Managed Care Cast

On this episode of Managed Care Cast, we speak with Cheryl Mason, director of Content and Informatics for the Health Language solutions team of Wolters Kluwer, who discusses how delays in routine care and other aspects of the pandemic are affecting payer organizations today, and how technology innovations like natural language processing can work to empower key initiatives in population health and beyond.

On this episode of Managed Care Cast, we speak with the lead clinician of a study by the Epic Health Research Network and Kaiser Family Foundation, which found that routine medical care and hospital admissions remained below expected levels in the early months of 2021, marking the second consecutive year for such results.

Trust in health care was eroding even before the COVID-19 pandemic. In a new book, "Re-Engaging in Trust: The Missing Ingredient to Fixing Healthcare," the authors, Jan Berger, MD, MJ, the CEO of Health Intelligence Partners, and Julie Slezak, MSPH, the president of the health care consulting firm, delve into this issue with data from multiple sources and viewed against the backdrop of multiple stakeholders. Trust among stakeholders—providers, patients, health care organizations and systems, payers, drug companies, and others—is essential, yet it is increasingly fragile, they write. Trust should be measured and improved alongside health care metrics, according to Berger, who discusses the book on this episode of Managed Care Cast.

With COVID-19 continuing to change the way in which health care is perceived and delivered, large employers have been tasked with managing employee health concerns in real time, while also planning for when the pandemic does subside. In the Business Group on Health’s 2022 Large Employers’ Health Care Strategy and Plan Design Survey, employers discussed their perspectives on trends in health care cost and coverage, and how these aspects will influence their benefits strategies and programs in the coming year. On this episode of Managed Care Cast, we speak with Ellen Kelsay, president and CEO of the Business Group on Health, who discussed 5 major areas of concern spotlighted by employers in the survey, which included health equity and the pandemic’s long-term impact.

The recently released Intergovernmental Panel on Climate Change’s sixth assessment report drove home many of the concerns regarding the detrimental impacts of climate change that many have been warning about for years. But along with renewed calls for governmental action come doubts that the United States’ and other health care systems are equipped to handle such an influx of increasing medical issues wrought by climate change. Health systems and personnel have already been tested with the monumental crisis of COVID-19, and with higher rates of diseases expected from increased exposure to pollution, to more emergency responses warranted by frequent natural disasters, health professionals around the world are calling for immediate action to curb current and future ramifications. On this episode of Managed Care Cast, we speak with Laalitha Surapaneni, MD, MPH, an assistant professor of medicine at the University of Minnesota. Surapaneni discusses her work in mobilizing calls for climate action, the threat

Co-pay accumulator adjustment programs, or CAAPs, can help incentivize use of lower-cost generics by excluding drug manufacturer assistance from counting toward a patient’s out-of-pocket maximum. However, a rule finalized by HHS last year allows CAAPs to be applied even when no generic alternative is available. If patients are not informed about the implications of these programs, they may be forced to abandon their prescriptions in the face of unaffordable co-pays. On this episode of Managed Care Cast, we’re talking with an author of a Commentary published in our August 2021 issue. The article, “CAAP Rule and Prescription Drug Prices,” explains the mechanisms of CAAPs and the potential consequences of the new HHS rule. Joining us today is Bryan S. Walsh, JD, of Brigham and Women’s Hospital and Harvard Medical School.

On this episode of Managed Care Cast, we speak with Michael Abrams, managing partner at Numerof & Associates, on persistent barriers to entry for generics entering the pharmaceutical market, the impact of antitrust laws issued by the Biden administration, and further steps that are warranted to address anticompetitive tactics.

Today, we’re bringing you part 1 of a 2-part podcast series discussing multiple sclerosis, or MS. As part of the MS Stakeholder Summit, a panel of experts discusses tailoring treatments to patients with MS, payer considerations, and more.

Vizient recently released its Summer 2021 Pharmacy Market Outlook, which projects pharmaceutical spending for 2022 based on an analysis of its members' data, and on this episode of Managed Care Cast, we talk about some of their findings. The report, which delves into its members’ purchasing patterns, predicts a 3.1% increase in pharmaceutical spending next year, with oncology drugs accounting for about 25% of the increase. The report also discusses increasing competition from biosimilars, including the recent approval of insulin glargine as an interchangeable biosimilar for the treatment of diabetes; the practice of white bagging; and other issues. On this episode of Managed Care Cast, we speak with Steven Lucio, PharmD, BCPS, senior principal, Pharmacy Solutions, about the report, which also discusses the continued impact of COVID-19 on health care.

August is National Psoriasis Awareness Month, and on this episode of Managed Care Cast, we bring you an excerpt of an interview conducted by Linda Stocum, assistant editor of Dermatology Times, for Medical World News, a new webcast from MJH Life Sciences. In it, Jerry Bagel, MD, MS, Windsor Dermatology, East Windsor, New Jersey, discusses how psoriasis is now understood to be an inflammatory disease that, if left intreated, can have devastating cardiovascular effects, affecting lifespan and quality of life, especially for young people. He also discusses the many lifestyle changes that some patients will need to make after their skin becomes clear.

