Managed Care Cast

On this episode of Managed Care Cast, we bring you part 1 of an 8-part video conversation with a payer and a primary health care provider about how they adapted to deliver health care in 2020 and 2021. We sat down with Tunde Sotunde, MD, MBA, the president and CEO of Blue Cross and Blue Shield of North Carolina, the largest insurer in that state covering more than 3.7 million members across all 100 counties, and Alan Story, MD, of Newtown Family Physicians, an independent primary care practice in Catawba County in the western part of the state. Our conversation, moderated by Allison Inserro, managing editor of AJMC.com, the website of The American Journal of Managed Care®, delves into value-based care, independent care practices, the health care workforce, health equity, and the role of Medicaid.

With key data presented at this year’s 63rd Annual American Society of Hematology Meeting and Exposition showing several CAR T-cell therapies as effective and safe options in the second- and even first-line setting for multiple myeloma and other cancers, discussions on when to best to use these therapies in the real-world setting has garnered increasing attention by payers and providers. At ASH 2021, we sat down with several key opinion leaders to discuss the use of real-world data for CAR T-cell therapies and its importance in influencing reimbursement and investment strategies by payers.

With key data presented at this year’s 63rd Annual American Society of Hematology Meeting and Exposition showing several CAR T-cell therapies as effective and safe options in the second- and even first-line setting for multiple myeloma and other cancers, discussions on when to best to use these therapies in the real-world setting has garnered increasing attention by payers and providers. At ASH 2021, we sat down with several key opinion leaders to discuss the use of real-world data for CAR T-cell therapies and its importance in influencing reimbursement and investment strategies by payers.

On this episode of Managed Care Cast, we’re talking with the co-editors-in-chief of The American Journal of Managed Care®, Dr Mark Fendrick and Dr Michael Chernew, and the editor-in-chief of The American Journal of Accountable Care®, Dr Dennis Scanlon. They look back on the past year and discuss the themes and topics they expect to see in the pages of the journals and in the world of health care in 2022. For more, visit ajmc.com. To get in touch with us, email info@ajmc.com or follow us on Twitter @AJMC_Journal. And if you like the podcast, don’t forget to subscribe and rate us.

When new drugs are approved by the FDA, they can take time to diffuse across the population as clinicians begin to prescribe them. Uptake is not always quick or uniform, due to reasons that can include clinical inertia, provider familiarity, and the cost to patients. On this episode of Managed Care Cast, we’re talking with the lead author of a study published in our December 2021 issue. The article, “Variation in Early Diffusion of Sacubitril/Valsartan and Implications for Understanding Novel Drug Diffusion,” describes how prescribing of the newly approved heart failure drug spread across the nation. Joining us today is Lauren Gilstrap, MD, MPH, of Dartmouth-Hitchcock Medical Center and The Dartmouth Institute for Health Policy and Clinical Practice.

In addition to shining a light on health disparities, medical misinformation, and public health infrastructure, the COVID-19 pandemic has also propelled calls for the transition to value-based care in the United States. To discuss this topic, among others, we sat down with Mara McDermott, the executive director of the Value Based Care Coalition, formerly known as the Next Gen ACO Coalition. On this episode of Managed Care Cast, McDermott discusses the organization’s recent re-brand, how its goals align with the Center for Medicare and Medicaid Innovation’s strategic refresh, and the future of value-based care.

In November, the Pharmacy Quality Alliance (PQA) and Patient Advocate Foundation (PAF) announced a collaboration aimed at developing a patient-centered outcomes research agenda to improve social determinants of health screenings and interventions in pharmacy settings. The year-long project received funding from the Eugene Washington PCORI Engagement Awards program and will feature an in-person workshop held in conjunction with the PQA Annual Meeting in May. To learn more about this initiative, why it is needed, and how it will be carried out, The American Journal of Managed Care® (AJMC®) spoke with Melissa Castora-Binkley, PhD, the senior director of research at PQA and Rebekah Angove, PhD, vice president for patient experience at PAF. In this episode of Managed Care Cast, Castora-Binkley and Angove discuss why pharmacists are in a unique position to help address social determinants of health and the importance of incorporating patients’ perspectives into research agendas.

