Managed Care Cast

Telehealth has been around for years in the United States, but it was not until the coronavirus disease 2019 (COVID-19) pandemic that it became regularly used. The growth of telehealth was fueled by the inability to see patients in person at the beginning of the pandemic and a move by the government to temporarily relax regulations. Joseph Kvedar, MD, president of the American Telemedicine Association, professor of Dermatology at Harvard Medical School, co-chair of the American Medical Association's Digital Medicine Payment Advisory Group, and editor-in-chief of npj Digital Medicine, explained that some of those relaxations might continue on after the pandemic passes, but some may get rolled back. In conversation with Patricia Salber, MD, MBA, of The Doctor Weighs In, Kvedar also discussed how breakthroughs in technology have helped make virtual visits possible, the future of telehealth, and more. Learn more: Contributor: Telehealth Claim Lines Increased 4132% Nationally From June 2019 to June 2020: https:

In this episode of Managed Care Cast, we talk with Michael N. Abrams, a cofounder and managing partner of Numerof & Associates, about the fifth annual report on the state of population health.

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 HHS defending a CDC change limiting coronavirus disease 2019 (COVID-19) testing for asymptomatic people; an inside look at the Facing Metastatic Breast Cancer Together campaign; a conversation with Kashyap Patel, MD, on his new book. Read more about the stories in this podcast: Amid Controversy, HHS Defends Change in COVID-19 Testing Guidance: https://www.ajmc.com/view/amid-controversy-hhs-defends-change-in-covid-19-testing-guidance Being Each Other’s Hero: Facing MBC Together: https://www.ajmc.com/view/being-each-others-hero-facing-mbc-together When the Topic Is Dying: A Conversation With Kashyap Patel, MD: https://www.ajmc.com/view/when-the-topic-is-dying-a-conversation-with-kashyap-patel-md How Virtual Care, Back-to-School Support, Health Inequities Are Influencing Employer Action: https://www.ajmc.com/view/how-virtual-care-back-to-school-support-health-inequities-

If there is any issue that has encapsulated the gravity of social determinants of health (SDOH) better than the coronavirus disease 2019 (COVID-19) pandemic, you'd probably be hard pressed to find a public health official able to name one. On this episode of Managed Care Cast, we share a little bit of our interview with the head of the American Public Health Association, which will appear in the September issue of The American Journal of Managed Care®. As schoolchildren, teachers, essential workers and others try to adjust to the changes wrought by this novel infectious disease this year, Georges C. Benjamin, MD, speaks about the "need to have a new societal compact for health."

Every week, The American Journal of Managed Care® recaps the top managed care news of the week. This week in managed care, the top news includes survival improves among wait-listed heart transplant candidates, the Trump administration offers a progress report on its kidney care initiative, and panelists say choice is vital to the biosimilar savings picture. Read more about the stories in this podcast: Survival Improves Among Wait-listed Heart Transplant Candidates: https://www.ajmc.com/view/survival-improves-among-wait-listed-heart-transplant-candidates Administration Offers Progress Report on Kidney Care Initiative: https://www.ajmc.com/view/administration-offers-progress-report-on-kidney-care-initiative Choice Is Vital to Biosimilar Savings Picture, Panelists Say: https://www.ajmc.com/view/choice-is-vital-to-biosimilar-savings-picture-panelists-say Do ICD-10 Codes Accurately Reflect COVID-19 Symptoms? https://www.ajmc.com/view/do-icd-10-codes-accurately-reflect-covid-19-symptoms For Short Bouts of Acute P

