Managed Care Cast

Although genomic testing is recognized in national oncology guidelines as key to determining the right therapy for metastatic colorectal cancer (MCC), overall biomarker testing rates remain poor. On this episode of Managed Care Cast, we speak with one of the authors of a recent study about this issue published in JCO Precision Oncology. Stuart Goldberg, MD, a hematologist oncologist at the John Theurer Cancer Center at Hackensack University Medical Center, discusses real-world testing of biomarkers in MCC by mining electronic health records. Goldberg is also the hospital’s first chief of the Division of Outcomes and Value Research, and the episode also discusses the relationship between value-based medicine and precision medicine and the promise of delivering improved outcomes at lower costs by avoiding ineffective therapies through the use of specialized testing and diagnostics.

On this episode of Managed Care Cast, we speak with John Showalter, MD, chief product officer at Jvion and an internal medicine physician, and Soy Chen, MS, director of data science at Jvion and part of their data science team. We discuss their research about using applied machine learning to predict healthcare utilization based on social determinants of health, appearing in the January 2019 Health IT issue of The American Journal of Managed Care®.

Nearly 75% of Americans will consider healthcare a main factor when they vote in the 2020 presidential election, according to a survey published by Wolters Kluwer late last year. The survey, called Mending HealthCare in America 2020: Consumers & Cost, showed alignment and deep divisions among patients and providers, with issues around transparency, cost, and care variability causing concern. On this episode of the podcast, we speak with Peter Bonis, MD, chief medical officer, Clinical Effectiveness, Wolters Kluwer, Health.

On this episode of Managed Care Cast, we speak with Kashyap Patel, MD, the chief executive officer of Carolina Blood and Cancer Care Associates—a leading OCM practice—and associate editor of Evidence-Based Oncology™ (EBO), as well as Tennessee Oncology’s Stephen M. Schleicher, MD, MBA, to discuss Oncology Care First.

On this Managed Care Cast, we speak with a health policy researcher who got the idea for a study about medical billing appearing in the December 2019 issue of The American Journal of Managed Care® after she received one that was unexpected. While efforts to abate surprise medical billing, such as the kind that come from out-of-network emergency department visits, are currently being debated in Washington, DC, the kind of billing discussed here occurs when patients struggle to understand the difference between preventive health services, which are covered at no cost under the Affordable Care Act, and billing for services at a doctor’s visit for an illness, condition, or injury. Katie Schmitz, a graduate student pursuing a master’s degree in health communication from Purdue University, is one of the coauthors of "Preventive/Office Visit Patient Knowledge and Their Insurance Information Gathering Perceptions." Read the full paper: https://www.ajmc.com/journals/issue/2019/2019-vol25-n12/preventiveoffice-visit-p

On this episode of KOL Corner, Amy Ellis, director of quality and value-based care at Northwest Medical Specialties, talks with Amanda Hodges, BSN, RN, OCN, the director of implementation of ReVital Cancer Implementation.

In today’s Managed Care Cast, we bring you portions of the panel discussion during the the last Institute for Value-Based Medicine® (IVBM®) event for 2019, where oncologists and others shared their thoughts, successes, and frustrations with the current Oncology Care Model, as well as the question and answer session.

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 research that may hold the key to slowing progression of multiple sclerosis; Humana says it is saving billions of dollars through value-based care; the challenges of rural healthcare delivery. Read more about the stories in this podcast: Researchers May Have Identified How to Slow the Progression of MS: https://www.ajmc.com/newsroom/researchers-may-have-identified-how-to-slow-the-progression-of-ms Humana Saves $3.5B, Drives Down Hospital Use Through Value-Based Care in Medicare Advantage: https://www.ajmc.com/focus-of-the-week/humana-saves-35b-drives-down-hospital-use-through-valuebased-care-in-medicare-advantage Tackling Rural Health Challenges During Rural Health Month and Beyond: https://www.ajmc.com/contributor/kelly-munson/2019/11/tackling-rural-health-challenges-during-rural-health-month-and-beyond Hope and Some Skepticism Whether Oncology Payment Models Will Wo

Women in the United States suffer from maternal mortality rates not seen elsewhere in developed countries, and nowhere is that more true than in patients served by Medicare. Although it is a national epidemic, inadequate maternal care disproportionately affects minority women and the 43% of US births financed by Medicaid. On this episode, we speak with  an executive vice president of Avia Health Solutions, which is trying to address this issue in conjunction with 30 healthcare systems.

