Managed Care Cast

Examining Health-Related Challenges Puerto Rico Still Faces a Year After Hurricane Maria 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 the Department of Justice giving the green light for the CVS–Aetna merger; premiums for employer insurance plans are on the rise; and the new North American trade deal includes protections for drug makers that will hurt biosimilars. Read more about the stories in this podcast: Justice Department Clears $68 Billion CVS–Aetna Merger: https://www.ajmc.com/newsroom/justice-department-clears-68-billion-cvsndashaetna-merger Premiums for Employer-Sponsored Family Insurance Increased 5% in 2018: https://www.ajmc.com/focus-of-the-week/premiums-for-employersponsored-family-insurance-increased-5-in-2018 What We're Reading: HealthCare.gov Maintenance; USMCA Drug Exclusivity; Medicare Telemedicine Proposal: https://www.ajmc.com/newsroom/what-were-reading-healthcaregov-maintenance-usmca-drug-exclusivity-medicare-teleme

As healthcare costs continue to increase, health systems are trying to better understand resource utilization among providers. The use of feedback reports can document physician practice patterns and increase accountability for resource use to prevent overuse and misuse. A new paper in the October issue of The American Journal of Managed Care measured changes in ordering rates for 4 resource use measures before and after dissemination of physician feedback reports. Lead author Eva Chang, PhD, of RTI International, discussed the findings and how the impact of the feedback reports varied depending on physician experience. Read the study and related research: Primary Care Physician Resource Use Changes Associated With Feedback Reports: https://www.ajmc.com/journals/issue/2018/2018-vol24-n10/primary-care-physician-resource-use-changes-associated-with-feedback-reports The American Journal of Managed Care—October 2018: https://www.ajmc.com/journals/issue/2018/2018-vol24-n10 Tackling Antibiotic Prescribers' Behavi

CMS’ accountable care organization program, the Medicare Shared Savings Program, could potentially be undergoing some big changes. During the recent fall 2018 meeting of the National Association of ACOs, the proposed changes were top of mind. Attendees were most concerned about how the faster timeline to taking on risk would impact participation, but were pleased with changes to the benchmark and risk adjustment. In this episode of Managed Care Cast, stakeholders at accountable care organizations (ACOs) and policy experts discuss the proposed changes and what impact they believe they will have on ACO participation. Read more about the stories in this podcast: CMS Plans to Overhaul MSSP Program to Force More Risk on ACOs: https://www.ajmc.com/newsroom/cms-plans-to-overhaul-mssp-program-to-force-more-risk-on-acos Proposed Rule for Medicare ACOs Includes Notable Changes for Rural Providers: https://www.ajmc.com/contributor/caravan-health/2018/09/proposed-rule-for-medicare-acos-includes-notable-changes-for-rura

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 Nobel Prize in Medicine was awarded to 2 people for research into immunotherapy; physician-run accountable care organizations bring savings for Medicare; research highlights the health impacts of sexual harassment and assault. Read more about the stories in this podcast: Nobel Prize Recognizes Discoveries With T Cells in Immunotherapy: https://www.ajmc.com/focus-of-the-week/nobel-prize-recognizes-discoveries-with-t-cells-in-immunotherapy The Long Road: Nobel Prize Winner James Allison Highlights the Value of Research: https://www.ajmc.com/newsroom/the-long-road-nobel-prize-winner-james-allison-highlights-the-value-of-research Physician ACOs Associated With Growing MSSP Savings Over 3 Years: https://www.ajmc.com/newsroom/physician-acos-associated-with-growing-mssp-savings-over-3-years What We're Readin

Employers may not look forward to purchasing healthcare, but they are in the position to transform the market. Key opinion leaders like Suzanne Delbanco, PhD, MPH, of Catalyst for Payment Reform; Brian Marcotte of the National Business Group on Health; and Judy Berger of Southwest Airlines, discuss how employers are getting more involved in healthcare by championing alternative payment models and other more services to their employees. Learn more about the most recent news and updates in Medicaid: Employers Play an Increasingly Important Role in the Move to Value-Based Care: www.ajmc.com/conferences/acdc-spring-2018/employers-play-an-increasingly-important-role-in-the-move-to-valuebased-care Employer Support Is Needed to Help Payment Reform Succeed: www.ajmc.com/newsroom/employer-support-is-needed-to-help-payment-reform-succeed Percent of Employers Offering Health Coverage Increases for First Time Since 2008: www.ajmc.com/focus-of-the-week/percent-of-employers-offering-health-coverage-increases-for-first-tim