The coronavirus disease 2019 (COVID-19)pandemic has created one of the most rapidly changing environments to ever hit health care. The pandemic has put a strain on hospitals and staff, but people are also worried about the impact COVID-19 is having on preventive care and the management of chronic illness. Scott Hayworth, MD, president and CEO of New York-based CareMount Medical, discussed how his medical group handled the pandemic in what had been the epicenter of the US outbreak back in the spring, as well as what changes the group has made that will permanently alter the way it delivers care, during a conversation with Patricia Salber, MD, MBA, of The Doctor Weighs In. Learn more: Continuation of Routine Screenings, Care Is Crucial During COVID-19 Pandemic: https://www.ajmc.com/view/continuation-of-routine-screenings-care-is-crucial-during-covid19-pandemic Cancer Care in the Age of COVID-19: Dr Patricia Salber Interviews Dr Bobby Reddy: https://www.ajmc.com/view/cancer-care-in-the-age-of-covid-19-dr-patri

Every week, The American Journal of Managed Care® recaps the top managed care news of the week. This week in managed care, the top news included all-cause mortality disparities among Black and White men in rural areas; vaping as a risk factor for COVID-19 in young adults; how the pandemic presents an opportunity for value-based care delivery. Read more about the stories in this podcast: All-Cause Mortality Disparities Persist Among Black, White Men Living in Rural US: https://www.ajmc.com/view/all-cause-mortality-disparities-persist-among-black-white-men-living-in-rural-us Vaping a Risk Factor for COVID-19 in Teens, Young Adults: https://www.ajmc.com/view/vaping-a-risk-factor-for-covid-19-in-teens-young-adults How Can the COVID-19 Pandemic Enhance Value-Based Health Care Delivery? https://www.ajmc.com/view/how-can-the-covid-19-pandemic-enhance-value-based-health-care-delivery FDA Clears clonoSEQ to Detect MRD in Chronic Lymphocytic Leukemia: https://www.ajmc.com/view/fda-clears-cloneseq-to-detect-mrd-in-

In the world of drug development, it is typically the outcomes of phase 3 clinical trials that get the most attention. With the possibility of game-changing treatments for a myriad of diseases, they garner the most headlines, especially as the world waits on vaccines and effective treatment for the coronavirus disease 2019 pandemic. But what happens during the early phase of testing? On today’s episode of Managed Care Cast, we speak with Jill A. Fisher, PhD, author of a new book, Adverse Events: Race, Inequality, and the Testing of New Pharmaceuticals. Her research took her inside clinical testing sites for phase 1 drug studies, a veiled world where healthy participants agree to spend days or weeks in a locked facility receiving an active ingredient or placebo. She interviewed participants, research staff, and others, and delves into the societal and economic forces that compel people—typically Black men in their 20s, 30s and 40s—to enroll repeatedly in phase 1 studies.

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 CMS updates on telehealth and more; COVID-19 vaccine developments and remaining challenges; a study examines the impact of state policies on life expectancy. Read more about the stories in this podcast: CMS Releases E&M Updates, Expands Telehealth, Makes ACO Changes: https://www.ajmc.com/view/cms-releases-e-and-m-updates-expands-telehealth-makes-aco-changes Experts Highlight COVID-19 Vaccine Developments and Remaining Challenges: https://www.ajmc.com/view/experts-highlight-covid-19-vaccine-developments-and-remaining-challenges How Do State Policies Impact Life Expectancy? https://www.ajmc.com/view/how-do-state-policies-impact-life-expectancy Tafasitamab Combination Approved for Adults With R/R DLBCL: https://www.ajmc.com/view/tafasitamab-combination-approved-for-adults-with-r-r-dlbcl The Correlation of Family Physician Work With Submitted Codes and Fees: https://www.a

On this episode of Managed Care Cast, we speak with Krisda H. Chaiyachati, MD, MPH, MSHP, about the study he co-wrote entitled “Economic Outcomes of Insurer-Led Care Management for High-Cost Medicaid Patients.” In the study, Chaiyachati and co-authors aim to evaluate the impact of the Community-Based Care Management program on total costs of care and utilization among adult high-need, high-cost patients enrolled in a Medicaid managed care organization. The program included teams of community health care workers and nurses who coordinated care for this cohort. Dr. Chaiyachati is an assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine and a clinical innovation manager at Penn Medicine’s Center for Healthcare Innovation The study was published in the July edition of The American Journal of Manage Care ®.

