-conditions-in-medicaid
Leading Diabetes Groups Publish Consensus Statement on "Beyond A1C" Measures to Guide FDA, Researchers: www.ajmc.com/newsroom/leading-diabetes-groups-publish-consensus-statement-on-beyond-a1c-measures-to-guide-fda-researchers
Significant Amount of Cancer Cases Attributable to Potentially Modifiable Risk Factors: www.ajmc.com/focus-of-the-week/significant-amount-of-cancer-cases-attributable-to-potentially-modifiable-risk-factors
Impact of Health Reform on Young Adult Prescription Medication Utilization: www.ajmc.com/journals/issue/2017/2017-vol23-n11/impact-of-health-reform-on-young-adult-prescription-medication-utilization
This week, the top managed care stories included a new rule from CMS to address drug costs for seniors; a campaign to get payers to fund the artificial pancreas is working; and a new survey identifies how Americans prefer to treat pain.
Read more about the stories in this podcast: New CMS Rule Takes Aim at Drug Costs for Seniors, Opioid Crisis: www.ajmc.com/focus-of-the-week/new-cms-rule-takes-aim-at-drug-costs-for-seniors-opioid-crisis
JDRF Announces Anthem Policy Change on Medtronic Artificial Pancreas: www.ajmc.com/newsroom/jdrf-announces-anthem-policy-change-on-medtronic-artificial-pancreas
Survey Identifies Americans' Preferences for Pain Management: www.ajmc.com/newsroom/survey-identifies-americans-preferences-for-pain-management
ASCO's TAPUR Study Expands to Enroll Patients Receiving Immunotherapy: www.ajmc.com/newsroom/ascos-tapur-study-expands-to-enroll-patients-receiving-immunotherapy
Changes in Cardiovascular Care Provision After the Affordable Care Act: www.ajmc.com/journals/issue/2017/2017-vol23-n11/changes-in-cardiovascular-care-provision-after-the-affordable-care-act
This week, the top stories in managed care included new hypertension guidelines lowering the threshold for high blood pressure, Trump nominating a new HHS secretary, and many consumers now have access to less expensive Affordable Care Act plans.
High Blood Pressure Starts at 130/80, New Guidelines Say: www.ajmc.com/conferences/aha-2017/80-new-guidelines-say
Trump Nominates Alex Azar, Former Lilly Executive, to Lead HHS: www.ajmc.com/newsroom/trump-nominates-alex-azar-former-lilly-executive-to-lead-hhs
Kaiser Analysis: For Many, Health Coverage Costs Less Than Individual Mandate Penalty: www.ajmc.com/focus-of-the-week/kaiser-analysis-for-many-health-coverage-costs-less-than-individual-mandate-penalty
Patient-Centered Oncology Care: www.ajmc.com/conferences/pcoc-2017/
This week, the top managed care stories included a vote in Maine to expand Medicaid and other election day 2017 results; CMS issued final rules for the Diabetes Prevention Program; and a report from the American Society of Clinical Oncology highlighted the link between alcohol consumption and cancer.
Read more about the stories in this episode: Maine Votes by Ballot Measure to Expand Medicaid, but the Governor Remains Opposed: www.ajmc.com/focus-of-the-week/maine-votes-by-ballot-measure-to-expand-medicaid-but-the-governor-remains-opposed
Final Medicare DPP Rule Adjusts Maintenance Period, Excludes Digital Providers: www.ajmc.com/newsroom/final-medicare-dpp-rule-adjusts-maintenance-period-excludes-digital-providers
ASCO: Alcohol Linked to Several Types of Cancer: www.ajmc.com/newsroom/asco-alcohol-linked-to-several-types-of-cancer
American College of Rheumatology 2017 Annual Meeting: www.ajmc.com/conferences/acr-2017
Patient-Centered Oncology Care®: www.ajmc.com/meetings/pcoc17#register
Suzanne Delbanco, PhD, MPH, of Catalyst for Payment Reform, and Patricia Salber, MD, MBA, of The Doctor Weighs In, discuss payment reform in the healthcare industry, including quality measurements and accountable care organizations.
