Managed Care Cast

On this episode of Managed Care Cast, we speak with Dr Abi Sundaramoorthy, MD, MBA, executive vice president of clinical enterprise at Somatus, a national value-based care company serving patients with underlying kidney disease, on the potential of value-based arrangements to address disparities in chronic kidney disease and promote preventive, effective care.

Fragmented health care is a known issue for patients and providers, and nowhere is the problem as acute as it is in the over-65 population. Studies have shown that patients who have a strong relationship with a primary care provider (PCP) who coordinates their care have better outcomes. But care provided by specialists has expanded over the past 2 decades, and the average PCP has twice as many specialists involved in the care of their fee-for-service Medicare patients as they did 20 years ago, according to research published in Annals of Internal Medicine this week. On this episode of Managed Care Cast, we speak with one of the coauthors of the study, "Trends in Outpatient Care for Medicare Beneficiaries and Implications for Primary Care, 2000 to 2019," which illustrates the changing trends in a PCP’s panel of Medicare patients and how that translates to an increased workload for primary care doctors. Michael L. Barnett, MD, MS, an assistant professor in the Department of Health Policy and Management at the

The 340 drug pricing program was first established in 1992 and allows participating hospitals to manufacture discounts on drugs used in an outpatient setting. In years since, federal agencies have clarified savings from the program should be directed at improving care for underserved patients. One method of doing this is providing uncompensated care, or charity care and other unreimbursed care, to uninsured or underinsured patients. In the years since its inception, debates around the program have centered on whether savings actually benefit the underserved as intended. To determine whether hospital provision of uncompensated care increased following hospital entry into the 340B program, Sunita M. Desai, PhD, and J. Michael McWilliams, MD, PhD, analyzed secondary data on 340B participation and uncompensated care provision from general acute care and critical access hospitals between 2003 and 2015. Their study “340B Drug Pricing Program and Hospital Provision of Uncompensated Care,” was published in the Oct

In this podcast, The American Journal of Managed Care's associate editorial director, Mary Caffrey, speaks with Michelle Afkhami, MD, from City of Hope, about best practices for oncology organizations to leverage molecular/genomic testing, the importance of identifying RET-positive patients early so they can receive targeted treatment, and more.

On this episode of Managed Care Cast, we discuss senior health needs amid the pandemic and how Centerwell Senior Primary Care's holistic, team based approach and value-based care delivery contributed to upticks in senior patient visits despite fears of COVID-19.

As the COVID-19 pandemic continues to take a toll on the nation a year-and-a-half later, public health workers, leaders, and researchers alike are still grappling with ways to convince a large swath of Americans to roll up their sleeves and get vaccinated. Even as cases and deaths decline nationally, states like Alaska continue to ration care as hospitals struggle with surges of largely unvaccinated patients with COVID-19. Currently, approximately 57% of the nation’s population is fully vaccinated, meaning at least 100 million more individuals have yet to receive the shot. For these reasons, safety precautions like masking, social distancing and encouraging vaccinations remain crucial to stamp out the virus. In a recent study published in Basic and Applied Social Psychology, researchers sought to increase compliance with coronavirus safety measures using cognitive dissonance as a guide, and their results yielded some promising conclusions. On this episode of Managed Care Cast, we speak with Logan Pearce,

For one cancer center, an outgrowth of the COVID-19 pandemic spurred plans to create an urgent care center for patients with cancer so that they could stay out of the emergency department. The Winship Cancer Institute of Emory University began planning for construction in 2020 after receiving a sizeable donation and broke ground this year. The Rollins Immediate Care Center is expected to open in 2022. On this episode of Managed Care Cast, we bring you an interview conducted by the editorial director of OncLive®, Gina Mauro, who talks with Charise Gleason, MSN, NP-BC, AOCNP, the advance practice provider chief at Winship Cancer Institute, about how having a dedicated cancer urgent care center will make cancer treatment plans seamless while also helping patients avoid exposure to infectious diseases in emergency waiting rooms.

Migraines plague some 35 million Americans, the majority of them women in their 30s and 40s, and disabling pain and symptoms are linked to lost productivity at work, school, and home. On this episode of Managed Care Cast, we bring you an excerpt of an interview with Deena E. Kuruvilla, MD, FAHS, the medical director of the Westport Headache Institute. She and Matt Hoffman, managing editor of NeurologyLive, another MJH Life Sciences medical news website, had a conversation a few weeks after this year’s American Headache Society Annual Scientific Meeting. They discuss the obstacles patients with migraine face during the pandemic to getting necessary care, the effect of worsening lifestyle changes over the past year and a half on patients with headaches, the difficulty in finding a clinician who knows about the latest migraine treatments, issues related to prior authorization, and more.

Black Americans are 4 times more likely to develop kidney failure and are diagnosed with chronic kidney disease later and in later stages than White Americans. They are less likely to be deemed eligible for a transplant, instead going on dialysis. Last week a joint report from the American Society of Nephrology (ASN) and the National Kidney Foundation (NKF) recommended the removal of a racially based modifier used in calculating the estimated glomerular filtration rate, which has the effect of making Black patients seem healthier than they really are, leading to care delays. On this episode of Managed Care Cast, we speak with Susan Quaggin, MD, FASN, a nephrologist and the chief of nephrology/hypertension and director of the Feinberg Cardiovascular and Renal Research Institute at Northwestern University, as well as current president of the ASN. She discusses the recommendations of the National Kidney Foundation (NKF) and ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases and wh

On this episode of Managed Care Cast, we speak with Cheryl Mason, director of Content and Informatics for the Health Language solutions team of Wolters Kluwer, who discusses how delays in routine care and other aspects of the pandemic are affecting payer organizations today, and how technology innovations like natural language processing can work to empower key initiatives in population health and beyond.

