Managed Care Cast

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 an effort by the Trump administration to bolster Medicare Advantage; an abortion case from Louisiana reached the Supreme Court; the study of adapting to changing oxygen levels wins the Nobel Prize. Read more about the stories in this podcast: Trump Executive Order Bolsters Medicare, MA to Compete Against "Medicare for All" Proposals: https://www.ajmc.com/newsroom/trump-executive-order-bolsters-medicare-ma-to-compete-against-medicare-for-all-proposals What We're Reading: Abortion Access Appeal; Trump to Suspend Visas for Uninsured Immigrants; Vape Ban in Oregon: https://www.ajmc.com/newsroom/what-were-reading-abortion-access-appeal-trump-to-suspend-visas-for-uninsured-immigrants-vape-ban-in-oregon Nobel Prize Honors 3 Who Showed How Cells Adapt to Oxygen Levels: https://www.ajmc.com/focus-of-the-week/nobel-prize-honors-3-who-showed-how-cells-adapt-to-oxygen-levels Cali

This month’s issue of The American Journal of Managed Care® took a look at differences in coverage of orphan and nonorphan drugs to get insight into variation in orphan drug coverage across the largest commercial plans in the United States. The study, which analyzed a data set of private health plan coverage decisions for specialty drugs in 3 ways, found that health plans restrict access to orphan drugs about one-third of the time and that restrictions vary across plans. To get more insight into the findings, and the reasons behind these trends, we sat down with James Chambers, PhD, associate professor of medicine at Tufts Medical Center Institute for Clinical Research and Health Policy Studies.

Exploring the Rise of Obesity-Related Cancers: A Conversation With Dr Debra Patt by Managed Care Cast

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care news included Medicare cuts hospital payments over readmissions; a second-generation chimeric antigen receptor T-cell therapy shows promise; a diabetes drug is approved to prevent kidney failure for the first time. Read more about the stories in this podcast: What We're Reading: Medicare Issues Readmission Penalties; Virginia Abortion Law Ruling; Vitamin A's Role in Skin Cancer: https://www.ajmc.com/newsroom/what-were-reading-medicare-issues-readmission-penalties-virginia-abortion-law-ruling-vitamin-as-role-in-skin-cancer- PwC Report Urges Action to Tackle Social Determinants of Health: https://www.ajmc.com/focus-of-the-week/pwc-report-urges-action-to-tackle-social-determinants-of-health Researchers Say Second-Generation CAR T-Cell Therapy Proves Successful in Early Studies, Human Trial Planned: https://www.ajmc.com/ne

Digging Deeper Into the Increasing Use of Telehealth by Managed Care Cast

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care news included state and federal crackdowns on vaping that forced out the president of Juul; FDA approved a groundbreaking diabetes treatment; Medicare Advantage premiums will decline for 2020. Read more about the stories in this podcast: What We're Reading: Walmart Removes E-Cigs; Sutter Health Antitrust Case; Sanders Proposes Medical Debt Elimination: https://www.ajmc.com/newsroom/what-were-reading-walmart-removes-ecigs-sutter-health-antitrust-case-sanders-proposes-medical-debt-elimination What We're Reading: Heartburn Medication Recall; Juul Labs CEO Steps Down; Amazon Launches Virtual Health Clinic: https://www.ajmc.com/newsroom/what-were-reading-heartburn-medication-recall-juul-labs-ceo-steps-down-amazon-launches-virtual-health-clinic Flavored E-Cigarettes Linked With Worsening Severity of Asthma in Mice: https://w

Now 3 years into the Oncology Care Model, practices participating in the episode-based model have recently received results from performance period 4, representing care delivered in the first half of 2018. Results from the previous 2 performance periods have some practices concerned because there was little improvement; During both performance period 2 and 3 approximately 30% of practices achieved savings. With performance period 4 results out now, it’s a transformative point in the model in which practices that have not yet achieved a performance-based payment have to either enter 2-sided risk or leave the model. To dive into the most recent results and their implications, we spoke with Charles Saunders, MD, chief executive officer of Integra Connect.  Read more about the Oncology Care Model performance period results: Lessons From the Field: How Practices Are Succeeding Under OCM: https://www.ajmc.com/focus-of-the-week/lessons-from-the-field-how-practices-are-succeeding-under-ocm Mike Fazio: Practices Are