This week, the top managed care news included the first day of open enrollment; data from CMS that indicate the progress accountable care organizations are making; and findings that most people with obesity aren't get screened for it or getting care.
Read more about the stories in this episode: Battered but Still on the Books, the ACA Starts a New Round of Open Enrollment: www.ajmc.com/focus-of-the-week/1101/battered-but-still-on-the-books-the-aca-starts-a-new-round-of-open-enrollment
CMS Releases Medicare Shared Savings Program 2016 Results: www.ajmc.com/contributor/travis-broome/2017/10/cms-releases-medicare-shared-savings-program-2016-results
Novartis Seeks Second Indication for Tisagenlecleucel: DLBCL: www.ajmc.com/newsroom/novartis-seeks-second-indication-for-tisagenlecleucel-dlbcl
Most With Obesity Don't Get a Diagnosis or Referral for Care, Study Finds: www.ajmc.com/newsroom/most-with-obesity-dont-get-a-diagnosis-or-referral-for-care-study-finds
Patient-Centered Oncology Care® registration: www.ajmc.com/meetings/pcoc17#register
This week, the top managed care news included a judge ruling President Donald Trump can end the cost-sharing reduction subsidies; findings on awareness of the Choosing Wisely campaign; and conference coverage from around the nation at NAMCP, COA, and more.
Read more about the stories in this episode: Judge Says Trump Can Block CSR Payments: www.ajmc.com/newsroom/judge-says-trump-can-block-csr-payments Choosing Wisely Brings Lots of Energy, but No Growth in Awareness: www.ajmc.com/focus-of-the-week/1024/choosing-wisely-brings-lots-of-energy-but-no-growth-in-awareness COA Payer Exchange Summit VII: www.ajmc.com/conferences/coa-2017-oncology-payment-reform National Association of Managed Care Physicians Fall Forum 2017: www.ajmc.com/conferences/namcp-fall-2017 VBID Summit Explores How Congress Can Make High-Deductible Plans Work for Consumers: www.ajmc.com/newsroom/vbid-summit-explores-how-congress-can-make-highdeductible-plans-work-for-consumers
Every week, The American Journal of Managed Care recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care news included the bipartisan deal to stabilize the Affordable Care Act's insurance markets; coverage from the Academy of Managed Care Pharmacy 2017 Nexus; a plan to reduce clinician burnout at the computer; and an FDA advisory panel has recommended approval for semaglutide, a once-weekly GLP-1 receptor agonist.
Read more about the stories in this episode: Deal Reached to Keep Health Insurance Subsidies: www.ajmc.com/focus-of-the-week/1017/Deal-Reached-to-Keep-Health-Insurance-Subsidies
The Academy of Managed Care Pharmacy Nexus 2017: www.ajmc.com/conferences/amcp-nexus-2017
Kite Pharma's CAR T-Cell Treatment Approved, Cheaper Than Tisagenlecleucel: www.ajmc.com/newsroom/kite-pharmas-car-t-cell-treatment-approved-cheaper-than-tisagenlecleucel
AMA Seeks to Make Health Data Work Better for Doctors, Patients: www.ajmc.com/focus-of-the-week/1017/AMA-Seeks-to-Make-Health-Data-Work-Better-for-Doctors-Patients
ACO & Emerging Healthcare Delivery Coalition Fall 2017: www.ajmc.com/acocoalition/fall17
FDA Panel Gives Nod to Once-Weekly Semaglutide for Type 2 Diabetes: www.ajmc.com/newsroom/fda-panel-gives-nod-to-once-weekly-semaglutide-for-type-2-diabetes
Evidence-Based Oncology, October 2017: www.ajmc.com/journals/evidence-based-oncology/2017/October-2017
As the senior national correspondent at Kaiser Health News, Sarah Varney covers health policy, specifically looking at federal law and how it rolls out in states and local jurisdictions. During her conversation with Patricia Salber, MD, MBA, of The Doctor Weighs In, she explained how her articles are shaped by the time she spends in the field talking to people affected by the policy decisions made in Washington, DC, or state capitals.