On this episode of Managed Care Cast, we speak with the lead clinician of a study by the Epic Health Research Network and Kaiser Family Foundation, which found that routine medical care and hospital admissions remained below expected levels in the early months of 2021, marking the second consecutive year for such results.

Trust in health care was eroding even before the COVID-19 pandemic. In a new book, "Re-Engaging in Trust: The Missing Ingredient to Fixing Healthcare," the authors, Jan Berger, MD, MJ, the CEO of Health Intelligence Partners, and Julie Slezak, MSPH, the president of the health care consulting firm, delve into this issue with data from multiple sources and viewed against the backdrop of multiple stakeholders. Trust among stakeholders—providers, patients, health care organizations and systems, payers, drug companies, and others—is essential, yet it is increasingly fragile, they write. Trust should be measured and improved alongside health care metrics, according to Berger, who discusses the book on this episode of Managed Care Cast.

With COVID-19 continuing to change the way in which health care is perceived and delivered, large employers have been tasked with managing employee health concerns in real time, while also planning for when the pandemic does subside. In the Business Group on Health’s 2022 Large Employers’ Health Care Strategy and Plan Design Survey, employers discussed their perspectives on trends in health care cost and coverage, and how these aspects will influence their benefits strategies and programs in the coming year. On this episode of Managed Care Cast, we speak with Ellen Kelsay, president and CEO of the Business Group on Health, who discussed 5 major areas of concern spotlighted by employers in the survey, which included health equity and the pandemic’s long-term impact.

The recently released Intergovernmental Panel on Climate Change’s sixth assessment report drove home many of the concerns regarding the detrimental impacts of climate change that many have been warning about for years. But along with renewed calls for governmental action come doubts that the United States’ and other health care systems are equipped to handle such an influx of increasing medical issues wrought by climate change. Health systems and personnel have already been tested with the monumental crisis of COVID-19, and with higher rates of diseases expected from increased exposure to pollution, to more emergency responses warranted by frequent natural disasters, health professionals around the world are calling for immediate action to curb current and future ramifications. On this episode of Managed Care Cast, we speak with Laalitha Surapaneni, MD, MPH, an assistant professor of medicine at the University of Minnesota. Surapaneni discusses her work in mobilizing calls for climate action, the threat

Co-pay accumulator adjustment programs, or CAAPs, can help incentivize use of lower-cost generics by excluding drug manufacturer assistance from counting toward a patient’s out-of-pocket maximum. However, a rule finalized by HHS last year allows CAAPs to be applied even when no generic alternative is available. If patients are not informed about the implications of these programs, they may be forced to abandon their prescriptions in the face of unaffordable co-pays. On this episode of Managed Care Cast, we’re talking with an author of a Commentary published in our August 2021 issue. The article, “CAAP Rule and Prescription Drug Prices,” explains the mechanisms of CAAPs and the potential consequences of the new HHS rule. Joining us today is Bryan S. Walsh, JD, of Brigham and Women’s Hospital and Harvard Medical School.

On this episode of Managed Care Cast, we speak with Michael Abrams, managing partner at Numerof & Associates, on persistent barriers to entry for generics entering the pharmaceutical market, the impact of antitrust laws issued by the Biden administration, and further steps that are warranted to address anticompetitive tactics.

Today, we’re bringing you part 1 of a 2-part podcast series discussing multiple sclerosis, or MS. As part of the MS Stakeholder Summit, a panel of experts discusses tailoring treatments to patients with MS, payer considerations, and more.

Vizient recently released its Summer 2021 Pharmacy Market Outlook, which projects pharmaceutical spending for 2022 based on an analysis of its members' data, and on this episode of Managed Care Cast, we talk about some of their findings. The report, which delves into its members’ purchasing patterns, predicts a 3.1% increase in pharmaceutical spending next year, with oncology drugs accounting for about 25% of the increase. The report also discusses increasing competition from biosimilars, including the recent approval of insulin glargine as an interchangeable biosimilar for the treatment of diabetes; the practice of white bagging; and other issues. On this episode of Managed Care Cast, we speak with Steven Lucio, PharmD, BCPS, senior principal, Pharmacy Solutions, about the report, which also discusses the continued impact of COVID-19 on health care.

August is National Psoriasis Awareness Month, and on this episode of Managed Care Cast, we bring you an excerpt of an interview conducted by Linda Stocum, assistant editor of Dermatology Times, for Medical World News, a new webcast from MJH Life Sciences. In it, Jerry Bagel, MD, MS, Windsor Dermatology, East Windsor, New Jersey, discusses how psoriasis is now understood to be an inflammatory disease that, if left intreated, can have devastating cardiovascular effects, affecting lifespan and quality of life, especially for young people. He also discusses the many lifestyle changes that some patients will need to make after their skin becomes clear.

Huntington disease is an incurable, progressive neurodegenerative condition that is ultimately fatal, and the field of research into this rare disease saw a setback a few months ago with the end of 2 clinical trials for a type of possible therapy from Roche and Wave Life Sciences. On this episode of Managed Care Cast, we bring you an excerpt of an interview, originally conducted by Matt Hoffman, senior editor of NeurologyLive, with Daniel Claassen, MD, MS, director, Huntington’s Disease Clinic, and division chief, of Behavioral and Cognitive Neurology, Vanderbilt University Medical Center. Claassen reviews the trial terminations and what that means for patients with this disease, but he also reviews some other candidates in the pharmaceutical pipeline, as well as the need for patient-reported outcomes and the possibility of wearable sensors.