Managed Care Cast

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 top pharmaceutical executives refuse to attend a Trump meeting after executive orders on costs; a survey shows concerns about reopening schools, toll of COVID-19 split by party lines, background; a review of 20 years of data concludes vaccines are "remarkably safe." Read more about the stories in this podcast: Trump Signs 4 Executive Orders in Effort to Carry Out Promise to Lower Drug Prices: https://www.ajmc.com/view/trump-signs-4-executive-orders-in-effort-to-carry-out-promise-to-lower-drug-prices What We're Reading: Pharma Execs Refuse to Attend Trump Meeting; Kodak Lands $765M US Loan; Persistent COVID-19 Symptoms: https://www.ajmc.com/view/what-were-reading-pharma-execs-refuse-to-attend-trump-meeting-kodak-lands-765m-us-loan-persistent-covid19-symptoms Concerns About Reopening Schools, Toll of COVID-19 Split by Party Lines, Background: https://www.ajmc.com/view/c

On this episode of Managed Care Cast, we speak with the senior vice president of Network Payment Innovation and Contract Management for Blue Cross Blue Shield of Massachusetts, which is launching new value-based payment approach for independent primary care practices. The pilot project will reward practices for keeping patients healthy while providing extra support during the pandemic.

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 states suing the Trump administration over an HHS rule on nondiscrimination; experimental vaccines show promise against coronavirus disease 2019 (COVID-19) in healthy subjects; diagnostic delays from COVID-19 may increase cancer-related deaths. Read more about the stories in this podcast: States Sue Trump Administration for Changing Nondiscrimination Provisions of ACA: https://www.ajmc.com/newsroom/states-sue-trump-administration-for-changing-nondiscrimination-provisions-of-aca Experimental Vaccines Show Promise Against COVID-19 in Healthy Subjects: https://www.ajmc.com/newsroom/experimental-vaccines-show-promise-against-covid19-in-healthy-subjects Diagnostic Delays From COVID-19 May Increase Cancer-Related Deaths, UK Studies Say: https://www.ajmc.com/focus-of-the-week/diagnostic-delays-from-covid19-may-increase-cancerrelated-deaths-uk-studies-say Cancer Organizations

On today’s episode of Managed Care Cast, we feature a short excerpt of an upcoming interview in the August issue of The American Journal of Managed Care® with Mandy K. Cohen, MD, MPH, North Carolina's secretary of the Department of Health and Human Services, as part of our yearlong Q&A series. We discussed the state's upcoming transition to Medicaid managed care, the pandemic, her advice to public health workers in the face of criticism, and how what is learned from the pandemic can help inform the future of managed care going forward.

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 states facing COVID-19 spikes reporting health coverage losses; new COVID-19 data protocol raises concerns; and experts discuss key steps to reduce racial inequities in cancer care. Learn more about the stories in this podcast: States Facing COVID-19 Spikes Report Greatest Health Insurance Coverage Losses: https://www.ajmc.com/focus-of-the-week/states-facing-covid19-spikes-report-greatest-health-insurance-coverage-losses New COVID-19 Hospital Data Protocol Raises Concerns: https://www.ajmc.com/newsroom/new-covid19-hospital-data-protocol-raises-concerns Key Steps to Reduce Racial Cancer Disparities Include Supporting Minority Scientists, Diversifying Medical Schools and Clinical Trials: https://www.ajmc.com/interviews/key-steps-to-reduce-racial-cancer-disparities-include-supporting-minority-scientists-diversifying-medical-schools-and-clinical-trials PrEP Use Has Change

Routine preventive screenings and vaccination rates have decreased due to the coronavirus disease 2019 (COVID-19) pandemic, while the Director of the National Cancer Institute recently warned delays in cancer screenings are likely to result in thousands of excess deaths. At the same time, a recent study found the pandemic could create losses of up to $15 billion for primary care practices. To find out what can be done about these setbacks, and to learn why it is so critical to continue screenings during the pandemic, we spoke with Andrea Gelzer, MD, senior vice president and corporate chief medical officer for AmeriHealth Caritas. On this episode of Managed Care Cast, Dr. Gelzer discusses the vital role telehealth has played during the pandemic, and how providers and payers can work together to encourage patients to continue routine care.

