Managed Care Cast

A quick roundup episode of major news and health policy developments from The American Journal of Managed Care.

On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Julia Lucaci, PharmD, MS, the senior director of global health economics and outcomes research at Becton, Dickinson and Company (BD), an international medical technology company. Her commentary, "Should Payers Incentivize Pharmacies to Blister-Package Chronic Medications?" argues that payers should consider offering higher reimbursement rates and/or preferred network status to pharmacies that dispense chronic medications in blister packs to enhance medication adherence and patient outcomes. During the conversation, Lucaci explores the widespread impact of medication nonadherence, the benefits and underutilization of blister packaging in the US, and strategies that could support broader adoption to improve chronic disease management and lower overall health care costs.

A quick roundup episode of major health policy developments, from shifting COVID-19 vaccine guidance and scientific publishing controversies to rising cancer care costs and the impact of oncology biosimilars.

On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Lindsey Leininger, PhD, health policy professor and faculty director of the Center for Health Care at the Tuck School of Business at Dartmouth College, and Allister Chang, MPA, co-founder of Fabric Health, a social-impact startup that aims to improve community well-being by transforming everyday moments in laundromats into opportunities to build trust, support Medicaid recertification, and connect families with health and social services. Their study, "Unmet Health Care and Health-Related Social Needs of Laundromat Users," published in this month's issue, identifies laundromats as a promising community-based setting for Medicaid outreach, with Medicaid enrollees comprising the majority of users and facing disproportionately high levels of unmet needs. During the conversation, Leininger and Chang highlight how engaging with enrollees at laundromats can help foster trust, address unmet social needs, and strengthen Medicaid engagement.

Victor Murray, senior director of Community Engagement and Capacity Building at the Camden Coalition, discusses the evolving role of social workers, emphasizing their expanded scope to include systems change, health equity, and policy work. He highlights the Camden Core Model, which addresses complex health and social needs through trauma-informed care and holistic support.

Explore how employers enhance workplace mental health by fostering a culture of support and engagement, focusing on holistic well-being strategies in this interview with Jim Kinville, University of Pittsburgh Medical Center.

On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Larragem Raines, MS, director of research at the Center for Innovation & Value Research, about her organization's open-source value model for major depressive disorder (MDD). She also defines dynamic pricing and explains how it is incorporated into the MDD value model, topics she expands upon in a recent contributor article. Looking ahead, Raines discusses the potential of artificial intelligence (AI) to improve diagnosis, treatment, and access in the MDD space.

Colleen Ereditario, MPH, RD, LDN, program manager, shares how the “Food as Medicine” approach of Allegheny Health Network (AHN) addresses food insecurity and guides patients to improve their health.

On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Brady Post, PhD, assistant professor at Northeastern University and lead author of a study published in this month's issue. His study, "Impact of Hospital-Physician Integration on Medicare Patient Mix," found no evidence that hospital-employed physicians treated a higher proportion of complex patients, at least among those enrolled in traditional Medicare. During the conversation, Post shares the inspiration behind his research, key findings, and areas for further investigation.

Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes. Overall, their findings show a significant uptick in tirzepatide dispensations, alongside other glucose- and weight-lowering medications, including semaglutide.

Today we are bringing you a conversation the use of continuous glucose monitoring technology and its transformative potential in diabetes care. Davida Kruger, a certified nurse practitioner at Henry Ford in the division of endocrinology, spoke with Jaime Murillo, MD, senior vice president and chief medical officer, medical affairs, United Health Group; Jeremy Wigginton, MD, chief medical officer at a regional Blue plan; Ian Neeland, MD, director of cardiovascular prevention, University Hospitals Harrington Health and Vascular Institute, and associate professor of medicine, Case Western Reserve University School of Medicine; and Ken Cohen, MD, executive director of translational research, Optum Health. The topics of conversation for today's podcast include how CGM addresses therapeutic inertia, enhances glycemic control, and drives improvements in patient outcomes and health care efficiency, as well as the barriers to adoption, strategies for expanding access, and the cost effectiveness of CGM implementation.

On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.

On this episode of Managed Care Cast, we are speaking with Jai N. Patel, PharmD, the associate director of shared resources management at Atrium Health Wake Forest Baptist Comprehensive Cancer Center. His study, "Medical Policy Determinations for Pharmacogenetic Tests Among US Health Plans," uncovered significant differences in coverage decisions for pharmacogenetic tests across major US health insurers and laboratory benefit managers; pharmacogenetic testing examines how an individual's genetic makeup impacts drug response. In our discussion, Patel shares what motivated this research, key takeaways from his findings, and steps needed to improve consistency in evidence evaluation and pharmacogenetic test coverage.

