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 in managed care, the top stories included HHS Secretary Alex Azar appearing before the Senate Committee on Finance to discuss the administration's plan to drive down prescription drug prices; FDA Commissioner Scott Gottlieb, MD, calling on payers to share data to aid drug innovation; and CMS calling for stricter oversight of Medicaid. Read more about the stories in this podcast: Azar Appears Before Senate Committee on Finance to Discuss Drug Innovation, Affordability: https://www.ajmc.com/focus-of-the-week/azar-appears-before-senate-committee-on-finance-to-discuss-drug-innovation-affordability Gottlieb Calls on Payers to Share Data to Aid Drug Innovation: https://www.ajmc.com/focus-of-the-week/gottlieb-calls-on-payers-to-share-data-to-aid-drug-innovation CMS Unveiling Stricter Oversight of Medicaid Due to Program Expansion: https://www.ajmc

Exploring the Current State of Precision Medicine at the ASCO Annual Meeting 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 in managed care, the top stories included Atul Gawande, MD, being named the CEO of the Amazon–Berkshire Hathaway–JPMorgan Chase healthcare venture; the Trump administration finalized rules for creating association health plans; an analysis found some cancer types are represented more than others in the Oncology Care Model. Read more about the stories in this podcast: Amazon, Berkshire Hathaway, JPMorgan Chase Announce CEO of Joint Health Company: https://www.ajmc.com/newsroom/amazon-berkshire-hathaway-jpmorgan-chase-announce-ceo-of-joint-health-company New Rule Allows Creation of Association Health Plans That Skirt ACA Regulations, Protections: https://www.ajmc.com/newsroom/new-rule-allows-creation-of-association-health-plans-that-skirt-aca-regulations-protections Participation in OCM May Transform Care for Certain Cancer Types More Quickly

Center for HOPE: Addressing Health Needs and Cancer Disparities Among Underserved Populations by Managed Care Cast

Lowering Costs And Readmission Rates Through a Meal Delivery Program by Managed Care Cast

This Week In Managed Care—Medicare Part A is Running Out and Other Health News by Managed Care Cast

Health literacy in the United States is low to begin with, and health financial literacy is even lower. The changing health insurance system is partly to blame. A few decades ago, health insurance covered everything. Now, patients have a lot more financial responsibility, and they don’t always understand it. In cancer, health financial literacy is particularly important since treatment can be so costly. This episode of Managed Care Cast includes conversations with a few experts in the field: Yousuf Zafar, MD, MHS, of the Duke Cancer Institute; Clara Lambert, BBA, OPN-CG, chair of the Association of Community Cancer Centers Financial Advocacy Network Advisory Committee; Todd Yezefski, MD, senior fellow in the Clinical Research Division at the Fred Hutchinson Cancer Research Center and Division of Medical Oncology at the University of Washington; and Michele McCourt, senior director of the CancerCare Co-Payment Assistance Foundation. Read more: A Descriptive Study of Patients Receiving Foundational Financial

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 include Senator Bill Cassidy's new plan to lower healthcare costs; policy recommendations from the American Diabetes Association on how to lower insulin prices; and coverage from the American Society of Clinical Oncology annual meeting. Read more about the stories in this podcast: Senator Cassidy Unveils Proposal to Lower Healthcare Costs: www.ajmc.com/newsroom/senator-cassidy-unveils-proposal-to-lower-healthcare-costs ADA Issues Recommendations Designed to Fix Insulin Pricing, Accessibility Crisis: http://www.ajmc.com/newsroom/ada-issues-recommendations-designed-to-fix-insulin-pricing-accessibility-crisis Persephone Trial: Cutting Trastuzumab Duration by Half Safer, Efficacious in HER2-Positive Breast Cancer: http://www.ajmc.com/conferences/asco-2018/persephone-trial-cutting-trastuzumab-duration-by-half-safe

