Managed Care Cast

In 2002, Bill Allman, working for Washington State, heard from a widow with a $75,000 bill from Medicaid, which was incurred as part of his long-term care costs. Like Allman, the man was a veteran. On this episode of Managed Care Cast, we learn how Allman, who is retiring at the end of 2019, launched a program to connect veterans to health benefits they didn't know they had, and in the process, figured out that states could reduce Medicaid spending.

In 2018, the Ochsner Accountable Care Network was able to reduce expected costs of care by more than $12.78 million for its Medicare beneficiaries, and it increased its savings 12% over 2017. This comes amidst research and claims that accountable care organizations may not be successful at reducing costs while improving outcomes. David Carmouche, MD, president of the Ochsner Health Network and executive director of the Ochsner Accountable Care Network, explains how the Ochsner accountable care organization (ACO) was able to find success and how other ACOs can get over the learning curve to achieve savings. Learn more about Ochsner https://www.ajmc.com/partners/ochsner

Every week, The American Journal of Managed Care® recaps the top managed care news of the week. This week, the top managed care news included the average Affordable Care Act premiums falling 4%; the FDA approving a triple combination treatment for cystic fibrosis; House Republicans releasing part 1 of their healthcare plan. Read more about the stories in this podcast: While Waiting for ACA Decision, HHS Says 2020 Benchmark Plan Premiums Mostly Lower: https://www.ajmc.com/newsroom/while-waiting-for-aca-decision-hhs-says-2020-benchmark-plan-premiums-mostly-lower FDA Approves Novel Triple Combination Therapy for Cystic Fibrosis: https://www.ajmc.com/newsroom/fda-approves-novel-triple-combination-therapy-for-cystic-fibrosis What We're Reading: Republicans Release Health Plan; J&J's Talc Problems; House Panel to Consider Vape Tax: https://www.ajmc.com/newsroom/what-were-reading-republicans-release-health-plan-jjs-talc-problems-house-panel-to-consider-vape-tax Blood Supply Falls Short of Need in Most Countries, S

Healthcare is increasingly trying to use big data and clinical pharmacists are no exception. On today's episode of Managed Care Cast, we talk with an assistant professor at Geisinger’s Center for Pharmacy Innovation and Outcomes about his work with big data.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week. This week, the top managed care news included a new guide that balances curbs on opioid abuse with the needs of patients with chronic pain; HHS proposed reforming antikickback rules to help boost value-based care; a report found flaws with Medicaid work requirements.

Who will care for America's growing aged population in the coming decades? Today on the podcast, we're speaking with PHI, a New York-based nonprofit organization that works to improve long-term services and care for the elderly and those with disabilities by focusing on the job quality of those providing day-to-day hands-on care—low-paid home health care aides and nursing assistants.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week. This week, the top managed care news included an effort by the Trump administration to bolster Medicare Advantage; an abortion case from Louisiana reached the Supreme Court; the study of adapting to changing oxygen levels wins the Nobel Prize. Read more about the stories in this podcast: Trump Executive Order Bolsters Medicare, MA to Compete Against "Medicare for All" Proposals: https://www.ajmc.com/newsroom/trump-executive-order-bolsters-medicare-ma-to-compete-against-medicare-for-all-proposals What We're Reading: Abortion Access Appeal; Trump to Suspend Visas for Uninsured Immigrants; Vape Ban in Oregon: https://www.ajmc.com/newsroom/what-were-reading-abortion-access-appeal-trump-to-suspend-visas-for-uninsured-immigrants-vape-ban-in-oregon Nobel Prize Honors 3 Who Showed How Cells Adapt to Oxygen Levels: https://www.ajmc.com/focus-of-the-week/nobel-prize-honors-3-who-showed-how-cells-adapt-to-oxygen-levels Cali

This month’s issue of The American Journal of Managed Care® took a look at differences in coverage of orphan and nonorphan drugs to get insight into variation in orphan drug coverage across the largest commercial plans in the United States. The study, which analyzed a data set of private health plan coverage decisions for specialty drugs in 3 ways, found that health plans restrict access to orphan drugs about one-third of the time and that restrictions vary across plans. To get more insight into the findings, and the reasons behind these trends, we sat down with James Chambers, PhD, associate professor of medicine at Tufts Medical Center Institute for Clinical Research and Health Policy Studies.

Exploring the Rise of Obesity-Related Cancers: A Conversation With Dr Debra Patt 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 news included Medicare cuts hospital payments over readmissions; a second-generation chimeric antigen receptor T-cell therapy shows promise; a diabetes drug is approved to prevent kidney failure for the first time. Read more about the stories in this podcast: What We're Reading: Medicare Issues Readmission Penalties; Virginia Abortion Law Ruling; Vitamin A's Role in Skin Cancer: https://www.ajmc.com/newsroom/what-were-reading-medicare-issues-readmission-penalties-virginia-abortion-law-ruling-vitamin-as-role-in-skin-cancer- PwC Report Urges Action to Tackle Social Determinants of Health: https://www.ajmc.com/focus-of-the-week/pwc-report-urges-action-to-tackle-social-determinants-of-health Researchers Say Second-Generation CAR T-Cell Therapy Proves Successful in Early Studies, Human Trial Planned: https://www.ajmc.com/ne

