Managed Care Cast

Providers who treat high-need, high-cost patients can face challenges to deliver efficient and effective care. Health centers funded by the Health Resources and Services administration (HRSA)—otherwise known as federally qualified health canters or FQHCs— provide care to nearly 30 million Americans, many of whom are uninsured or underinsured. Because data on these patients’ complexity and utilization patterns are limited, researchers set out to better define these patient populations using information from the 2014 Health Center Patient Survey. On this episode of Managed Care Cast, we speak with Nadereh Pourat, PhD, MSPH, associate center director and the director of the health economics and evaluation research program at the UCLA Center for Health Policy Research, and Alex Sripipatana, PhD, MPH, director of the division of data and evaluation at HRSA. Pourat, Sripipatant and colleagues recently published the HRSA-funded study “Intersection of Complexity and High Utilization among health center patients ag

There is already an enormous amount of concern and worry about the effect of the pandemic on cancer screening; for instance, a recent report from the American Association for Cancer Research found an 87% drop in breast cancer screening, an 84% decline in cervical cancer screening, and an 80% reduction in colon cancer screening. On this episode of Managed Care Cast, we discuss how health care inequities will make this problem worse, with Monica Soni, MD, associate chief medical officer at New Century Health. Soni, who previously was the director of specialty care for the Los Angeles County Department of Health Services, the nation’s second-largest municipal health system, delves into how racial disparities in health care and social determinants of health hinder preventing cancer in the first place. She also provides some reaction to President Joe Biden’s Cancer Moonshot announcement.

According to the CDC, 37.3 million individuals in the United States currently have diabetes, while of these, 8.5 million are undiagnosed. In addition, more than 1 in 3 Americans currently have prediabetes—or higher than normal blood sugar levels—but 80% of this population is unaware they even have the condition. The American Diabetes Association estimates diagnosed diabetes costs the country $327 billion annually. Obesity is a key risk factor for type 2 diabetes. Data from 2018 show 42.4% of the United States population is obese, marking a steep increase from the 30.5% reported in the year 2000. Type 2 diabetes is preventable, and programs like the National Diabetes Prevention Program (DPP) have been proven to lower disease incidence among those at high risk via dietary changes and other lifestyle interventions. To learn more about how employers are leveraging the DPP to reduce diabetes rates among their workforce, The American Journal of Managed Care® sat down with Jill Hutt, vice president of member se

On January 1, 2022, California law SB-306 went into effect with the aim of reducing soaring sexually transmitted infection (STI) rates in the state. As part of SB- 306, California now requires health insurance to cover at-home STI testing kits and requires syphilis screening during both the first and third trimester of pregnancy, in addition to other mitigation strategies. Even before the COVID-19 pandemic, US STI rates were reaching crisis levels, with CDC data showing an increase of nearly 20% of chlamydia cases between 2015 and 2019, an increase of more than 50% of gonorrhea cases within this time window, and an over 70% increase in cases of syphilis. All 3 of these conditions are curable, if detected early enough and treated correctly. To learn more about SB-306, we spoke with Amy Moy, the chief external affairs officer at Essential Access Health, one of the bill’s co-sponsors. On this episode of Managed Care Cast, Amy outlines what SB-306 does, how it addresses some of the stigma associated with STI

This week’s Managed Care Cast conversation took place on the same day President Joe Biden announced the return of the Cancer Moonshot, a program he initiated when he was vice president in the Obama administration. The reinvigorated program aims to cut cancer deaths by 50% over the next 25 years and to increase cancer screening, which has dropped sharply during the pandemic. This Friday, February 4, is World Cancer Day, an initiative led by the Union for International Cancer Control (UICC), and this year's theme is about closing care gaps. For this episode of Managed Care Cast, we spoke with Meghan Gutierrez, CEO of the Lymphoma Research Foundation, about financial toxicity, how the pandemic has affected patients’ financial needs when they have cancer, health care disparities and care gaps, and more.

