Managed Care Cast

A lot of healthcare is simply exchange of information, but the current healthcare system doesn’t allow for that exchange to happen in a convenient way. The Network for Excellence in Health Innovation (NEHI) has released a new roadmap that reinvents healthcare in the United States through the use of technology. Susan Dentzer, president and CEO of NEHI, discusses the Health Care Without Walls model of care, how it would improve care, as well as physician work satisfaction, and what it would take to implement such a system. Read more about NEHI and telehealth: NEHI Recommends Implementing Value-Based Contracts With High-Cost Oncology Treatments: https://www.ajmc.com/newsroom/nehi-recommends-implementing-valuebased-contracts-with-highcost-oncology-treatments- Getting Telehealth Right: Engaging Patients and Providers: https://www.ajmc.com/conferences/acr-2016/getting-telehealth-right--engaging-patients-and-providers-virtually-in-health-wellness-and-treatment More Patients Willing to Switch to Telehealth Provider

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 research that showed cancer surpassed cardiovascular disease to be the leading cause of death in high-income counties; HHS Secretary Alex Azar announced a new mandatory payment model is coming to oncology; a policy change could make mental health treatment more available. Read more about the stories in this podcast: Cancer Surpasses CVD as Leading Cause of Death in High-Income Counties: https://www.ajmc.com/focus-of-the-week/cancer-surpasses-cvd-as-leading-cause-of-death-in-highincome-counties Azar Announces Mandatory Oncology Payment Model Is Coming: https://www.ajmc.com/newsroom/azar-announces-mandatory-oncology-payment-model-is-coming HHS Lifting IMD Exclusion for Medicaid Payment for Inpatient Mental Health Treatment: https://www.ajmc.com/newsroom/hhs-lifting-imd-exclusion-for-medicaid-payment-for-inp

Using Community-Based Care Management to Lower Service Use, Spending Among High-Risk Patients by Managed Care Cast

CGRP Inhibitors: A Promising New Class of Drugs for Migraine 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 stories included Medicaid expansion wins at the ballot box; new melanoma guidelines that promote recommended treatments and discuss genetic testing; research found high blood pressure in young adults predicts future cardiovascular events. Read more about the stories in this podcast: What We're Reading: Midterm Elections, Healthcare Edition—Medicaid Expansion, Ballot Measures, Single Payer: https://www.ajmc.com/newsroom/what-were-reading-midterm-elections-healthcare-edition-medicaid-expansion-ballot-measures-single-payer New Melanoma Guidelines Identify Recommended Treatments, Weigh in on Genetic Testing: https://www.ajmc.com/focus-of-the-week/new-melanoma-guidelines-identify-recommended-treatments-weigh-in-on-genetic-testing High Blood Pressure in Young Adults Indicative of CVD Events Later in Life: https://www.ajmc.co

Heard at Psych Congress: Clinical Impacts of Stigma Surrounding Mental Illness 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 new included a proposal to allow Medicare to pay the same prices for certain drugs as what other countries pay; President Donald Trump signed a law to fight the opioid crisis; an FDA advisory panel voted narrowly to retain a 10-year-old guidance for safety trials for diabetes drugs. Read more about the stories in this podcast: Trump Proposes Allowing Medicare to Base Drug Prices on What Other Countries Pay: https://www.ajmc.com/newsroom/trump-proposes-allowing-medicare-to-base-drug-prices-on-what-other-countries-pay Will Bipartisan US Opioid Law Go Far Enough to Save Lives? https://www.ajmc.com/newsroom/will-bipartisan-us-opioid-law-go-far-enough-to-save-lives Narrow Vote Calls for Keeping Drug Safety Trials, but Many See Changes: https://www.ajmc.com/focus-of-the-week/narrow-vote-calls-for-keeping-drug-safety-trials-b

Recently, Barbara McAneny, MD, the current president of the American Medical Association (AMA), visited The American Journal of Managed Care® (AJMC®)’s office for a wide-ranging discussion on new payment models, transforming care, and the work of the AMA. McAneny is an oncologist who has been at the forefront of transforming care for patients with cancer. In 2012 she and her organization, Innovative Oncology Business Solutions, received a $19.76 million grant by the Center for Medicare and Medicaid Innovation to develop a community oncology medical home model. The model was implemented in 7 practices and aimed to improve patient care, outcomes, and satisfaction, while reducing costs. She will be the keynote speaker November 16 in Philadelphia at Patient-Centered Oncology Care®, AJMC®’s annual multistakeholder meeting featuring payers, providers, and patient advocates. Read more: The Future of Oncology? COME HOME, the Oncology Medical Home: https://www.ajmc.com/journals/evidence-based-oncology/2013/2013-1-v

