Podcasts about healthcare utilization

In his weekly clinical update, Daniel Griffin and Vincent Racaniello discuss withdrawal of the ACIP charter published in April 2026, the first council meeting on antibiotic resistant bacteria, the latest developments surrounding hantavirus infections, and the Ebola outbreak in the Congo and Uganda before Dr. Griffin deep dives into the measles outbreak, recent statistics RSV, influenza and SARS-CoV-2 infections, the Wasterwater Scan dashboard, Johns Hopkins measles tracker, transmission of SARS-CoV-2 through the air including ventilation systems, how to access and pay for Paxlovid, where to go for answers about long COVID-19, early use of antiviral drugs for COVID-19 patients and contacting your federal government representative to stop the assault on science and biomedical research. Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode US health department withdraws vaccine advisory panel charter (Reuters) Meeting of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (Federal Register) Andes Hantavirus Outbreak on a Cruise Ship, 2026 (NEJM) "Super-Spreaders" and Person-to-Person Transmission of Andes Virus in Argentina (NEJM) Person-to-Person Transmission of Andes Virus in Hantavirus Pulmonary Syndrome, Argentina, 2014 (CDC: Emerging Infectious Diseases) Hantavirus on board with Prof. VincentRacaniello (microbeTV) Hantavirus Doesn't Spread Easily, but Officials May Be Downplaying Risks (NY Times) Cross-binding antibodies capable of neutralising diverse hantaviruses are produced in response to Puumala virus infection (eBioMedicine) Hantavirus dashboard (Hantavirus.live) Visualizing the hantavirus cruise outbreak in maps and charts (CNN) Epidemic of Ebola Disease caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda determined a public health emergency of international concern (WHO) Ebola outbreak response intensifies in DRC and Uganda as cases mount (DG: Alerts) WHO ramps up support to the Democratic Republic of the Congo's Ebola outbreak response (WHO: Democratic Republic of Congo) Vaccine experts debate options to combat outbreak of unusual Ebola strain (Science) US promises to fund clinic established to treat Ebola (X-USForeignAssist) U.S.-Bound Flight Diverted to Canada Because of Ebola Restrictions (NY Times) Wastewater for measles (WasterWater Scan) Measles cases and outbreaks (CDC Rubeola) Big outbreak, bright lights…Measles Dashboard (South Carolina Department of Public Health) Utah measles outbreak response (Utah Department of Health and Human Services) UtahMeasles Dashboard (Utah Department of Health and Human Services) Tracking Measles Cases in the U.S. (Johns Hopkins) Measles vaccine recommendations from NYP (jpg) Weekly measles and rubella monitoring (Government of Canada) Measles (WHO) Get the FACTS about measles (NY State Department of Health) Measles(CDC Measles (Rubeola)) Measles vaccine (CDC Measles (Rubeola)) Presumptive evidence of measles immunity (CDC) Contraindications and precautions to measles vaccination (CDC) Adverse events associated with childhood vaccines: evidence bearing on causality (NLM) Measles Vaccination: Know the Facts(ISDA: Infectious Diseases Society of America) Deaths following vaccination: what does the evidence show (Vaccine) Influenza: Waste water scan for 11 pathogens (WastewaterSCan) USrespiratory virus activity (CDC Respiratory Illnesses) Respiratory virus activity levels (CDC Respiratory Illnesses) Flu vaccine recommendations: Vaccines and Related Biological Products Advisory Committee March 12, 2026 Meeting Announcement (FDA) WHO updates all 3 viral strains to be included in fall flu shots (CIDRAP) FDA vaccine advisers recommend adding subclade K to fall shots (CIDRAP) Weekly surveillance report: cliff notes (CDC FluView) OPTION 2: XOFLUZA $50 Cash Pay Option(xofluza) RSV: Waste water scan for 11 pathogens (WastewaterSCan) Respiratory Diseases (Yale