This week, the top managed care stories included a new executive order to allow sale of health insurance across state lines; Iowa wait for a response to its request to opt out of parts of the Affordable Care Act; and a new study finds childhood obesity increased 10-fold over 4 decades.
This week, the top managed care stories included speculation regarding who would replace Tom Price, MD, as HHS secretary; a report on breast cancer mortality trends and racial disparities from 1989 to 2015; and the FDA announced new strategies to improve patient access to less expensive drugs.
This week, the top managed care stories included the end of the latest attempt to repeal the Affordable Care Act; a call to include the patient's voice in cancer quality metrics; and an argument for caution regarding the newly approved CAR T-cell therapy, Kymriah.
Recovering from the devastation in hurricane-affected areas will take a long time, as Michael Griffin, president and CEO and Daughters of Charity Services of New Orleans, knows well.
Twelve years after Hurricane Katrina hit the Gulf Coast city, New Orleans is still recovering. In a discussion with Patricia Salber, MD, MBA, of The Doctor Weighs In, Griffin explains his experience in New Orleans, where the recovery currently is, and what lessons he's learned that hard hit areas, like Puerto Rico can take note of during these difficult months and years of rebuilding.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included a new direction for the Center for Medicare and Medicaid Innovation; a bipartisan group of governors spoke out against the latest effort to repeal the Affordable Care Act; and the World Health Organization warned that antibiotics currently being developed were not enough to fight antibiotic-resistant infections.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top stories in managed care included competing healthcare reform bills in the Senate; the FDA announced progress in clearing up the backlog of orphan drug requests; and a study examines how much it really costs to bring a drug to the market.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included more insurers rolling back participation in Affordable Care Act exchanges, while governors testify ways to stabilize the market; the FDA put 3 combination trials of nivolumab on hold; and a study finds very few visits to the emergency department are truly avoidable.
In New Jersey, the call went out to find volunteer nurses willing to travel down to Texas to help with relief efforts and assist those nurses who were tired and overworked in the flood zone, and 50 nurses answered the call within a few days.
This week, the top stories in managed care include a disaster relief efforts in Houston after Hurricane Harvey; the approval of the first gene therapy in the United States; and a new cardiovascular indication for a popular drug to treat type 2 diabetes.
This week, the top stories in managed care include a study on which mammogram recommendations to follow; findings that continuous glucose monitoring benefits patients with type 2 diabetes; and a new position statement on treating patients with diabetes and hypertension.
Surviving cancer doesn't mean the challenges are all in the past. After cancer is treated and cured, many survivors still face financial debt and lingering toxcities that impact their lives. Samantha Eisenstein Watson, MBA, CEO and founder of The Samfund, explains the challenges that young adult cancer survivors, in particular, go through and how her organization tries to help alleviate some of the financial burden. Plus, a look at what the effects of cancer treatment mean for fertility and what challenges this represents for young adults.
This week, the top managed care articles included a report from the Congressional Budget Office on the impact of eliminating the Affordable Care Act's cost-sharing reduction payments; a decision from CMS to eliminate 2 mandatory bundled payment programs; and a new value-based alliance that called for ending use of a test for diagnosing heart attacks.
There is a lot of evolution happening in healthcare in a number of areas, including policy, technology, and the market, explained Deanne Kasim, founding partner of Santesys Solutions.
This week, a look at the politics of right-to-try legislation; research finds the FDA's expedited review programs have been successful; and a review of guidelines from American College of Cardiology, the American Diabetes Association, and the American Heart Association highlights the best way to prevent cardiovascular risk in patients with diabetes.
This week, a bipartisan group of members of the House of Representatives released proposals for fixing the Affordable Care Act (ACA); the FDA approved a targeted therapy for patients with acute myeloid leukemia who have a rare genetic mutation; and a study found that since the ACA was implemented, more patients have gained access to clinical trials.