While there remain a lot of unknowns about coronavirus disease 2019 (COVID-19) and the risk of infection patients with cancer face, it is known that when they do contract the virus, they are at a higher risk of mortality, explained Sandeep “Bobby” Reddy, MD, an oncologist at Harbor-UCLA Medical Center and chief medical officer of NantHealth, during an interview with Patricia Salber, MD, MBA, of The Doctor Weighs In. Reddy discussed the clinical care of cancer patients in the age of COVID-19, including how care has changed as a result of the pandemic; best practices at treatment centers to protect patients and staff; recommendations for patients, whether they are in the middle of treatment, haven’t yet started treatment, or have discovered something worrisome but haven’t yet been diagnosed; and more. Read about related stories: Diagnostic Delays From COVID-19 May Increase Cancer-Related Deaths, UK Studies Say: https://www.ajmc.com/view/diagnostic-delays-from-covid19-may-increase-cancerrelated-deaths-uk-studi

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 top pharmaceutical executives refuse to attend a Trump meeting after executive orders on costs; a survey shows concerns about reopening schools, toll of COVID-19 split by party lines, background; a review of 20 years of data concludes vaccines are "remarkably safe." Read more about the stories in this podcast: Trump Signs 4 Executive Orders in Effort to Carry Out Promise to Lower Drug Prices: https://www.ajmc.com/view/trump-signs-4-executive-orders-in-effort-to-carry-out-promise-to-lower-drug-prices What We're Reading: Pharma Execs Refuse to Attend Trump Meeting; Kodak Lands $765M US Loan; Persistent COVID-19 Symptoms: https://www.ajmc.com/view/what-were-reading-pharma-execs-refuse-to-attend-trump-meeting-kodak-lands-765m-us-loan-persistent-covid19-symptoms Concerns About Reopening Schools, Toll of COVID-19 Split by Party Lines, Background: https://www.ajmc.com/view/c

On this episode of Managed Care Cast, we speak with the senior vice president of Network Payment Innovation and Contract Management for Blue Cross Blue Shield of Massachusetts, which is launching new value-based payment approach for independent primary care practices. The pilot project will reward practices for keeping patients healthy while providing extra support during the pandemic.

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 states suing the Trump administration over an HHS rule on nondiscrimination; experimental vaccines show promise against coronavirus disease 2019 (COVID-19) in healthy subjects; diagnostic delays from COVID-19 may increase cancer-related deaths. Read more about the stories in this podcast: States Sue Trump Administration for Changing Nondiscrimination Provisions of ACA: https://www.ajmc.com/newsroom/states-sue-trump-administration-for-changing-nondiscrimination-provisions-of-aca Experimental Vaccines Show Promise Against COVID-19 in Healthy Subjects: https://www.ajmc.com/newsroom/experimental-vaccines-show-promise-against-covid19-in-healthy-subjects Diagnostic Delays From COVID-19 May Increase Cancer-Related Deaths, UK Studies Say: https://www.ajmc.com/focus-of-the-week/diagnostic-delays-from-covid19-may-increase-cancerrelated-deaths-uk-studies-say Cancer Organizations

On today’s episode of Managed Care Cast, we feature a short excerpt of an upcoming interview in the August issue of The American Journal of Managed Care® with Mandy K. Cohen, MD, MPH, North Carolina's secretary of the Department of Health and Human Services, as part of our yearlong Q&A series. We discussed the state's upcoming transition to Medicaid managed care, the pandemic, her advice to public health workers in the face of criticism, and how what is learned from the pandemic can help inform the future of managed care going forward.

