Managed Care Cast

PCOC Recap: Seven Leaders Define Patient-Centered Oncology Care by Managed Care Cast

Crystal Clear: What Availity's Founding Story Teaches About Price Transparency by Managed Care Cast

Host Carol Skenes, chief of staff at Turquoise, previews Crystal Clear With Carol Skenes, a new podcast about making health care more transparent and easier to navigate. She explains why opaque payment processes leave patients without answers on cost. She also outlines what a simpler, waste-free transaction could look like and who is working toward it. Follow for season 1.

Patients Open to Lower-Cost Weight Maintenance to Expand GLP-1 Access by Managed Care Cast

In part 2 of this conversation recorded at Patient-Centered Oncology Care 2026 in Nashville, Melody Chang, vice president of pharmacy operations at American Oncology Network (AON), talks with 2 AON colleagues. Susan Sabo Wagner, vice president of clinical innovation, explains why financial toxicity should be managed as a clinical toxicity. She also covers how electronic patient-reported outcomes can support patients on CAR T-cell and bispecific therapies between visits, and how AON is rolling out behavioral health partnerships, distress screening, and area deprivation index data across its practices. Alti Rahman, chief strategy and innovation officer, describes how AON is now supplying quality measures to payers instead of receiving them, and previews a closing panel on building trust among payers, providers, and patients through 2030. Both share what stood out most at the meeting, from patient access to keeping pace with fast-moving therapies.

For years, first-relapse myeloma regimens have delivered just 1 to 2 years of progression-free survival and immunomodulatory drugs were dosed to the maximum tolerated dose. Iberdomide, the first CELMoD approved by the FDA and the first myeloma approval based on minimal residual disease negative status, changes this narrative. In this episode, we speak with Sagar Lonial, MD, FACP, FASCO, professor and chair of the Department of Hematology and Medical Oncology at Emory University School of Medicine, chief medical officer at Winship Cancer Institute, and lead investigator of the phase 3 EXCALIBER trial. Lonial breaks down the new EXCALIBER data he presented at IMS 2026, including MRD negativity rates for the study and comparator arms; how dosing was chosen for optimal fit rather than force; and and why MRD as an end point has potential to get new therapeutics to patients faster.

On this episode, AJMC spoke with Jaspreet Loyal, MD, about vitamin K refusals, which many clinicians believe may be a downstream effect of broader vaccine hesitancy.

Opaque benchmarks, payment lags of 12 to 18 months, and rules that changed mid-model led American Oncology Network (AON) to exit the Enhancing Oncology Model (EOM), according to AON Chief Medical Officer Stephen "Fred" Divers, MD. In this inaugural episode of The Business of Value, Divers tells host Lalan Wilfong, MD, chief medical officer of Navista, how 505(b)(2) drugs complicated practice finances, why retrospective data limited the ability to improve, and why other payers did not follow Medicare's lead. He also explains how AON is pursuing other value-based arrangements built on real-time data and what practices should know before joining similar models.

Community oncology practices can close the gap between innovation and implementation by building patient feedback into real-time clinical pathways, using AI to speed up physician decision-making, and better supporting caregivers of patients on CAR T and bispecific therapies, according to leaders from the American Oncology Network (AON). In the first of 2 podcasts from Patient-Centered Oncology Care 2026, Melody Chang, RPh, MBA, BCOP, is joined by Fred Divers, MD; Puneeth Indurlal, MD; and Brooke Peters, PharmD. They recap their PCOC panels and explain how the discussions connect to AON's work on clinical trials, rural access, and caregiver education.

This week's Managed Care Cast episode features a conversation between The American Journal of Managed Care® (AJMC®) and Grace Mackleby, PhD, a research scientist at the USC Schaeffer Center, about her study, "Plan Switching Among Medicare Advantage Enrollees Dually Eligible for Medicaid," published in the September 2026 issue of AJMC. The study examined how often beneficiaries switched from one Medicare Advantage (MA) plan to another or from MA to traditional Medicare (TM). It compared enrollees dually eligible for Medicaid with those eligible for Medicare only. Mackleby explained that dually eligible beneficiaries account for about one-fifth of the Medicare population and tend to have more chronic conditions, higher costs, and greater needs; they are also subject to different rules on when they can switch plans. Mackleby and coauthors Angela Liu, PhD, and Erin Trish, PhD, used administrative Medicare enrollment data to track switching from 2016 to 2022. She highlighted 3 main results. First, about 22% of

On this episode, I spoke with Jonathan Kimmelman, PhD, professor of biomedical ethics and associate member of the Department of Experimental Medicine at McGill University, about the ethical concerns surrounding Kalshi as it relates to clinical trial outcomes and FDA approvals.

