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 diabetes drug showing positive results in treating heart failure; new lipid guidelines promoting the use of proprotein convertase subtilisin/kexin type 9 inhibitors; and a study finding doctors are more likely to prescribe opioids if they are in a hurry. Read more about the stories in this podcast: Dapagliflozin Cuts Risk of CV Death, Worsening of Heart Failure 26%, Whether Diabetes Present or Not: https://www.ajmc.com/newsroom/dapagliflozin-cut-risk-of-cv-death-worsening-of-heart-failure-26-whether-diabetes-present-or-not New Guidelines Supported by Lipid-Lowering Therapy Studies, Indicating Benefit of PCSK9 Inhibitors: https://www.ajmc.com/focus-of-the-week/new-guidelines-supported-by-lipidlowering-therapy-studies-indicating-benefit-of-pcsk9-inhibitors Providers More Likely to Prescribe Opioids as the

On this episode of Managed Care Cast, we speak with the author of a new book that discusses the price and cost of American healthcare. Martin Makary, MD, MPH, a surgical oncologist and chief of the Johns Hopkins Islet Transplant Center, talked about what he found while writing The Price We Pay: What Broke American Health Care—and How to Fix It. Makary discusses spurious billing practices, overtreatment, and the opioid issue, as well as efforts by some providers and employers to reshape primary care.

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 stories included a huge ruling against one opioid maker and a settlement offer from another; an expert panel calling for broader screening for hepatitis C; a review showing there are more fatal events linked to a multiple sclerosis drug than previously known. Read more about the stories in this podcast: What We're Reading: Purdue Pharma Settlement; HCV Screening; Medicare for All Support: https://www.ajmc.com/newsroom/what-were-reading-purdue-pharma-settlement-hcv-screening-medicare-for-all-support Fatal AEs Associated With Alemtuzumab for MS May Occur More Frequently Than Previously Thought: https://www.ajmc.com/newsroom/fatal-aes-associated-with-alemtuzumab-for-ms-may-occur-more-frequently-than-previously-thought FDA Grants Fast Track Designation for Dapagliflozin to Prevent Kidney Failure: https://www.ajmc.com/newsr

As advocates for addressing social determinants of health (SDOH) look to get buy in from stakeholders, there's a need for building evidence base to show that initiatives addressing these determinants work. To discuss the importance of both quantifying and communicating the return on investment of these initiatives, we spoke with Susan Mani, MD, vice president of Clinical Transformation and Ambulatory Quality at LifeBridge Health. Read more about building an evidence base for SDOH initiatives Building the Evidence Base to Quantify, Communicate the ROI of SDOH Initiatives: www.ajmc.com/conferences/whcc-2019/building-the-evidence-base-to-quantify-communicate-the-roi-of-sdoh-initiatives

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 in managed care, the top news included outcomes results in treating heart failure; US prevention experts said more women should get BRCA testing; the American Heart Association offered an advisory on treating high triglycerides with prescription omega-3 fatty acids. Read more about the stories in this podcast: AstraZeneca's Dapagliflozin Meets Primary End Point in Heart Failure Trial: https://www.ajmc.com/newsroom/astrazenecas-dapagliflozin-meets-primary-end-point-in-heart-failure-trial FDA's Fast Track Designation for Empagliflozin in Heart Failure Points to New Paradigm: https://www.ajmc.com/newsroom/fdas-fast-track-designation-for-empagliflozin-in-heart-failure-points-to-new-paradigm More Women May Be Screened for BRCA Mutations Following USPSTF Guideline Update: https://www.ajmc.com/newsroom/more-women-may-be-screened-for-brca-mutations

Employers are the single largest provider and purchaser of healthcare insurance in the United States and they represent a potential force for change in the US healthcare system. In order to control costs and provide better care to their employees, employers have been banding together through local coalitions. Many coalitions across the country have coalesced under the National Alliance of Healthcare Purchaser Coalitions. At the National Alliance’s recent Leadership Summit, held at the end of June in Pittsburgh, we spoke with some of the leaders about key issues facing employers in healthcare and how those top concerns may have changed over the past few years. Read more: Employers Compendium: https://www.ajmc.com/compendium/employers National Alliance of Healthcare Purchaser Coalitions partner page: https://www.ajmc.com/partners/national-alliance Greater Philadelphia Business Coalition on Health partner page: https://www.ajmc.com/partners/gpbch National Alliance of Healthcare Purchaser Coalitions’ 2019 Leade