School of Public Health) US respiratory virus activity (CDC Respiratory Illnesses) RSV-Network (CDC Respiratory Syncytial virus Infection) Vaccines for Adults (CDC: Respiratory Syncytial Virus Infection (RSV)) Economic Analysis of Protein Subunit and mRNA RSV Vaccination in Adults aged 50-59 Years (CDC: ACIP) Respiratory Diseases (Yale School of Public Health) Maternal RSV Vaccination, Infant Nirsevimab, or Both: Interim Analysis of a Randomized Trial (Pediatrics) Waste water scan for 11 pathogens (WastewaterSCan) COVID-19 deaths (CDC) Respiratory Illnesses Data Channel (CDC: Respiratory Illnesses) COVID-19 national and regional trends (CDC) COVID-19 variant tracker (CDC) SARS-CoV-2 genomes galore (Nextstrain) Potential airborne transmission of SARS-COV-2 through bathroom ventilation ducts associated with an outbreak in a residential building in Santander, Spain, 2020 (PLoS One) Where to get pemgarda (Pemgarda) EUAfor the pre-exposure prophylaxis of COVID-19 (INVIYD) Infusion center (Prime Fusions) Recent COVID-19 Vaccination and Risk of SARS-CoV-2 Transmission (JAMA Network OPEN) CDC Quarantine guidelines (CDC) NIH COVID-19 treatment guidelines (NIH) Drug interaction checker (University of Liverpool) Help your eligible patients access PAXLOVID with the PAXCESS Patient Support Program (Pfizer Pro) UnderstandingCoverageOptions (PAXCESS) Infectious Disease Society guidelines for treatment and management (ID Society) Molnupiravir safety and efficacy (JMV) Convalescent plasma recommendation for immunocompromised (ID Society) What to do when sick with a respiratory virus (CDC) Managing healthcare staffing shortages (CDC) Anticoagulation guidelines (hematology.org) Daniel Griffin's evidence based medical practices for long COVID (OFID) Long COVID hotline (Columbia : Columbia University Irving Medical Center) The answers: Long COVID Early antiviral use may lower risk of long COVID in mildly ill patients, aid recovery from infection (CIDRAP) Early-Phase Oral Antiviral Use and Post–COVID-19 Condition in Outpatients (JAMA Network OPEN) Impact of Early Oral Antiviral Use for Outpatients With COVID-19 on Healthcare Utilization and Recovery (ANCHOR-02) (International Journal of Infectious Diseases) Reaching out to US house representative Letters read on TWiV 1324 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene Ramsey. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv Content in this podcast should not be construed as medical advice.

What if the healthcare system your loved one relies on doesn't even know they need help until it's too late — and what would it look like if it did? In this Q1 2026 episode, Jamie Preston sits down with Matt Staub, CEO of Your Health, for a candid and wide-ranging look at how one of the country's largest home-based care providers is navigating the evolving landscape of value-based care, population health, and the human experience at the center of it all. Matt brings his characteristic clarity and heart to a conversation that is equal parts strategy, story, and honest reckoning with what the system still gets wrong. Key topics covered: Why 11% of patients account for 67% of all healthcare spending — and why most of them don't know they're in an ACO The evolution of value-based care: from quality-over-cost to outcomes + patient experience over total costs How Your Health is becoming proactive — not reactive — about falls, readmissions, and high-needs patients The quiet crisis of patient trust: down from 71% in 2020 to just 33% today, and what the correlation means for hospitalizations Real stories: a 79-year-old patient who went from barely existing to living fully — and Matt's own mom, who hasn't fallen since leaving the hospital after her stroke If you work in healthcare, advocate for someone in the system, or simply believe that better is possible — this episode will change the way you see what care can be.