During Suicide Prevention Month, UPMC experts discuss how lived experience, peer support, and connection strengthen suicide prevention.

September is Blood Cancer Awareness Month, and to mark it, we have a special Director's Cut episode of Managed Care Cast. My name is Maggie Shaw, lead editor at AJMC, and my guest today is Surbhi Sidana, MD, associate professor of medicine at Stanford University, where she leads the Myeloma Disease Focused Group and serves as associate director for clinical research in the BMT and Cell Therapy Division. We talk about her path into myeloma research, the field's shift from a once-fatal diagnosis to real conversations about cure, the barriers patients face accessing CAR T-cell therapy, and her advice for the next generation of hematologists.

Health-system pharmacy is entering a decade of change, and Future-Proofing Pharmacy is built to keep asking what that future should look like. In this debut episode, host Mark Makhinson, PharmD, senior director of outpatient and specialty pharmacy at Mount Sinai Health System, introduces the podcast's mission: exploring how pharmacy leaders can build organizations that are clinically meaningful, scalable, and ready to adapt, rather than simply reacting to financial pressure, workforce shifts, and drug shortages as they arise. Makhinson lays out the questions the series will return to throughout its run, including what a health system pharmacy enterprise looks like in 2035, where artificial intelligence can meaningfully help, and where human judgment should remain central. Episode 1 kicks off with Nilesh Desai, PharmD, chief pharmacy officer at University of Miami Health System, who shares the pharmacy enterprise he would build from scratch in 2035 and the lessons that shaped his thinking during a major phar

This week's Managed Care Cast episode features a conversation between The American Journal of Managed Care® and August 2026 authors Jeff Romine, PhD, and Kofi Essel, MD, MPH, about their study, "Insurance-Provided Grocery Assistance and Health Care Outcomes Among Patients With Diabetes." It examined the association between a commercial health plan's grocery assistance benefit and health care use and outcomes among members with type 2 diabetes, offering evidence in a space where prior food-as-medicine research has centered largely on Medicare and Medicaid populations. The benefit provided members between $1200 and $3000 annually, distributed across pay periods on a card usable at a range of grocery chains. Purchases excluded alcohol, tobacco, and preprepared foods, with an emphasis on fruits, vegetables, and other healthy items. Essel noted the design was a deliberate light touch, requiring no dietitian or health coach support, which he said made it more scalable than medically tailored meal programs that h

Socially vulnerable Medicare patients see dramatically better outcomes—such as fewer emergency department visits, fewer preventable hospital admissions, and 23.4% to 30% less use of high-risk medications—when their physicians take on full financial risk for their care compared with those in traditional fee-for-service Medicare. That's the core finding of a new study published in the June issue of Population Health, Equity & Outcomes, and the subject of this conversation between Ken Cohen, MD, chief medical officer for Optum Health, and host Sophia Humphreys, PharmD, vice president of health system strategy and innovation at The American Journal of Managed Care.

UPMC and Birth Root Community Doula describe a 4-year partnership addressing food insecurity, housing, and maternal health disparities in Erie, Pennsylvania.

In this episode of Managed Care Cast, Alvin Thomas, PhD, clinical psychologist at the University of Wisconsin-Madison, discusses the mental health challenges facing Black and Latino boys and young men.

For this Managed Care Cast episode, The American Journal of Managed Care® (AJMC®) spoke with Anuraag R. Kansal, PhD, who leads health economics research at GRAIL, about his study, “State Medicaid Budgetary Implications of New Cancers," published in the July 2026 issue; it examined how new cancer diagnoses affected state Medicaid budgets. He conducted the study with Amanda C. Chen, PhD, of the USC Mann School of Pharmacy and Pharmaceutical Sciences, and David C. Grabowski, PhD, of Harvard Medical School. Kansal explained to AJMC that despite Medicaid's younger population, cancer remains the third-largest source of program spending. Most existing research had focused on commercial and Medicare populations rather than Medicaid specifically. Consequently, using de-identified CMS claims data, he and his team identified new cancer diagnoses, defined as no prior cancer evidence in the preceding 6 months, and compared spending, hospitalizations, and emergency department use between metastatic and non-metastatic ca

Expanding Support Systems for Black Maternal Health by Managed Care Cast