This week, Republicans in the Senate broke ranks and rejected multiple measures to repeal and replace the Affordable Care Act; CMS put out a call for ideas for new payment models in behavioral healthcare; and AJMC® publishes 2 studies on empowering consumers to find the best prices for medications.
This week, the top managed care stories included more twists in Senate Republicans' efforts to repeal the Affordable Care Act as first the bill to repeal and replace failed to garner enough votes and then an idea to repeal only was a non-starter; a Medicare fraud sweep targeted opioid distribution; and the CDC reported 30 million Americans now have diabetes.
Danny Sands, MD, practicing physician at Beth Israel Deaconess Medical Center and co-founder of the Society of Participatory Medicine, didn't always know he wanted to be a doctor and he went to college torn between medicine, law, or engineering. Although he went through to medical school, he has retained his interest in law and engineering, which has proven useful as the industry went through changes in regulation and technology.
In his new book, Mistreated: Why We Think We're Getting Good Health Care—and Why We're Usually Wrong, Robert Pearl, MD, the former CEO of Kaiser Permanente discusses the cost of healthcare in the United States relative to outcomes and ways to fix the system.
During his interview with Patricia Salber, MD, MBA, Pearl explains what has caused the high costs of care in the United States and what can be done to address them, how poor communication between providers and institutions leads to poor care and preventable issues, changing the context of medicine and demands by patients and employers, and more.
This Week in Managed Care—Insurers Avoid HealthCare.gov, and Other Health News by Managed Care Cast
This Week in Managed Care—Senators Hear Reactions to Health Bill, and Other News by Managed Care Cast
This week, the top managed care news included the Senate announcing it would delay voting on the healthcare bill until after July 4; the FDA outlined a plan to expedite drug approvals; and Joe and Jill Biden launched the Biden Cancer Initiative.
Shortly before the Congressional Budget Office (CBO) released its score for the Senate healthcare bill, Patricia Salber, MD, MBA, of The Doctor Weighs In, and Nathan Bays, managing director at Cain Brothers, a healthcare investment bank, and policy advisor to The Health Management Academy, discussed how the Senate bill stands up to the House bill and speculation about how the CBO might score the bill.
This week, the Senate released its healthcare bill; CMS proposed changes to the implementation of the Medicare Access and CHIP Reauthorization Act; a study found Medicaid expansion increased emergency department utilization, but more people had insurance coverage; and another diabetes drug received a new cardiovascular indication.
Michael Petersen, MD, of Accenture Health, discusses the opioid epidemic and how data analytics can be used to break down the silos in healthcare to better care for people addicted to opioids and to prevent further spread of the epidemic.
The Oncology Stakeholders Summit, Fall 2016, Peer Exchange video program from The American Journal of Managed Care brought together Andrew Pecora, MD, of Hackensack Meridian Health; Rena M. Conti, PhD, of The University of Chicago; Brenton Fargnoli, MD, of Flatiron Health; and Bhuvana Sagar, MD, of Cigna Health, to discuss alternative payment models in oncology and the transition from fee-for-service to value-based care.
This week, CMS released a report that found 2 million people dropped Affordable Care Act coverage after failing to pay their premiums just 2 months after open enrollment ended; a study presented at the 77th Scientific Sessions of the American Diabetes Association found the diabetes drug canagliflozin reduced cardiovascular risk; and the Supreme Court of the United States ruled in favor of biosimilars in the case Sandoz v Amgen.
This week, CMS announced it would take Social Security numbers off Medicare cards to combat fraud and protect seniors from identity theft; a national plan to combat chronic obstructive pulmonary disease was released; and a nutrition advocacy group called on the FDA to stick with the schedule for rolling out a new nutrition facts label.
This week, the Congressional Budget Office published its new score for the American Health Care Act; the White House released its fiscal year 2018 budget, which includes deep cuts to science and healthcare programs; and for the first time, the FDA approved a drug based on a genetic marker, not a tumor location.
Earlier this year, Veena Shankaran, MD, MS, associate professor at the University of Washington, had a winning case study for the PAN Foundation's annual PAN Challenge. The case study outlined an education program created to improve patient financial literacy and help connect patients to funding organizations.