Host Dr. Davide Soldato and guests Dr. Kerin Adelson and Dr. Maureen Canavan discuss JCO article "Association Between Systemic Anticancer Therapy Administration Near the End of Life with Health Care and Hospice Utilization in Older Adults: A SEER Medicare Analysis of End-of-Life Care Quality," highlighting adverse outcomes for patients who receive any type of systemic anticancer therapy(SACT) at EOL (end of life) and the need for better communication between oncologists and patients regarding expected risk and benefits of such treatments to properly align goals-of-care. TRANSCRIPT Dr. Davide Soldato: Hello and welcome to JCO After Hours, the podcast where we sit down with authors from some of the latest articles published in the Journal of Clinical Oncology. I am your host, Dr. Davide Soldato, medical oncologist at Ospedale San Martino in Genoa, Italy. Today, we are joined by JCO authors Dr. Maureen Canavan, epidemiologist and associate research scientist at Yale Cancer Outcomes, Public Policy and Effectiveness Research Center; and by Dr. Kerin Adelson, Chief Quality and Value Officer, medical oncologist, and clinical researcher on health services and clinical care delivery at MD Anderson Cancer Center. In the manuscript "Association Between Systemic Anticancer Therapy Administration Near the End of Life With Health Care and Hospice Utilization in Older Adults: A SEER-Medicare Analysis of End-of-Life Care Quality." that you recently published in the JCO, you performed an analysis that included more than 30,000 older adults in the SEER-Medicare database, and you observed that 7.6% of these patients received any systemic anticancer medication within 30 days of death. So, I wanted you to explain why you thought that this was a priority right now, and whether there was any previous data that was published in the literature, and if you think that there was any significant gap in the literature that led you to the research you just published. Dr. Kerin Adelson: We have published a series of articles looking at real-world trends  in patterns of care, particularly related to systemic anticancer therapy at the end of life. This has been gaining increasing focus in recent years because of the understanding that when patients stay on systemic anticancer therapy, that is often a surrogate for a lack of goal-concordant care. So, patients who continue to receive systemic therapy have worse quality of life, are more likely generally to have a medicalized death, and less likely to use hospice. And what our prior work has shown is that more and more we are seeing patients using immunotherapies and targeted therapies towards the end of life. No prior work had really comprehensively examined whether these novel therapies were associated with those same patterns of care increases in acute care utilization and decreases in hospice. Dr. Davide Soldato: So basically, the data that we had up until that point was mostly with cytotoxic chemotherapy, and the emergence of this new treatment, which frequently are thought to be less toxic and so less problematic also in the end of life, led to this research. Is that correct? Dr. Kerin Adelson: Correct. Dr. Maureen Canavan: I would also build on that. I think that as the landscape of cancer care changes, it is important to really understand the availability of treatments, but then also, as Kerin noted, it is important to focus on goal-concordant care. We have established literature, studies we have done and some other studies that have looked at cytotoxic chemotherapy, but with the emergence of these targeted therapies, we really did not know a few things. We did not know the rates of utilization in a large national population, and how that was associated with these elements of medicalized death like ED use, hospitalizations, acute care use. So this was really a question that we had going into it. How can we expand the knowledge base so that both patients and providers can be more cognizant when thinking about goals of care conversations and ensuring that that is in place? Dr. Kerin Adelson: And our work has kind of evolved to answer some critical questions. So, one of our early papers looked at different rates of systemic anticancer therapy at the end of life, and that is where we showed that we were seeing a lot more immunotherapy and targeted therapy. And then we asked the question, well, oncologists generally when they give these treatments, they are hoping that those treatments are going to work and help the patients live longer. So we did another paper where we actually looked at practices who were more aggressive near the end of life and whether they had better overall survival than practices that were less aggressive, accounting for the fact that there could be populations of patients who benefited. And in fact, we showed there was no survival difference. So then this paper sort of answered the question: Well, if it is not having benefit, is this treatment actually doing harm? And this study gets at that question: What are the harms of continuing patients on therapy past the point of benefit? Dr. Maureen Canavan: And I think building off of that, the use of the SEER-Medicare database is a quite robust database. So in this, we have very specific data we can track. We can track the exact type of treatment they had, you know, was it a targeted therapy? Was it immunotherapy? So looking at those subclasses of therapy. We were also able to directly link it within that time frame to the acute care utilization, a limitation that we had in some of our previous work that that data was not always available. So it is more focused in the sense that we were looking at older adults, so patients 66 years of age and older, but we were able to get those individual metrics. So to Kerin's point, we did not