Managed Care Cast

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

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