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 Trump administration giving governors the power to overhaul section 1332 waivers under the Affordable Care Act (ACA); CMS disclosed a breach in the portal that agents and brokers use to assist consumers signing up for health coverage under the ACA; about one-third of all US healthcare payments in 2017 were tied to alternative payment models. Read more about the stories in this podcast: Trump Administration Gives States More Power to Alter ACA Exchange Offerings: https://www.ajmc.com/newsroom/trump-administration-gives-states-more-power-to-alter-aca-exchange-offerings CMS Reports Data Breach in ACA Agent and Broker Portal: https://www.ajmc.com/focus-of-the-week/cms-reports-data-breach-in-aca-agent-and-broker-portal CMS Cuts Budget for ACA Marketing to $10 Million for 2019 Plan Year: https://www.ajmc.co

A survivor of chronic lymphocytic leukemia who participated in the first CAR T trial in 2010 looks back at his experience and also discusses his views on how patient-reported outcomes (PROs) should be used, if at all, by the Centers for Medicare and Medicaid (CMS).

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 Trump administration unveiling plans to include drug prices in television ads; CMS touted Medicare Advantage at the beginning of open enrollment for Medicare; research found Medicare beneficiaries who live in housing with support services stay out of the hospital. Read more about the stories in this podcast: Trump Officials Outline Plan to Put Drug Prices in TV Ads: https://www.ajmc.com/newsroom/trump-officials-outline-plan-to-put-drug-prices-in-tv-ads Verma Talks Up Medicare Advantage Growth at Insurance Industry Meeting: https://www.ajmc.com/newsroom/verma-talks-up-medicaid-advantage-growth-at-insurance-industry-meeting CMS Will Allow Medicare Advantage Plans to Use Step Therapy to Negotiate Drug Prices: https://www.ajmc.com/newsroom/cms-will-allow-medicare-advantage-plans-to-use-step-therapy-to-neg

Examining Health-Related Challenges Puerto Rico Still Faces a Year After Hurricane Maria 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 the Department of Justice giving the green light for the CVS–Aetna merger; premiums for employer insurance plans are on the rise; and the new North American trade deal includes protections for drug makers that will hurt biosimilars. Read more about the stories in this podcast: Justice Department Clears $68 Billion CVS–Aetna Merger: https://www.ajmc.com/newsroom/justice-department-clears-68-billion-cvsndashaetna-merger Premiums for Employer-Sponsored Family Insurance Increased 5% in 2018: https://www.ajmc.com/focus-of-the-week/premiums-for-employersponsored-family-insurance-increased-5-in-2018 What We're Reading: HealthCare.gov Maintenance; USMCA Drug Exclusivity; Medicare Telemedicine Proposal: https://www.ajmc.com/newsroom/what-were-reading-healthcaregov-maintenance-usmca-drug-exclusivity-medicare-teleme

As healthcare costs continue to increase, health systems are trying to better understand resource utilization among providers. The use of feedback reports can document physician practice patterns and increase accountability for resource use to prevent overuse and misuse. A new paper in the October issue of The American Journal of Managed Care measured changes in ordering rates for 4 resource use measures before and after dissemination of physician feedback reports. Lead author Eva Chang, PhD, of RTI International, discussed the findings and how the impact of the feedback reports varied depending on physician experience. Read the study and related research: Primary Care Physician Resource Use Changes Associated With Feedback Reports: https://www.ajmc.com/journals/issue/2018/2018-vol24-n10/primary-care-physician-resource-use-changes-associated-with-feedback-reports The American Journal of Managed Care—October 2018: https://www.ajmc.com/journals/issue/2018/2018-vol24-n10 Tackling Antibiotic Prescribers' Behavi