Are millennial patients with multiple sclerosis (MS) different from older patients? If they are different, is it partly because the MS field has benefitted from new therapeutic options and increased knowledge about the role of diet and exercise and modifiable behaviors, such as smoking? On a recent episode of Medical World News®, Matt Hoffman, managing editor of Neurology Live®, sat down for a conversation with Mitzi Joi Williams, MD, a board-certified neurologist and MS specialist in Smyrna, Georgia, about the trends she see in younger patients with MS and how they approach treatment decisions and other disease considerations. We invite you to listen to an excerpt of the broadcast here on Managed Care Cast, and you can find a link to the full episode in the show notes. https://www.medicalworldnews.com/view/deep-dive-into-treating-millennials-with-multiple-sclerosis

The Alliance of Community Health Plans (ACHP) recently released its 2021 Report on Affordability. In this episode of Managed Care Cast, we speak with Ceci Connolly, the president and CEO of ACHP, about the steps that its payer members are taking to lower costs through offerings such as virtual-first care, remote patient monitoring, and other new products, some of which were created because of the pandemic.

Proponents of price transparency hope that publishing health care prices can enable patients to shop for their health care services and better understand the bills that they receive. However, little is known about the value of marketwide transparency tools that reveal charges for out-of-network care. On this episode of Managed Care Cast, we’re talking with an author of a study published in our November 2021 issue. The article, “Assessing Utilization of a Marketwide Price Transparency Tool,” describes how consumers use a shopping tool to research health care prices in their area. Joining us today is Grace Kim, MHA, a PhD student at New York University.

COVID-19’s effects on the body are now known to be far-reaching—and long-lasting in the most severe cases—but when it started spreading across the world in early 2020, initial attention was focused on the lungs. That concern led to worries about the impact of infection for individuals with respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and asthma. On this episode of Managed Care Cast, we speak with Meilan K. Han, MD, MS, the author of a book released this month called Breathing Lessons: A Doctor’s Guide to Lung Health. Han, a pulmonologist, gives an inside tour of the lungs and how they work, zooms out to examine the drivers of poor respiratory health, and addresses policy changes that are needed to improve lung health. Han, who started writing the book at the beginning of the pandemic, is a professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan. She also serves on the scientific advisory committees for both the COPD Foundation and

On this episode of Managed Care Cast, we speak with Dr Abi Sundaramoorthy, MD, MBA, executive vice president of clinical enterprise at Somatus, a national value-based care company serving patients with underlying kidney disease, on the potential of value-based arrangements to address disparities in chronic kidney disease and promote preventive, effective care.

Fragmented health care is a known issue for patients and providers, and nowhere is the problem as acute as it is in the over-65 population. Studies have shown that patients who have a strong relationship with a primary care provider (PCP) who coordinates their care have better outcomes. But care provided by specialists has expanded over the past 2 decades, and the average PCP has twice as many specialists involved in the care of their fee-for-service Medicare patients as they did 20 years ago, according to research published in Annals of Internal Medicine this week. On this episode of Managed Care Cast, we speak with one of the coauthors of the study, "Trends in Outpatient Care for Medicare Beneficiaries and Implications for Primary Care, 2000 to 2019," which illustrates the changing trends in a PCP’s panel of Medicare patients and how that translates to an increased workload for primary care doctors. Michael L. Barnett, MD, MS, an assistant professor in the Department of Health Policy and Management at the

