Managed Care Cast

On this episode of Managed Care Cast, we speak with Virginia Wang, PhD, and Matthew L. Maciejewski, PhD, who talk about their recent study on racial disparities in home dialysis, and what more needs to be done to increase uptake and reduce disparities in home dialysis for non-White patients.

On this episode of Managed Care Cast, we feature several leaders in diversity, equity, and inclusion advancing health equity in their respective organization’s policy and practice initiatives.

On this episode of Managed Care Cast, we speak with Jennifer Schneider, MD, co-founder and chief executive officer of Homeward, a value-based care provider aiming to improve access to high-quality care in rural communities through tech-enabled clinical services, partnerships with local physicians and health plans, and community-level demographic data.

On this episode of Managed Care Cast, we speak with Elizabeth Cuevas, MD, division chief of Allegheny Health Network’s Center for Inclusion Health, on prevalent health inequities facing marginalized communities in the Western Pennslyvania region and strategies to identify and address these issues.

For patients to receive timely access to care and for providers to deliver that care on a correspondingly timely basis, the correctness of provider contact information is of utmost importance. However, the results of a new study on the accuracy of mental health provider directories and network adequacy, published in the February issue of The American Journal of Managed Care® and online at AJMC.com, paint a less-than-stellar picture of these data, with implications for the ability of consumers to be able to use mental health care services when they need them. On this episode of Managed Care Cast, we speak with Simon F. Haeder, PhD, MPA, professor of public health at the Texas A&M University School of Public Health, 1 of 3 authors of the article, “Provider Directory Inaccuracy and Timely Access for Mental Health Care.” He and his co-investigators looked at the accuracy of directories of psychiatrists and nonphysician mental health providers for all plans regulated by the California Department of Managed Health

Mental health issues and substance use disorder are one of the contributing factors to America’s high maternal mortality rates, in addition to poverty, racism, and lack of access to adequate health care. Last year, the CDC reported that suicide accounts for 9% of the maternal mortality rate 1 year postpartum. Anxiety, perinatal and postpartum depression, and birth-related PTSD are the most common complications of pregnancy and childbirth, affecting 1 in 5 individuals, and for those affect, 75% do not get treatment. Women of color are both more likely to experience these conditions and also also less likely to seek help. On this episode of Managed Care Cast, we speak with Heather Waters, LCSW who leads the maternal health and children’s health services team at Inland Empire Health Plan, a managed care plan serving more than 1.4 million residents on Medi-Cal in California. She tells us about a new maternal mental health program at IEHP aimed at supporting new mothers, both before they give birth and afterward

Wanting to provide the best treatment available, help people live their healthiest lives, and alleviate the health care burden on providers, Intermountain Healthcare, a Utah-based not-for-profit system of 33 hospitals in 7 states, and Story Health, a California-based health technology and services company, have partnered to disseminate specialty care for patients living with heart failure in rural areas. Goals of this new partnership include ensuring patients get the care they need in a sustainable manner, increasing health system efficiency by preventing unnecessary hospitalizations, and getting high-quality care from urban population centers to rural patients while saving costs to the health care system and saving patients and their families time and convenience. On this episode of Managed Care Cast, we speak with Tom Stanis, CEO and co-founder of Story Health, and Phillip Wood, Intermountain Ventures program director on how their partnership came about, how it is going so far, and the future of their col

On this episode of Managed Care Cast, we speak with Reverend Paul Abernathy, chief executive officer of the Neighborhood Resilience Project and board member of UPMC for You, who discusses his experiences in promoting health and resiliency in trauma-affected communities, as well as challenges related to access and accessibility of care and medical mistrust.

To mark the publication of The American Journal of Managed Care®’s 12th annual health IT issue, on this episode of Managed Care Cast, we speak with Christopher M. Whaley, PhD, health care economist at the RAND Corporation, who focuses on health economics issues, including the influence of the COVID-19 pandemic on health care delivery. In particular, he examines how existing technology has pivoted to become a backbone for virtual care delivery while its ongoing evolvement has highlighted inequities in care delivery, making access and lack thereof divisive issues. In their article in the health IT issue, “Differences in Telehealth During COVID-19 Between Commercial and Medicaid Enrollees,” Whaley and his co-authors compare rates of telehealth and in-person evaluation and management visits between individuals with commercial insurance through the California Public Employees’ Retirement System, or CalPERS, and those with publicly funded coverage through the California Medicaid program, with implications for equi

The editors of The American Journal of Managed Care® reflect on the past year and discuss what they’re looking forward to in 2023.

High-deductible health plans (HDHPs) have gained traction in recent years as a means to reduce unnecessary health care spending. The monthly premiums are low, but the high deductibles can lead to higher downstream costs for individuals and families. Potential downsides include the risk of patients deterring or avoiding necessary care. A team headed by Matthew D. Eisenberg, PhD, from the Johns Hopkins Bloomberg School of Public Health, recently investigated the impact of HDHPs through the lens of the ongoing epidemic of substance use disorder, or SUD, in the United States. The article detailing their study’s findings appears in the October issue of The American Journal of Managed Care®. On this episode of Managed Care Cast, we speak with Dr Eisenberg on his team’s findings that these plans may have reduced SUD service use through the shifting of costs to their members, thereby exacerbating this already troubling epidemic that has resulted in declines in life expectancy and increases in drug- and alcohol-rela