CMS’ accountable care organization program, the Medicare Shared Savings Program, could potentially be undergoing some big changes. During the recent fall 2018 meeting of the National Association of ACOs, the proposed changes were top of mind. Attendees were most concerned about how the faster timeline to taking on risk would impact participation, but were pleased with changes to the benchmark and risk adjustment. In this episode of Managed Care Cast, stakeholders at accountable care organizations (ACOs) and policy experts discuss the proposed changes and what impact they believe they will have on ACO participation. Read more about the stories in this podcast: CMS Plans to Overhaul MSSP Program to Force More Risk on ACOs: https://www.ajmc.com/newsroom/cms-plans-to-overhaul-mssp-program-to-force-more-risk-on-acos Proposed Rule for Medicare ACOs Includes Notable Changes for Rural Providers: https://www.ajmc.com/contributor/caravan-health/2018/09/proposed-rule-for-medicare-acos-includes-notable-changes-for-rura

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 Nobel Prize in Medicine was awarded to 2 people for research into immunotherapy; physician-run accountable care organizations bring savings for Medicare; research highlights the health impacts of sexual harassment and assault. Read more about the stories in this podcast: Nobel Prize Recognizes Discoveries With T Cells in Immunotherapy: https://www.ajmc.com/focus-of-the-week/nobel-prize-recognizes-discoveries-with-t-cells-in-immunotherapy The Long Road: Nobel Prize Winner James Allison Highlights the Value of Research: https://www.ajmc.com/newsroom/the-long-road-nobel-prize-winner-james-allison-highlights-the-value-of-research Physician ACOs Associated With Growing MSSP Savings Over 3 Years: https://www.ajmc.com/newsroom/physician-acos-associated-with-growing-mssp-savings-over-3-years What We're Readin

Employers may not look forward to purchasing healthcare, but they are in the position to transform the market. Key opinion leaders like Suzanne Delbanco, PhD, MPH, of Catalyst for Payment Reform; Brian Marcotte of the National Business Group on Health; and Judy Berger of Southwest Airlines, discuss how employers are getting more involved in healthcare by championing alternative payment models and other more services to their employees. Learn more about the most recent news and updates in Medicaid: Employers Play an Increasingly Important Role in the Move to Value-Based Care: www.ajmc.com/conferences/acdc-spring-2018/employers-play-an-increasingly-important-role-in-the-move-to-valuebased-care Employer Support Is Needed to Help Payment Reform Succeed: www.ajmc.com/newsroom/employer-support-is-needed-to-help-payment-reform-succeed Percent of Employers Offering Health Coverage Increases for First Time Since 2008: www.ajmc.com/focus-of-the-week/percent-of-employers-offering-health-coverage-increases-for-first-tim

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 comments to several proposals from CMS; Medicare advocates say voters will be motivated by healthcare cost concerns during the midterm elections; research showed diabetes drug dapagliflozin, an SGLT2 inhibitor, reduces risks of major cardiovascular events. Read more about the stories in this podcast: Hospital Groups, Others Raise Concerns Over CMS Payment Proposal: https://www.ajmc.com/newsroom/hospital-groups-others-raise-concerns-over-cms-payment-proposal Senate Votes 98-2 to Ban Pharmacist Gag Clauses: https://www.ajmc.com/newsroom/senate-votes-982-to-ban-pharmacist-gag-clauses What We're Reading: Safety-Net Readmissions; Gag Clause Bill to Trump; CREATES Impact on Drug Spend: https://www.ajmc.com/newsroom/what-were-reading-safetynet-readmissions-gag-clause-bill-to-trump-creates-impact-on-drug-spend Me

Medicaid Transformation Project: Addressing Health, Social Needs of Vulnerable Populations 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 the Senate overwhelmingly voting to ban pharmacist gag clauses; a study found the current vaccine pipeline for HIV, tuberculosis, and malaria may fall short; an expert noted a trend of healthcare cost data seeping into nonhealthcare companies’ earnings calls. Read more about the stories in this podcast: Senate Votes 98-2 to Ban Pharmacist Gag Clauses: https://www.ajmc.com/newsroom/senate-votes-982-to-ban-pharmacist-gag-clauses Launch of Highly Efficacious HIV, Tuberculosis, and Malaria Vaccines Unlikely, Study Says: https://www.ajmc.com/newsroom/launch-of-highly-efficacious-hiv-tuberculosis-and-malaria-vaccines-unlikely-study-says When Employee Healthcare Costs Move Stocks: https://www.ajmc.com/contributor/joseph-andelin/2018/09/when-employee-healthcare-costs-move-stocks A Multidisciplinary Approach to Ma