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included Purdue Pharma filing for bankruptcy; new data showing the number of people who get screened for HIV at least once falls far short of what CDC recommends; findings that most US hospital markets are now highly concentrated. Read more about the stories in this podcast: What We're Reading: Purdue Pharma Files for Bankruptcy; Rise in Uninsured Immigrants; Spiked CBD in Maryland: https://www.ajmc.com/newsroom/what-were-reading-purdue-pharma-files-for-bankruptcy-rise-in-uninsured-immigrants-spiked-cbd-in-maryland How Many People Actually Get Screened for HIV? https://www.ajmc.com/newsroom/how-many-people-actually-get-screened-for-hiv Nearly 75% of US Hospital Markets Highly Concentrated, HCCI Report Shows: https://www.ajmc.com/newsroom/nearly-75-of-us-hospital-markets-highly-concentrated-hcci-report-shows Wha

Exploring Reference-Based Pricing as a Method for Lowering Healthcare Costs by Managed Care Cast

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care news included a report showing the US uninsured rate rose in 2018; the Trump administration indicating it will ban all flavors of e-cigarettes except for tobacco; new research showing the prevalence of hemophilia is 3 times larger than originally believed. Read more about the stories in this podcast: Despite Strong Economy, Census Report Says Uninsured Rate Rose in 2018: https://www.ajmc.com/focus-of-the-week/despite-strong-economy-census-report-says-uninsured-rate-rose-in-2018 What We're Reading: FDA Investigating Juul; Sutter Health Handed Lawsuit; European Doctor Sues FDA: https://www.ajmc.com/newsroom/what-were-reading-fda-investigating-juul-sutter-health-handed-lawsuit-european-doctor-sues-fda Trump Administration Seeks to Rid Market of Flavored e-Cigarettes: https://www.ajmc.com/newsroom/trump-administration-seek

To date, most alternative payment models (APMs) that have emerged in the shift toward value-based care have been initiated by payers and focused on primary care providers. However, there has recently been a new wave of payment reform in which providers, mostly specialists, are designing and implementing their own APMs in their practices. A study published in the September issue of The American Journal of Managed Care analyzed some of these new payment models to gain insight into what providers are prioritizing in their APMs. To get more insight into the study and its findings, we spoke with study author Suhas Gondi, BA, of Harvard Medical School.

Relationships in healthcare are important and trust is crucial to those relationships. However, it has been on the decline in the United States. We speak with the executive vice president of the ABIM Foundation and representatives from the 8 winning organizations of the foundation's Trust Practice Challenge about the programs they implemented to rebuild trust. Read more: ABIM Foundation Trust Practice Challenge: https://abimfoundation.org/what-we-do/rebuilding-trust-in-health-care/trust-practice-challenge 5 Things About Medical Mistrust: www.ajmc.com/newsroom/5-things-about-medical-mistrust From the Editorial Board: Daniel B. Wolfson, MHSA: www.ajmc.com/journals/issue/2019/2019-vol25-n5/from-the-editorial-board-daniel-b-wolfson-mhsa

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care news included a diabetes drug showing positive results in treating heart failure; new lipid guidelines promoting the use of proprotein convertase subtilisin/kexin type 9 inhibitors; and a study finding doctors are more likely to prescribe opioids if they are in a hurry. Read more about the stories in this podcast: Dapagliflozin Cuts Risk of CV Death, Worsening of Heart Failure 26%, Whether Diabetes Present or Not: https://www.ajmc.com/newsroom/dapagliflozin-cut-risk-of-cv-death-worsening-of-heart-failure-26-whether-diabetes-present-or-not New Guidelines Supported by Lipid-Lowering Therapy Studies, Indicating Benefit of PCSK9 Inhibitors: https://www.ajmc.com/focus-of-the-week/new-guidelines-supported-by-lipidlowering-therapy-studies-indicating-benefit-of-pcsk9-inhibitors Providers More Likely to Prescribe Opioids as the

On this episode of Managed Care Cast, we speak with the author of a new book that discusses the price and cost of American healthcare. Martin Makary, MD, MPH, a surgical oncologist and chief of the Johns Hopkins Islet Transplant Center, talked about what he found while writing The Price We Pay: What Broke American Health Care—and How to Fix It. Makary discusses spurious billing practices, overtreatment, and the opioid issue, as well as efforts by some providers and employers to reshape primary care.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included a huge ruling against one opioid maker and a settlement offer from another; an expert panel calling for broader screening for hepatitis C; a review showing there are more fatal events linked to a multiple sclerosis drug than previously known. Read more about the stories in this podcast: What We're Reading: Purdue Pharma Settlement; HCV Screening; Medicare for All Support: https://www.ajmc.com/newsroom/what-were-reading-purdue-pharma-settlement-hcv-screening-medicare-for-all-support Fatal AEs Associated With Alemtuzumab for MS May Occur More Frequently Than Previously Thought: https://www.ajmc.com/newsroom/fatal-aes-associated-with-alemtuzumab-for-ms-may-occur-more-frequently-than-previously-thought FDA Grants Fast Track Designation for Dapagliflozin to Prevent Kidney Failure: https://www.ajmc.com/newsr

