Managed Care Cast

Entering its 51st year, the American Kidney Fund has made it its mission to help all patients affected by chronic kidney disease (CKD), which is the fastest-growing noncontagious disease in the United States: from those at risk for chronic kidney disease through patients requiring dialysis and/or transplant. First and foremost is uncovering the primary cause of their kidney failure. Unfortunately, for 14% of low-income patients, the origins of their CKD remain a medical mystery. In December of 2020, the American Kidney Fund convened the Unknown Causes of Kidney Disease Summit, bringing together government agencies, industry, patients, researchers, and rare disease organizations, hoping that by helping underserved patients get to the root cause of their kidney disease, they could also help solve this mystery for a broader patient population. From this, a roadmap was born for what would become the Unknown Causes of Kidney Disease Project, launched in mid-2021, with goals that include advocating for equitable k

It’s well known the state of maternal morbidity and mortality in the United States is subpar. From stark racial disparities in maternal deaths to a severe shortage of midwives and doulas, birthing people in the United States face unique challenges not seen in other high-income countries. Plus, the recent increase in legislation aimed at curbing abortion access throughout the nation may serve to exacerbate these problems, as more women are forced to carry unwanted pregnancies to term. To better understand how we got here and examine some potential solutions to these problems, The American Journal of Manage Care® sat down with Breana Lipscomb, the senior advisor of Maternal Health & Rights at the Center for Reproductive Rights. This week also marks Black Maternal Health Week, and on this episode of Managed Care Cast, Lipscomb outlines steps needed to improve care for Black mothers in the US—a demographic that is more than 3 times more likely to have a maternal death compared with their white counterparts.

National Public Health Week, the annual initiative from the American Public Health Association, falls within the first full week of April. On this episode of Managed Care Cast, to mark the conclusion of National Public Health Week this year, which ran from April 4-10, we speak with Perry N. Halkitis, PhD, MS, MPH, dean of the Rutgers School of Public Health, who is also a public health psychologist, infectious disease epidemiologist, applied statistician, researcher, educator, and advocate. He discusses training the next generation of public health professionals, why a paradigm shift is necessary around integrating mental health awareness into public health education, and the importance of activism and advocacy to eliminating health disparities.

In January 2022, Vanderbilt University Medical Center, Meharry Medical College, and the University of Miami Miller School of Medicine announced the receipt of a $12.4 million grant from the National Institutes of Health to develop the Southeast Collaborative for Innovative and Equitable Solutions to Chronic Disease Disparities. The center’s work aims to reduce disparities seen in the southeast United States, with particular focus on cardiovascular disease, obesity, diabetes, and other related conditions among African Americans and Latino populations. Currently, over 20% of this region lives in poverty, while racial and ethnic minorities comprise nearly 40% of the population. Southern states also tend to be the least healthy in the nation and account for the majority of Medicaid expansion holdouts under the Affordable Care Act. To learn more about geographic disparities in chronic disease rates, The American Journal of Managed Care® (AJMC®) sat down with Consuelo Wilkins, MD, MSCI, professor of medicine,

An unprecedented level of detail and robustness around interoperability standards is on its way, and on this episode of Managed Care Cast, we speak with Donald Rucker, MD, the former National Coordinator for Health Information Technology in HHS, about what the opportunities and responsibilities for payers are. The change is precipitated by 2020 rulemaking regarding the 21st Century Cures Act requirement regarding application programming interfaces. The new requirement will enable access to patient-level data across a patient population, allowing for more analysis that can inform clinical decisions, track those decisions to costs, and even influence future policy. Rucker, who received his medical degree from the University of Pennsylvania and also has an MBA in business and an MS in medical computer science and informatics from Stanford University, is currently chief strategy officer at 1upHealth.

Within Virginia, one of 13 states that fall within the Appalachian region of the United States, the current overall poverty rate is 10.6%, giving the state a 10th place ranking on a list of the top 10 states with the lowest poverty rates. However, the average poverty rate of the southwest corner of the state, which includes the 6 counties of Buchanan, Dickenson, Russell, Lee, Scott, and Wise, is double that of the state, at 21.9%. Supported entirely by grants and donations, The Health Wagon has been providing free health care services for the often medically underserved and indigent individuals—who are either underinsured or uninsured—in this part of Virginia for more than 4 decades. On this episode of Managed Care Cast, we speak with The Health Wagon’s President and CEO Teresa Tyson, DNP, MSN, FNP-BC, FAANP, and Clinical Director Paula Hill-Collins, DNP, MSN, FAANP, to learn more about the often urgent services they provide, to discover how the not-for-profit innovates care through culturally sensitive ser