Huntington disease is an incurable, progressive neurodegenerative condition that is ultimately fatal, and the field of research into this rare disease saw a setback a few months ago with the end of 2 clinical trials for a type of possible therapy from Roche and Wave Life Sciences. On this episode of Managed Care Cast, we bring you an excerpt of an interview, originally conducted by Matt Hoffman, senior editor of NeurologyLive, with Daniel Claassen, MD, MS, director, Huntington’s Disease Clinic, and division chief, of Behavioral and Cognitive Neurology, Vanderbilt University Medical Center. Claassen reviews the trial terminations and what that means for patients with this disease, but he also reviews some other candidates in the pharmaceutical pipeline, as well as the need for patient-reported outcomes and the possibility of wearable sensors.

In this episode of Managed Care Cast, the lead author of an article in the July issue of The American Journal of Managed Care® describes the latest research that looks at the power of self-insured employers to negotiate hospital prices and the relationship between employer market power and hospital prices. Matthew Eisenberg, PhD, and coauthors used the US Census Bureau County Business Patterns data from 2010 to 2016 to estimate employer market power in metropolitan statistical areas (MSAs) and used Truven Health MarketScan commercial claims to estimate mean hospital prices and price ratios at the MSA level. The paper, "Large Self-insured Employers Lack Power to Effectively Negotiate Hospital Prices," notes a few alternative ways that employers have tried to increase their ability to raise their purchasing power, but the success has been limited. Eisenberg, an economist and assistant professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, joi

In a recent paper published in JAMA Network Open, Charlie Wray, DO, MS, and colleagues examined experiences and opinions of nearly 150,000 Americans representing the 5 major forms of health insurance coverage. Specifically, the researchers used survey data from the 2016-2018 Behavioral Risk Factor Surveillance System and compared access to care, cost of care, and reported satisfaction among those with public or private insurance. Representing the experiences of over 61 million US adults, respondents included Medicaid and Medicare beneficiaries, those with Veterans Health Administration or military coverage, and those with individually purchased and employer-sponsored coverage. On this episode of Managed Care Cast, Wray, an assistant professor of medicine at the University of California San Francisco, describes the surprising findings of the teams’ analyses, and offers some solutions to improving the quality of health insurance coverage in the United States.

Social distancing, vigilant sanitizing, and mask wearing required by COVID-19 did more than combat the pandemic—it cut down on flu cases as well as improved respiratory health for some patients. Some studies indicate that the measures also reduced Clostridium difficile, or C difficile, in hospitals and facilities. A recent set of interviews on Medical World News®, the 24-hour online news program for health care professionals from MJH Life Sciences™, highlighted this development. The interviews, discussing the prospect of these mitigation efforts continuing post pandemic, were conducted by one of our sister sites, HCPLive®, which covered the Digestive Disease Week meeting this spring. This episode of Managed Care Cast features a few of those interviews: Christie Teigland, PhD, vice president of Advanced Analytics for Avalere Health; Alpesh N. Amin, MD, University of California Irvine School of Medicine; and Brian E. Lacy, MD, PhD, Mayo Clinic.

Today, we’re bringing you part 2 of the MS Stakeholder Summit series. During part 1, which first ran 2 weeks ago, a panel of experts discussed tailoring treatments to patients with multiple sclerosis, payer considerations, and more. In this second part of the series, the same panel of experts continues their talk on MS. They will discuss newer therapies, switching therapies, and more.

Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute, discusses 2 reports on strengthening primary care after the COVID-19 pandemic: one from her own organization and the other from the National Academy of Medicine.

Diabetes care guidelines identify critical points in patients’ care when providers should refer them to diabetes self-management education, or DSME. However, it’s not known whether these clinical indicators of need actually increase the likelihood of receiving a referral. On this episode of Managed Care Cast, we’re talking with an author of an Original Research article published in our June 2021 issue. The article, “Patient Need and Provider Referrals to Diabetes Self-management Education,” finds that although there is an association between patient need and DSME referral, many patients in need still aren’t being referred. Joining us today is Brittany Brown-Podgorski, PhD, MPH, who is a postdoctoral fellow at the University of Texas at Austin and will soon be joining the faculty of the University of Pittsburgh.

Gun violence is one of the most prominent public health issues facing America today, and accounted for over 43,500 deaths in 2020 alone—the highest number in decades. But a major driver of gun-related deaths in this country that often goes unmentioned is suicide. Research shows having access to a firearm significantly increases the risk of suicide via firearm, and during the pandemic, amid an unprecedented surge in firearm purchases, these purchasers appeared far more likely to have experienced suicidal ideation. To learn more about the intersection between COVID-19, firearm ownership, and suicide, and to mark National Gun Violence Awareness Month, we spoke with Michael D. Anestis, PhD, an associate professor at the Rutgers School of Public Health. On this episode of Managed Care Cast, Anestis discusses his most recent research on the paramount importance of safe firearm storage, this epidemic’s disproportionate impact on people of color, and future steps needed to help decrease rates of gun-inflicted su

This month, the PwC Health Research Institute (HRI) released its annual Medical Cost Trend report for 2022. Reflecting the impact of the COVID-19 pandemic, the report predicts a 6.5% medical cost trend in 2022, slightly lower than the 7% medical cost trend in 2021 and slightly higher than it was between 2016 and 2020. On this episode of Managed Care Cast, we speak with Trina Tsouderos, who leads HRI, and discuss some of the drivers behind those numbers, as patients who put off care begin to seek services, as workers carry a high burden of mental and emotional stress, and as health care systems invest as they plan ahead for the next crisis.

In this episode of Managed Care Cast, we speak with a coauthor of an article in June’s Health Affairs examining the racial and ethnic composition of beneficiaries in Medicare Advantage plans and the potential implications as the program continues to grow.