Managed Care Cast

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, joi

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 su

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

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 K

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.