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 comments to several proposals from CMS; Medicare advocates say voters will be motivated by healthcare cost concerns during the midterm elections; research showed diabetes drug dapagliflozin, an SGLT2 inhibitor, reduces risks of major cardiovascular events. Read more about the stories in this podcast: Hospital Groups, Others Raise Concerns Over CMS Payment Proposal: https://www.ajmc.com/newsroom/hospital-groups-others-raise-concerns-over-cms-payment-proposal Senate Votes 98-2 to Ban Pharmacist Gag Clauses: https://www.ajmc.com/newsroom/senate-votes-982-to-ban-pharmacist-gag-clauses What We're Reading: Safety-Net Readmissions; Gag Clause Bill to Trump; CREATES Impact on Drug Spend: https://www.ajmc.com/newsroom/what-were-reading-safetynet-readmissions-gag-clause-bill-to-trump-creates-impact-on-drug-spend Me

Medicaid Transformation Project: Addressing Health, Social Needs of Vulnerable Populations 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 the Senate overwhelmingly voting to ban pharmacist gag clauses; a study found the current vaccine pipeline for HIV, tuberculosis, and malaria may fall short; an expert noted a trend of healthcare cost data seeping into nonhealthcare companies’ earnings calls. Read more about the stories in this podcast: Senate Votes 98-2 to Ban Pharmacist Gag Clauses: https://www.ajmc.com/newsroom/senate-votes-982-to-ban-pharmacist-gag-clauses Launch of Highly Efficacious HIV, Tuberculosis, and Malaria Vaccines Unlikely, Study Says: https://www.ajmc.com/newsroom/launch-of-highly-efficacious-hiv-tuberculosis-and-malaria-vaccines-unlikely-study-says When Employee Healthcare Costs Move Stocks: https://www.ajmc.com/contributor/joseph-andelin/2018/09/when-employee-healthcare-costs-move-stocks A Multidisciplinary Approach to Ma

A Multidisciplinary Approach to Managing Complexities in Cancer Care 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 medical groups asking CMS to halt or slow down its plans to cut physician reimbursement for evaluation and management services; the Senate weighs a package of bills to combat the opioid epidemic; new research shows the Affordable Care Act pushed the uninsured rate down to 10%. Read more about the stories in this podcast: Medical Groups Tell CMS to Stand Down From Linking Reimbursement to Paperwork Burdens: https://www.ajmc.com/newsroom/medical-groups-tell-cms-to-stand-down-from-linking-reimbursement-to-paperwork-burdens What We're Reading: Senate Opioid Bills; Michigan's Medicaid Work Requirements; Missouri Abortion Ruling: https://www.ajmc.com/newsroom/what-were-reading-senate-opioid-bills-michigans-medicaid-work-requirements-missouri-abortion-ruling ACA Pushed Uninsured Rate Down to 10% in 2016, Even Mo

The September issue of The American Journal of Managed Care® highlighted research into social determinants of health and ways to address social determnants in the health system. In a commentary, Dhruv Khullar, MD, MPP, and Rainu Kaushal, MD, MPH, both of the Weill Cornell Department of Health Policy and Research, outlined how health systems can utilize data-sharing networks to deliver targeted care to high-need, high-cost patients. In this interview, Khullar outlines the idea of precision health, challenges the industry faces when trying to share data, and what steps can be taken to implement such care. Learn more about drug prices in the United States and efforts to lower them: “Precision Health” for High-Need, High-Cost Patients: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/precision-health-for-highneed-highcost-patients Language Barriers and LDL-C/SBP Control Among Latinos With Diabetes: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/language-barriers-and-ldlcsbp-control-among-latinos-w

