Managed Care Cast

The significant effect of the COVID-19 pandemic on mental health was spotlighted in a recent collaborative study conducted by the National Alliance of Healthcare Purchaser Coalitions, Total Brain, and One Mind. Compared with before the pandemic began, study findings indicate stark increases in rates of depression, anxiety, and stress, with women shown to be at a greater risk. On this episode of Managed Care Cast, we speak with Michael Thompson, president and CEO of the National Alliance, and Louis Gagnon, CEO of Total Brain, on their findings and how employers can optimize how they monitor and support mental health in their respective workforce.

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 proposing rules for value-based contracting in Medicaid; claims data highlighting racial disparities in COVID-19 effects; an interview with Anthony Fauci, MD, on the progress made against HIV. Read more about the stories in this podcast: CMS Issues Rules to Promote Value-Based Contracting, Pay for High-Cost Therapies in Medicaid: https://www.ajmc.com/newsroom/cms-issues-rules-to-promote-valuebased-contracting-pay-for-highcost-therapies-in-medicaid Medicare Claims Data Further Highlight Pandemic's Toll on Racial Minorities: https://www.ajmc.com/focus-of-the-week/medicare-claims-data-further-highlight-pandemics-toll-on-racial-minorities What Is Being Done to Assess the Disproportionate Effect of COVID-19 on Minority, Rural Communities? https://www.ajmc.com/focus-of-the-week/what-is-being-done-to-assess-the-disproportionate-effect-of-covid19-on-minority-rural-communi

Older and poorer Americans are disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. In this episode of Managed Care Cast, we speak with Richard Shinto, MD, MBA, president and CEO of InnovaCare Health, about the company’s care of their Medicare Advantage and Medicaid beneficiaries in Puerto Rico during the COVID-19 pandemic. He last spoke with us in 2018 about the effect that Hurricane Maria had on the organization and its members. In today’s podcast, he shares how coping with the aftermath of the 2017 hurricane assisted them with 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 more details about the COVID-19 vaccine process; attempts to reinforce social distancing amid reopening; a recap of the American Diabetes Association 2020 Virtual Scientific Sessions. Read more about the stories in this podcast: US Releases More Details About COVID-19 Vaccine Process, Says Some Doses Will Be Free: https://www.ajmc.com/newsroom/us-releases-more-details-about-covid19-vaccine-process-says-some-doses-will-be-free With States Reopening, CDC Tries to Reinforce Social Distancing Guidance: https://www.ajmc.com/newsroom/with-states-reopening-cdc-tries-to-reinforce-social-distancing-guidance American Diabetes Association 2020 Virtual Scientific Sessions: https://www.ajmc.com/conferences/ada-2020 What We're Reading: Drug Price TV Ruling Upheld; WHO Ends Hydroxychloroquine Study; Caution Issued on Rally Attendance: https://www.ajmc.com/newsroom/what-were-reading-

The ramifications of the COVID-19 pandemic has caused uncertainty among employers nationwide adjusting to this new normal. Notably, viable health care coverage has emerged as an essential necessity, with employees seeking favorable benefits. A recent analysis by Willis Towers Watson indicates that individual markets, once characterized as volatile, have emerged as an option now associated with stability and growth. On this episode of Managed Care Cast, we speak with John Barkett, MBA, senior director of Policy Affairs in Benefits Delivery and Administration for Willis Towers Watson, on the current outlook of individual markets in private exchange solutions amid the pandemic.

In this episode of Managed Care Cast, we speak with the lead author of a study in the June issue of The American Journal of Managed Care® about the nationwide dearth of suppliers of the Medicare Diabetes Prevention Program, which aims to reach older adults with prediabetes. Natalie D. Ritchie, associate research scientist in the Denver Health and Hospital Authority Office of Research and an assistant professor at the University of Colorado School of Medicine and College of Nursing, discussed her thoughts on why not enough suppliers are offering the program. The study ("Medicare Diabetes Prevention Program: Where Are the Suppliers?") can be found at ajmc.com/link/4659.