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 research that shows stents may offer no more value than drugs for some heart patients; a ban on flavored tobacco products gains momentum; a survey finds most American families struggle with social factors that impact health. Read more about the stories in this podcast: In Stable Heart Disease, Study Finds Stents Might Be No Better Than Drugs: https://www.ajmc.com/conferences/aha-2019/in-stable-heart-disease-study-finds-stents-might-be-no-better-than-drugs American Heart Association Scientific Sessions 2019: https://www.ajmc.com/conferences/aha-2019 What We're Reading: Vaping Ban Bill; Anal Cancer Rates; Medical Bill Protections: https://www.ajmc.com/newsroom/what-were-reading-vaping-ban-bill-anal-cancer-rates-medical-bill-protections Social Factors of Health Impacting Majority of US Families, Survey Says: https://www.ajmc.com/focus-of-the-week/social-factors-of-health

Healthcare is changing due to a combination of technological improvements and rising costs. For instance, more than half of surgical procedures now take place in an outpatient environment, but, as with many things in healthcare, there isn’t a lot of transparency. Today on Managed Care Cast, we speak with Michael Abrams, managing partner of Numerof & Associates, about patient safety and outpatient settings.

Chronic disease affects most employees in the United States, and today, on World Diabetes Day, Managed Care Cast speaks with the lead author of a study about chronic disease that appears in the November issue of The American Journal of Managed Care®. Author Maren S. Fragala, PhD, CSCS.D, talks about how employer-sponsored health screenings can help identifiy previously undiagnosed disease, enabling early detection and treatment, and help keep workers healthier.

During this week’s podcast, we sit down with Mark Lewis, MD, a gastrointestinal oncologist at Intermountain Healthcare. In addition to being a practicing oncologist, Lewis has been living with cancer himself with a hereditary tumor syndrome that’s been passed down in his family, giving him a unique experience that has driven his approach to treating his own patients. During the interview, Lewis discusses his personal history with cancer, how he’s seen the cancer landscape change over the last 2 decades, and his experience with treating neuroendocrine tumors.

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 started planning for life after the Oncology Care Model; a judge blocked a rule requiring immigrants to have health coverage; Election Day brought news for Medicaid work rules. Read more about the stories in this podcast: CMS, CMMI Seek Feedback on Oncology Care First, Successor to OCM: https://www.ajmc.com/newsroom/cms-cmmi-seek-feedback-on-oncology-care-first-successor-to-ocm Electronic PROs a Proposed Feature of Successor Model in Oncology Care: https://www.ajmc.com/focus-of-the-week/electronic-pros-a-proposed-feature-of-successor-model-in-oncology-care What We're Reading: Trump's Immigrant Health Insurance Rule Blocked; Tips to Choose a Health Plan; FDA Advises Zantac Recalls: https://www.ajmc.com/newsroom/what-were-reading-trumps-immigrant-health-insurance-rule-blocked-tips-to-choose-a-health-plan-fda-advises-zantac-recalls What We're Reading: Democrats Win W

In 2002, Bill Allman, working for Washington State, heard from a widow with a $75,000 bill from Medicaid, which was incurred as part of his long-term care costs. Like Allman, the man was a veteran. On this episode of Managed Care Cast, we learn how Allman, who is retiring at the end of 2019, launched a program to connect veterans to health benefits they didn't know they had, and in the process, figured out that states could reduce Medicaid spending.

In 2018, the Ochsner Accountable Care Network was able to reduce expected costs of care by more than $12.78 million for its Medicare beneficiaries, and it increased its savings 12% over 2017. This comes amidst research and claims that accountable care organizations may not be successful at reducing costs while improving outcomes. David Carmouche, MD, president of the Ochsner Health Network and executive director of the Ochsner Accountable Care Network, explains how the Ochsner accountable care organization (ACO) was able to find success and how other ACOs can get over the learning curve to achieve savings. Learn more about Ochsner https://www.ajmc.com/partners/ochsner

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 average Affordable Care Act premiums falling 4%; the FDA approving a triple combination treatment for cystic fibrosis; House Republicans releasing part 1 of their healthcare plan. Read more about the stories in this podcast: While Waiting for ACA Decision, HHS Says 2020 Benchmark Plan Premiums Mostly Lower: https://www.ajmc.com/newsroom/while-waiting-for-aca-decision-hhs-says-2020-benchmark-plan-premiums-mostly-lower FDA Approves Novel Triple Combination Therapy for Cystic Fibrosis: https://www.ajmc.com/newsroom/fda-approves-novel-triple-combination-therapy-for-cystic-fibrosis What We're Reading: Republicans Release Health Plan; J&J's Talc Problems; House Panel to Consider Vape Tax: https://www.ajmc.com/newsroom/what-were-reading-republicans-release-health-plan-jjs-talc-problems-house-panel-to-consider-vape-tax Blood Supply Falls Short of Need in Most Countries, S

Healthcare is increasingly trying to use big data and clinical pharmacists are no exception. On today's episode of Managed Care Cast, we talk with an assistant professor at Geisinger’s Center for Pharmacy Innovation and Outcomes about his work with big data.

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 new guide that balances curbs on opioid abuse with the needs of patients with chronic pain; HHS proposed reforming antikickback rules to help boost value-based care; a report found flaws with Medicaid work requirements.

Who will care for America's growing aged population in the coming decades? Today on the podcast, we're speaking with PHI, a New York-based nonprofit organization that works to improve long-term services and care for the elderly and those with disabilities by focusing on the job quality of those providing day-to-day hands-on care—low-paid home health care aides and nursing assistants.