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 stories included CMS giving chimeric antigen receptor T-cell payments a boost; a US task force announcing that those at risk for pancreatic cancer should be screened; FDA revealing Novartis withheld data about a high-cost gene therapy. Read more about the stories in this podcast: CMS Gives CAR T Payments Short-term Boost, Adjusts Hospital Wage Index: https://www.ajmc.com/focus-of-the-week/cms-gives-car-t-payments-shortterm-boost-adjusts-hospital-wage-index Still No Call for Widespread Screening for Pancreatic Cancer, but USPSTF Says Yes for Those With Known Risk: https://www.ajmc.com/focus-of-the-week/still-no-call-for-widespread-screening-for-pancreatic-cancer-but-uspstf-says-yes-for-those-with-known-risk What We're Reading: FDA Says Novartis Hid Data; Judge Halts Ark. Abortion Rules; New Phase in Opioid Suits: https:

Transitioning to value-based care is a marathon, not a race, and should be viewed as a mission and a culture, Jeff Hunnicutt, chief executive officer at Highlands Oncology Group, told Amy Ellis, director of quality and value-based care at Northwest Medical Specialties. In order to successfully transform a practice, there needs to be a clear message and set values ingrained in the mindset of staff at the frontline of patient care.

As a progressive disease diabetes presents an ongoing challenge for physicians to provide adequate control of patients’ diabetes, and new agents with novel mechanisms of action help reduce the burden in the management of diabetes. In a recent Peer Exchange discussion, Dr Peter Salgo, of Columbia University College of Physicians and Surgeons and NewYork-Presbyterian Hospital, led a discussion on novel agents and their role in treating patients with and with cardiovascular disease. On the panel was Dr. Om Ganda of Joslin Diabetes Center; Jim Kenney of JTKenney, a managed care consulting practice; and Dr Helena Rodbard, past president of the American College of Endocrinology and past president of the American Association of Clinical Endocrinologists. Listen to the full discussion: https://www.ajmc.com/peer-exchange/new-classes-for-treatment-of-type-2-diabetes/

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 HHS laying out a plan for importing certain prescription drugs from other countries; a potential new standard of care for chronic lymphocytic leukemia; 3 insulin makers get subpoenaed over their pricing practices. Read more about the stories in this podcast: HHS, FDA Outline Foundation for Importing Certain Drugs From Other Countries: https://www.ajmc.com/newsroom/hhs-fda-outline-foundation-for-importing-certain-drugs-from-other-countries CMS Testing Pilot to Give FFS Medicare Providers Historical Claims Data on Patients: https://www.ajmc.com/newsroom/cms-testing-pilot-to-give-ffs-medicare-providers-historical-claims-data-on-patients Ibrutinib–Rituximab Improves Survival Compared With Current Treatment for Chronic Lymphocytic Leukemia: https://www.ajmc.com/newsroom/ibrutinibndashrituximab-improves-surviva

While precision medicine has started to inch its way to becoming a norm in healthcare, there are still barriers holding back widespread implementation amomg providers and organizations. From reimbursement challenges to primary use in oncology to proving the return on investment of implementing a precision medicine program, addressing these barriers could open the door to more providers and oragnizations embracing precision medicine in their practice.  To discuss these challenges and ways to mitigate them, we sat down with Joel Diamond, MD, a practicing physician, adjunct associate professor of Biomedical Informatics at the University of Pittsburgh, and cofounder and chief medical officer of 2bPrecise.

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 bipartisan Senate bills taking aim at drug prices, especially insulin; a study linking payer refusal to pay for proprotein convertase subtilisin/kexin type 9 inhibitors with heart attacks and deaths; and a former FDA commissioner visiting The American Journal of Managed Care®. Read more about the stories in this podcast: Senate Finance Committee Unveils Bipartisan Bill to Lower Drug Costs: https://www.ajmc.com/newsroom/senate-committee-unveils-bipartisan-bill-to-lower-drug-costs Bipartisan Senate Bill Seeks to Roll Back a Decade's Worth of Insulin Price Hikes: https://www.ajmc.com/focus-of-the-week/bipartisan-senate-bill-seeks-to-roll-back-a-decades-worth-of-insulin-price-hikes Rejected, Unfilled PCSK9 Inhibitor Prescriptions Linked to Higher Risk of Cardiovascular Events: https://www.ajmc.com/focus-of-th

