Managed Care Cast

In a prior study, nearly 7 in 10 employees indicated in a survey that the COVID-19 pandemic is the most stressful time of their entire professional career. Researchers from Lyra Health, an employee behavioral health provider, recently conducted a study examining the efficacy, in real-world circumstances, of a structured, cognitive behavioral coaching program delivered through video or telephone. On this episode of Managed Care Cast, we speak with Connie Chen, MD, chief medical officer at Lyra Health, about the study “Effectiveness of a Cognitive Behavioral Coaching Program Delivered Via Video in Real World Settings.”

Against a backdrop of the health care and cost concerns stemming from the COVID-19 pandemic, the April issue of The American Journal of Managed Care® features an interview with Dr. Sherry Glied,  health economist and dean of New York University’s Robert F. Wagner Graduate School of Public Service, about the Affordable Care Act and Medicaid, as well as the vital role that public service leadership plays in navigating a crisis of this scale.

The 2020 Community Oncology Conference, hosted by the Community Oncology Alliance (COA), will take place virtually on April 23 and April 24. The American Journal of Managed Care® (AJMC®) is bringing you a series of previews so you can learn more about what to expect when you attend this virtual meeting. In this interview we speak with Debra Patt, MD, MPH, MBA, executive vice president of policy and strategy at Texas Oncology who is presenting on applied informatics in oncology at the virtual meeting.

The 2020 Community Oncology Conference, hosted by the Community Oncology Alliance (COA), takes place virtually on April 23 and April 24. The American Journal of Managed Care® (AJMC®) is bringing you a series of previews so you can learn more about what you'll hear when you attend this virtual meeting. In this interview we're speaking with Lee Schwartzberg, MD, FACP, the chief medical director of West Cancer Center and the chief medical officer of OneOncology, and who is moderating a stakeholder panel discussion on genomic profiling in cancer.

Complex care management programs aim to improve health outcomes of high-cost, high-need patients through coordinating medical and social services. In general, Medicaid patients have high rates of chronic conditions and often utilize preventable acute care, leading to avoidable spending. To determine the impact complex care management programs can have on Medicaid beneficiaries, researchers conducted a study at CareMore Health in Memphis, Tennessee. On this episode of Managed Care cast, we speak with Farhad Modarai, DO, on a recent paper he co-wrote, entitled, "Impact of Complex Care Management on Spending and Utilization for High-Need, High Cost Medicaid Patients." The study can be found in the February issue of The American Journal of Managed Care®.

Efforts to ensure that veterans have timely access to healthcare include community partnerships and the Veterans Choice Program, but new research suggests that women veterans may be receiving less care, particularly those who report unstable housing or mental/behavioral health issues, On this episode of Managed Care Cast, we speak with Laurel A. Copeland, PhD, about the paper “Gender Differences in Newly Separated Veterans’ Use of Healthcare.” The study can be found in the March issue of The American Journal of Managed Care®.

Prior authorizations play a key role in checking on the safety and appropriateness of medical treatments among patients, but when they take too long, efficiency of care suffers. On this episode of Managed Care Cast, we speak with April Todd, senior vice president, CORE and Explorations for CAQH, on CAQH CORE’s recent approval of a 2-day rule for health plans in requesting additional supporting information from providers and making final determinations on prior authorization requests. CAQH CORE is a multi-stakeholder collaboration aimed at creating healthcare operating rules for electronic administrative transactions and establishing a common foundation for the operational components of value-based payment.

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.

When implemented as intended, preventive drug lists (PDLs) can help high-deductable health plan members save money by covering preventive medications at lower or no costs. However, after conducting a series of interviews, researchers found this is not always the case among patients with asthma who have PDLs. Some patients were unaware their plans had PDLs, while other PDLs did not cover the cost of asthma medication. On this episode of Managed Care cast, we speak with Melissa B. Gilkey, PhD, and Alison A. Galbraith, MD, MPH, about their paper, "Preventive Drug Lists as Tools for Managing Asthma Medication Costs." The study can be found in the February issue of The American Journal of Managed Care®.

Although genomic testing is recognized in national oncology guidelines as key to determining the right therapy for metastatic colorectal cancer (MCC), overall biomarker testing rates remain poor. On this episode of Managed Care Cast, we speak with one of the authors of a recent study about this issue published in JCO Precision Oncology. Stuart Goldberg, MD, a hematologist oncologist at the John Theurer Cancer Center at Hackensack University Medical Center, discusses real-world testing of biomarkers in MCC by mining electronic health records. Goldberg is also the hospital’s first chief of the Division of Outcomes and Value Research, and the episode also discusses the relationship between value-based medicine and precision medicine and the promise of delivering improved outcomes at lower costs by avoiding ineffective therapies through the use of specialized testing and diagnostics.

