Managed Care Cast

On this episode of Managed Care Cast, we speak with Reverend Paul Abernathy, chief executive officer of the Neighborhood Resilience Project and board member of UPMC for You, who discusses his experiences in promoting health and resiliency in trauma-affected communities, as well as challenges related to access and accessibility of care and medical mistrust.

To mark the publication of The American Journal of Managed Care®’s 12th annual health IT issue, on this episode of Managed Care Cast, we speak with Christopher M. Whaley, PhD, health care economist at the RAND Corporation, who focuses on health economics issues, including the influence of the COVID-19 pandemic on health care delivery. In particular, he examines how existing technology has pivoted to become a backbone for virtual care delivery while its ongoing evolvement has highlighted inequities in care delivery, making access and lack thereof divisive issues. In their article in the health IT issue, “Differences in Telehealth During COVID-19 Between Commercial and Medicaid Enrollees,” Whaley and his co-authors compare rates of telehealth and in-person evaluation and management visits between individuals with commercial insurance through the California Public Employees’ Retirement System, or CalPERS, and those with publicly funded coverage through the California Medicaid program, with implications for equi

The editors of The American Journal of Managed Care® reflect on the past year and discuss what they’re looking forward to in 2023.

High-deductible health plans (HDHPs) have gained traction in recent years as a means to reduce unnecessary health care spending. The monthly premiums are low, but the high deductibles can lead to higher downstream costs for individuals and families. Potential downsides include the risk of patients deterring or avoiding necessary care. A team headed by Matthew D. Eisenberg, PhD, from the Johns Hopkins Bloomberg School of Public Health, recently investigated the impact of HDHPs through the lens of the ongoing epidemic of substance use disorder, or SUD, in the United States. The article detailing their study’s findings appears in the October issue of The American Journal of Managed Care®. On this episode of Managed Care Cast, we speak with Dr Eisenberg on his team’s findings that these plans may have reduced SUD service use through the shifting of costs to their members, thereby exacerbating this already troubling epidemic that has resulted in declines in life expectancy and increases in drug- and alcohol-rela

Teams from the Mass General Brigham health system and the Commonwealth Care Alliance, both in Massachusetts, have collaborated on a value-based care initiative with the principal goals of improving patient clinical outcomes, reducing unnecessary health care utilization, and making care more accessible. iCMP PLUS (Patients Linked to Urgent Support) is an integrated care management program providing intensive, multidisciplinary care to the highest-risk dual-eligible patients with Medicaid ACO coverage who have complex medical needs and high health care costs. Care team members meet patients where they are, demonstrating the effectiveness of community-based care management support programs. On this episode of Managed Care Cast, we speak with Jack Rowe, MD, MPH, and Lori Tishler, MD, MPH, 2 authors of “Intensive Care Management of a Complex Medicaid Population: A Randomized Evaluation,” published in the September issue of The American Journal of Managed Care®, about their findings on the program’s effectiveness

The Inflation Reduction Act, signed this month, extends the premium tax credits for health insurance purchased through the health care marketplace for another 2 years. The credits were included in the 2021 American Rescue Plan Act, and were due to expire at the end of this year. Vicki Fung, PhD, is associate investigator at the Mongan Institute Health Policy Center, Mass General Research Institute, and lead author of “Premium Tax Credits in the American Rescue Plan and Off-Marketplace Enrollees,” published in the August issue of The American Journal of Managed Care®. On this episode of Managed Care Cast, she details how the expanded premium tax credits help individuals purchasing insurance coverage through the marketplace. She also addresses the important ways these plans differ from employee-purchased coverage and the benefits and drawbacks of each and the difficulties involved when deciding whether or not to switch coverage.

