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 allowing step therapy in Medicare Advantage plans in a bid to allow for drug price negotiation; larger practices with more resources, technology and care management processes have higher readmission rates than smaller practices; studies find that empagliflozin also reduces liver fat in patients with diabetes and nonalcoholic fatty liver disease. Read more about the stories in this podcast: CMS Will Allow Medicare Advantage Plans to Use Step Therapy to Negotiate Drug Prices: https://www.ajmc.com/newsroom/cms-will-allow-medicare-advantage-plans-to-use-step-therapy-to-negotiate-drug-prices CMS Approves Extra Payments for CAR T, Increases Other Payments in Final Rule: https://www.ajmc.com/newsroom/cms-approves-extra-payments-for-car-t-increases-other-payments-in-final-rule Larger Practices Spend More

One of the most common causes of liver disease in the United States is nonalcoholic fatty liver disease, affecting between 30% and 40% of adults, according to the National Institute of Diabetes, and Digestive and Kidney Diseases. It’s a condition in which excess fat is stored in the liver—a buildup that is not caused by heavy alcohol use. Despite how common nonalcoholic fatty liver disease (NAFLD) is, there are currently no approved medications on the market. In this podcast, we talk to a clinician involved with a program that uses lifestyle management and a patient advocate, who is trying to shape policy to help patients with NAFLD and its more extreme version, nonalcoholic steatohepatitis (NASH). Read more about NAFLD and NASH: Studies Point to Empagliflozin as First Choice for Fatty Liver Disease in T2D: https://www.ajmc.com/newsroom/studies-point-to-empagliflozin-as-first-choice-for-fatty-liver-disease-in-t2d Drug Approvals That Dr Aimee Tharaldson Is Keeping an Eye on for 2019: https://www.ajmc.com/con

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 report that found quality issues and fraud in Medicare’s hospice program; the Trump administration expanded short-term health plans; cancer screening rates are falling short of targets. Read more about the stories in this podcast: Report Finds Medicare Hospice Program Beset With Quality, Care Issues: https://www.ajmc.com/newsroom/report-finds-medicare-hospice-program-beset-with-quality-care-issues Trump Administration Finalizes Rule for Short-Term, Limited Duration Health Plans: https://www.ajmc.com/newsroom/trump-administration-finalizes-rule-for-shortterm-limited-duration-health-plans What We're Reading: Part D Premiums; US Healthcare Spending; Consequences of Sudden Inactivity: https://www.ajmc.com/newsroom/what-were-reading-part-d-premiums-us-healthcare-spending-consequences-of-sudden-inactivity

Advancing Precision Oncology With the Syapse Precision Medicine Council 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 CMS reversing its decision to suspend the risk adjustment payment program; out-of-pocket costs and copayment accumulators put an HIV prevention drug out of reach for patients; research finds geography can determine posttreatment imaging for women with breast cancer. Read more about the stories in this podcast: What We're Reading: Resuming Risk Adjustment Program; New Endometriosis Drug; Lilly Denounces Drug Imports: https://www.ajmc.com/newsroom/what-were-reading-resuming-risk-adjustment-program-new-endometriosis-drug-lilly-denounces-drug-imports PrEP for HIV Prevention: Essential for Ending the Epidemic, but Out of Reach for Many: https://www.ajmc.com/focus-of-the-week/prep-for-hiv-prevention-essential-for-ending-the-epidemic-but-out-of-reach-for-many Geography Influences Type of Posttreatment Imaging

Nurse Practitioners: Taking on New Roles as Physician Shortage Grows 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 patient advocates, providers, payers, and pharma commenting on the Trump administration's drug pricing plan; a survey that found physicians and payers believe progress toward value-based care is slowing; a study that questions the standards of evidence for breakthrough therapy approvals. Read more about the stories in this podcast: From Patient Advocates to Pharma, Groups Weigh in on Trump Blueprint for Drug Costs: https://www.ajmc.com/newsroom/from-patient-advocates-to-pharma-groups-weigh-in-on-trump-blueprint-for-drug-costs Novartis Will Freeze Drug Prices Through End of 2018, CEO Says: https://www.ajmc.com/newsroom/novartis-will-freeze-drug-prices-through-end-of-2018-ceo-says What We're Reading: 340B Lawsuit to Be Refiled; Digging Into Breakthrough Approvals; Screen Time and ADHD: https://www.ajmc.c