Although racism and bias have been long documented issues affecting health equity, findings of a recent study published in Health Affairs indicates these issues may be more embedded in the US health care system than originally thought. Examining electronic health records (EHRs) from an urban academic medical center, researchers found that negative descriptors were significantly more likely to appear in the records of Black patients compared with White patients. Other factors—such as insurance type, marriage status, and even the COVID-19 pandemic—influenced the odds of having this potentially stigmatizing language appear in a patient’s EHR. On this episode of Managed Care Cast, we speak with the first author on the study, Michael Sun, a medical student at the Pritzker School of Medicine at the University of Chicago, on the findings, as well as the steps that can be taken to increase awareness among clinicians of these stigmatizing descriptors.

In recent years, predictive models in medicine have become increasingly popular what with the continued integration of artificial intelligence and data technology into health care. However, these models can carry the risk of bias depending on which individuals make up the data sets. The close relationship between health care and technology also raises a myriad of questions when it comes to regulation, accountability, and model implementation. In this month’s Health IT issue of the American Journal of Managed Care, Paige Nong, a PhD candidate in public health at the University of Michigan, and colleagues present research on facilitating informed decision making and communicating equity issues when integrating predictive models into care. On this episode of Managed Care Cast, Nong outlines how the researchers carried out their study, the ethical challenges of combining computer science with health, and next steps for combatting bias in predictive models.

On December 30th, 2021 the No Surprises Act went into effect. Broadly speaking, the act aims to curb surprise bills Americans may incur when they receive care from an out-out-network provider. In response to the act’s implementation, the American Hospital Association, American Medical Association, and others sued, claiming the law jeopardizes patients’ access to care on the basis that providers and insurers must negotiate these costs when they arise, and if an agreement is not made, an arbitration process for determining fair payment will take place. On this episode of Managed Care Cast, we speak with Mark Miller, PhD, the executive vice president of health care at Arnold Ventures. In our conversation, Miller lays out how this law came about, its implications for patients, and what might happen if lawsuits against it succeed.

On this episode of Managed Care Cast, we interview the lead author of a paper in the January issue of Health Affairs about what physicians know and don't know regarding their responsibilities to accommodate patients with disabilities when they come in for an office visit.

On this episode of Managed Care Cast, we bring you part 1 of an 8-part video conversation with a payer and a primary health care provider about how they adapted to deliver health care in 2020 and 2021. We sat down with Tunde Sotunde, MD, MBA, the president and CEO of Blue Cross and Blue Shield of North Carolina, the largest insurer in that state covering more than 3.7 million members across all 100 counties, and Alan Story, MD, of Newtown Family Physicians, an independent primary care practice in Catawba County in the western part of the state. Our conversation, moderated by Allison Inserro, managing editor of AJMC.com, the website of The American Journal of Managed Care®, delves into value-based care, independent care practices, the health care workforce, health equity, and the role of Medicaid.

With key data presented at this year’s 63rd Annual American Society of Hematology Meeting and Exposition showing several CAR T-cell therapies as effective and safe options in the second- and even first-line setting for multiple myeloma and other cancers, discussions on when to best to use these therapies in the real-world setting has garnered increasing attention by payers and providers. At ASH 2021, we sat down with several key opinion leaders to discuss the use of real-world data for CAR T-cell therapies and its importance in influencing reimbursement and investment strategies by payers.

With key data presented at this year’s 63rd Annual American Society of Hematology Meeting and Exposition showing several CAR T-cell therapies as effective and safe options in the second- and even first-line setting for multiple myeloma and other cancers, discussions on when to best to use these therapies in the real-world setting has garnered increasing attention by payers and providers. At ASH 2021, we sat down with several key opinion leaders to discuss the use of real-world data for CAR T-cell therapies and its importance in influencing reimbursement and investment strategies by payers.

On this episode of Managed Care Cast, we’re talking with the co-editors-in-chief of The American Journal of Managed Care®, Dr Mark Fendrick and Dr Michael Chernew, and the editor-in-chief of The American Journal of Accountable Care®, Dr Dennis Scanlon. They look back on the past year and discuss the themes and topics they expect to see in the pages of the journals and in the world of health care in 2022. For more, visit ajmc.com. To get in touch with us, email info@ajmc.com or follow us on Twitter @AJMC_Journal. And if you like the podcast, don’t forget to subscribe and rate us.