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 distributing COVID-19 funds to Medicaid and CHIP providers; the National Kidney Foundation issues a statement on health disparities and racial violence; a preview of our coverage of the American Diabetes Association 2020 Virtual Scientific Sessions. Read more about the stories in this podcast: HHS to Send COVID-19 Funds to Medicaid, CHIP, Safety Net Hospitals: https://www.ajmc.com/newsroom/hhs-to-send-covid19-funds-to-medicaid-chip-safety-net-hospitals National Kidney Foundation Issues Statement on Health Disparities, Racial Violence: https://www.ajmc.com/newsroom/national-kidney-foundation-issues-statement-on-health-disparities-racial-violence American Diabetes Association 2020 Virtual Scientific Sessions: https://www.ajmc.com/conferences/ada-2020 Diabetes Educators Release Updated Report on DSMES Accessibility, Usage: https://www.ajmc.com/focus-of-the-week/diabe

Chronic musculoskeletal pain costs the United States hundreds of billions of dollars each year. Now, with the coronavirus disease 2019 (COVID-19) pandemic, healthcare providers are tasked with providing optimal care to patients while minimizing human contact as much as possible. On this episode of Managed Care Cast, we speak with Jeffrey Krauss, MD, chief medical officer of Hinge Health and Stanford Clinical assistant professor. In a study Dr. Krauss co-wrote entitled “Digital care for chronic musculoskeletal pain: 10,000 participant longitudinal cohort study,” researchers evaluated the efficacy of a 12-week digital care program aimed to reduce lower back and knee pain in a real-world population. According to authors, the results support the prospect for digital care programs to serve the overwhelming number of musculoskeletal pain sufferers worldwide.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week. This week, top managed care stories included an additional setback for Medicaid work rules; another study finding more benefits from SGLT2 inhibitors; researchers finding unwanted end-of-life care causes stress. Read more about the stories in this podcast: OCM, Other APM Timelines Extended Due to COVID-19: www.ajmc.com/focus-of-the-week/ocm-other-apm-timelines-extended-due-to-covid-19 Racial Disparities Shift in Observation Status in Hospital Admissions for Avoidable Conditions: www.ajmc.com/focus-of-the-week/racial-disparities-shift-in-observation-status-in-hospital-admissions-for-avoidable-conditions Study Finds Nonprofit Hospitals Did Not Direct Medicaid Expansion Savings Into Communities: www.ajmc.com/focus-of-the-week/study-finds-nonprofit-hospitals-did-not-direct-medicaid-expansion-savings-into-communities- ASCO 2020 Annual Meeting: www.ajmc.com/conferences/asco-2020 Improving Quality of Care in Oncology Th

In this episode of Managed Care Cast, we speak with the lead author of a study in the May issue of The American Journal of Managed Care® about the shift in new accountable care organizations (ACOs) from being led by hospital systems to being led by physician groups, and the accompanying policy shifts that are needed. David Muhlestein, the chief strategy and chief research officer at Leavitt Partners, also discussed his thoughts on the affect of coronavirus disease 2019 on ACOs. The study is titled "Accountable Care Organizations Are Increasingly Led by Physician Groups Rather Than Hospital Systems."

Amid COVID-19, patients with Parkinson disease have had to adjust to the physical and mental challenges precipitated by the pandemic. Notably, those with Parkinson disease, who are already linked with heightened feelings of stress and anxiety, may be further at risk. On this episode of Managed Care Cast, we speak with Rachel Dolhun, MD, vice president of Medical Communications at The Michael J. Fox Foundation for Parkinson Research, about recent innovations by The Michael J. Fox Foundation to assist patients and families of patients with Parkinson disease in adjusting to this new normal.