see the survival benefit. What do we see then for these medicalized death elements? So the higher rates of all of them across the board. Dr. Davide Soldato: So coming back to the cohort and to the data that you utilized, Dr. Canavan mentioned the use of the SEER system to analyze these data. You already mentioned that you included mostly older adults, so those aged 66 and more. And also there was a little bit of restriction regarding the fact that the patient needed to be covered by Medicare in the last year of death concerning Part A and Part B, and the last 30 days from death concerning Part D. So I just wanted to ask a little bit of a question regarding these findings and whether you think that we also need additional work, especially in the younger population because I think it is something that all of us who work in oncology have seen. The aggressiveness, and this is also something that you showed in your data, tends to increase as the age of the patient tends to decrease. So we tend to be more aggressive towards younger patients. So just a comment on that on the population and generalizability of the findings. Dr. Maureen Canavan: Yeah, I will start with the data question element. Thank you. I think there are a few things to point out for that. So in terms of the restriction to ensure that they had continuous Part D coverage, that was necessary for us to track their oral medication use during that time. So kind of an easy response. The Part A, Part B requirement, it is actually pretty widely used in studies of SEER-Medicare data, and that is you want to establish the patient population, that they are not getting treated with another insurance provider in some way that you are not able to track. So that ensures that we can track not only their systemic anticancer therapy use but also when we are trying to make sure that we are controlling for confounders like chronic conditions and stuff, we are able to track the presence of chronic conditions. So we wanted to make sure we were not biasing the data, so I think that was an important consideration. You do point out very wisely that there are then limitations with the generalizability, and I think we would be lacking if we did not account for that. But I think it is important to establish this baseline relationship association, and then you can step out, we will say, to more diverse populations. So I think we could potentially maybe try to relax the timeline to see if people that might have influx in and out of the Medicare system are still seeing those same rates. I think it is likely they would. But I think to the bigger point that you bring up is that establishing this within the older adults where, you know, we do see as they get older maybe less rates of systemic therapy, extending it to the younger population. There is a challenge with that in that just that data is not available to the robust level that SEER-Medicare is. Both Kerin and I have noted that there is the possibility to look within one specific insurance provider type. Again, recognizing the limitations of the generalizability, but always slowly pushing the needle, finding out more about younger adult populations. And I think this is maybe in an ideal world, but setting the precedent that we really do need to track this on a national scale within younger adults because they do have the need. We do see these higher rates of utilization, and really making sure again with the mindset always of the best interest of patients and the most informative to providers in how we are looking at care. So I think generalizability is definitely a goal. However, there are limitations of the availability of data for younger populations and I think that they are a necessary restraint that all researchers should acknowledge. Dr. Kerin Adelson: Yeah, I think it is important for our audience to understand that health services research and large database research is really limited by what databases are available and what are the characteristics of those databases. So we have done a lot of work in an electronic health record database, and there you can get certain kinds of granularity that you may not be able to get in a payer or a claims-based database. But what you do not get is that comprehensive look at, say, what happens if a patient goes to another practice. Claims-based databases offer you that, but research on US populations is limited by our payment system. So when you look at younger patients, there are so many different insurance companies that when you are trying to get that comprehensive view, it can be hard or very expensive actually. These commercial insurers will sell their data to different databases. So for us, the largest single payer in the United States is the US government, and that is for patients who are over age 65, and that is why you see lots of US-based studies done in the Medicare population. Interestingly, a recent paper by a Canadian group showed very, very similar patterns. It was a significantly smaller study but, right, Canada is a single-payer system and so they were able to really look at all ages, and we did see the same patterns of care in a different payment system. Dr. Davide Soldato: Going back a little bit to the type of treatments that were observed in your manuscript, so we start from a 7.6% of patients who received any type of systemic anticancer therapy within 30 days from death. And when we split the different categories that you analyzed, which I think is a very strong aspect of your manuscript, we see that more or less 50% of the patients received chemotherapy, 20% more or less received immunotherapy, more or less 20% targeted therapy, and then there is a combination of those agents. So just wanted to have a little bit of your opinion compared also to the data that you