Teams from the Mass General Brigham health system and the Commonwealth Care Alliance, both in Massachusetts, have collaborated on a value-based care initiative with the principal goals of improving patient clinical outcomes, reducing unnecessary health care utilization, and making care more accessible. iCMP PLUS (Patients Linked to Urgent Support) is an integrated care management program providing intensive, multidisciplinary care to the highest-risk dual-eligible patients with Medicaid ACO coverage who have complex medical needs and high health care costs. Care team members meet patients where they are, demonstrating the effectiveness of community-based care management support programs. On this episode of Managed Care Cast, we speak with Jack Rowe, MD, MPH, and Lori Tishler, MD, MPH, 2 authors of “Intensive Care Management of a Complex Medicaid Population: A Randomized Evaluation,” published in the September issue of The American Journal of Managed Care®, about their findings on the program’s effectiveness

The Inflation Reduction Act, signed this month, extends the premium tax credits for health insurance purchased through the health care marketplace for another 2 years. The credits were included in the 2021 American Rescue Plan Act, and were due to expire at the end of this year. Vicki Fung, PhD, is associate investigator at the Mongan Institute Health Policy Center, Mass General Research Institute, and lead author of “Premium Tax Credits in the American Rescue Plan and Off-Marketplace Enrollees,” published in the August issue of The American Journal of Managed Care®. On this episode of Managed Care Cast, she details how the expanded premium tax credits help individuals purchasing insurance coverage through the marketplace. She also addresses the important ways these plans differ from employee-purchased coverage and the benefits and drawbacks of each and the difficulties involved when deciding whether or not to switch coverage.

As more and more biosimilars enter different markets around the globe, payers and practices will need to consistently evaluate the economics of covering biosimilars and take a stance on whether to support their adoption. Both payers and practices can play a big role in encouraging biosimilar adoption, and health care institutions that have already begun pushing for more biosimilar use, such as Emory Healthcare, have seen substantial savings. On this episode of Managed Care Cast, we speak with Ryan Haumschild, PharmD, MS, MBA, the director of pharmacy services at Emory Healthcare and the Winship Cancer Institute. Haumschild is also an Advisory Board member for The American Journal of Managed Care® and its sister site, The Center for Biosimilars®. The interview took place at the The Institute of Value-Based Medicine® (IVBM), hosted by Emory Healthcare, on July 18 in Atlanta, Georgia. Haumschild was chair of the event and gave a presentation on the current pharmacoeconomics of biosimilars and his predictions

Even before the pandemic began in 2020, the number of health care organizations appointing chief health equity officers had started to grow. Is this a role for 1 person only or do initiatives to tackle health care disparities and other issues begin at a higher level? And how can change really be accomplished so there is a measurable effect on health outcomes? In this episode of Managed Care Cast, we speak with Sachin Jain, MD, MBA, who joined SCAN Group and Health Plan 2 years ago as president and CEO. He discusses an effort, recently described in an article in Harvard Business Review, about how SCAN made 10% of senior managers’ annual bonuses dependent on how well the gap in medication adherence among diverse populations was reduced. The former CareMore executive shares why executives at the top of organizations need to champion and lead initiatives to reduce health care disparities and do more than “virtue signaling” on health equity issues.

Today we are bringing you part 2 of a 2-part sponsored podcast series discussing treatment goals in insterstitial lung disease (ILD). The discussion was moderated by Ryan Haumschild, PharmD, director of Pharmacy Services at Emory Healthcare and Winship Cancer Institute. The conversation for today’s podcast includes an in-depth review of treatment landscape of systemic sclerosis ILD as well as a discussion on unmet needs and emerging therapies in ILD.

discusses why the program is needed, the goals of the program, and some of the reasons why children and adolescents are struggling. We also discuss 988, an upgrade to the National Suicide Prevention Lifeline number coming July 16, 2022. The number will connect individuals with trained counselors, and, if needed, send specially trained responders with the aim of reducing armed law enforcement interventions. If you or someone you know is in crisis, help is available by calling the the National Suicide Prevention Lifeline toll-free number, which is 988 beginning on July 16, 2022—or call the existing number, 1-800-273-TALK (8255)—to reach your local certified crisis center.

Today we’re highlighting a discussion with a panel of experts in interstitial lung disease moderated by Ryan Haumschild, PharmD, director of Pharmacy Services at Emory Healthcare and Winship Cancer Institute. The topics of conversation for today’s podcast include treatment goals in patients with ILD and a review of treatment paradigms and standard of care therapies.

On this episode of Managed Care Cast, we speak with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.

In January of this year, entrepreneur and Dallas Mavericks owner Mark Cuban launched a direct-to-consumer pharmacy called the Cost Plus Drug Company, promising savings by eliminating middlemen and charging cost plus 15% and a pharmacy fee. What if Medicare could do the same? On this episode of Managed Care Cast, we speak with a researcher who coauthored a study out this week that looked at the savings to Medicare Part D if the same model had been employed for some of the most used generic drugs. Hussain S. Lalani, MD, MPH, an internist and one of the coauthors, discussed the findings of the paper, published Monday in the Annals of Internal Medicine. The analysis compared the price paid by Medicare Part D plans in 2020 with the price of 89 generic drugs sold by the pharmacy in 2022. The researchers, from Brigham and Women’s Hospital and Harvard Medical School, used the price paid by Medicare Part D plans in 2020 and looked at the price of 89 generic drugs sold by the pharmacy in 2022. After adjusting for ch