In a prior study, nearly 7 in 10 employees indicated in a survey that the COVID-19 pandemic is the most stressful time of their entire professional career. Researchers from Lyra Health, an employee behavioral health provider, recently conducted a study examining the efficacy, in real-world circumstances, of a structured, cognitive behavioral coaching program delivered through video or telephone. On this episode of Managed Care Cast, we speak with Connie Chen, MD, chief medical officer at Lyra Health, about the study “Effectiveness of a Cognitive Behavioral Coaching Program Delivered Via Video in Real World Settings.”

Against a backdrop of the health care and cost concerns stemming from the COVID-19 pandemic, the April issue of The American Journal of Managed Care® features an interview with Dr. Sherry Glied,  health economist and dean of New York University’s Robert F. Wagner Graduate School of Public Service, about the Affordable Care Act and Medicaid, as well as the vital role that public service leadership plays in navigating a crisis of this scale.

The 2020 Community Oncology Conference, hosted by the Community Oncology Alliance (COA), will take place virtually on April 23 and April 24. The American Journal of Managed Care® (AJMC®) is bringing you a series of previews so you can learn more about what to expect when you attend this virtual meeting. In this interview we speak with Debra Patt, MD, MPH, MBA, executive vice president of policy and strategy at Texas Oncology who is presenting on applied informatics in oncology at the virtual meeting.

The 2020 Community Oncology Conference, hosted by the Community Oncology Alliance (COA), takes place virtually on April 23 and April 24. The American Journal of Managed Care® (AJMC®) is bringing you a series of previews so you can learn more about what you'll hear when you attend this virtual meeting. In this interview we're speaking with Lee Schwartzberg, MD, FACP, the chief medical director of West Cancer Center and the chief medical officer of OneOncology, and who is moderating a stakeholder panel discussion on genomic profiling in cancer.

Complex care management programs aim to improve health outcomes of high-cost, high-need patients through coordinating medical and social services. In general, Medicaid patients have high rates of chronic conditions and often utilize preventable acute care, leading to avoidable spending. To determine the impact complex care management programs can have on Medicaid beneficiaries, researchers conducted a study at CareMore Health in Memphis, Tennessee. On this episode of Managed Care cast, we speak with Farhad Modarai, DO, on a recent paper he co-wrote, entitled, "Impact of Complex Care Management on Spending and Utilization for High-Need, High Cost Medicaid Patients." The study can be found in the February issue of The American Journal of Managed Care®.

Efforts to ensure that veterans have timely access to healthcare include community partnerships and the Veterans Choice Program, but new research suggests that women veterans may be receiving less care, particularly those who report unstable housing or mental/behavioral health issues, On this episode of Managed Care Cast, we speak with Laurel A. Copeland, PhD, about the paper “Gender Differences in Newly Separated Veterans’ Use of Healthcare.” The study can be found in the March issue of The American Journal of Managed Care®.

Prior authorizations play a key role in checking on the safety and appropriateness of medical treatments among patients, but when they take too long, efficiency of care suffers. On this episode of Managed Care Cast, we speak with April Todd, senior vice president, CORE and Explorations for CAQH, on CAQH CORE’s recent approval of a 2-day rule for health plans in requesting additional supporting information from providers and making final determinations on prior authorization requests. CAQH CORE is a multi-stakeholder collaboration aimed at creating healthcare operating rules for electronic administrative transactions and establishing a common foundation for the operational components of value-based payment.

This week, top managed care stories included an additional setback for Medicaid work rules; another study finding more benefits from SGLT2 inhibitors; researchers finding unwanted end-of-life care causes stress.

When implemented as intended, preventive drug lists (PDLs) can help high-deductable health plan members save money by covering preventive medications at lower or no costs. However, after conducting a series of interviews, researchers found this is not always the case among patients with asthma who have PDLs. Some patients were unaware their plans had PDLs, while other PDLs did not cover the cost of asthma medication. On this episode of Managed Care cast, we speak with Melissa B. Gilkey, PhD, and Alison A. Galbraith, MD, MPH, about their paper, "Preventive Drug Lists as Tools for Managing Asthma Medication Costs." The study can be found in the February issue of The American Journal of Managed Care®.