already published and that you mentioned before. Was this in line with previous data? Was there anything surprising about this? We saw a little bit of a raise in the use of immunotherapy and targeted therapy as you were saying, but still, there is a very high proportion of chemotherapy, 50%. Dr. Kerin Adelson: So I think that really, really reflects the time period in which we studied where immunotherapies were gaining ground. There was tons of excitement and we were seeing this shift. I bet if we do the same study in five years that chemotherapy percent may even go down to half, and we are going to see more and more targeted and immunotherapies, and that is just reflecting the pattern of drug discovery that we are seeing. Dr. Davide Soldato: Coming to the real question that you wanted to answer with this manuscript, so is systemic anticancer therapy associated with worse outcomes in terms of healthcare utilization and use of hospice resources? Was there any hint that for example immunotherapy was related to less of these adverse outcomes? Dr. Kerin Adelson: So I will be honest, I was a little bit surprised that the combination of chemotherapy and immunotherapy was that much more strongly correlated with acute care use at the end of life. You know, I had really thought most likely that what we would see were similar rates. And we did. Each different type of systemic anticancer therapy was associated with significantly higher odds of ending up in the hospital, going to the ICU, dying in the hospital, going to the ED. But that group that got dual therapy was that much higher, you know, over three times the risk. And that surprised me because what it suggested is that there is likely a component of treatment toxicity that is leading to some of the acute care use. It is not simply just a constellation of patients who have not yet transitioned towards hospice or palliative care or end-of-life care who are then more likely to end up in the hospital. But the fact that we see a difference between, say, single-agent immunotherapy and dual combination with chemotherapy does suggest that the treatments are actually contributing to some of what we are seeing. Dr. Davide Soldato: But still, all of the treatments that you evaluated were still associated with higher healthcare utilization. Like there was no signal that, for example, giving immunotherapy at the end of life was not associated with these adverse outcomes. Correct? Dr. Kerin Adelson: Correct. And you will find oncologists out there who will say, actually, these treatments are so good that they might actually lower rates of hospitalization because they keep patients healthy. And certainly, that may be true upstream or earlier in the course of disease, but at the end of life, any form of systemic anticancer therapy is really a surrogate marker for lack of transition towards what is likely appropriate end-of-life therapy. And I just want to point out that time spent in the hospital, going back and forth to invasive procedures, going to the intensive care unit, even going back and forth to an infusion center, that is time that is not spent at home with loved ones for people who have very little time left to live. Dr. Davide Soldato: Thank you very much. That was exactly the point that I wanted you to stress because I think it is really the most important message that we can get as oncologists from this manuscript. Like there is no treatment that is not associated with potentially harming our patient and, as you were saying, taking off time with loved ones in a critical period of the life of these individuals who have been diagnosed and treated for cancer. So, basically what we saw in the paper was a 7.65% utilization of systemic anticancer therapy. And I might imagine that for some oncologists or for some hematologists that might not actually be that much. Like they could potentially say, "Okay, but it is like 7%, it is not that high. I would have expected something higher." So I just wanted a little bit of perspective regarding also quality metrics that we have available for these types of indicators at end-of-life care. What would be the appropriate percentage of people receiving any type of treatment within 30 days from death? Dr. Maureen Canavan: A couple caveats, as a data person I always like to give those. This was among all cancer patients, so not necessarily patients that had been on active treatment. So I think that number was actually quite lower than when we looked in another study about patients that had chemo within the last year, so on, you know, active treatment. So I think that is an element to take into consideration is that those numbers will vary based on who your denominator population is. So that is important to consider. Additionally, the National Quality Forum, they call for reducing rates of systemic therapy at end of life. But I think they, similar to how I would be, are cautious to point out this is the exact number, or it should be zero. Because there are cases where you have to go in line with patient preferences. And if a patient is very adamant that they want to continue treatment, that needs to be a decision that comes between them and their provider. So, you know, the zero, though sounding ideal to us who want to encourage transitions and encourage goals of care conversation is a nice number, it is not a realistic. So, to evade your question completely, I do not think there is a set number. But the goal is to make sure that both patients, providers, everyone is informed and is making the best holistic decision. So there is this natural tendency, I think, to keep fighting both for the patient and the provider to try to beat something, but recognizing the point at which we are beyond a benefit of treatment and what would be most beneficial to