Managed Care Cast

On this episode, AJMC spoke with Jaspreet Loyal, MD, about vitamin K refusals, which many clinicians believe may be a downstream effect of broader vaccine hesitancy.

Opaque benchmarks, payment lags of 12 to 18 months, and rules that changed mid-model led American Oncology Network (AON) to exit the Enhancing Oncology Model (EOM), according to AON Chief Medical Officer Stephen "Fred" Divers, MD. In this inaugural episode of The Business of Value, Divers tells host Lalan Wilfong, MD, chief medical officer of Navista, how 505(b)(2) drugs complicated practice finances, why retrospective data limited the ability to improve, and why other payers did not follow Medicare's lead. He also explains how AON is pursuing other value-based arrangements built on real-time data and what practices should know before joining similar models.

Community oncology practices can close the gap between innovation and implementation by building patient feedback into real-time clinical pathways, using AI to speed up physician decision-making, and better supporting caregivers of patients on CAR T and bispecific therapies, according to leaders from the American Oncology Network (AON). In the first of 2 podcasts from Patient-Centered Oncology Care 2026, Melody Chang, RPh, MBA, BCOP, is joined by Fred Divers, MD; Puneeth Indurlal, MD; and Brooke Peters, PharmD. They recap their PCOC panels and explain how the discussions connect to AON's work on clinical trials, rural access, and caregiver education.

This week's Managed Care Cast episode features a conversation between The American Journal of Managed Care® (AJMC®) and Grace Mackleby, PhD, a research scientist at the USC Schaeffer Center, about her study, "Plan Switching Among Medicare Advantage Enrollees Dually Eligible for Medicaid," published in the September 2026 issue of AJMC. The study examined how often beneficiaries switched from one Medicare Advantage (MA) plan to another or from MA to traditional Medicare (TM). It compared enrollees dually eligible for Medicaid with those eligible for Medicare only. Mackleby explained that dually eligible beneficiaries account for about one-fifth of the Medicare population and tend to have more chronic conditions, higher costs, and greater needs; they are also subject to different rules on when they can switch plans. Mackleby and coauthors Angela Liu, PhD, and Erin Trish, PhD, used administrative Medicare enrollment data to track switching from 2016 to 2022. She highlighted 3 main results. First, about 22% of

On this episode, I spoke with Jonathan Kimmelman, PhD, professor of biomedical ethics and associate member of the Department of Experimental Medicine at McGill University, about the ethical concerns surrounding Kalshi as it relates to clinical trial outcomes and FDA approvals.

During Suicide Prevention Month, UPMC experts discuss how lived experience, peer support, and connection strengthen suicide prevention.

September is Blood Cancer Awareness Month, and to mark it, we have a special Director's Cut episode of Managed Care Cast. My name is Maggie Shaw, lead editor at AJMC, and my guest today is Surbhi Sidana, MD, associate professor of medicine at Stanford University, where she leads the Myeloma Disease Focused Group and serves as associate director for clinical research in the BMT and Cell Therapy Division. We talk about her path into myeloma research, the field's shift from a once-fatal diagnosis to real conversations about cure, the barriers patients face accessing CAR T-cell therapy, and her advice for the next generation of hematologists.

Health-system pharmacy is entering a decade of change, and Future-Proofing Pharmacy is built to keep asking what that future should look like. In this debut episode, host Mark Makhinson, PharmD, senior director of outpatient and specialty pharmacy at Mount Sinai Health System, introduces the podcast's mission: exploring how pharmacy leaders can build organizations that are clinically meaningful, scalable, and ready to adapt, rather than simply reacting to financial pressure, workforce shifts, and drug shortages as they arise. Makhinson lays out the questions the series will return to throughout its run, including what a health system pharmacy enterprise looks like in 2035, where artificial intelligence can meaningfully help, and where human judgment should remain central. Episode 1 kicks off with Nilesh Desai, PharmD, chief pharmacy officer at University of Miami Health System, who shares the pharmacy enterprise he would build from scratch in 2035 and the lessons that shaped his thinking during a major phar

This week's Managed Care Cast episode features a conversation between The American Journal of Managed Care® and August 2026 authors Jeff Romine, PhD, and Kofi Essel, MD, MPH, about their study, "Insurance-Provided Grocery Assistance and Health Care Outcomes Among Patients With Diabetes." It examined the association between a commercial health plan's grocery assistance benefit and health care use and outcomes among members with type 2 diabetes, offering evidence in a space where prior food-as-medicine research has centered largely on Medicare and Medicaid populations. The benefit provided members between $1200 and $3000 annually, distributed across pay periods on a card usable at a range of grocery chains. Purchases excluded alcohol, tobacco, and preprepared foods, with an emphasis on fruits, vegetables, and other healthy items. Essel noted the design was a deliberate light touch, requiring no dietitian or health coach support, which he said made it more scalable than medically tailored meal programs that h

Socially vulnerable Medicare patients see dramatically better outcomes—such as fewer emergency department visits, fewer preventable hospital admissions, and 23.4% to 30% less use of high-risk medications—when their physicians take on full financial risk for their care compared with those in traditional fee-for-service Medicare. That's the core finding of a new study published in the June issue of Population Health, Equity & Outcomes, and the subject of this conversation between Ken Cohen, MD, chief medical officer for Optum Health, and host Sophia Humphreys, PharmD, vice president of health system strategy and innovation at The American Journal of Managed Care.