On this episode of Managed Care Cast, we speak with George Jones, chief operating officer at UpScript Health, an online pioneer of eprescribing 20 years ago, to learn how telemedicine has progressed from asynchronous conferencing to real-time video consultation, enabling the treatment of complex conditions beyond primary care.

On this episode of Managed Care Cast, we speak with Perry N. Halkitis, PhD, MS, MPH, dean of the Rutgers School of Public Health. Our conversation centers on the potential withdrawal of the United States from the World Health Organization, the new directive for the CDC to stop communications with the WHO, and their public health implications. We also touch on the importance of accurate public health information and the role of public health leaders in advocating for science and health.

Today, we're diving deep into a crucial aspect of preventive healthcare: the Annual Wellness Visit. Our guest is Dr. Christopher Wheelock, a clinical transformation physician executive at Highmark Health, responsible for developing payer and provider collaborations to move toward value-based care. In the past, he was heavily involved with developing the workflow, patient scripting and templating for the Annual Wellness Visit when CMS first established it in 2011 as part of the Affordable Care Act. In today's episode, Dr. Wheelock sheds light on the various elements of the Annual Wellness Visit, including self-assessments of psychosocial issues and screenings for conditions like dementia and incontinence. He also explains the expansion of services in 2025 for Medicare beneficiaries. We also explore the intricacies of coding and billing for these visits, especially if they go beyond the scope of the Annual Wellness Visit; the value they bring to patients, providers, and payers; and the critical role of effective communication and preparation to maximize the benefit of the Annual Wellness Visit.

On this episode of Managed Care Cast, we're talking with Allison Ju-Chen Hu, PhD, a postdoctoral associate in the Department of Population Health Sciences at Weill Cornell Medicine. Her study, "Medicaid Managed Care Network Adequacy Standards and Mental Health Care Access," examined the association between quantitative network adequacy standards (NAS) and mental health care access among adult Medicaid enrollees, including those with mental health conditions.

Joining us for this episode of Managed Care Cast is Robert H. Hopkins, Jr, MD, mnedical director at the National Foundation for Infectious Diseases and NFID liaison to the Advisory Committee on Immunization Practices, who will help separate fact from fiction about avian influenza and discuss what needs to be done to prevent a future escalation.

Today, we do a deep dive into psychedelic-assisted therapy with Jessica Tracy, head of Growth and Partnerships at Enthea. She shares how employers and unions can support mental health and address access barriers to evidence-based ketamine treatments.

March 11, 2025, will mark 5 years since the World Health Organization (WHO) declared COVID-19 a pandemic. Between January 22, 2020, and March 10, 2023, Johns Hopkins University recorded over 676 million confirmed COVID-19 cases worldwide and more than 6.8 million related deaths. In the US alone, it reported over 103 million cases and more than 1 million deaths during this timeframe. Although the WHO declared an end to the public health emergency on May 5, 2023, followed by the CDC on May 11, COVID-19 continues to impact thousands of individuals worldwide. On this episode of Managed Care Cast, we're speaking with Jenny Han, MD, a COVID-19 expert from Emory School of Medicine and Grady Hospital in Atlanta, Georgia. We'll explore the current state of COVID-19, including risk factors, treatments, and the impacts of long COVID. We will also discuss prevention strategies, vaccination efforts, and future steps to improve COVID-19 care and outcomes.

The editors in chief of The American Journal of Managed Care® discuss the key managed care research and news from 2024 and look forward to the journal's upcoming 30th anniversary.

Today we are bringing you a conversation on treatment with Bruton tyrosine kinase inhibitors for patients with treatment-naïve chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL). Ryan Haumschild, PharmD, MS, MBA, CPEL, vice president of ambulatory pharmacy at Emory Healthcare and Winship Cancer Institute, spoke with 3 experts: Tara Graff, DO, medical oncologist, Mission Cancer and Blood; Jacqueline Barrientos, MD, MS, chief, Hematologic Malignancies, and director, Oncology Research at Mount Sinai Comprehensive Cancer Center; and Matthew Davids, MD, MMSc, director of Clinical Research, Division of Lymphoma, Dana-Farber Cancer Institute, and associate professor of medicine, Harvard Medical School. They covered a wide range of topics including the data on treatment regimens for both CLL and MCL, the cost of treatment, patient-specific considerations during treatment decision making, and the future of treatment.

Rachael Drake, pharmacy technician coordinator, University of Kansas Health System, explains how her team collaborates with insurance companies and providers to support patients with non-Hodgkin lymphoma access treatment.