Going Below the Surface of Healthcare Cost Discussions With Dr Bobby Dubois 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 stories included a study on the impact physician burnout is having on care quality; the latest Affordable Care Act showdown took place in a Texas courtroom; the share of employers offering health coverage increased for the first time since 2008. Read more about the stories in this podcast: Physician Burnout Associated With Poorer Patient Outcomes: https://www.ajmc.com/focus-of-the-week/physician-burnout-associated-with-poorer-patient-outcomes What We're Reading: Co-Pay Accumulators; GOP Pre-Existing Conditions Bill; Supervised Injection Sites: https://www.ajmc.com/newsroom/what-were-reading-copay-accumulators-gop-preexisting-conditions-bill-supervised-injection-sites Texas Hearing Against ACA Wraps Up as Senators Tie Issue to Kavanaugh: https://www.ajmc.com/newsroom/texas-hearing-against-aca-wraps-up-as-senators-tie-is

Bringing Virtual Tumor Boards, Real-Time Data to the Point of Care 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 stories included encouraging results from the Next Generation Accountable Care Organization model; concerns that CMS' new billing rules will hurt the sickest patients; a study confirms  the value of daily aspirin for patients with diabetes. Read more about the stories in this podcast: Next Generation ACO Model Saves $62 Million in First Year: https://www.ajmc.com/focus-of-the-week/next-generation-aco-model-saves-62-million-in-first-year Patient, Provider Groups Tell CMS Proposed E/M Service Cuts Will Hurt Sickest Patients: https://www.ajmc.com/newsroom/patient-provider-groups-tell-cms-proposed-em-service-cuts-will-hurt-sickest-patients ASCEND Results Confirm Aspirin Prevents Primary Vascular Events in Diabetes: https://www.ajmc.com/focus-of-the-week/ascend-results-confirm-aspirin-prevents-primary-vascular-events-in-dia

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 panel mostly endorsed the use of patient-reported outcomes for coverage of chimeric antigen receptor T-cell therapy; the US Preventive Services Task Force released new recommendations for cervical cancer screening; research found accountable care organization penetration may be changing how physicians work. Read more about the stories in this podcast: Many Questions to Ask in Setting National Coverage for CAR T Therapies: https://www.ajmc.com/focus-of-the-week/many-questions-to-ask-in-setting-national-coverage-for-cart-therapies MEDCAC Panel Mostly Endorses PROs for CAR T Therapies: https://www.ajmc.com/newsroom/medcac-panel-mostly-endorses-pros-for-car-t-therapies USPSTF Updates Cervical Cancer Screening Recommendations: https://www.ajmc.com/newsroom/uspstf-updates-cervical-cancer-screening-recommendat

Currently, 30 million people in the United States have diabetes and the American Diabetes Association estimates that the total economic cost of disease was $327 billion in 2017. An additional 84 million American adults have prediabetes, and 90% of them don’t know they have it, according to the CDC. Given the high cost of treating diabetes and the large population with prediabetes, which puts them at an increased risk of developing type 2 diabetes, prevention has become a point of focus. At the annual meeting of the American Association of Diabetes Educators, held August 17 to 20, prevention and delay of type 2 diabetes was one of the 2018 priority topics. Today, we’re taking a look back to 2017, when The American Journal of Managed Care® convened a panel of experts to discuss diabetes prevention and the use of technology. Read more about the stories in this podcast: Peer Exchange—Technology in Diabetes Care: From Prevention to Disease Management: https://www.ajmc.com/peer-exchange/technology-in-diabetes-ca

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 outlining a plan to encourage Medicare accountable care organizations to take on more risk, faster; a study found substantial growth in Medicaid managed care enrollment; an analysis showed nearly 1 in 5 inpatient hospital stays includes a claim from an out-of-network provider. Read more about the stories in this podcast: CMS Plans to Overhaul MSSP Program to Force More Risk on ACOs: https://www.ajmc.com/newsroom/cms-plans-to-overhaul-mssp-program-to-force-more-risk-on-acos CMS Proposal Is a Start for Making Risk More Appealing to ACOs: https://www.ajmc.com/contributor/travis-broome/2018/08/cms-proposal-is-a-start-for-making-risk-more-appealing-to-acos Medicaid Managed Care Grew Substantially From 1999 to 2012: https://www.ajmc.com/focus-of-the-week/medicaid-managed-care-grew-substantially-from-1999

Optimizing Number and Timing of Doctor's Appointment Reminders: An Interview With Dr John F. Steiner by Managed Care Cast