Managed Care Cast

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 implementati

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 effec

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.