Among the latest data being presented at the American Society of Hematology Annual Meeting and Exposition, held December 7-10, 2024, in San Diego, California, were 3 abstracts that focused on patient preferences and treatment choices. Sikander Ailawadhi, MD, professor of medicine in the Division of Hematology/Oncology at the Mayo Clinic Florida was a coauthor on all 3 abstracts, covering patient preferences for Bruton tyrosine kinase inhibitors in chronic lymphocytic leukemia and small lymphocytic lymphoma, survivorship burden and patient preferences affecting treatment choices in multiple myeloma, and race/ethnicity-specific sociodemographic and economic factors driving refusal of treatment in multiple myeloma.

Today we are bringing you insights from 3 separate interviews with experts about the treatment, management, and burdens of idiopathic pulmonary fibrosis (IPF). In this podcast, you'll hear insight from the following individuals: Toby Maher, MD, PhD, professor of clinical medicine, Keck School of Medicine, USC; Martin Kolb, MD, PhD, professor of medicine, McMaster University; and Steven Nathan, MD, FCCP, medical director of the Advanced Lung Disease Program and Lung Transplant Program, Inova Fairfax Hospital, and professor of medicine, University of Virginia. These experts discuss what IPF is, how it impacts patients' quality of life, barriers to care, and treatments in the pipeline.

On this episode of Managed Care Cast, we're talking with Joanne Armstrong, MD, MPH, the vice president and chief medical officer for women's health and genomics at CVS Health. We explored the progress and persistent challenges in women's health, highlighting topics like care access, the role of technology, maternal health outcomes, and efforts to break the stigma around menopause.

In this special episode of Managed Care Cast, the executive editor of The American Journal of Managed Care, Mary Caffrey, speaks with Tyler Sandahl, PharmD, of Cleveland Clinic, and Michael Byrne, DO, of Tennessee Oncology, about the use of bispecific antibodies to treat patients with multiple myeloma, the importance of caregivers for this regimen, how the entire staff plays a role, the common adverse events patients need to be looking out for, and more.

On this episode of Managed Care Cast, we're talking with Josie Cooper, BA, executive director of the Alliance for Patient Access. Her study, "Utilization Management and Physician Burnout," involved a survey that assessed physician experiences with utilization management and burnout, investigating the potential link between the 2.

Dr Elizabeth Warner, chief medical officer at CDPHP, discusses how Wellness Way's focus on patient experience, community partnerships, and integration of physical and mental health care services sets it apart from traditional hospital-based care.

Prompt care supports mental well-being, as hidradenitis suppurativa is often associated with depression and anxiety due to its physical and social challenges.

On this episode of Managed Care Cast, we're talking with Benjamin Ukert, PhD, of Elevance Health's Public Policy Institute. His study, "Racial and Ethnic Disparities in Prior Authorizations for Patients With Cancer," evaluated prior authorization decisions in cancer care by race and ethnicity for commercially insured patients.

In our conversation with Jeff Giullian, MD, MBA, chief medical officer with DaVita Kidney Care, we dive into 4 important aspects of kidney care: prevention, social support, integrated care, and patient support

On this episode of Managed Care Cast, we're talking with Rick Chapman, PhD, chief science officer of the Center for Innovation & Value Research, formerly known as the Innovation and Value Initiative (IVI). We discussed the Center's Rare Disease project, including the primary goals, key discoveries from Phase 1, and what to expect moving forward.

To help celebrate and recognize National Recovery Month, we have brought you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In this final episode, we speak with Lyndra Bills, MD, senior medical director, and Shari Hutchison, MS, director of program evaluation and outcomes, both with Community Care Behavioral Health Organization.

Delia Orosco, MS, director of Community Wellness Centers at Inland Empire Health Plan (IEHP), shares insight into innovative initiatives like the mobile mammogram clinics.

To recognize National Recovery Month, we are bringing you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In episode 4, Amy Herschell, PhD, associate vice president, Program Implementation and Evaluation, Community Care Behavioral Health Organization, and Jessica Meyers, MSEd, senior advisor for implementation, UPMC Center for High-Value Health Care.

On this episode of Managed Care Cast, we're talking with Simon F. Haeder, PhD, MPA, associate professor of public health at Texas A&M University. His study, "When is a Network Adequate? Consumer Perspectives on Network Adequacy Definitions," explored the factors that consumers consider essential for an adequate provider network, including travel times, inclusive care, and language access.