As more and more biosimilars enter different markets around the globe, payers and practices will need to consistently evaluate the economics of covering biosimilars and take a stance on whether to support their adoption. Both payers and practices can play a big role in encouraging biosimilar adoption, and health care institutions that have already begun pushing for more biosimilar use, such as Emory Healthcare, have seen substantial savings. On this episode of Managed Care Cast, we speak with Ryan Haumschild, PharmD, MS, MBA, the director of pharmacy services at Emory Healthcare and the Winship Cancer Institute. Haumschild is also an Advisory Board member for The American Journal of Managed Care® and its sister site, The Center for Biosimilars®. The interview took place at the The Institute of Value-Based Medicine® (IVBM), hosted by Emory Healthcare, on July 18 in Atlanta, Georgia. Haumschild was chair of the event and gave a presentation on the current pharmacoeconomics of biosimilars and his predictions

Even before the pandemic began in 2020, the number of health care organizations appointing chief health equity officers had started to grow. Is this a role for 1 person only or do initiatives to tackle health care disparities and other issues begin at a higher level? And how can change really be accomplished so there is a measurable effect on health outcomes? In this episode of Managed Care Cast, we speak with Sachin Jain, MD, MBA, who joined SCAN Group and Health Plan 2 years ago as president and CEO. He discusses an effort, recently described in an article in Harvard Business Review, about how SCAN made 10% of senior managers’ annual bonuses dependent on how well the gap in medication adherence among diverse populations was reduced. The former CareMore executive shares why executives at the top of organizations need to champion and lead initiatives to reduce health care disparities and do more than “virtue signaling” on health equity issues.

Today we are bringing you part 2 of a 2-part sponsored podcast series discussing treatment goals in insterstitial lung disease (ILD). The discussion was moderated by Ryan Haumschild, PharmD, director of Pharmacy Services at Emory Healthcare and Winship Cancer Institute. The conversation for today’s podcast includes an in-depth review of treatment landscape of systemic sclerosis ILD as well as a discussion on unmet needs and emerging therapies in ILD.

discusses why the program is needed, the goals of the program, and some of the reasons why children and adolescents are struggling. We also discuss 988, an upgrade to the National Suicide Prevention Lifeline number coming July 16, 2022. The number will connect individuals with trained counselors, and, if needed, send specially trained responders with the aim of reducing armed law enforcement interventions. If you or someone you know is in crisis, help is available by calling the the National Suicide Prevention Lifeline toll-free number, which is 988 beginning on July 16, 2022—or call the existing number, 1-800-273-TALK (8255)—to reach your local certified crisis center.

Today we’re highlighting a discussion with a panel of experts in interstitial lung disease moderated by Ryan Haumschild, PharmD, director of Pharmacy Services at Emory Healthcare and Winship Cancer Institute. The topics of conversation for today’s podcast include treatment goals in patients with ILD and a review of treatment paradigms and standard of care therapies.

On this episode of Managed Care Cast, we speak with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.

In January of this year, entrepreneur and Dallas Mavericks owner Mark Cuban launched a direct-to-consumer pharmacy called the Cost Plus Drug Company, promising savings by eliminating middlemen and charging cost plus 15% and a pharmacy fee. What if Medicare could do the same? On this episode of Managed Care Cast, we speak with a researcher who coauthored a study out this week that looked at the savings to Medicare Part D if the same model had been employed for some of the most used generic drugs. Hussain S. Lalani, MD, MPH, an internist and one of the coauthors, discussed the findings of the paper, published Monday in the Annals of Internal Medicine. The analysis compared the price paid by Medicare Part D plans in 2020 with the price of 89 generic drugs sold by the pharmacy in 2022. The researchers, from Brigham and Women’s Hospital and Harvard Medical School, used the price paid by Medicare Part D plans in 2020 and looked at the price of 89 generic drugs sold by the pharmacy in 2022. After adjusting for ch

On the After Hours section of Medical World News, we like to show you what scientists, researchers, health care providers, and others are doing in their spare time to relax and recharge. On this episode of Managed Care Cast, we’re highlighting a hobby from a biosimilar expert who says he can make whisky more accessible and affordable through—you guessed it—his own biosimilar whisky. Sarfaraz K. Niazi, PhD, is an adjunct professor of biopharmaceutical sciences at the University of Illinois and the University of Houston, and a member of the advisory board of The Center for Biosimilars®', a sister site to AJMC.com, the website of The American Journal of Managed Care. On a recent episode of After Hours, he spoke with Matthew Gavidia, an assistant editor at AJMC.com, about his unusual whiskey-making hobby, the history of the traditional process, and how he distills his own biosimilar version.