CMS first implemented the Comprehensive Primary Care Plus, or CPC+, Initiative in January 2017. The medical home model is a large-scale redesign effort meant to improve primary care through payer reform and care delivery transformation. However, an interim data analysis of the initiative’s first 3 years among Medicare fee-for-service beneficiaries did not demonstrate improvements in either care continuity or care fragmentation. On this episode of Managed Care Cast, we speak with Lori Timmins, PhD, senior researcher, and Eugene Rich, MD, senior fellow, both of Mathematica. With their fellow authors, Carol Urato, MA, researcher at Mathematica; Lisa M. Kern, MD, MPH, associate professor of medicine at Weill Cornell Medicine in New York; and Arkadipta Ghosh, PhD, principal researcher at Mathematica, they published their study, “Primary Care Redesign and Care Fragmentation Among Medicare Beneficiaries,” in the March issue of The American Journal of Managed Care®.

Sexual orientation and gender identity change efforts (SOGICE), more commonly known as conversion therapy, is a discredited practice opposed by a number of medical, mental health, and human rights organizations, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry. Yet annually, the practice’s harms lead to estimated direct and indirect costs of $9.23 billion in the United States, according to a new study published in JAMA Pediatrics. SOGICE can take the form of individual or group psychotherapy, inpatient treatment, or administration by religious leaders, while many individuals undergo multiple modalities, typically as youths. The practice relies on the false belief that being LGBTQ+ is pathologic, and its enforcers promote sexual and gender identify rejection often to the mental health detriment of recipients. Currently, 25 states; Washington, DC; and Puerto Rico all have bans in place prohibiting SOGICE for minors. However, unlicensed individuals, li

On this episode of Managed Care Cast, we speak with Tim Gronniger, the CEO of Caravan Health, about what to look for as accountable care organizations (ACOs) and policy makers try to encourage more providers to join value-based care arrangements.

Since 1999, nearly 841,000 Americans have died of drug overdoses, according to data from the CDC, while opioids serve as the main driver of these deaths. Synthetic opioids account for 73% of opioid-involved overdose deaths. The COVID-19 pandemic exacerbated the opioid epidemic as individuals encountered disruptions in routine treatment, alongside steep increases in depression and anxiety rates. One group of individuals susceptible to opioid use disorder are those with chronic, non-cancer pain. Although interventions such as full mu agonist chronic opioid analgesic therapy (COAT) cessation exist for this population, data show this practice can actually impede vocational and social return to function and to increase length of disability. In a study published in the October issue of The American Journal of Managed Care® (AJMC®) Marcelina Jasmine Silva DO, and colleagues outlined outcomes from the Focus on Opioid Transitions (FOOT Steps) Program, which was created to help patients with chronic non-cancer pain

Human papillomavirus, or HPV, is the most common sexually transmitted infection in the United States and causes the majority of cervical cancer cases in the country. But screening for HPV can catch the virus early and potentially prevent it from developing into cervical cancer. In addition, safe and effective vaccines against HPV exist, essentially making cervical cancer a preventable disease. However, uptake of HPV vaccines remains sporadic throughout the United States compared with other nations like the United Kingdom, where cervical cancer is nearly eliminated in young women. Furthermore, despite its prevalence, an HPV diagnosis gap exists among racial groups in the US, as White women are 3 times more likely to be told they have HPV than Black women. To dig deeper into racial disparities in HPV, Leslie Cofie, PhD, MPH, an assistant professor of health education and promotion at the College of Health and Human Performance, East Carolina University, conducted a study to understand HPV vaccination up

Providers who treat high-need, high-cost patients can face challenges to deliver efficient and effective care. Health centers funded by the Health Resources and Services administration (HRSA)—otherwise known as federally qualified health canters or FQHCs— provide care to nearly 30 million Americans, many of whom are uninsured or underinsured. Because data on these patients’ complexity and utilization patterns are limited, researchers set out to better define these patient populations using information from the 2014 Health Center Patient Survey. On this episode of Managed Care Cast, we speak with Nadereh Pourat, PhD, MSPH, associate center director and the director of the health economics and evaluation research program at the UCLA Center for Health Policy Research, and Alex Sripipatana, PhD, MPH, director of the division of data and evaluation at HRSA. Pourat, Sripipatant and colleagues recently published the HRSA-funded study “Intersection of Complexity and High Utilization among health center patients ag

There is already an enormous amount of concern and worry about the effect of the pandemic on cancer screening; for instance, a recent report from the American Association for Cancer Research found an 87% drop in breast cancer screening, an 84% decline in cervical cancer screening, and an 80% reduction in colon cancer screening. On this episode of Managed Care Cast, we discuss how health care inequities will make this problem worse, with Monica Soni, MD, associate chief medical officer at New Century Health. Soni, who previously was the director of specialty care for the Los Angeles County Department of Health Services, the nation’s second-largest municipal health system, delves into how racial disparities in health care and social determinants of health hinder preventing cancer in the first place. She also provides some reaction to President Joe Biden’s Cancer Moonshot announcement.