This week, the White House budget director hinted at adding mandatory drug rebates in Medicare; a report found seniors are paying more than ever out-of-pocket for healthcare; and the National Diabetes Prevention Program released promising data from the first 4 years of the program.
Richard A. Bankowitz, MD, MBA, FACP, executive vice president for clinical affairs at America's Health Insurance Plans (AHIP) always had an affinity for data and early on in his career had an interest in using a data-driven approach to improve quality in healthcare.
Throughout his conversation with Mandi Bishop, MA, CEO and founder of Lifely Insights, Bankowitz discussed the role of insurers in facilitating healthcare transformation, how health plans can better address underlying causes that impact a person's ability to manage their health, the role of AHIP as a resource for health plans, and other topics.
This week, the Senate began working on its own Obamacare replacement bill after the American Health Care Act passed the House of Representatives; Scott Gottlieb, MD, was confirmed as FDA commissioner; and AJMC was in Chicago covering the news out of Digestive Disease Week.
Last week, President Donald Trump's nominee for FDA was confirmed by a Senate committee and will now go before the full Senate for a vote; community oncologists met to discuss the Cancer Moonshot and the trouble with pharmacy benefit managers; and a study found obesity shortens more lives than cigarettes.
Medicare Part A is an automatic entitlement that older Americans start receiving when they begin receiving their Social Security check, but the other parts of Medicare can be more difficult to enroll in. Mandi Bishop, CEO of Aloha Knows, interviewed 2 intelligent individuals who went through a 5-month process to get a mistake fixed for enrollment in Medicare Part B.
In the last week, CMS issued a new rule to end abuse on the Affordable Care Act insurance exchanges; a study found that type 2 diabetes may possibly be reversed; and CareMore unveiled a new care model to deliver primary care from the dentist's chair.
In the latest Managed Care Cast, Patricia Salber, MD, MBA, of The Doctor Weighs In, speaks with Kai Yeung, PharmD, PhD, about his winning research paper on creating a value-based formulary.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week, the top managed care stories included an update for a controversial prostate cancer screening guideline; the consequences of conflicting breast cancer guidelines; and Florida seeks work requirements for Medicaid.
Darin Brannan, CEO, president, and co-founder of ClearDATA, may have extensive experience in Silicon Valley, but he came from a family of physicians who wanted to bring new technology into the industry to drive efficiency and prevent accidental medical errors and deaths.
This week, the top managed care news included Scott Gottlieb, MD, the nominee to lead the FDA, testifying before a Senate panel as part of his confirmation process; a rough week for Mylan with an EpiPen recall and a class-action lawsuit; and a new study that tied late nights to depression for people with diabetes.
This week, the top managed care news included new radiology guidelines for early-stage breast cancer; 4 continuing healthcare challenges for President Donald Trump; and Medicare coverage for Dexcom's continuous glucose monitor.
This week, the top stories in managed care included last-minute changes to Republicans' bill to repeal the Affordable Care Act; a lack of votes to pass the GOP health bill, which was ultimately pulled; and promising study results on PCSK9 inhibitors and SGLT2 inhibitors presented at the 66th Scientific Session of the American College of Cardiology.
The field of immunotherapy is a work in progress and researchers are now expanding the use of this treatment and doing a better job of identifying the patients that will benefit the most from it.
This week included the much-anticipated report from the Congressional Budget Office releasing rating of the GOP's health plan; the Senate voted to confirm Seema Verma for CMS administrator; and President Donald Trump nominated Scott Gottlieb, MD, to lead the FDA.
Raj Toleti, CEO and founder of HealthGrid, has created patient-driven technologies to help empower them when they are accessing care.
During the latest Managed Care Cast, Mandi Bishop, chief evangelist and founder of Aloha Health, and Toleti discuss how health technology solutions will help move the needle on value-based care transformations, patient activation, improving patient portals and information sharing, and more.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week included a bill from House Republicans to repeal and replace the Affordable Care Act, a new program at Walgreens to train pharmacists on an advanced cancer-care curriculum, and findings that health coaching helps the neediest patients most.