The pandemic highlighted deep partisan divisions in the United States over public health measures. Disputes over masking and beliefs about science and vaccines that prevent severe illness and death from infection with SARS-CoV2, the virus that causes COVID-19, affected nearly every area of life. That rancor impacted death rates in counties that voted Republican in the 2020 presidential election, according to a new study out Monday in the journal Health Affairs. In counties where 70% or more of eligible voters chose the Republican party, there were nearly 73 additional deaths from COVID-19 per 100,000 people compared with Democratic counties (where less than 30% voted Republican). On today’s episode of Managed Care Cast, we speak with the lead author of the study, Neil J. Sehgal, PhD, MPH, assistant professor of health policy and management in the University of Maryland (UMD) School of Public Health. He discusses the findings of the paper, coauthored with other scholars from UMD, as well as the Universi

Income inequality is a hot topic in politics today, and while the rising role of social determinants of health is being recognized in care delivery and research, a new study published in Social Science & Medicine aimed to determine to what extent income gaps are associated with Americans’ declining health. On this episode of Managed Care Cast, we speak with Hui Zheng, PhD, an associate professor in the Department of Sociology at Ohio State University and co-author of “Rising Childhood Income Inequality and Declining Americans’ Health.” The American Journal of Managed Care® sat down with Zheng to learn more about how income inequality has shifted throughout the 20th and 21st centuries and the potential implications of this shift, along with some solutions to the problem.

Cholangiocarcinoma—or biliary duct cancer—affects about 8000 US patients a year. On this episode of Managed Care Cast, we bring you an excerpt of an interview with Jesper B. Andersen, PhD, associate professor and group leader at the University of Copenhagen and the Biotech Research and Innovation center at the Department of Health. There have been 3 FDA drug approvals for drugs that treat cholangiocarcinoma, but only for patients that have certain mutations or rearrangements, signifying an unmet need, noted Andersen. And due to the limited number of patients, clinical trials are challenging. Dr Anderson spoke recently with Brielle Benyon, senior editor of CURE®, a publication by MJH Life Sciences. You can watch this interview and many others with by Visiting Medicalworldnews.com, where you can get expert insights you won’t find anywhere else.

On this episode of Managed Care Cast, we speak with Tham Le, PhD, MPH, and Linda Wastila, PhD, MSPH, lead and senior authors, respectively, of “Patterns of Opioid Use in Commercially Insured Patients With Cancer,” which was published in the May issue of The American Journal of Managed Care®. They took up their investigation after finding that most previous similar studies of opioid use focused on problems with opioid use among general populations and that patients with cancer are an often overlooked population where opioid use is concerned. They sought a greater understanding of which patients with cancer are at risk for undertreatment and who is at risk for a substance use disorder. Overall, they believe that policies concerning opioid misuse need strengthening while continuing to address the genuine pain needs of patients with cancer and that they need to balance the benefits of opioid prescribing with the risks.

Drug overdose deaths are skyrocketing, with more than 100,000 people dying in 2021, according to the CDC. Obtaining treatment for substance use disorders (SUDs) has never been easy, and this month in Health Affairs, a recent paper examined trends in the use of treatment services to see what, if anything, changed from 2010 to 2019. Despite an increase in insurance coverage over much of that time period and other policy changes, the results were disappointing, according to one of the authors interviewed about the findings on today’s Managed Care Cast. Brendan Saloner, PhD, is an associate professor at the Johns Hopkins Bloomberg School of Public Health who specializes in health policy, particularly policies that affect vulnerable populations, including those with drug problems and behavioral or mental health issues.

On this episode of Managed Care Cast, we speak with Dr Joanne Armstrong, vice president and chief medical officer for Women’s Health and Genomics at CVS Health, on the distinct pathophysiology of cardiovascular disease in women, applicability of current screening and care delivery guidelines for heart health in regards to minority populations, and how her own health experiences have influenced her perspective on cardiovascular disease management.