As advocates for addressing social determinants of health (SDOH) look to get buy in from stakeholders, there's a need for building evidence base to show that initiatives addressing these determinants work. To discuss the importance of both quantifying and communicating the return on investment of these initiatives, we spoke with Susan Mani, MD, vice president of Clinical Transformation and Ambulatory Quality at LifeBridge Health. Read more about building an evidence base for SDOH initiatives Building the Evidence Base to Quantify, Communicate the ROI of SDOH Initiatives: www.ajmc.com/conferences/whcc-2019/building-the-evidence-base-to-quantify-communicate-the-roi-of-sdoh-initiatives

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week in managed care, the top news included outcomes results in treating heart failure; US prevention experts said more women should get BRCA testing; the American Heart Association offered an advisory on treating high triglycerides with prescription omega-3 fatty acids. Read more about the stories in this podcast: AstraZeneca's Dapagliflozin Meets Primary End Point in Heart Failure Trial: https://www.ajmc.com/newsroom/astrazenecas-dapagliflozin-meets-primary-end-point-in-heart-failure-trial FDA's Fast Track Designation for Empagliflozin in Heart Failure Points to New Paradigm: https://www.ajmc.com/newsroom/fdas-fast-track-designation-for-empagliflozin-in-heart-failure-points-to-new-paradigm More Women May Be Screened for BRCA Mutations Following USPSTF Guideline Update: https://www.ajmc.com/newsroom/more-women-may-be-screened-for-brca-mutations

Employers are the single largest provider and purchaser of healthcare insurance in the United States and they represent a potential force for change in the US healthcare system. In order to control costs and provide better care to their employees, employers have been banding together through local coalitions. Many coalitions across the country have coalesced under the National Alliance of Healthcare Purchaser Coalitions. At the National Alliance’s recent Leadership Summit, held at the end of June in Pittsburgh, we spoke with some of the leaders about key issues facing employers in healthcare and how those top concerns may have changed over the past few years. Read more: Employers Compendium: https://www.ajmc.com/compendium/employers National Alliance of Healthcare Purchaser Coalitions partner page: https://www.ajmc.com/partners/national-alliance Greater Philadelphia Business Coalition on Health partner page: https://www.ajmc.com/partners/gpbch National Alliance of Healthcare Purchaser Coalitions’ 2019 Leade

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included the Trump administration looking to bar legal immigrants from using public benefits; a study in The American Journal of Managed Care® finding that a law to limit surprise medical bills is working; data on Affordable Care Act enrollment showing the effect of subsidies. Read more about the stories in this podcast: Trump Administration Publishes Final Rule Aimed at Legal Immigrants Using Public Benefits: https://www.ajmc.com/newsroom/trump-administration-publishes-final-rule-aimed-at-legal-immigrants-using-public-benefits Influence of Out-of-Network Payment Standards on Insurer–Provider Bargaining: California’s Experience: https://www.ajmc.com/journals/issue/2019/2019-vol25-n8/influence-of-outofnetwork-payment-standards-on-insurer-provider-bargaining-californias-experience What We're Reading: Ebola Vaccin

On this episode of Managed Care Cast, we’re bringing you a portion of a panel discussion about the Oncology Care Model, held in July 2019 during a meeting of The Institute for Value-Based Medicine (IVBM), an initiative of The American Journal of Managed Care®. At IVBM events, we gather thought leaders to share best practices across medicine, pharmacy, and management in regional locations around the country. This podcast is taken from our meeting focusing on Innovation and Quality in Oncology Care. Read previous coverage of IVBM events: Managing Costs in Diabetes Means Intervening Early to Avoid Complications Later, Experts Say: www.ajmc.com/journals/evidence-based-diabetes-management/2019/june-2019/managing-costs-in-diabetes-means-intervening-early-to-avoid-complications-later-experts-say Even With Room for Improvement, OCM Practices Agree: They Would Participate Again; and Practice Transformations Improve Access, Increase Communication in the Shift to Value-Based Cancer Care: www.ajmc.com/journals/evidence-