UPMC and Birth Root Community Doula describe a 4-year partnership addressing food insecurity, housing, and maternal health disparities in Erie, Pennsylvania.

In this episode of Managed Care Cast, Alvin Thomas, PhD, clinical psychologist at the University of Wisconsin-Madison, discusses the mental health challenges facing Black and Latino boys and young men.

For this Managed Care Cast episode, The American Journal of Managed Care® (AJMC®) spoke with Anuraag R. Kansal, PhD, who leads health economics research at GRAIL, about his study, “State Medicaid Budgetary Implications of New Cancers," published in the July 2026 issue; it examined how new cancer diagnoses affected state Medicaid budgets. He conducted the study with Amanda C. Chen, PhD, of the USC Mann School of Pharmacy and Pharmaceutical Sciences, and David C. Grabowski, PhD, of Harvard Medical School. Kansal explained to AJMC that despite Medicaid's younger population, cancer remains the third-largest source of program spending. Most existing research had focused on commercial and Medicare populations rather than Medicaid specifically. Consequently, using de-identified CMS claims data, he and his team identified new cancer diagnoses, defined as no prior cancer evidence in the preceding 6 months, and compared spending, hospitalizations, and emergency department use between metastatic and non-metastatic ca

Expanding Support Systems for Black Maternal Health by Managed Care Cast

On this episode of Managed Care Cast, The American Journal of Managed Care® (AJMC®) was joined by Erin L. Duffy, PhD, MPH, an author of a study published in the June 2026 issue. She is a health policy researcher at the Schaeffer Center for Health Policy & Economics at the University of Southern California, with a focus on health care affordability, access to care, and how health systems can better serve patients. Duffy’s study, "Availability of Hospital Financial Assistance Documents in Non-English Languages," found that nonprofit and system-affiliated hospitals have superior language access. During her conversation with AJMC, she discussed what inspired the research, the study's key findings, and ways to improve equitable access to information about financial assistance, regardless of language. To conclude, Duffy previewed her study to be published in the July 2026 issue of AJMC, which builds on this work by evaluating the readability of financial assistance documents.

Most patients with metabolic dysfunction–associated steatotic liver disease (MASLD) go undiagnosed until significant liver damage has already occurred, despite the availability of simple, guideline-supported screening tools that remain notoriously underused in both primary care and weight management settings. That's according to a conversation between Naim Alkhouri, MD, chief medical officer at Summit Clinical Research and director of the Steatotic Liver Disease Program at the Clinical Research Institute of Ohio, and Chika Anekwe, MD, obesity medicine clinical director at the Massachusetts General Hospital Weight Center and an instructor in medicine at Harvard Medical School. In this episode of Beyond the Silo: Integrated Care Across the CRM Continuum, the third installment in a series examining the cardio-renal-metabolic continuum, Alkhouri and Anekwe discuss why MASLD and its more aggressive form, metabolic dysfunction–associated steatohepatitis (MASH), belong alongside the heart and kidney in conversation

In this episode, Bhavana "Tina" Bhatnagar, DO, discusses how the field of acute myeloid leukemia has been fundamentally transformed; what this means for patients in rural, underserved settings; and where hematologic oncology is headed next.

Perry Halkitis, PhD, MS, MPH, dean of the Rutgers School of Public Health, watched epidemics emerge, witnessed governments fail to respond, and seen communities mobilize when institutions would not. From the early days of the AIDS crisis to COVID-19, Ebola, and beyond, he has drawn consistent lessons about what makes public health succeed and what causes it to collapse.

For patients with cancer, diagnosis doesn't just bring a physical battle. It can trigger a trauma response that can linger long after treatment ends, quietly reshaping how people sleep, think, and connect with the world around them.

Early detection of chronic kidney disease (CKD) means little if it does not lead to timely treatment, yet a significant gap persists between when CKD is found and when evidence-based therapies are started. That disconnect is the focus of the second episode of Beyond the Silo: Integrated Care Across the CRM Continuum, a podcast series from The American Journal of Managed Care®, in which Ralph Riello, PharmD, BCPS, leads a conversation with Nihar Desai, MD, MPH, on how to shift CKD care from a reactive, late-stage model to one that is proactive, pathway-driven, and equitable. The discussion builds on the first episode's focus on urine albumin-to-creatinine ratio underutilization, stipulating that screening has occurred and asking what must happen next. You can listen to the first episode here: https://www.ajmc.com/link/89943