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 stories included the Trump administration looking to bar legal immigrants from using public benefits; a study in The American Journal of Managed Care® finding that a law to limit surprise medical bills is working; data on Affordable Care Act enrollment showing the effect of subsidies. Read more about the stories in this podcast: Trump Administration Publishes Final Rule Aimed at Legal Immigrants Using Public Benefits: https://www.ajmc.com/newsroom/trump-administration-publishes-final-rule-aimed-at-legal-immigrants-using-public-benefits Influence of Out-of-Network Payment Standards on Insurer–Provider Bargaining: California’s Experience: https://www.ajmc.com/journals/issue/2019/2019-vol25-n8/influence-of-outofnetwork-payment-standards-on-insurer-provider-bargaining-californias-experience What We're Reading: Ebola Vaccin

On this episode of Managed Care Cast, we’re bringing you a portion of a panel discussion about the Oncology Care Model, held in July 2019 during a meeting of The Institute for Value-Based Medicine (IVBM), an initiative of The American Journal of Managed Care®. At IVBM events, we gather thought leaders to share best practices across medicine, pharmacy, and management in regional locations around the country. This podcast is taken from our meeting focusing on Innovation and Quality in Oncology Care. Read previous coverage of IVBM events: Managing Costs in Diabetes Means Intervening Early to Avoid Complications Later, Experts Say: www.ajmc.com/journals/evidence-based-diabetes-management/2019/june-2019/managing-costs-in-diabetes-means-intervening-early-to-avoid-complications-later-experts-say Even With Room for Improvement, OCM Practices Agree: They Would Participate Again; and Practice Transformations Improve Access, Increase Communication in the Shift to Value-Based Cancer Care: www.ajmc.com/journals/evidence-

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 stories included CMS giving chimeric antigen receptor T-cell payments a boost; a US task force announcing that those at risk for pancreatic cancer should be screened; FDA revealing Novartis withheld data about a high-cost gene therapy. Read more about the stories in this podcast: CMS Gives CAR T Payments Short-term Boost, Adjusts Hospital Wage Index: https://www.ajmc.com/focus-of-the-week/cms-gives-car-t-payments-shortterm-boost-adjusts-hospital-wage-index Still No Call for Widespread Screening for Pancreatic Cancer, but USPSTF Says Yes for Those With Known Risk: https://www.ajmc.com/focus-of-the-week/still-no-call-for-widespread-screening-for-pancreatic-cancer-but-uspstf-says-yes-for-those-with-known-risk What We're Reading: FDA Says Novartis Hid Data; Judge Halts Ark. Abortion Rules; New Phase in Opioid Suits: https:

Transitioning to value-based care is a marathon, not a race, and should be viewed as a mission and a culture, Jeff Hunnicutt, chief executive officer at Highlands Oncology Group, told Amy Ellis, director of quality and value-based care at Northwest Medical Specialties. In order to successfully transform a practice, there needs to be a clear message and set values ingrained in the mindset of staff at the frontline of patient care.

As a progressive disease diabetes presents an ongoing challenge for physicians to provide adequate control of patients’ diabetes, and new agents with novel mechanisms of action help reduce the burden in the management of diabetes. In a recent Peer Exchange discussion, Dr Peter Salgo, of Columbia University College of Physicians and Surgeons and NewYork-Presbyterian Hospital, led a discussion on novel agents and their role in treating patients with and with cardiovascular disease. On the panel was Dr. Om Ganda of Joslin Diabetes Center; Jim Kenney of JTKenney, a managed care consulting practice; and Dr Helena Rodbard, past president of the American College of Endocrinology and past president of the American Association of Clinical Endocrinologists. Listen to the full discussion: https://www.ajmc.com/peer-exchange/new-classes-for-treatment-of-type-2-diabetes/

