Managed Care Cast

Just halfway through the year, and 2019 has been busy for biosimilars with new guidance and approvals, but the loss of a big advocate of biosimilars from the FDA. In this episode of Managed Care Cast, Kelly Davio, senior editor of The Center for Biosimilars®, a sister site of The American Journal of Managed Care®, discusses new approvals, what the loss of Scott Gottlieb, MD, as FDA commissioner means, the reality of pay-for-delay deals, and more. Learn more about biosimilars at centerforbiosimilars.com.

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 uncertainty surrounding the fate of the Affordable Care Act's individual mandate; a study finding Medicare beneficiaries may be paying more for some generics than brand-name drugs; the Trump administration proposing 5 new payment models to transform kidney disease care. Read more about the stories in this podcast: Appeals Court Shows Uncertainty Over Constitutionality of ACA's Individual Mandate: https://www.ajmc.com/focus-of-the-week/appeals-court-shows-uncertainty-over-constitutionality-of-acas-individual-mandate Medicare Beneficiaries May Pay More for Some Generics Than Brand-Name Drugs: https://www.ajmc.com/focus-of-the-week/medicare-beneficiaries-may-pay-more-for-some-generics-than-brandname-drugs Despite Growth, Uptake of Downside Risk in ACO Contracts Remains Low: https://www.ajmc.com/focus-of-the-

While many women in healthcare report experiencing subtle or not-so-subtle bias and microaggressions at work, a recently published study sought to determine how healthcare professionals associate men and women with career and family, and also how surgeons associate men and women with surgery and family medicine. In this podcast, we speak with the lead author, Arghavan Salles, MD, PhD, about the findings, as well as other issues affecting women in healthcare.

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, we recap the top managed care news from the first half of 2019, including outcomes from some of the biggest diabetes trials, research into the annual Medicare wellness visit, and an experimental treatment in Parkinson disease. Read more about the stories in this podcast: Medicare Annual Wellness Visit Association With Healthcare Quality and Costs: https://www.ajmc.com/journals/issue/2019/2019-vol25-n3/medicare-annual-wellness-visit-association-with-healthcare-quality-and-costs Cardiovascular Prevention Guidelines Call for Less Aspirin, More SGLT2s, GLP-1s for Type 2 Diabetes: https://www.ajmc.com/conferences/acc-2019/cardiovascular-prevention-guidelines-call-for-less-aspirin-more-sglt2s-glp-1s-for-type-2-diabetes New Treatment May Have the Potential to Slow, Stop, or Reverse Parkinson Disease: https://www.ajmc.com/newsroom/new-treatment-ma

Working Toward More Transparency in Healthcare 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 President Trump issuing an executive order for more healthcare transparency; provisional data indicating that overdose deaths may be falling; the Supreme Court agreeing to hear insurers' Affordable Care Act lawsuit. Read more about the stories in this podcast: Trump Issues Executive Order Intended to Require Disclosure of Negotiated Rates Between Insurers, Hospitals: https://www.ajmc.com/newsroom/trump-issues-executive-order-intended-to-require-disclosure-of-negotiated-rates-between-insurers-hospitals Provisional Data Predict Overdose Death Rates Will Fall for First Time in Decades: https://www.ajmc.com/newsroom/provisional-data-predict-overdose-death-rates-will-fall-for-first-time-in-decades What We're Reading: Supreme Court to Hear ACA Suit; Missouri Abortion Clinic; City of Hope Investment: https://www

Today on Managed Care Cast, we speak with Benjamin Isgur, leader of PwC’s Health Research Institute, about their latest report, Medical Cost Trend Report 2020: Beyond the Numbers. We talk about what is making the medical cost trend start to move upwards and what employers are trying to do about it.

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 finding slow progress in reducing low-value care; a study finding savings by accountable care organizations may be overstated; CMS proposing a rule to allow for electronic prior authorization in Part D drugs. Read more about the stories in this podcast: Analysis Finds Progress in Reducing Spending on Low-Value Services Positive but Sluggish: https://www.ajmc.com/focus-of-the-week/analysis-finds-progress-in-reducing-spending-on-lowvalue-services-positive-but-sluggish Savings of MSSP ACOs May Be Overstated, Annals Study Finds: https://www.ajmc.com/newsroom/savings-of-mssp-acos-may-be-overstated-annals-study-finds CMS Proposes Electronic Prior Authorization for Part D Drugs: https://www.ajmc.com/newsroom/cms-proposes-electronic-prior-authorization-for-part-d-drugs FDA Approves Liraglutide for Youth

Value-based care has been a big prerogative of CMS for the last decade, and it's not going away, Brian Kern, a lawyer with Frier Levitt, told Amy Ellis, director of quality and value-based care at Northwest Medical Specialties. The government programs, such as the Bundled Payments for Care Improvement, Medicare Shared Savings Program, and Oncology Care Model, are important because practices learn from them and hopefully take these similar models to private payers, which transform healthcare. Through these value-based care programs, data analytics is crucial to help physicians understand cost, improve outcomes, and increase patient satisfaction.

Today we’re speaking with Dr Mark Simon, the chief medical officer of OB Hospitalist Group. OB Hospitalist contracts with hospitals across the United States to create OB emergency departments. The group employs more than 600 experienced OBs who are available 24 hours a day, 7 days a week to ensure that an OB is always in the hospital, rather than on call. OB Hospitalist also works with hospitals to reduce costs by being an outsourced provider of obstetricians.