With healthcare costs in the United States rising, employers have been trying to find a way to get a handle on these costs by improving employee health and well-being. Workplace wellness programs have been around for decades, but they received a boost in 2010 with the Affordable Care Act allowing companies to offer financial incentives to get employees to participate in the programs. However, the research on these wellness programs has been mixed, to say the least, with more recent research finding that these programs don’t really work. But more than just the unclear health benefits of these programs, there are real data and privacy concerns for employees. In this podcast, Al Lewis, a famed opponent of workplace wellness programs, provides insight on just why he’s so confident these programs don’t work, and Deborah Peel, MD, outlines her privacy concerns in the age of data sharing. Read more: Do Wellness Outcomes Reports Systematically and Dramatically Overstate Savings? www.ajmc.com/contributor/al-lewis-jd

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 include the finding that new guidelines will mean the number of people with hypertension will soar; research finds that most diabetes apps don’t lower glycated hemoglobin; and a health plan announced its plan to fight housing instability. Read more about the stories in this podcast: Under 2017 Guideline, More Than 105 Million Americans Have Hypertension: www.ajmc.com/focus-of-the-week/under-2017-guideline-over-105-million-americans-have-hypertension AHRQ Finds Very Few Diabetes Apps Improve A1C Levels: www.ajmc.com/newsroom/ahrq-finds-very-few-diabetes-apps-improve-a1c-levels Kaiser Permanente Investing $200 Million to Address Housing Instability, Improve Health: www.ajmc.com/newsroom/kaiser-permanente-investing-200-million-to-adress-housing-instability-improve-health FDA Expands Indication for PrEP to Reduce R

Creators of President Donald Trump’s blueprint to control drug prices, American Patients First, say it represents real reform. Critics see a pulled punch to the pharmaceutical industry. Mary Caffrey, the managing editor of The American Journal of Managed Care’s Evidence-Based series, spoke with Harvard healthcare economist Michael E. Chernew, PhD, who is the co-editor in chief of AJMC, to discuss elements of the Trump administration proposal to control drug prices. Chernew is also a former vice chair of the Medicare Payment Advisory Commission. Read more: Trump Offers Blueprint to Drive Down Prescription Drug Prices; Targets Rebates, "Middlemen": www.ajmc.com/newsroom/-trump-offers-blueprint-to-drive-down-prescription-drug-prices-targets-rebates-middlemen Azar Stumps for Plan to Hold Down Prescription Drug Costs: www.ajmc.com/focus-of-the-week/azar-stumps-for-plan-to-hold-down-prescription-drug-costs Trump Targets Drug Prices, Right-to-Try in State of the Union: www.ajmc.com/newsroom/trump-targets-drug-pric

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 President Donald Trump's plan to drive down drug prices; the FDA approved the first biosimilar of the year; a study found rapid uptake of PD-1 agents after FDA approval. Read more about the stories in this podcast: Trump Offers Blueprint to Drive Down Prescription Drug Prices; Targets Rebates, "Middlemen": www.ajmc.com/newsroom/-trump-offers-blueprint-to-drive-down-prescription-drug-prices-targets-rebates-middlemen Azar Stumps for Plan to Hold Down Prescription Drug Costs: www.ajmc.com/focus-of-the-week/azar-stumps-for-plan-to-hold-down-prescription-drug-costs FDA Approves Epoetin Alfa Biosimilar for Anemia: www.ajmc.com/newsroom/fda-approves-epoetin-alfa-biosimilar-for-anemia Study Finds Rapid Uptake of Anti–PD-1 Agents Following FDA Approval: www.ajmc.com/newsroom/study-finds-rapid-uptake-of-anti8

The Scope of Physician Burnout: Symptoms, Impacts, and Efforts to Address It 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 another report that shows uninsured rates are rising; FDA confirms shortages of the EpiPen, but the manufacturer insists the delay will be short; a Senate panel examines the need for transparency in insulin pricing. Read more about the stories in this podcast: No States Reported a Decline in the Uninsured Rate From 2016 to 2017: www.ajmc.com/focus-of-the-week/no-states-reported-a-decline-in-the-uninsured-rate-from-2016-to-2017 FDA Confirms Short-Term Shortages of EpiPen: www.ajmc.com/newsroom/fda-confirms-shortterm-shortages-of-epipen ADA's Cefalu Calls for Transparency Across Supply Chain to Address Insulin Costs: www.ajmc.com/newsroom/adas-cefalu-calls-for-transparency-across-supply-chain-to-address-insulin-costs Daratumumab Approved as Frontline Treatment in Newly Diagnosed Multiple Myeloma: www.ajm

