Managed Care Cast

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-

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-

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-s

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/v

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

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:

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-

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 Supporti

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-persist

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

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 Initiative

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.co

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

Surprise Medical Bills Drive Up Health Premiums for All by Managed Care Cast

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

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”: ht