the patient in terms of getting back to that idea of, you know, the time with their families and whatnot. So is the number zero? No. Could it probably be lower than we have? I think yes, definitely. Dr. Kerin Adelson: I completely agree with everything Dr. Canavan said. I think one of the other challenges is that this data isn't being tracked and publicly reported across the world. And so what that optimal rate is, is a little unclear. We see different rates also depending on the population included. So one of the things Dr. Canavan said is our database included patients who were likely treated long ago for cancer and cured of their cancer. So they were less likely to die on systemic therapy. But until everybody starts tracking and reporting, it is really hard to know where we are as a country or really as a global population, and then what are the bars that we want to achieve in driving down the rates. I think some data shows that probably something in the range of 10% or below, you know, for patients who have more active cancer is probably where we should be going and driving towards. But until we have more public reporting of these metrics and consistency in how we measure them, it is really hard to come up with a single number. Dr. Davide Soldato: I have the impression that sometimes there is also a little bit of difficulty for the oncologist or the hematologist to really understand who are the patients who are approaching end of life. So there has been some data and you also report some of them in the discussion of the manuscript regarding, for example, prompts inside of the electronic health records or the use of artificial intelligence to try to predict what is the disease course. So just wanted a little bit of perspective if you think that these tools could potentially be helpful and if you think that we will be able at a certain point to implement them in routine clinical care. Dr. Kerin Adelson: I have been working on trying to do this actually at MD Anderson and coming up with a really reliable data tool that will tell us who are the patients who are going to die in short order after receiving systemic anticancer therapy. And it is not that easy, I will say. So, you know, I think we all want this amazing machine learning model that is incredibly reliable. But like any statistical test, there are problems, right? So a very sensitive test that is going to identify high, high risk of dying at the end of life is going to be compromised by false positives. And when an oncologist knows that the test might be a false positive, it becomes very hard for them to take action on it. Similarly, you know, a very, very specific test is going to be compromised by false negatives. So in that case, you could end up having patients who are at risk for dying and still treating them with chemotherapy. And so, you know, I think in the end we need some tools. It will be great if machine learning becomes very reliable and we have the right structured data elements in our electronic health records to give these reliable prediction tools. But I think there are some basic things that we all know, and those are the markers of chronicity of cancer. So patients who have had multiple lines of therapy already, right? Past the point of clinical trial benefit. Patients who have lost significant amounts of weight. Patients who are not getting out of bed and have worse performance status. Patients who are increasingly confused, right? And not mentally engaging the way they did previously. Those markers have been shown in numerous publications by a colleague of mine, David Hui and others, to really be pretty strong predictors, and they resonate with clinicians more than a machine learning score might. You know, I think when clinicians do not understand what the elements in a machine learning tool are, they are less likely to trust it and more likely to say, "Oh, it is a false positive or a false negative." But very few clinicians can argue against the fact that the patient who hasn't gotten out of bed in two weeks is somebody who is less likely to benefit. Dr. Davide Soldato: Dr. Adelson, I would like to close this podcast and I would like to thank you again for joining us today. Dr. Maureen Canavan: Thank you so much. Dr. Kerin Adelson: Thank you so much for having us. Dr. Davide Soldato: Dr. Canavan, Dr. Adelson, we appreciate you sharing more on your JCO article titled "Association Between Systemic Anticancer Therapy Administration Near the End of Life With Health Care and Hospice Utilization in Older Adults: A SEER-Medicare Analysis of End-of-Life Care Quality." If you enjoy our show, please leave us a rating and review and be sure to come back for another episode. You can f ind all ASCO shows at asco.org/podcast. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    Disclosures Kerin AdelsonStock and Other Ownership Interests: Carrum Health Consulting or Advisory Role: Abbvie, Quantum Health, Gilead SciencesPatents, Royalties, Other Intellectual Property: Genentech Other Relationship: Genentech/Roche Employment: Emilio Health/Brightline Health(An Immediate Family Member) Stock and Other Ownership Interests: Emilio Health/Brightline Health, Lyra Health (An Immediate Family Member)