There are concerns that cancer care costs may increase as the site of provider-administers cancer drugs shifts from physician officers to hospital outpatient departments. Researchers in the July issue of The American Journal of Managed Care examined chemotherapy-related spending in Medicare Part B after controlling for patient characteristics, such as cancer type, and explored differences in chemotherapy utilization patterns between the 2 settings. In this interview, lead author Yamini Kalidindi, a research assistant at Pennsylvania State University and a graduate student in the department of health policy and administration, explains why the findings of her study differ from previous research and highlights the importance of considering patient characteristics such as cancer type. Read the paper in the July issue: Differences in Spending on Provider-Administered Chemotherapy by Site of Care in Medicare: https://www.ajmc.com/journals/issue/2018/2018-vol24-n7/differences-in-spending-on-provideradministered-c

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 additional moves by the Trump administration to unravel the Affordable Care Act; Pfizer canceled a round of drug price increases after speaking to the president; advocates for 340B sound the alarm on efforts to reform the program. Read more about the stories in this podcast: Pause in Risk Adjustment Payments Announced, CMS Blames District Court's Decision: https://www.ajmc.com/newsroom/pause-in-risk-adjustment-payments-announced-cms-blames-district-courts-decision CMS Cuts Budget for ACA Marketing to $10 Million for 2019 Plan Year: https://www.ajmc.com/newsroom/cms-cuts-budget-for-aca-marketing-to-10-million-for-2019-plan-year What We're Reading: Pfizer Halts Price Increases; Azar's Attention Is Split; VA Pick Clears First Hurdle: https://www.ajmc.com/newsroom/what-were-reading-pfizer-halts-price-incre

Providing an open channel of communication between pharmacists and patients, medication therapy management (MTM) allows pharmacists to optimize medications for their patients and patients to take an active role in their healthcare. As MTM services help pharmacists better understand how different medications interact with each other, MTM has been recommended as a way to identify and prevent opioid misuse. In an effort to provide greater incentive for Part D sponsors to use MTM programs, the Center for Medicare and Medicaid Innovation launched in January 2017 the 5-year Part D Enhanced Medication Therapy Management (eMTM) Model. The model is assessing whether incentives, such as payment and regulatory flexibilities, will result in enhancements in the MTM program, ultimately leading to improved patient outcomes and reduced costs. In this podcast, we speak with Brian Litten, JD, chief strategic officer, Tabula Rasa HealthCare; and Calvin Knowlton, BScPharm, MDiv, PhD, chief executive officer and founder of Tab

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 federal judge blocking Kentucky’s Medicaid work requirements; CMS announced it would launch a demonstration to encourage Medicare Advantage providers to take on more risk; and researchers identify racial disparities in HIV incidence and recommended a 5-part plan of action. Read more about the stories in this podcast: Federal Judge Blocks Kentucky's Medicaid Work Requirements: https://www.ajmc.com/newsroom/federal-judge-blocks-kentuckys-medicaid-work-requirements Kentucky Cuts Medicaid Vision, Dental Benefits Following Block to Work Requirements: https://www.ajmc.com/newsroom/kentucky-cuts-medicaid-vision-dental-benefits-following-block-to-work-requirements CMS Will Waive MIPS for Doctors Who Agree to More Medicare Advantage Risk: https://www.ajmc.com/newsroom/cms-will-waive-mips-for-doctors-who-agree

Health disparities stemming from social, economic, and environmental factors have become a growing target in healthcare with payers, providers, and policy makers turning their attention on how to address those nonmedical factors that impact an individual’s overall health and health outcomes outside of the medical setting. While the importance of addressing social determinants of health is becoming more clear, there are still challenges for this new field—delving into the arena can be daunting for health systems and there is not much evidence yet on best practices for screening patients and getting them to the right resouces. In this podcast, we talk to Clifford Goodman, PhD, of The Lewin Group; Shantanu Agrawal, MD, MPhil, of National Quality Forum; and Rachel Gold, PhD, MPH, of the Kaiser Permanente Center for Health Research. Read more about the stories in this podcast: Doctors Talk About How Social Determinants Affect Their Work With Patients: https://www.ajmc.com/focus-of-the-week/doctors-talk-about-ho