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 HHS laying out a plan for importing certain prescription drugs from other countries; a potential new standard of care for chronic lymphocytic leukemia; 3 insulin makers get subpoenaed over their pricing practices. Read more about the stories in this podcast: HHS, FDA Outline Foundation for Importing Certain Drugs From Other Countries: https://www.ajmc.com/newsroom/hhs-fda-outline-foundation-for-importing-certain-drugs-from-other-countries CMS Testing Pilot to Give FFS Medicare Providers Historical Claims Data on Patients: https://www.ajmc.com/newsroom/cms-testing-pilot-to-give-ffs-medicare-providers-historical-claims-data-on-patients Ibrutinib–Rituximab Improves Survival Compared With Current Treatment for Chronic Lymphocytic Leukemia: https://www.ajmc.com/newsroom/ibrutinibndashrituximab-improves-surviva

While precision medicine has started to inch its way to becoming a norm in healthcare, there are still barriers holding back widespread implementation amomg providers and organizations. From reimbursement challenges to primary use in oncology to proving the return on investment of implementing a precision medicine program, addressing these barriers could open the door to more providers and oragnizations embracing precision medicine in their practice.  To discuss these challenges and ways to mitigate them, we sat down with Joel Diamond, MD, a practicing physician, adjunct associate professor of Biomedical Informatics at the University of Pittsburgh, and cofounder and chief medical officer of 2bPrecise.

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 bipartisan Senate bills taking aim at drug prices, especially insulin; a study linking payer refusal to pay for proprotein convertase subtilisin/kexin type 9 inhibitors with heart attacks and deaths; and a former FDA commissioner visiting The American Journal of Managed Care®. Read more about the stories in this podcast: Senate Finance Committee Unveils Bipartisan Bill to Lower Drug Costs: https://www.ajmc.com/newsroom/senate-committee-unveils-bipartisan-bill-to-lower-drug-costs Bipartisan Senate Bill Seeks to Roll Back a Decade's Worth of Insulin Price Hikes: https://www.ajmc.com/focus-of-the-week/bipartisan-senate-bill-seeks-to-roll-back-a-decades-worth-of-insulin-price-hikes Rejected, Unfilled PCSK9 Inhibitor Prescriptions Linked to Higher Risk of Cardiovascular Events: https://www.ajmc.com/focus-of-th

Addressing the Complexities of Value-Based Payment Models 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 CMS pushing for bundled payments in radiation oncology; reports detailing deficiencies in hospice care; a study finding widening disparities in life expectancy among white Americans. Read more about the stories in this podcast: CMS Proposes Bundled Payments for Radiation Oncology: https://www.ajmc.com/newsroom/cms-proposes-bundled-payments-for-radiation-oncology OIG Reports Find Deficiencies in Hospice Care and Resulting Harms to Patients: https://www.ajmc.com/focus-of-the-week/oig-reports-find-deficiencies-in-hospice-care-and-resulting-harms-to-patients Study Reveals Declining Life Expectancy Among White Americans That Defies Easy Answers: https://www.ajmc.com/focus-of-the-week/study-reveals-declining-life-expectancy-among-white-americans-that-defies-easy-answers Systolic, Diastolic BP Both Predict Cardi

Pharmaceutical manufacturers sought to improve patient access to treatments through the use of co-payment assistance cards. But, while these cards reduce the out-of-pocket cost for enrollees, employers worry that they could result in increased medication use and associated expenditures, thus negating efforts made with benefit designs. To mitigate the issue, pharmacy benefit managers have introduced co-pay accumulator adjustment programs, which prevent pharmaceutical manufacturer subsidies put toward a patient’s out-of-pocket costs from counting toward the deductible. As a result, high-deductible health plan enrollees could face a sharp spike in out-of-pocket costs when the manufacturer subsidy limits are reached, but the patient has not reached their deductible. Despite the lack of data around how these programs affect patient outcomes, they have become popular among employers. Bruce Sherman, MD, FCCP, chief medical officer of the National Alliance of Healthcare Purchasers Coalition, discusses the findings

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.