Accountable care organizations are incentivized to reduce spending and improve quality of care. One way they have tried to do achieve these goals is by establishing control over a patient’s full continuum of care by minimizing the care patients receive from other providers outside of the ACO, including specialists. Michael Barnett, MD, and J. Michael McWilliams, MD, PhD, have a paper in the May issue of The American Journal of Managed Care® on leakage of specialty care among ACOs and the changes in specialty care leakage and use associated with the Medicare Shared Savings Program. Read the paper: http://www.ajmc.com/journals/issue/2018/2018-vol24-n5/changes-in-specialty-care-use-and-leakage-in-medicare-accountable-care-organizations

Patients who get care at a hospital often receive bills that are bigger than they were expecting. In the case of Medicare, this can happen when a beneficiary receives care at a hospital for several days but was never formally admitted to the hospital. The result is higher out-of-pocket expenses and fewer Medicare benefits—the biggest being the qualification of a nursing home stay after being discharged from a hospital. While hospitals must now inform Medicare recipients when they are being held under observation status, the use of observation still places an undue burden on seniors. Andria Jacobs, chief operating officer for PCG Software, discusses the impact of being held in observation, what CMS has done to try to alleviate the situation, and what else needs to be done. Read Andria's past articles: http://www.ajmc.com/contributor/andria-jacobs-rn-ms-cen-cphq

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 report that insurance coverage gains are reversing; a deal to lower the cost of Praluent for Express Scripts members; findings that synthetic opioids are playing a bigger role in overdose deaths. Increases in Insurance Coverage Rates From ACA Beginning to Reverse: www.ajmc.com/focus-of-the-week/increases-in-insurance-coverage-rates-from-aca-beginning-to-reverse Sanofi, Regeneron to Cut Praluent Prices Under Exclusive Express Scripts Deal That Ends Prior Approval Delays: www.ajmc.com/newsroom/sanofi-regeneron-to-cut-praluent-prices-under-exclusive-express-scripts-deal-that-ends-prior-approval-delays Dr Jay Edelberg on Safety, Efficacy of Praluent and Remaining Payment Challenges: www.ajmc.com/conferences/aha-2017/dr-jay-edelberg-on-safety-efficacy-of-praluent-and-remaining-payment-challenges Synthetic

Low-Value Services: Their Impact and Challenges With Addressing Them 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 an announcement from CMS of creating direct provider contracting, plus a broad set of proposed rules for health information technology; new recommendations to improve postpartum care; a look at future competition among specialty drugs. Read more about the stories in this podcast: CMS: "Meaningful Use" Is Out, "Interoperability" Is In: www.ajmc.com/newsroom/cms-meaningful-use-is-out-interoperability-is-in Humana Launches Bundled Payment Model to Improve Maternity Outcomes and Cost: www.ajmc.com/newsroom/humana-launches-bundled-payment-model-to-improve-maternity-outcomes-and-cost What We're Reading: VA Pick's Hearing Delayed; Hospital Profits Fall; Re-Imagining Postpartum Care: www.ajmc.com/newsroom/what-were-reading-va-picks-hearing-delayed-hospital-profits-fall-reimagining-postpartum-care ACOG Annual C

At the beginning of the year, The American Journal of Managed Care® convened a panel of experts in infectious disease and managed care to discuss management of HIV, including the need for individualized care the role for newer treatments options. Here, we provide some of that conversation. Watch the full discussion: Special Considerations in HIV Management: www.ajmc.com/peer-exchange/special-considerations-in-hiv-management/