Send us a textIn this episode of Rupa's Fellows Friday on The Incubator Podcast, host Rupa Srirupa welcomes Dr. Ambika Bhatnagar, a third-year neonatology fellow at Yale. Dr. Bhatnagar shares her journey from medical school in India to fellowship in the U.S. and dives into her research focusing on moderate to late preterm infants—an often overlooked but significant portion of the preterm population.She explains why this group, though not as critically ill as extremely preterm infants, still faces unique morbidities and places a substantial burden on families and the healthcare system. Her study investigates long-term healthcare utilization in these infants over their first two years of life, analyzing not just hospital readmissions but also ER visits, subspecialty consultations, and therapy appointments.Dr. Bhatnagar discusses her findings, including the role of breastfeeding in reducing healthcare utilization and surprising trends in demographic factors. She also shares insights on mentorship during fellowship, building a research project from scratch, and her involvement with NeoQuest, an educational platform for neonatology fellows.This conversation highlights the importance of curiosity-driven research and its potential to improve outcomes for a vulnerable but under-researched neonatal population. Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Many patients have access to healthcare programs but don't participate, leading to poorer health outcomes and higher costs. This episode explores a novel solution: Reciprocity Health – a member of the StartUp Health community since 2023 – has developed their platform TheraPay to use financial incentives to encourage healthy behavior. Hear Matt Swanson, CEO & Co-founder, discuss how to design programs that benefit both patients and the healthcare system. Learn: How TheraPay improves patient engagement for better health outcomes The cost-saving potential of proactive care Strategies for closing the healthcare utilization gap This episode is a must-listen for anyone interested in improving healthcare access, financial incentives in health, and building a more cost-effective healthcare system. Listen now and unlock the power of positive reinforcement for better health! Are you ready to tell your story? Members of our Health Moonshot Communities are leading startups with breakthrough technology-driven solutions for the world's biggest health challenges. Exposure in StartUp Health Media to our global audience of investors and partners – including our podcast, newsletters, magazine, and YouTube channel – is a benefit of StartUp Health's PRO Membership. To schedule a call and see if you qualify to join and increase brand awareness through our multi-media storytelling efforts, submit our three-minute application. If you're mission-driven, collaborative, and ready to contribute as much as you gain, you might be the perfect fit. Learn more and apply today. Want more content like this? Sign up for StartUp Health Insider™ to get funding insights, news, and special updates delivered to your inbox.

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. Welcome to diabetes core update where every month we go over the most important articles to come out in the field of diabetes. Articles that are important for practicing clinicians to understand to stay up with the rapid changes in the field.  This issue will review: 1.     Insulin Efsitora versus Degludec in Type 2 Diabetes without Previous Insulin Treatment   2.     Semaglutide and Opioid Overdose Risk in Patients With Type 2 Diabetes and Opioid Use Disorder 3.     Associations of Diabetes and Prediabetes with Mortality and Life Expectancy in China: A National Study 4.     GLP-1 Medication Use for Type 2 Diabetes in the US 5.     Healthcare Utilization and Cost Associated with Empagliflozin in Older Adults with Type 2 Diabetes   For more information about each of ADA's science and medical journals, please visitwww.diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Director, Family Medicine Residency Program, Chair-Department of Family Medicine, Abington Jefferson Health

The Journal of Rheumatology's Editor-in-Chief Earl Silverman discusses this month's selection of articles that are most relevant to the clinical rheumatologist. Comparative Effectiveness of BNT162b2 and mRNA-1273 Vaccines Against COVID-19 Infection Among Patients With Systemic Autoimmune Rheumatic Diseases on Immunomodulatory Medications - doi.org/10.3899/jrheum.220870 Validation of the Antineutrophil Cytoplasmic Antibody Renal Risk Score and Modification of the Score in a Chinese Cohort With a Majority of Myeloperoxidase-Positive Patients - doi.org/10.3899/jrheum.220818 Predicting Disease Activity in Rheumatoid Arthritis With the Fibromyalgia Survey Questionnaire: Does the Severity of Fibromyalgia Symptoms Matter? - doi.org/10.3899/jrheum.220507 Effect of Communicative and Critical Health Literacy on Trust in Physicians Among Patients With Systemic Lupus Erythematosus (SLE): The TRUMP2-SLE Project - doi.org/10.3899/jrheum.220678 Investigating Associations Between Access to Rheumatology Care, Treatment, Continuous Care, and Healthcare Utilization and Costs Among Older Individuals With Rheumatoid Arthritis - doi.org/10.3899/jrheum.220729

Commentary by Dr. Valentin Fuster

The Journal of Rheumatology's Editor-in-Chief Earl Silverman discusses this month's selection of articles that are most relevant to the clinical rheumatologist. Inflammatory Bowel Disease Risk in Patients With Axial Spondyloarthritis Treated With Biologic Agents Determined Using the BSRBR-AS and a MetaAnalysis - doi.org/10.3899/jrheum.211034 Women With Psoriatic Arthritis Experience Higher Disease Burden Than Men: Findings From a Real-World Survey in the United States and Europe - doi.org/10.3899/jrheum.220154 The Effect of Psychiatric Comorbidity on Healthcare Utilization for Youth With Newly Diagnosed Systemic Lupus Erythematosus - doi.org/10.3899/jrheum.220052 The Reclassification of Patients With Previously Diagnosed Eosinophilic Granulomatosis With Polyangiitis Based on the 2022 ACR/EULAR Criteria for Antineutrophil Cytoplasmic Antibody–Associated Vasculitis -doi.org/10.3899/jrheum.220560 Adult-Onset Still Disease After ChAdOx1 nCOV-19 Vaccination - doi.org/10.3899/jrheum.220219

Jakob Emerson shares the latest news on the Payer industry.