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 CMS planning to pay more for at-home dialysis equipment; ACR supports continued use of telemedicine after the COVID-19 pandemic passes; coverage of AIDS 2020, the 23rd International AIDS Conference. Read more about the stories in this podcast: CMS Seeks Incentives for At-Home Dialysis in Wake of COVID-19: https://www.ajmc.com/newsroom/cms-seeks-incentives-for-athome-dialysis-in-wake-of-covid19 ACR Position Statement Supports Use of Telemedicine After COVID-19 Crisis: https://www.ajmc.com/newsroom/acr-position-statement-supports-use-of-telemedicine-after-covid19-crisis Telehealth Growth in April Suggests Continuing Impact of COVID-19: https://www.ajmc.com/contributor/robin-gelburd-jd/2020/07/telehealth-growth-in-april-suggests-continuing-impact-of-covid19 Study Results Show Possible Link Between Medicaid Expansion, Drop in Advanced Breast Cancer: https://www.ajmc.com/n

Medication access barriers and nonadherence significantly impact medication underuse in the United States. This issue is estimated to cost the country’s healthcare system between $100 billion to $290 billion annually, as patients who underuse medication are more likely to have complications, which can result in costly health care utilization. Recently, The Pharmacy Quality Alliance (PQA) and National Pharmaceutical Council (NPC) announced 2 research grants funding studies of patients’ real-world medication access barriers. Leveraging the framework devised by the PQA and NPC released in March 2019, researchers at The Johns Hopkins Hospital and University of Rhode Island will investigate this problem and release their findings in 2021. Oral anticancer therapies have become popular alternatives to more traditional care, such as chemotherapy. However, research shows that adherence to oral anti-cancer therapies can range from 20% to 100%. Several factors contribute to medication non-adherence and access barrie

The last decade has brought great strides in diabetes care. Better insulins and better technology can allow people with diabetes—both type 1 and type 2—to keep their blood sugar from rising and falling in ways that cause long-term damage to their eyesight and vascular systems. New classes of drugs for patients with type 2 diabetes have been shown to cut the risk of heart and renal failure, and more widespread use could help some patients avoid dialysis. But the good news is not felt by everyone. Amid this progress, the rate of amputations rose 50% between 2009 and 2015. African American patients lose limbs at triple the rate of other groups.  The mission of the Affordable Care Act—spend more to prevent disease and complications, and save money later—has bypassed many of these patients for one reason: they lack access to care. Fourteen states have not expanded Medicaid, including several Deep South states where diabetes and obesity rates are highest. The result of these state-level policy decisions is becomi

The significant effect of the COVID-19 pandemic on mental health was spotlighted in a recent collaborative study conducted by the National Alliance of Healthcare Purchaser Coalitions, Total Brain, and One Mind. Compared with before the pandemic began, study findings indicate stark increases in rates of depression, anxiety, and stress, with women shown to be at a greater risk. On this episode of Managed Care Cast, we speak with Michael Thompson, president and CEO of the National Alliance, and Louis Gagnon, CEO of Total Brain, on their findings and how employers can optimize how they monitor and support mental health in their respective workforce.

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 CMS proposing rules for value-based contracting in Medicaid; claims data highlighting racial disparities in COVID-19 effects; an interview with Anthony Fauci, MD, on the progress made against HIV. Read more about the stories in this podcast: CMS Issues Rules to Promote Value-Based Contracting, Pay for High-Cost Therapies in Medicaid: https://www.ajmc.com/newsroom/cms-issues-rules-to-promote-valuebased-contracting-pay-for-highcost-therapies-in-medicaid Medicare Claims Data Further Highlight Pandemic's Toll on Racial Minorities: https://www.ajmc.com/focus-of-the-week/medicare-claims-data-further-highlight-pandemics-toll-on-racial-minorities What Is Being Done to Assess the Disproportionate Effect of COVID-19 on Minority, Rural Communities? https://www.ajmc.com/focus-of-the-week/what-is-being-done-to-assess-the-disproportionate-effect-of-covid19-on-minority-rural-communi

Older and poorer Americans are disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. In this episode of Managed Care Cast, we speak with Richard Shinto, MD, MBA, president and CEO of InnovaCare Health, about the company’s care of their Medicare Advantage and Medicaid beneficiaries in Puerto Rico during the COVID-19 pandemic. He last spoke with us in 2018 about the effect that Hurricane Maria had on the organization and its members. In today’s podcast, he shares how coping with the aftermath of the 2017 hurricane assisted them with the pandemic.

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 more details about the COVID-19 vaccine process; attempts to reinforce social distancing amid reopening; a recap of the American Diabetes Association 2020 Virtual Scientific Sessions. Read more about the stories in this podcast: US Releases More Details About COVID-19 Vaccine Process, Says Some Doses Will Be Free: https://www.ajmc.com/newsroom/us-releases-more-details-about-covid19-vaccine-process-says-some-doses-will-be-free With States Reopening, CDC Tries to Reinforce Social Distancing Guidance: https://www.ajmc.com/newsroom/with-states-reopening-cdc-tries-to-reinforce-social-distancing-guidance American Diabetes Association 2020 Virtual Scientific Sessions: https://www.ajmc.com/conferences/ada-2020 What We're Reading: Drug Price TV Ruling Upheld; WHO Ends Hydroxychloroquine Study; Caution Issued on Rally Attendance: https://www.ajmc.com/newsroom/what-were-reading-

The ramifications of the COVID-19 pandemic has caused uncertainty among employers nationwide adjusting to this new normal. Notably, viable health care coverage has emerged as an essential necessity, with employees seeking favorable benefits. A recent analysis by Willis Towers Watson indicates that individual markets, once characterized as volatile, have emerged as an option now associated with stability and growth. On this episode of Managed Care Cast, we speak with John Barkett, MBA, senior director of Policy Affairs in Benefits Delivery and Administration for Willis Towers Watson, on the current outlook of individual markets in private exchange solutions amid the pandemic.