Addressing the Complexities of Value-Based Payment Models 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 CMS pushing for bundled payments in radiation oncology; reports detailing deficiencies in hospice care; a study finding widening disparities in life expectancy among white Americans. Read more about the stories in this podcast: CMS Proposes Bundled Payments for Radiation Oncology: https://www.ajmc.com/newsroom/cms-proposes-bundled-payments-for-radiation-oncology OIG Reports Find Deficiencies in Hospice Care and Resulting Harms to Patients: https://www.ajmc.com/focus-of-the-week/oig-reports-find-deficiencies-in-hospice-care-and-resulting-harms-to-patients Study Reveals Declining Life Expectancy Among White Americans That Defies Easy Answers: https://www.ajmc.com/focus-of-the-week/study-reveals-declining-life-expectancy-among-white-americans-that-defies-easy-answers Systolic, Diastolic BP Both Predict Cardi

Pharmaceutical manufacturers sought to improve patient access to treatments through the use of co-payment assistance cards. But, while these cards reduce the out-of-pocket cost for enrollees, employers worry that they could result in increased medication use and associated expenditures, thus negating efforts made with benefit designs. To mitigate the issue, pharmacy benefit managers have introduced co-pay accumulator adjustment programs, which prevent pharmaceutical manufacturer subsidies put toward a patient’s out-of-pocket costs from counting toward the deductible. As a result, high-deductible health plan enrollees could face a sharp spike in out-of-pocket costs when the manufacturer subsidy limits are reached, but the patient has not reached their deductible. Despite the lack of data around how these programs affect patient outcomes, they have become popular among employers. Bruce Sherman, MD, FCCP, chief medical officer of the National Alliance of Healthcare Purchasers Coalition, discusses the findings

Just halfway through the year, and 2019 has been busy for biosimilars with new guidance and approvals, but the loss of a big advocate of biosimilars from the FDA. In this episode of Managed Care Cast, Kelly Davio, senior editor of The Center for Biosimilars®, a sister site of The American Journal of Managed Care®, discusses new approvals, what the loss of Scott Gottlieb, MD, as FDA commissioner means, the reality of pay-for-delay deals, and more. Learn more about biosimilars at centerforbiosimilars.com.

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 uncertainty surrounding the fate of the Affordable Care Act's individual mandate; a study finding Medicare beneficiaries may be paying more for some generics than brand-name drugs; the Trump administration proposing 5 new payment models to transform kidney disease care. Read more about the stories in this podcast: Appeals Court Shows Uncertainty Over Constitutionality of ACA's Individual Mandate: https://www.ajmc.com/focus-of-the-week/appeals-court-shows-uncertainty-over-constitutionality-of-acas-individual-mandate Medicare Beneficiaries May Pay More for Some Generics Than Brand-Name Drugs: https://www.ajmc.com/focus-of-the-week/medicare-beneficiaries-may-pay-more-for-some-generics-than-brandname-drugs Despite Growth, Uptake of Downside Risk in ACO Contracts Remains Low: https://www.ajmc.com/focus-of-the-

While many women in healthcare report experiencing subtle or not-so-subtle bias and microaggressions at work, a recently published study sought to determine how healthcare professionals associate men and women with career and family, and also how surgeons associate men and women with surgery and family medicine. In this podcast, we speak with the lead author, Arghavan Salles, MD, PhD, about the findings, as well as other issues affecting women in healthcare.