Digging Deeper Into the Increasing Use of Telehealth 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 news included state and federal crackdowns on vaping that forced out the president of Juul; FDA approved a groundbreaking diabetes treatment; Medicare Advantage premiums will decline for 2020. Read more about the stories in this podcast: What We're Reading: Walmart Removes E-Cigs; Sutter Health Antitrust Case; Sanders Proposes Medical Debt Elimination: https://www.ajmc.com/newsroom/what-were-reading-walmart-removes-ecigs-sutter-health-antitrust-case-sanders-proposes-medical-debt-elimination What We're Reading: Heartburn Medication Recall; Juul Labs CEO Steps Down; Amazon Launches Virtual Health Clinic: https://www.ajmc.com/newsroom/what-were-reading-heartburn-medication-recall-juul-labs-ceo-steps-down-amazon-launches-virtual-health-clinic Flavored E-Cigarettes Linked With Worsening Severity of Asthma in Mice: https://w

Now 3 years into the Oncology Care Model, practices participating in the episode-based model have recently received results from performance period 4, representing care delivered in the first half of 2018. Results from the previous 2 performance periods have some practices concerned because there was little improvement; During both performance period 2 and 3 approximately 30% of practices achieved savings. With performance period 4 results out now, it’s a transformative point in the model in which practices that have not yet achieved a performance-based payment have to either enter 2-sided risk or leave the model. To dive into the most recent results and their implications, we spoke with Charles Saunders, MD, chief executive officer of Integra Connect.  Read more about the Oncology Care Model performance period results: Lessons From the Field: How Practices Are Succeeding Under OCM: https://www.ajmc.com/focus-of-the-week/lessons-from-the-field-how-practices-are-succeeding-under-ocm Mike Fazio: Practices Are

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 Purdue Pharma filing for bankruptcy; new data showing the number of people who get screened for HIV at least once falls far short of what CDC recommends; findings that most US hospital markets are now highly concentrated. Read more about the stories in this podcast: What We're Reading: Purdue Pharma Files for Bankruptcy; Rise in Uninsured Immigrants; Spiked CBD in Maryland: https://www.ajmc.com/newsroom/what-were-reading-purdue-pharma-files-for-bankruptcy-rise-in-uninsured-immigrants-spiked-cbd-in-maryland How Many People Actually Get Screened for HIV? https://www.ajmc.com/newsroom/how-many-people-actually-get-screened-for-hiv Nearly 75% of US Hospital Markets Highly Concentrated, HCCI Report Shows: https://www.ajmc.com/newsroom/nearly-75-of-us-hospital-markets-highly-concentrated-hcci-report-shows Wha

Exploring Reference-Based Pricing as a Method for Lowering Healthcare Costs 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 news included a report showing the US uninsured rate rose in 2018; the Trump administration indicating it will ban all flavors of e-cigarettes except for tobacco; new research showing the prevalence of hemophilia is 3 times larger than originally believed. Read more about the stories in this podcast: Despite Strong Economy, Census Report Says Uninsured Rate Rose in 2018: https://www.ajmc.com/focus-of-the-week/despite-strong-economy-census-report-says-uninsured-rate-rose-in-2018 What We're Reading: FDA Investigating Juul; Sutter Health Handed Lawsuit; European Doctor Sues FDA: https://www.ajmc.com/newsroom/what-were-reading-fda-investigating-juul-sutter-health-handed-lawsuit-european-doctor-sues-fda Trump Administration Seeks to Rid Market of Flavored e-Cigarettes: https://www.ajmc.com/newsroom/trump-administration-seek

To date, most alternative payment models (APMs) that have emerged in the shift toward value-based care have been initiated by payers and focused on primary care providers. However, there has recently been a new wave of payment reform in which providers, mostly specialists, are designing and implementing their own APMs in their practices. A study published in the September issue of The American Journal of Managed Care analyzed some of these new payment models to gain insight into what providers are prioritizing in their APMs. To get more insight into the study and its findings, we spoke with study author Suhas Gondi, BA, of Harvard Medical School.

Relationships in healthcare are important and trust is crucial to those relationships. However, it has been on the decline in the United States. We speak with the executive vice president of the ABIM Foundation and representatives from the 8 winning organizations of the foundation's Trust Practice Challenge about the programs they implemented to rebuild trust. Read more: ABIM Foundation Trust Practice Challenge: https://abimfoundation.org/what-we-do/rebuilding-trust-in-health-care/trust-practice-challenge 5 Things About Medical Mistrust: www.ajmc.com/newsroom/5-things-about-medical-mistrust From the Editorial Board: Daniel B. Wolfson, MHSA: www.ajmc.com/journals/issue/2019/2019-vol25-n5/from-the-editorial-board-daniel-b-wolfson-mhsa

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 news included a diabetes drug showing positive results in treating heart failure; new lipid guidelines promoting the use of proprotein convertase subtilisin/kexin type 9 inhibitors; and a study finding doctors are more likely to prescribe opioids if they are in a hurry. Read more about the stories in this podcast: Dapagliflozin Cuts Risk of CV Death, Worsening of Heart Failure 26%, Whether Diabetes Present or Not: https://www.ajmc.com/newsroom/dapagliflozin-cut-risk-of-cv-death-worsening-of-heart-failure-26-whether-diabetes-present-or-not New Guidelines Supported by Lipid-Lowering Therapy Studies, Indicating Benefit of PCSK9 Inhibitors: https://www.ajmc.com/focus-of-the-week/new-guidelines-supported-by-lipidlowering-therapy-studies-indicating-benefit-of-pcsk9-inhibitors Providers More Likely to Prescribe Opioids as the

On this episode of Managed Care Cast, we speak with the author of a new book that discusses the price and cost of American healthcare. Martin Makary, MD, MPH, a surgical oncologist and chief of the Johns Hopkins Islet Transplant Center, talked about what he found while writing The Price We Pay: What Broke American Health Care—and How to Fix It. Makary discusses spurious billing practices, overtreatment, and the opioid issue, as well as efforts by some providers and employers to reshape primary care.