Managed Care Cast

This week, the top news in managed care included CDC guidance on safe activities for fully vaccinated individuals; American Rescue Plan signed into law; new lung cancer screening criteria expand eligibility.

This activity is supported by an educational grant from Boehringer Ingelheim. Today, we are bringing you part 1 of a 2-part podcast series discussing chronic obstructive pulmonary disease (COPD). In part 1, moderator Neil Minkoff, MD, chief medical officer of Coeus Healthcare, leads a discussion with a panel of experts about the burden of COPD, available treatments, and more.

This week, the top managed care news included President Biden updating production timeline for nationwide vaccine availability; efforts by the National Quality Forum to measure telehealth quality and value; FDA approves first treatment for rare genetic metabolic pediatric disorder.

As the COVID-19 pandemic has led to a nation-wide boom in telehealth use, new questions are emerging regarding reimbursement, accessibility, data protection, and quality measurement. Although the practice has greatly aided in maintaining care for many Americans throughout the past year, several challenges have been reported. To create a measurement framework linking quality of care delivered by telehealth, health care system readiness, and health outcomes in rural areas specifically, the National Quality Forum (NQF) recently announced a committee of 25 individuals to discuss, update, and enhance NQF’s telehealth framework, first released in 2017. Currently, there are no nationally endorsed telehealth quality measures. On this episode of Managed Care Cast, we speak with Sheri Winsper, RN, MSN, MHA, the senior vice president for quality measurement at NQF. For the past 20 years, the forum has worked to advance health care quality across the nation by endorsing measures that assess quality of care and value.

An FDA panel meets to discuss J&J's COVID-19 vaccine ahead of an expected emergency use authorization decision, cemiplimab approved for first-line advanced non–small cell lung cancer with PD-L1 expression, and real-world outcomes contrast cancer clinical trial results in Medicare patients.

On this edition of Managed Care Cast, we present a short excerpt from a January webinar titled “Color and COVID-19: The Virus’ Disproportionate Impact” hosted by the MJH Life Sciences™ COVID-19 Coalition about how the pandemic has had an unequal, devastating impact on communities of color.

This week, the top managed care news included Entresto winning the first FDA nod in a hard-to-treat type of heart failure; President Joe Biden nominates a new CMS administrator; experts discuss the potential for Biden health reforms.

On this episode of Managed Care Cast, we highlight a new feature on AJMC.com, the website of The American Journal of Managed Care (AJMC®) called Clinical Spotlight, where our editors provide a series of interviews with leading experts in certain specialties. Over the past few months, we’ve talked with specialists in chronic obstructive pulmonary disease (COPD), small-cell lung cancer, and chimeric antigen receptor (CAR) T-cell therapy. The first interview excerpt is with Rose McNulty, editor at AJMC, who speaks with Charles Rudin, MD, chief of the Thoracic Oncology Service at Memorial Sloan Kettering Cancer Center and principal investigator of the National Cancer Institute Small Cell Lung Cancer Consortium. He provides insights into the state of SCLC treatment, clinical trials, and what the future may hold. The second is with Gianna Melillo, associate editor, who interviews Antonio Anzueto, MD, a professor of medicine at University of Texas Health in San Antonio and a member of the science committee for

This week, the top managed care news included President Biden’s DOJ reversing course in case seeking to overturn the Affordable Care Act; once-weekly semaglutide and lifestyle changes slashed body weight by 15%; updates on COVID-19 vaccines and treatments.

With the growth of alternative payment models and value-based contracting, policy makers and researchers are looking to other sectors that offer the potential for cooperation with the health care system, including education. Schools and health care organizations are a natural fit to work together to improve outcomes for children, but value-based alignment between the 2 systems will require the development of both contracting mechanisms and a foundation of trust. On this episode of Managed Care Cast, we’re talking with two coauthors of a commentary published in our February 2021 issue. The commentary, “Achieving Better Value in Pediatric Care: School Systems as Clinical and Financial Partners?”, explains the opportunities for the health care and education systems to cooperate in value-based contracts to improve outcomes for students, as well as how this goal may be affected by the ongoing coronavirus disease 2019 pandemic. The authors joining us today are Venus Wong, PhD, of the Clinical Excellence and Resea

On this episode of Managed Care Cast, we speak with experts from ChristianaCare, one of the largest health care providers in the mid-Atlantic region, serving patients in Delaware and parts of Maryland, New Jersey, and Pennsylvania. Hoping to increase the percentage of their patients with diabetes who have a hemoglobin A1C of 9% or lower, in 2019, ChristianaCare implemented a diabetes pilot program at 4 of its primary care sites, partnering each site with an endocrinologist and embedding a behavioral counselor at Primary Care Concord in Chadds Ford, Pennsylvania. With an original goal of growing this patient group by 10% by July of 2019, they instead saw 16% growth.

This week, the top managed care news included nationwide pharmacies to receive vaccine doses; experts issue recommendations for improving health care in 2021; HIV may increase risk of severe COVID-19 infection.

Findings from the latest Quest Diagnostics Health trends study, made in collaboration with The Harris Poll, underscore racial disparities in US health care brought to light by the coronavirus disease 2019 (COVID-19)pandemic. The online survey, conducted from November 10-12, 2020, found that among over 2000 adult participants, Black and Hispanic/Latinx Americans are nearly 2 times as likely as White Americans to say their access to COVID-19 vaccines, treatments, and health care, once available, is worse than other racial/ethnic groups. To help combat these disparities, Quest Diagnostics launched the Quest for Health Equity Initiative in August 2020. On this episode of Managed Care Cast, we speak with Harvey Kaufman, MD, the senior medical director at Quest Diagnostics about the Health Trends Study results, the organization’s mission to mitigate testing disparities, and the importance of access to preventive services.

This week, the top managed care news included Biden reopening Affordable Care Act insurance marketplaces; medical claim denial rates highest in initial COVID-19 hotspots; obesity linked with mortality in acute lymphoblastic leukemia.

On this episode, we speak with Andrew Smith, PhD, Huntsman Mental Health Institute at the University of Utah School of Medicine, coauthor of a paper looking at the mental health stressors facing first responders and health care workers during the coronavirus disease 2019 (COVID-19) pandemic. The paper found that a sizable number of these frontline workers are at risk for psychiatric illnesses at severity levels higher than other national disasters, including 9/11 and Hurricane Katrina.

This week, the top managed care news included President Joe Biden's executive orders to reform public health; incoming CDC Director to prioritize communication, coronavirus disease 2019 vaccine rollout; CMS finalizes rule on electronic prior authorization.

The authors of a Clinical research article in the January 2021 Health IT issue of The American Journal of Managed Care® discuss their findings and suggestions for making telehealth access more equitable for all.

This week, the top managed care news included new CDC guidance to base state COVID-19 vaccine supply on administration rates; a report finds record drop in cancer mortality but persistent disparities; Jardiance moves 1 step closer to FDA approval for use in heart failure.

On this episode of Managed Care Cast, we speak with the new chief financial officer of Strive Health, a value-based kidney care company that works with payers and providers to create an integrated care delivery system for chronic kidney disease (CKD) and end stage renal disease (ESRD). We discuss the changes coming to nephrology practices as well as new ways of looking at the whole patient to try and halt the slide to irreversible ESRD.

This week, the top managed care news included FDA advising against changes to vaccine dose schedules; drop in mammography screenings during the first months of the pandemic; first anti-TIGIT therapy granted Breakthrough Therapy designation by the FDA.