When new drugs are approved by the FDA, they can take time to diffuse across the population as clinicians begin to prescribe them. Uptake is not always quick or uniform, due to reasons that can include clinical inertia, provider familiarity, and the cost to patients. On this episode of Managed Care Cast, we’re talking with the lead author of a study published in our December 2021 issue. The article, “Variation in Early Diffusion of Sacubitril/Valsartan and Implications for Understanding Novel Drug Diffusion,” describes how prescribing of the newly approved heart failure drug spread across the nation. Joining us today is Lauren Gilstrap, MD, MPH, of Dartmouth-Hitchcock Medical Center and The Dartmouth Institute for Health Policy and Clinical Practice.

In addition to shining a light on health disparities, medical misinformation, and public health infrastructure, the COVID-19 pandemic has also propelled calls for the transition to value-based care in the United States. To discuss this topic, among others, we sat down with Mara McDermott, the executive director of the Value Based Care Coalition, formerly known as the Next Gen ACO Coalition. On this episode of Managed Care Cast, McDermott discusses the organization’s recent re-brand, how its goals align with the Center for Medicare and Medicaid Innovation’s strategic refresh, and the future of value-based care.

In November, the Pharmacy Quality Alliance (PQA) and Patient Advocate Foundation (PAF) announced a collaboration aimed at developing a patient-centered outcomes research agenda to improve social determinants of health screenings and interventions in pharmacy settings. The year-long project received funding from the Eugene Washington PCORI Engagement Awards program and will feature an in-person workshop held in conjunction with the PQA Annual Meeting in May. To learn more about this initiative, why it is needed, and how it will be carried out, The American Journal of Managed Care® (AJMC®) spoke with Melissa Castora-Binkley, PhD, the senior director of research at PQA and Rebekah Angove, PhD, vice president for patient experience at PAF. In this episode of Managed Care Cast, Castora-Binkley and Angove discuss why pharmacists are in a unique position to help address social determinants of health and the importance of incorporating patients’ perspectives into research agendas.

Are millennial patients with multiple sclerosis (MS) different from older patients? If they are different, is it partly because the MS field has benefitted from new therapeutic options and increased knowledge about the role of diet and exercise and modifiable behaviors, such as smoking? On a recent episode of Medical World News®, Matt Hoffman, managing editor of Neurology Live®, sat down for a conversation with Mitzi Joi Williams, MD, a board-certified neurologist and MS specialist in Smyrna, Georgia, about the trends she see in younger patients with MS and how they approach treatment decisions and other disease considerations. We invite you to listen to an excerpt of the broadcast here on Managed Care Cast, and you can find a link to the full episode in the show notes. https://www.medicalworldnews.com/view/deep-dive-into-treating-millennials-with-multiple-sclerosis

The Alliance of Community Health Plans (ACHP) recently released its 2021 Report on Affordability. In this episode of Managed Care Cast, we speak with Ceci Connolly, the president and CEO of ACHP, about the steps that its payer members are taking to lower costs through offerings such as virtual-first care, remote patient monitoring, and other new products, some of which were created because of the pandemic.

Proponents of price transparency hope that publishing health care prices can enable patients to shop for their health care services and better understand the bills that they receive. However, little is known about the value of marketwide transparency tools that reveal charges for out-of-network care. On this episode of Managed Care Cast, we’re talking with an author of a study published in our November 2021 issue. The article, “Assessing Utilization of a Marketwide Price Transparency Tool,” describes how consumers use a shopping tool to research health care prices in their area. Joining us today is Grace Kim, MHA, a PhD student at New York University.

COVID-19’s effects on the body are now known to be far-reaching—and long-lasting in the most severe cases—but when it started spreading across the world in early 2020, initial attention was focused on the lungs. That concern led to worries about the impact of infection for individuals with respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and asthma. On this episode of Managed Care Cast, we speak with Meilan K. Han, MD, MS, the author of a book released this month called Breathing Lessons: A Doctor’s Guide to Lung Health. Han, a pulmonologist, gives an inside tour of the lungs and how they work, zooms out to examine the drivers of poor respiratory health, and addresses policy changes that are needed to improve lung health. Han, who started writing the book at the beginning of the pandemic, is a professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan. She also serves on the scientific advisory committees for both the COPD Foundation and