According to the CDC, 37.3 million individuals in the United States currently have diabetes, while of these, 8.5 million are undiagnosed. In addition, more than 1 in 3 Americans currently have prediabetes—or higher than normal blood sugar levels—but 80% of this population is unaware they even have the condition. The American Diabetes Association estimates diagnosed diabetes costs the country $327 billion annually. Obesity is a key risk factor for type 2 diabetes. Data from 2018 show 42.4% of the United States population is obese, marking a steep increase from the 30.5% reported in the year 2000. Type 2 diabetes is preventable, and programs like the National Diabetes Prevention Program (DPP) have been proven to lower disease incidence among those at high risk via dietary changes and other lifestyle interventions. To learn more about how employers are leveraging the DPP to reduce diabetes rates among their workforce, The American Journal of Managed Care® sat down with Jill Hutt, vice president of member se

On January 1, 2022, California law SB-306 went into effect with the aim of reducing soaring sexually transmitted infection (STI) rates in the state. As part of SB- 306, California now requires health insurance to cover at-home STI testing kits and requires syphilis screening during both the first and third trimester of pregnancy, in addition to other mitigation strategies. Even before the COVID-19 pandemic, US STI rates were reaching crisis levels, with CDC data showing an increase of nearly 20% of chlamydia cases between 2015 and 2019, an increase of more than 50% of gonorrhea cases within this time window, and an over 70% increase in cases of syphilis. All 3 of these conditions are curable, if detected early enough and treated correctly. To learn more about SB-306, we spoke with Amy Moy, the chief external affairs officer at Essential Access Health, one of the bill’s co-sponsors. On this episode of Managed Care Cast, Amy outlines what SB-306 does, how it addresses some of the stigma associated with STI

This week’s Managed Care Cast conversation took place on the same day President Joe Biden announced the return of the Cancer Moonshot, a program he initiated when he was vice president in the Obama administration. The reinvigorated program aims to cut cancer deaths by 50% over the next 25 years and to increase cancer screening, which has dropped sharply during the pandemic. This Friday, February 4, is World Cancer Day, an initiative led by the Union for International Cancer Control (UICC), and this year's theme is about closing care gaps. For this episode of Managed Care Cast, we spoke with Meghan Gutierrez, CEO of the Lymphoma Research Foundation, about financial toxicity, how the pandemic has affected patients’ financial needs when they have cancer, health care disparities and care gaps, and more.

Although racism and bias have been long documented issues affecting health equity, findings of a recent study published in Health Affairs indicates these issues may be more embedded in the US health care system than originally thought. Examining electronic health records (EHRs) from an urban academic medical center, researchers found that negative descriptors were significantly more likely to appear in the records of Black patients compared with White patients. Other factors—such as insurance type, marriage status, and even the COVID-19 pandemic—influenced the odds of having this potentially stigmatizing language appear in a patient’s EHR. On this episode of Managed Care Cast, we speak with the first author on the study, Michael Sun, a medical student at the Pritzker School of Medicine at the University of Chicago, on the findings, as well as the steps that can be taken to increase awareness among clinicians of these stigmatizing descriptors.

In recent years, predictive models in medicine have become increasingly popular what with the continued integration of artificial intelligence and data technology into health care. However, these models can carry the risk of bias depending on which individuals make up the data sets. The close relationship between health care and technology also raises a myriad of questions when it comes to regulation, accountability, and model implementation. In this month’s Health IT issue of the American Journal of Managed Care, Paige Nong, a PhD candidate in public health at the University of Michigan, and colleagues present research on facilitating informed decision making and communicating equity issues when integrating predictive models into care. On this episode of Managed Care Cast, Nong outlines how the researchers carried out their study, the ethical challenges of combining computer science with health, and next steps for combatting bias in predictive models.

On December 30th, 2021 the No Surprises Act went into effect. Broadly speaking, the act aims to curb surprise bills Americans may incur when they receive care from an out-out-network provider. In response to the act’s implementation, the American Hospital Association, American Medical Association, and others sued, claiming the law jeopardizes patients’ access to care on the basis that providers and insurers must negotiate these costs when they arise, and if an agreement is not made, an arbitration process for determining fair payment will take place. On this episode of Managed Care Cast, we speak with Mark Miller, PhD, the executive vice president of health care at Arnold Ventures. In our conversation, Miller lays out how this law came about, its implications for patients, and what might happen if lawsuits against it succeed.

On this episode of Managed Care Cast, we interview the lead author of a paper in the January issue of Health Affairs about what physicians know and don't know regarding their responsibilities to accommodate patients with disabilities when they come in for an office visit.