In this episode of Managed Care Cast, we speak with the lead author of a study in the June issue of The American Journal of Managed Care® about the nationwide dearth of suppliers of the Medicare Diabetes Prevention Program, which aims to reach older adults with prediabetes. Natalie D. Ritchie, associate research scientist in the Denver Health and Hospital Authority Office of Research and an assistant professor at the University of Colorado School of Medicine and College of Nursing, discussed her thoughts on why not enough suppliers are offering the program. The study ("Medicare Diabetes Prevention Program: Where Are the Suppliers?") can be found at ajmc.com/link/4659.

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 HHS distributing COVID-19 funds to Medicaid and CHIP providers; the National Kidney Foundation issues a statement on health disparities and racial violence; a preview of our coverage of the American Diabetes Association 2020 Virtual Scientific Sessions. Read more about the stories in this podcast: HHS to Send COVID-19 Funds to Medicaid, CHIP, Safety Net Hospitals: https://www.ajmc.com/newsroom/hhs-to-send-covid19-funds-to-medicaid-chip-safety-net-hospitals National Kidney Foundation Issues Statement on Health Disparities, Racial Violence: https://www.ajmc.com/newsroom/national-kidney-foundation-issues-statement-on-health-disparities-racial-violence American Diabetes Association 2020 Virtual Scientific Sessions: https://www.ajmc.com/conferences/ada-2020 Diabetes Educators Release Updated Report on DSMES Accessibility, Usage: https://www.ajmc.com/focus-of-the-week/diabe

Chronic musculoskeletal pain costs the United States hundreds of billions of dollars each year. Now, with the coronavirus disease 2019 (COVID-19) pandemic, healthcare providers are tasked with providing optimal care to patients while minimizing human contact as much as possible. On this episode of Managed Care Cast, we speak with Jeffrey Krauss, MD, chief medical officer of Hinge Health and Stanford Clinical assistant professor. In a study Dr. Krauss co-wrote entitled “Digital care for chronic musculoskeletal pain: 10,000 participant longitudinal cohort study,” researchers evaluated the efficacy of a 12-week digital care program aimed to reduce lower back and knee pain in a real-world population. According to authors, the results support the prospect for digital care programs to serve the overwhelming number of musculoskeletal pain sufferers worldwide.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week. This week, top managed care stories included an additional setback for Medicaid work rules; another study finding more benefits from SGLT2 inhibitors; researchers finding unwanted end-of-life care causes stress. Read more about the stories in this podcast: OCM, Other APM Timelines Extended Due to COVID-19: www.ajmc.com/focus-of-the-week/ocm-other-apm-timelines-extended-due-to-covid-19 Racial Disparities Shift in Observation Status in Hospital Admissions for Avoidable Conditions: www.ajmc.com/focus-of-the-week/racial-disparities-shift-in-observation-status-in-hospital-admissions-for-avoidable-conditions Study Finds Nonprofit Hospitals Did Not Direct Medicaid Expansion Savings Into Communities: www.ajmc.com/focus-of-the-week/study-finds-nonprofit-hospitals-did-not-direct-medicaid-expansion-savings-into-communities- ASCO 2020 Annual Meeting: www.ajmc.com/conferences/asco-2020 Improving Quality of Care in Oncology Th

In this episode of Managed Care Cast, we speak with the lead author of a study in the May issue of The American Journal of Managed Care® about the shift in new accountable care organizations (ACOs) from being led by hospital systems to being led by physician groups, and the accompanying policy shifts that are needed. David Muhlestein, the chief strategy and chief research officer at Leavitt Partners, also discussed his thoughts on the affect of coronavirus disease 2019 on ACOs. The study is titled "Accountable Care Organizations Are Increasingly Led by Physician Groups Rather Than Hospital Systems."

Amid COVID-19, patients with Parkinson disease have had to adjust to the physical and mental challenges precipitated by the pandemic. Notably, those with Parkinson disease, who are already linked with heightened feelings of stress and anxiety, may be further at risk. On this episode of Managed Care Cast, we speak with Rachel Dolhun, MD, vice president of Medical Communications at The Michael J. Fox Foundation for Parkinson Research, about recent innovations by The Michael J. Fox Foundation to assist patients and families of patients with Parkinson disease in adjusting to this new normal.