The 340 drug pricing program was first established in 1992 and allows participating hospitals to manufacture discounts on drugs used in an outpatient setting. In years since, federal agencies have clarified savings from the program should be directed at improving care for underserved patients. One method of doing this is providing uncompensated care, or charity care and other unreimbursed care, to uninsured or underinsured patients. In the years since its inception, debates around the program have centered on whether savings actually benefit the underserved as intended. To determine whether hospital provision of uncompensated care increased following hospital entry into the 340B program, Sunita M. Desai, PhD, and J. Michael McWilliams, MD, PhD, analyzed secondary data on 340B participation and uncompensated care provision from general acute care and critical access hospitals between 2003 and 2015. Their study “340B Drug Pricing Program and Hospital Provision of Uncompensated Care,” was published in the Oct

In this podcast, The American Journal of Managed Care's associate editorial director, Mary Caffrey, speaks with Michelle Afkhami, MD, from City of Hope, about best practices for oncology organizations to leverage molecular/genomic testing, the importance of identifying RET-positive patients early so they can receive targeted treatment, and more.

On this episode of Managed Care Cast, we discuss senior health needs amid the pandemic and how Centerwell Senior Primary Care's holistic, team based approach and value-based care delivery contributed to upticks in senior patient visits despite fears of COVID-19.

As the COVID-19 pandemic continues to take a toll on the nation a year-and-a-half later, public health workers, leaders, and researchers alike are still grappling with ways to convince a large swath of Americans to roll up their sleeves and get vaccinated. Even as cases and deaths decline nationally, states like Alaska continue to ration care as hospitals struggle with surges of largely unvaccinated patients with COVID-19. Currently, approximately 57% of the nation’s population is fully vaccinated, meaning at least 100 million more individuals have yet to receive the shot. For these reasons, safety precautions like masking, social distancing and encouraging vaccinations remain crucial to stamp out the virus. In a recent study published in Basic and Applied Social Psychology, researchers sought to increase compliance with coronavirus safety measures using cognitive dissonance as a guide, and their results yielded some promising conclusions. On this episode of Managed Care Cast, we speak with Logan Pearce,

For one cancer center, an outgrowth of the COVID-19 pandemic spurred plans to create an urgent care center for patients with cancer so that they could stay out of the emergency department. The Winship Cancer Institute of Emory University began planning for construction in 2020 after receiving a sizeable donation and broke ground this year. The Rollins Immediate Care Center is expected to open in 2022. On this episode of Managed Care Cast, we bring you an interview conducted by the editorial director of OncLive®, Gina Mauro, who talks with Charise Gleason, MSN, NP-BC, AOCNP, the advance practice provider chief at Winship Cancer Institute, about how having a dedicated cancer urgent care center will make cancer treatment plans seamless while also helping patients avoid exposure to infectious diseases in emergency waiting rooms.

Migraines plague some 35 million Americans, the majority of them women in their 30s and 40s, and disabling pain and symptoms are linked to lost productivity at work, school, and home. On this episode of Managed Care Cast, we bring you an excerpt of an interview with Deena E. Kuruvilla, MD, FAHS, the medical director of the Westport Headache Institute. She and Matt Hoffman, managing editor of NeurologyLive, another MJH Life Sciences medical news website, had a conversation a few weeks after this year’s American Headache Society Annual Scientific Meeting. They discuss the obstacles patients with migraine face during the pandemic to getting necessary care, the effect of worsening lifestyle changes over the past year and a half on patients with headaches, the difficulty in finding a clinician who knows about the latest migraine treatments, issues related to prior authorization, and more.

Black Americans are 4 times more likely to develop kidney failure and are diagnosed with chronic kidney disease later and in later stages than White Americans. They are less likely to be deemed eligible for a transplant, instead going on dialysis. Last week a joint report from the American Society of Nephrology (ASN) and the National Kidney Foundation (NKF) recommended the removal of a racially based modifier used in calculating the estimated glomerular filtration rate, which has the effect of making Black patients seem healthier than they really are, leading to care delays. On this episode of Managed Care Cast, we speak with Susan Quaggin, MD, FASN, a nephrologist and the chief of nephrology/hypertension and director of the Feinberg Cardiovascular and Renal Research Institute at Northwestern University, as well as current president of the ASN. She discusses the recommendations of the National Kidney Foundation (NKF) and ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases and wh