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 stories included HHS Secretary Alex Azar appearing before the Senate Committee on Finance to discuss the administration's plan to drive down prescription drug prices; FDA Commissioner Scott Gottlieb, MD, calling on payers to share data to aid drug innovation; and CMS calling for stricter oversight of Medicaid. Read more about the stories in this podcast: Azar Appears Before Senate Committee on Finance to Discuss Drug Innovation, Affordability: https://www.ajmc.com/focus-of-the-week/azar-appears-before-senate-committee-on-finance-to-discuss-drug-innovation-affordability Gottlieb Calls on Payers to Share Data to Aid Drug Innovation: https://www.ajmc.com/focus-of-the-week/gottlieb-calls-on-payers-to-share-data-to-aid-drug-innovation CMS Unveiling Stricter Oversight of Medicaid Due to Program Expansion: https://www.ajmc

Exploring the Current State of Precision Medicine at the ASCO Annual Meeting 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 in managed care, the top stories included Atul Gawande, MD, being named the CEO of the Amazon–Berkshire Hathaway–JPMorgan Chase healthcare venture; the Trump administration finalized rules for creating association health plans; an analysis found some cancer types are represented more than others in the Oncology Care Model. Read more about the stories in this podcast: Amazon, Berkshire Hathaway, JPMorgan Chase Announce CEO of Joint Health Company: https://www.ajmc.com/newsroom/amazon-berkshire-hathaway-jpmorgan-chase-announce-ceo-of-joint-health-company New Rule Allows Creation of Association Health Plans That Skirt ACA Regulations, Protections: https://www.ajmc.com/newsroom/new-rule-allows-creation-of-association-health-plans-that-skirt-aca-regulations-protections Participation in OCM May Transform Care for Certain Cancer Types More Quickly

Center for HOPE: Addressing Health Needs and Cancer Disparities Among Underserved Populations by Managed Care Cast

Lowering Costs And Readmission Rates Through a Meal Delivery Program by Managed Care Cast

This Week In Managed Care—Medicare Part A is Running Out and Other Health News by Managed Care Cast

Health literacy in the United States is low to begin with, and health financial literacy is even lower. The changing health insurance system is partly to blame. A few decades ago, health insurance covered everything. Now, patients have a lot more financial responsibility, and they don’t always understand it. In cancer, health financial literacy is particularly important since treatment can be so costly. This episode of Managed Care Cast includes conversations with a few experts in the field: Yousuf Zafar, MD, MHS, of the Duke Cancer Institute; Clara Lambert, BBA, OPN-CG, chair of the Association of Community Cancer Centers Financial Advocacy Network Advisory Committee; Todd Yezefski, MD, senior fellow in the Clinical Research Division at the Fred Hutchinson Cancer Research Center and Division of Medical Oncology at the University of Washington; and Michele McCourt, senior director of the CancerCare Co-Payment Assistance Foundation. Read more: A Descriptive Study of Patients Receiving Foundational Financial

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 include Senator Bill Cassidy's new plan to lower healthcare costs; policy recommendations from the American Diabetes Association on how to lower insulin prices; and coverage from the American Society of Clinical Oncology annual meeting. Read more about the stories in this podcast: Senator Cassidy Unveils Proposal to Lower Healthcare Costs: www.ajmc.com/newsroom/senator-cassidy-unveils-proposal-to-lower-healthcare-costs ADA Issues Recommendations Designed to Fix Insulin Pricing, Accessibility Crisis: http://www.ajmc.com/newsroom/ada-issues-recommendations-designed-to-fix-insulin-pricing-accessibility-crisis Persephone Trial: Cutting Trastuzumab Duration by Half Safer, Efficacious in HER2-Positive Breast Cancer: http://www.ajmc.com/conferences/asco-2018/persephone-trial-cutting-trastuzumab-duration-by-half-safe