On this episode of Managed Care Cast, we speak with John Showalter, MD, chief product officer at Jvion and an internal medicine physician, and Soy Chen, MS, director of data science at Jvion and part of their data science team. We discuss their research about using applied machine learning to predict healthcare utilization based on social determinants of health, appearing in the January 2019 Health IT issue of The American Journal of Managed Care®.

Nearly 75% of Americans will consider healthcare a main factor when they vote in the 2020 presidential election, according to a survey published by Wolters Kluwer late last year. The survey, called Mending HealthCare in America 2020: Consumers & Cost, showed alignment and deep divisions among patients and providers, with issues around transparency, cost, and care variability causing concern. On this episode of the podcast, we speak with Peter Bonis, MD, chief medical officer, Clinical Effectiveness, Wolters Kluwer, Health.

On this episode of Managed Care Cast, we speak with Kashyap Patel, MD, the chief executive officer of Carolina Blood and Cancer Care Associates—a leading OCM practice—and associate editor of Evidence-Based Oncology™ (EBO), as well as Tennessee Oncology’s Stephen M. Schleicher, MD, MBA, to discuss Oncology Care First.

On this Managed Care Cast, we speak with a health policy researcher who got the idea for a study about medical billing appearing in the December 2019 issue of The American Journal of Managed Care® after she received one that was unexpected. While efforts to abate surprise medical billing, such as the kind that come from out-of-network emergency department visits, are currently being debated in Washington, DC, the kind of billing discussed here occurs when patients struggle to understand the difference between preventive health services, which are covered at no cost under the Affordable Care Act, and billing for services at a doctor’s visit for an illness, condition, or injury. Katie Schmitz, a graduate student pursuing a master’s degree in health communication from Purdue University, is one of the coauthors of "Preventive/Office Visit Patient Knowledge and Their Insurance Information Gathering Perceptions." Read the full paper: https://www.ajmc.com/journals/issue/2019/2019-vol25-n12/preventiveoffice-visit-p

On this episode of KOL Corner, Amy Ellis, director of quality and value-based care at Northwest Medical Specialties, talks with Amanda Hodges, BSN, RN, OCN, the director of implementation of ReVital Cancer Implementation.

In today’s Managed Care Cast, we bring you portions of the panel discussion during the the last Institute for Value-Based Medicine® (IVBM®) event for 2019, where oncologists and others shared their thoughts, successes, and frustrations with the current Oncology Care Model, as well as the question and answer session.

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 research that may hold the key to slowing progression of multiple sclerosis; Humana says it is saving billions of dollars through value-based care; the challenges of rural healthcare delivery. Read more about the stories in this podcast: Researchers May Have Identified How to Slow the Progression of MS: https://www.ajmc.com/newsroom/researchers-may-have-identified-how-to-slow-the-progression-of-ms Humana Saves $3.5B, Drives Down Hospital Use Through Value-Based Care in Medicare Advantage: https://www.ajmc.com/focus-of-the-week/humana-saves-35b-drives-down-hospital-use-through-valuebased-care-in-medicare-advantage Tackling Rural Health Challenges During Rural Health Month and Beyond: https://www.ajmc.com/contributor/kelly-munson/2019/11/tackling-rural-health-challenges-during-rural-health-month-and-beyond Hope and Some Skepticism Whether Oncology Payment Models Will Wo

Women in the United States suffer from maternal mortality rates not seen elsewhere in developed countries, and nowhere is that more true than in patients served by Medicare. Although it is a national epidemic, inadequate maternal care disproportionately affects minority women and the 43% of US births financed by Medicaid. On this episode, we speak with  an executive vice president of Avia Health Solutions, which is trying to address this issue in conjunction with 30 healthcare systems.

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 research that shows stents may offer no more value than drugs for some heart patients; a ban on flavored tobacco products gains momentum; a survey finds most American families struggle with social factors that impact health. Read more about the stories in this podcast: In Stable Heart Disease, Study Finds Stents Might Be No Better Than Drugs: https://www.ajmc.com/conferences/aha-2019/in-stable-heart-disease-study-finds-stents-might-be-no-better-than-drugs American Heart Association Scientific Sessions 2019: https://www.ajmc.com/conferences/aha-2019 What We're Reading: Vaping Ban Bill; Anal Cancer Rates; Medical Bill Protections: https://www.ajmc.com/newsroom/what-were-reading-vaping-ban-bill-anal-cancer-rates-medical-bill-protections Social Factors of Health Impacting Majority of US Families, Survey Says: https://www.ajmc.com/focus-of-the-week/social-factors-of-health

Healthcare is changing due to a combination of technological improvements and rising costs. For instance, more than half of surgical procedures now take place in an outpatient environment, but, as with many things in healthcare, there isn’t a lot of transparency. Today on Managed Care Cast, we speak with Michael Abrams, managing partner of Numerof & Associates, about patient safety and outpatient settings.