Just hours before House Republicans released their long-awaited Affordable Care Act replacement bill, Patricia Salber, MD, MBA, of The Doctor Weighs In, and Nathan Bays, general counsel and executive director at the Health Management Academy, discussed what was expected to be included in the final bill and mostly accurately predicted the main provisions of the new bill.
The widespread nature of the opioid epidemic will require coordination from a variety of stakeholders and all levels of government. In this podcast, experts discuss how the crisis got so out of hand, various tactics being undertaken to reverse the opioid, and the current impact of stigma on getting treatment.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week included President Donald Trump's first address to Congress, which included his guiding principles for replacing the Affordable Care Act; a leaked version of the House GOP's own draft for healthcare reform; alarming trends in colorectal cancer rates in younger adults; and outcomes of having an in-house specialty pharmacy.
Georges C. Benjamin, MD, executive director of the American Public Health Association, was involved with putting on the replacement meeting for the CDC's canceled conference on climate change and health. He discussed how climate change is a social justice issue, the Environmental Protection Agency, and the health impacts of climate change in an interview with Patricia Salber, MD, MBA.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week included news that Republicans have an outline for replacing the Affordable Care Act, pharmacy benefit managers and pharmaceutical companies pointing fingers at one another over drug costs, and a report on engagement for patients with chronic conditions.
At the 5th annual Patient-Centered Oncology Care (PCOC) meeting in Baltomore, Maryland, speakers discussed new therapies, such as CAR-T cells, financial toxicity, payment reform, and more. Here we present key takeaways from the sessions and panels presented at the PCOC meeting in Baltimore in the words of the presenters themselves.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.
This week included news that insurers in both blocked megamergers—Aetna-Humana and Anthem-Cigna—are not interested in appealing the decision and instead want to terminate the deals, a new proposed rule to tighten up enrollment for the Affordable Care Act and stabilize the marketplace, and a new law in New Jersey that provides the strictest mandates in the country for treating opioid and heroin addiction.
This week, the top managed care stories included final enrollment numbers for the Affordable Care Act for 2017, a report that revealed low rates of lung cancer screening, and a study found that a population-based weight management strategies can prevent diabetes.
In the latest Managed Care Cast, Mandi Bishop, MA, CEO of Aloha Health, interviews Christopher A. Snider, a patient community advocate for Symplur, creator of patient community site My Disease Secret, and host of the Just Talking podcast, and social media strategist for Smart Patients.
They discuss Snider’s own diabetes diagnosis—he was diagnosed with type 1 diabetes in 2002—and his journey to patient advocate, finding a patient community on social media, what Symplur is doing with Twitter data it captures from disease communities, and more.
“My perspective with Symplur is that there is a lot of data that the patient community could potentially use to improve itself,” he said. “My initial work with them has been to try to figure out how to bring access to this mountain of data … that a lot of people don’t necessarily know exist … try to bring access to the patient community.”
You can follow Christopher on Twitter @iam_spartacus or visit his site at www.christopherasnider.com.
Mandi Bishop, MA, CEO of Aloha Health, and Nicole Fisher, founder and CEO of HHR Strategies, discuss how the Affordable Care Act is woven into the fabric of American healthcare, provided some speculation on the new administration in the White House, and dove into Fisher's work on concussion legislation for youth sports and her involvement in the NFL concussion Congressional hearings.
On the heels of the hearing for President-elect Donald J. Trump’s pick for HHS secretary Representative Tom Price, R-Georgia, Patricia Salber, MD, MBA, of The Doctor Weighs In, spoke with Sally C. Pipes, president and CEO of the Pacific Research Institute, about potential elements of an Affordable Care Act replacement plan.
As Andy Slavitt, MBA, acting administrator of CMS, comes to the end of his tenure, he spoke with Mandi Bishop, MA, CEO of Aloha Health, about the task of making health policy translatable and the legacy of payment reform he leaves behind.