Chris Barton, senior director of Integrated Systems of Care & Network Innovation at Horizon Blue Cross Blue Shield of New Jersey, discusses how the Youth Behavioral Health Strategy program focuses on addressing the specific needs of youth with mental health and substance use issues through a comprehensive approach

To recognize National Recovery Month, we are bringing you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In episode 3, we speak with Kim MacDonald-Wilson, ScD, CPRP, senior director, Recovery and Wellness Transformation, and Tracy Carney, CPS, CPRP, senior recovery specialist, both at Community Care Behavioral Health Organization, part of the UPMC Insurance Services Division.

To recognize National Recovery Month, we are bringing you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In episode 2, Rebekah Sedlock, DSW, LCSW, Community Care Behavioral Health, part of the UPMC Insurance Services Division, and Mandy Fauble, PhD, LCSW, UPMC Western Behavioral Health at Safe Harbor.

To recognize National Recovery Month, we are bringing you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In episode 1, we speak with Michael Lynch, MD, associate professor of emergency medicine at the University of Pittsburgh and an attending emergency physician and medical toxicologist at the University of Pittsburgh Medical Center.

On this episode of Managed Care Cast, we're talking with Eden Miller, DO, founder of the Diabetes and Obesity Care clinic in Bend, Oregon, which provides high-level obesity intervention and diabetes treatment and prevention. Her study, "Inadequate Insurance Coverage for Overweight/Obesity Management," reviews the US obesity epidemic and discusses insufficient insurance coverage for obesity management.

On this episode of Managed Care Cast, we're talking with Marge Ciancetta, the product manager of Cotiviti's Star Intelligence solution, which helps health plans and providers improve their Medicare Advantage Star Ratings. We discussed all things Star Ratings, including their importance, how they are calculated, and their impact on plans in 2024. Looking ahead, we also discussed strategies to improve ratings for 2025, especially for smaller plans.

On this episode of Managed Care Cast, we're talking with Sreekanth Chaguturu, MD, chief medical officer of CVS Health; Cathy Moffitt, MD, FAAP, CHIE, chief medical officer of Aetna; and Joneigh Khaldun, MD, MPH, FACEP, chief health equity officer of CVS Health. We discuss various topics, including the current challenges in primary and preventive care engagement, the role of trust in patient-provider relationships, and how community-based approaches and partnerships are improving care access nationwide.

On this episode of Managed Care Cast we speak with Jeffery A. Goad, PharmD, MPH, 2024-2025 president of the National Foundation for Infectious Diseases, on the recent report from the World Health Organization and UNICEF on public immunization rates, with national and global health implications.

On this episode of Managed Care Cast, we're talking with Jason Spangler, MD, MPH, the CEO of the Center for Innovation and Value Research, formerly known as the Innovation and Value Initiative (IVI). We discuss the strengths and limitations of health technology assessment (HTA), one major limitation being its lack of equity. We also touch on IVI's recent rebrand to the Center for Innovation and Value Research on July 16 and how people can get involved.

Melissa Clarke, MD, CMQ, the chief health equity officer at Elevance Health, explains "Health Equity by Design" and how Elevance Health is committed to ensuring a personalized and intentional approach for all its members, regardless of race or ethnicity, sexual orientation, gender identity, disability, and geographic or financial access.

On this episode of Managed Care Cast, we're talking with Jason Shafrin, PhD, the senior managing director of FTI Consulting's Center for Healthcare Economics and Policy and an adjunct professor in the University of Southern California's Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences. His study, "Quantifying the Insurance Value for Rare Diseases: Duchenne Muscular Dystrophy," estimates the insurance value of novel Duchenne muscular dystrophy (DMD) treatment from a survey of individuals planning to have children.

Today we are bringing you a conversation between 3 experts on paroxysmal nocturnal hemoglobinuria (PNH). Ryan Haumschild, PharmD, MS, MBA, vice president of Pharmacy at Emory Healthcare and Winship Cancer Institute, spoke with Jamie Koprivnikar, MD, of John Theurer Cancer Center; David Dingli, MD, PhD, of Mayo Clinic; and Brian P. Mulherin, MD, of American Oncology Network. The topics of conversation for today's podcast include the pathophysiology of PNH, complement inhibitors, treatment strategies, and the challenges of managing this rare, life-threatening disorder.

On this episode of Managed Care Cast, we're talking with Sreekanth Chaguturu, MD, the chief medical officer of CVS Health. We discuss the impact of recent pharmaceutical innovations, namely glucagon-like peptide-1 (GLP-1) receptor agonists and biosimilars, on patient health outcomes. Also, we explore the role of trust between patients and providers in adopting new medications, along with initiatives used to reduce drug prices and improve access.

Kim Zynn, vice president of UPMC Health Plan's provider network and development relations team, shares how physicians can become LGBTQIA+ affirming providers, which is designated within the health plan.