Managed Care Cast

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 Resea

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 a

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-conti

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-th