During his tenure, Slavitt, who has held the position since March 2015, oversaw the rollout of a number of new payment models to move healthcare to a value-based care system, including the implementation of the Medicare Access and CHIP Reauthorization Act. In addition, he has made a point to work on providing Americans with tools to help them find the best hospitals.
In the interview with Bishop, he offered insights for the incoming administration in the continued move toward value-based care.
At the fall live meeting of The American Journal of Managed Care's ACO & Emerging Healthcare Delivery Coalition, speakers discussed how to care for complex patients, and the latest in reimbursement. The week before the Coalition met, CMS released the final rule for the Medicare Access and CHIP Reauthorization Act, which was a huge topic of conversation. Among the speakers was CMS' Kate Goodrich, MD, who joined a panel discuss the particulars of the rule and how providers will be impacted.
Here we present key takeaways from the sessions and panels presented at the Coalition meeting in Philadelphia in the words of the presenters themselves.
Last week, AJMC published an interview between Mandi Bishop and Helen Figge that touched on digital health, the use of technology across the care continuum, and patient experience. This segment of the conversation on recommendations for people, specifically women, entering the healthcare industry, was originally cut for time.
While health technology tool get better and better, they provide benefits for patients, but should not be there to replace clinicians, explained Helen Figge, MBA, CPHIMS, FHIMSS, senior vice president of global strategies and development at LumiraDx.
There are a lot of unknowns about how Republicans will move to repeal and replace the Affordable Care Act now that they will have a Republican in the White House. Joe Antos, PhD, resident scholar at the American Enterprise Institute, did his best to speculate how a repeal might play out and what will happen with Medicaid expansion under a Trump presidency.
Through a pricing survey of providers, database curation, and crowdsourcing, Clear Health Costs is providing information to consumers to help them understand what things cost in healthcare. The company supplies reasonable and comprehensive survey of pricing information so people can go into a provider office and know if they have cheaper alternatives available to them.
During an interview with 3 members of the Coalition, Patricia Salber, MD, MBA, of The Doctor Weighs In, discussed the work of the Coalition, scaling its success, the upcoming conference, and more.
President-elect Donald J. Trump’s upset win almost certainly means the end of the Affordable Care Act as we know it, but experts who spoke at Patient-Centered Oncology Care said the movement toward value-based payment will continue.
As the healthcare industry moves toward value-based care and accountable care organizations and other new financial models gain greater importance, Aledade is looking to guide physicians to success.
Dr. Patricia Salber, of The Doctor Weighs In, interviewed Travis Broome of Aledade on the mission of Aledade and healthcare transformation. For more on Aledade, see Broome's articles: http://www.ajmc.com/contributor/travis-broome/
Researchers from Tufts Medical Center analyzed findings from 26 studies to determine how drug exclusion policies affect patients and healthcare costs. They found that in most cases, exclusion policies work.
Dr. Patricia Salber, of The Doctor Weighs In, interviewed the lead author, Dr. James Chambers, to discuss his findings.
Read the full study: http://www.ajmc.com/journals/issue/2016/2016-vol22-n8/the-impact-of-formulary-drug-exclusion-policies-on-patients-and-healthcare-costs
Margaret E. O'Kane has been making lasting impacts on healthcare quality measurement for years. But when she founded the National Committee for Quality Assurance, the organization was sometimes underestimated and not taken seriously.
In fall 2015, The American Journal of Managed Care convened a panel of experts to discuss healthcare reform in the United States.
In these segments, panelists Leah Binder, president and CEO of The Leapfrog Group; Austin Frakt, PhD, an associate professor at the Boston University School of Public Health and School of Medicine and a health economist at the Department of Veterans Affairs; Margaret E. O'Kane, MHA, president of the National Committee for Quality Assurance; and Matt Salo, executive director of the National Association of Medicaid Directors, discussed a number of topics, including Medicaid expansion, drug prices, managing specialty populations, and more.
Watch the video series here: http://www.ajmc.com/peer-exchange/healthcare-reform-stakeholders-summit-fall-2015