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 states facing COVID-19 spikes reporting health coverage losses; new COVID-19 data protocol raises concerns; and experts discuss key steps to reduce racial inequities in cancer care. Learn more about the stories in this podcast: States Facing COVID-19 Spikes Report Greatest Health Insurance Coverage Losses: https://www.ajmc.com/focus-of-the-week/states-facing-covid19-spikes-report-greatest-health-insurance-coverage-losses New COVID-19 Hospital Data Protocol Raises Concerns: https://www.ajmc.com/newsroom/new-covid19-hospital-data-protocol-raises-concerns Key Steps to Reduce Racial Cancer Disparities Include Supporting Minority Scientists, Diversifying Medical Schools and Clinical Trials: https://www.ajmc.com/interviews/key-steps-to-reduce-racial-cancer-disparities-include-supporting-minority-scientists-diversifying-medical-schools-and-clinical-trials PrEP Use Has Change

Routine preventive screenings and vaccination rates have decreased due to the coronavirus disease 2019 (COVID-19) pandemic, while the Director of the National Cancer Institute recently warned delays in cancer screenings are likely to result in thousands of excess deaths. At the same time, a recent study found the pandemic could create losses of up to $15 billion for primary care practices. To find out what can be done about these setbacks, and to learn why it is so critical to continue screenings during the pandemic, we spoke with Andrea Gelzer, MD, senior vice president and corporate chief medical officer for AmeriHealth Caritas. On this episode of Managed Care Cast, Dr. Gelzer discusses the vital role telehealth has played during the pandemic, and how providers and payers can work together to encourage patients to continue routine 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 CMS planning to pay more for at-home dialysis equipment; ACR supports continued use of telemedicine after the COVID-19 pandemic passes; coverage of AIDS 2020, the 23rd International AIDS Conference. Read more about the stories in this podcast: CMS Seeks Incentives for At-Home Dialysis in Wake of COVID-19: https://www.ajmc.com/newsroom/cms-seeks-incentives-for-athome-dialysis-in-wake-of-covid19 ACR Position Statement Supports Use of Telemedicine After COVID-19 Crisis: https://www.ajmc.com/newsroom/acr-position-statement-supports-use-of-telemedicine-after-covid19-crisis Telehealth Growth in April Suggests Continuing Impact of COVID-19: https://www.ajmc.com/contributor/robin-gelburd-jd/2020/07/telehealth-growth-in-april-suggests-continuing-impact-of-covid19 Study Results Show Possible Link Between Medicaid Expansion, Drop in Advanced Breast Cancer: https://www.ajmc.com/n

Medication access barriers and nonadherence significantly impact medication underuse in the United States. This issue is estimated to cost the country’s healthcare system between $100 billion to $290 billion annually, as patients who underuse medication are more likely to have complications, which can result in costly health care utilization. Recently, The Pharmacy Quality Alliance (PQA) and National Pharmaceutical Council (NPC) announced 2 research grants funding studies of patients’ real-world medication access barriers. Leveraging the framework devised by the PQA and NPC released in March 2019, researchers at The Johns Hopkins Hospital and University of Rhode Island will investigate this problem and release their findings in 2021. Oral anticancer therapies have become popular alternatives to more traditional care, such as chemotherapy. However, research shows that adherence to oral anti-cancer therapies can range from 20% to 100%. Several factors contribute to medication non-adherence and access barrie

The last decade has brought great strides in diabetes care. Better insulins and better technology can allow people with diabetes—both type 1 and type 2—to keep their blood sugar from rising and falling in ways that cause long-term damage to their eyesight and vascular systems. New classes of drugs for patients with type 2 diabetes have been shown to cut the risk of heart and renal failure, and more widespread use could help some patients avoid dialysis. But the good news is not felt by everyone. Amid this progress, the rate of amputations rose 50% between 2009 and 2015. African American patients lose limbs at triple the rate of other groups.  The mission of the Affordable Care Act—spend more to prevent disease and complications, and save money later—has bypassed many of these patients for one reason: they lack access to care. Fourteen states have not expanded Medicaid, including several Deep South states where diabetes and obesity rates are highest. The result of these state-level policy decisions is becomi