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, we recap the top managed care news from the first half of 2019, including outcomes from some of the biggest diabetes trials, research into the annual Medicare wellness visit, and an experimental treatment in Parkinson disease. Read more about the stories in this podcast: Medicare Annual Wellness Visit Association With Healthcare Quality and Costs: https://www.ajmc.com/journals/issue/2019/2019-vol25-n3/medicare-annual-wellness-visit-association-with-healthcare-quality-and-costs Cardiovascular Prevention Guidelines Call for Less Aspirin, More SGLT2s, GLP-1s for Type 2 Diabetes: https://www.ajmc.com/conferences/acc-2019/cardiovascular-prevention-guidelines-call-for-less-aspirin-more-sglt2s-glp-1s-for-type-2-diabetes New Treatment May Have the Potential to Slow, Stop, or Reverse Parkinson Disease: https://www.ajmc.com/newsroom/new-treatment-ma

Working Toward More Transparency in Healthcare 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 President Trump issuing an executive order for more healthcare transparency; provisional data indicating that overdose deaths may be falling; the Supreme Court agreeing to hear insurers' Affordable Care Act lawsuit. Read more about the stories in this podcast: Trump Issues Executive Order Intended to Require Disclosure of Negotiated Rates Between Insurers, Hospitals: https://www.ajmc.com/newsroom/trump-issues-executive-order-intended-to-require-disclosure-of-negotiated-rates-between-insurers-hospitals Provisional Data Predict Overdose Death Rates Will Fall for First Time in Decades: https://www.ajmc.com/newsroom/provisional-data-predict-overdose-death-rates-will-fall-for-first-time-in-decades What We're Reading: Supreme Court to Hear ACA Suit; Missouri Abortion Clinic; City of Hope Investment: https://www

Today on Managed Care Cast, we speak with Benjamin Isgur, leader of PwC’s Health Research Institute, about their latest report, Medical Cost Trend Report 2020: Beyond the Numbers. We talk about what is making the medical cost trend start to move upwards and what employers are trying to do about it.

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 finding slow progress in reducing low-value care; a study finding savings by accountable care organizations may be overstated; CMS proposing a rule to allow for electronic prior authorization in Part D drugs. Read more about the stories in this podcast: Analysis Finds Progress in Reducing Spending on Low-Value Services Positive but Sluggish: https://www.ajmc.com/focus-of-the-week/analysis-finds-progress-in-reducing-spending-on-lowvalue-services-positive-but-sluggish Savings of MSSP ACOs May Be Overstated, Annals Study Finds: https://www.ajmc.com/newsroom/savings-of-mssp-acos-may-be-overstated-annals-study-finds CMS Proposes Electronic Prior Authorization for Part D Drugs: https://www.ajmc.com/newsroom/cms-proposes-electronic-prior-authorization-for-part-d-drugs FDA Approves Liraglutide for Youth

Value-based care has been a big prerogative of CMS for the last decade, and it's not going away, Brian Kern, a lawyer with Frier Levitt, told Amy Ellis, director of quality and value-based care at Northwest Medical Specialties. The government programs, such as the Bundled Payments for Care Improvement, Medicare Shared Savings Program, and Oncology Care Model, are important because practices learn from them and hopefully take these similar models to private payers, which transform healthcare. Through these value-based care programs, data analytics is crucial to help physicians understand cost, improve outcomes, and increase patient satisfaction.

Today we’re speaking with Dr Mark Simon, the chief medical officer of OB Hospitalist Group. OB Hospitalist contracts with hospitals across the United States to create OB emergency departments. The group employs more than 600 experienced OBs who are available 24 hours a day, 7 days a week to ensure that an OB is always in the hospital, rather than on call. OB Hospitalist also works with hospitals to reduce costs by being an outsourced provider of obstetricians.

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 the Community Oncology Alliance submitting an alternative to the Oncology Care Model; more study results demonstrating diabetes drugs can prevent renal failure; US task force recommending pre-exposure prophylaxis for HIV prevention. Read more about the stories in this podcast: COA Submits OCM 2.0 Proposal: https://www.ajmc.com/newsroom/coa-submits-ocm-20-proposal DECLARE Shows Diabetes Drug Farxiga Prevented Renal Decline, Even for Those With Good Kidney Health: https://www.ajmc.com/conferences/ada-2019/declare-shows-diabetes-drug-farxiga-prevented-renal-decline-even-for-those-with-good-kidney-health More CV, Renal Outcomes at ADA: CREDENCE, CARMELINA, CAROLINA: https://www.ajmc.com/conferences/ada-2019/more-cv-renal-outcomes-at-ada-credence-carmelina-carolina Oral Semaglutide Meets CV Safety Mark, Reduce