Managed Care Cast

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.

Dr. Anders Kolb on Leading Blood Cancer United Into a New Era by Managed Care Cast

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 Portl

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. Ask ChatGPT

Managed Care Cast News Roundup: July 8, 2025 by Managed Care Cast

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 Medicai