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 the Community Oncology Alliance submitting an alternative to the Oncology Care Model; more study results demonstrating diabetes drugs can prevent renal failure; US task force recommending pre-exposure prophylaxis for HIV prevention. Read more about the stories in this podcast: COA Submits OCM 2.0 Proposal: https://www.ajmc.com/newsroom/coa-submits-ocm-20-proposal DECLARE Shows Diabetes Drug Farxiga Prevented Renal Decline, Even for Those With Good Kidney Health: https://www.ajmc.com/conferences/ada-2019/declare-shows-diabetes-drug-farxiga-prevented-renal-decline-even-for-those-with-good-kidney-health More CV, Renal Outcomes at ADA: CREDENCE, CARMELINA, CAROLINA: https://www.ajmc.com/conferences/ada-2019/more-cv-renal-outcomes-at-ada-credence-carmelina-carolina Oral Semaglutide Meets CV Safety Mark, Reduce

The rate of innovation in oncology has been impressive, with novel therapies, such as chimeric antigen receptor T-cell therapies, and new diagnostics that make it easier to understand which patients will benefit from certain targeted therapies. With all of these innovations coming to market and being tested in clinical trials, it might make sense that some people are ready to move on from the treatments of the past. In a new commentary published in the June issue of The American Journal of Managed Care®, Bruce Feinberg, DO, of Cardinal Health, explains why people shouldn’t count out chemotherapy just yet. In the latest podcast interview, Feinberg explains his views on chemotherapy and how important it still is in cancer care. Reports of the Demise of Chemotherapy Have Been Greatly Exaggerated: www.ajmc.com/journals/issue/2019/2019-vol25-n6/reports-of-the-demise-of-chemotherapy-have-been-greatly-exaggerated Phase 3 TAILORx Results Confirm Chemotherapy Unnecessary in 70% of Women With Early-Stage Breast Canc

The burden of medical expenses, whether incurred through a catastrophic illness or surprise medical bills, affects the uninsured and insured alike. A 5-year-old charity called RIP Medical Debt buys medical debt incurred, so far, by more than 250,000 Americans. We talk to one of the cofounders and coauthors of "End Medical Debt," the book they wrote about the issue.

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 the American Society of Clinical Oncology discussing drug pricing; community oncologists seeking a delay in taking on downside risk in the Oncology Care Model; CDC finding a drop in new diabetes cases in the United States. Read more about the stories in this podcast: ASCO Town Hall Brings Tense Conversation About Drug Pricing: https://www.ajmc.com/conferences/asco-2019/asco-town-hall-brings-tense-conversation-about-drug-pricing Cannabis Risks and Benefits in Cancer Symptom Management: Much Remains Unknown: https://www.ajmc.com/conferences/asco-2019/cannabis-risks-and-benefits-in-cancer-symptom-management-much-remains-unknown American Society of Clinical Oncology Annual Meeting 2019: https://www.ajmc.com/conferences/asco-2019 COA Urges Delay in Downside Risk Deadline for OCM: https://www.ajmc.com/newsroom/

Heard at ISPOR: Debating the Benefits and Pitfalls of the QALY by Managed Care Cast

We sit down with David Smith, the executive director of the Medicaid Transformation Project, to get an update about the integration challenges health systems are facing, including system issues, infrastructure issues, coding and payment issues, and more.

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 the FDA's approval of a $2.1 million gene therapy; a study revealing that the worldwide need for palliative care will nearly double by 2060; the FDA granting priority review to Amarin’s Vascepa for a cardiovascular indication. Read more about the stories in this podcast: FDA Approves Gene Therapy With $2.1M Price Tag for Spinal Muscular Atrophy in Pediatric Patients: https://www.ajmc.com/newsroom/fda-approves-gene-therapy-with-21m-price-tag-for-spinal-muscular-atrophy-in-pediatric-patients Serious Health-Related Suffering to Nearly Double by 2060, Highlighting Need to Ramp Up Palliative Care Efforts: https://www.ajmc.com/focus-of-the-week/serious-healthrelated-suffering-to-nearly-double-by-2060-highlighting-need-to-ramp-up-palliative-care-efforts What We're Reading: FDA Grants Priority Review for Amarin's

In the first of a series of interviews with key opinion leaders, Amy Ellis, director of quality and value-based care at Northwest Medical Specialties, discusses practice transformation with Jess Quiring, a patient navigator at New Mexico Cancer Center. During the converation, Quiring explained how her practice modified the depression and distress screening tools for the different populations it treated. For instance, it changed the language based on what was more acceptable to Native Americans receiving treatment. She also explained the various programs the practice offers to patients, such as yoga, an art workshop, and meal preparation assistance, as well as several support groups.

Exploring the Increased Prevalence, Evolving Role of Physician Assistants 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 study questioning the Hospital Readmissions Reduction Program; FDA issuing a warning about do-it-yourself artificial pancreas systems; measles cases reach the highest level since 1994. Read more about the stories in this podcast: Study Questions Penalizing, Incentivizing PCPs for Readmission Rates: https://www.ajmc.com/focus-of-the-week/study-questions-penalizing-incentivizing-pcps-for-readmission-rates FDA Issues Warning on Do-It-Yourself Artificial Pancreas: https://www.ajmc.com/newsroom/fda-issues-warning-on-do-it-yourself-artificial-pancreas What We're Reading: Tobacco Age Legislation; Most Measles Cases Since 1994; Hidden Dangers of Heart Device: https://www.ajmc.com/newsroom/what-were-reading-tobacco-age-legislation-most-measles-cases-since-1994-hidden-dangers-of-heart-device Alkermes' Novel Schiz