In this episode, Princy N. Kumar, MD, and Paul E. Sax, MD, discuss new COVID-19 data from IDWeek 2022, including:COVID-19 vaccines, including omicron BA.1 bivalent boosterRisk factors for breakthrough COVID-19 infectionsCOVID-19 diagnostics, including digital droplet PCRCOVID-19 therapeutics, including:Nirmatrelvir plus ritonavirTixagevimab plus cilgavimabBaricitinibTocilizumabInhaled interferon β-1aCOVID-19 therapeutics and outcomes in patients with immunocompromiseLong COVIDPresenters:Princy N. Kumar, MD, FIDSA, MACPProfessor of Medicine and MicrobiologyChief, Division of Infectious Diseases and Travel MedicineSenior Associate Dean of StudentsGeorgetown University School of MedicineWashington, DCPaul E. Sax, MDClinical DirectorHIV Program and Division of Infectious DiseasesBrigham and Women's HospitalProfessor of MedicineHarvard Medical SchoolBoston, MassachusettsFollow along with the downloadable slideset at:http://bit.ly/3gkJI67Link to full program:http://bit.ly/3TSVthM

Best of PsA on Day 1 Dr. Rachel Tate discusses the best PSA data presented Saturday, November 12, 2002 at ACR22 Convergence.  Abstract 0387: Sleep Quality in Patients with Psoriatic Arthritis and Its Relationship with Activity and Comorbidity Abstract 0377: Differences in Early-onset vs. Late-onset Psoriatic Arthritis: Data from the RESPONDIA and REGISPONSER Studies Can computers tell the difference between RA & PsA? Dr. David Liew discusses Abstract 0242 presented at ACR22 in Philadelphia, PA. Abstract 0242: Neural Networks for Distinguishing Rheumatoid Arthritis from Psoriatic Arthritis by Using Magnetic Resonance Imaging Can you use the BASDAI in Pregnancy? Dr. Eric Dein discusses abstract 0374 presented at ACR22 Convergence in Philadelphia, PA. Abstract 0374: The BASDAI Index During Pregnancy Drs Tate and Worthing What's going on on the Hill Session # 12S119. Effect of voclosporin in class V lupus nephritis Dr. Yusof discusses abstract 0355 presented at ACR22 Convergence in Philadelphia, PA.  Abstract 0355: Long-term Use of Voclosporin in Patients with Class V Lupus Nephritis: Results from the AURORA 2 Continuation Study Microbiome and AxSPA Dr. Akhil Sood discusses abstract 1162 presented at ACR22 Convergence in Philadelphia, PA.  Abstract 1162: Improvement of Gut Microbiota Dysbiosis in Patients with Axial Spondyloarthritis After One Year of Biological Treatment Opioids and Health Care Utilization in PsA and AS Dr Aurelie Najm  discusses Abstract 0402 presented at ACR22 Convergence in Philadelphia, PA. Abstract 0402: Opioid Use and Healthcare Utilization in Adults with PsA and AS Switching Between JAK Inhibiters in RA Dr. Janet Pope discusses abstract 0274 presented at ACR22 Convergence in Philadelphia, PA.  Abstract 0274: Real-world Utilisation and Switching Between Janus Kinase Inhibitors in Patients with Rheumatoid Arthritis in the Australian OPAL Dataset Treatment Choices and Mortality in RA ILd 2 Dr. Julian Segen, Philadelphia Dr. Bryant England, Philadelphia Upadacitinib vs  Adalimumab in PsA using RAPID3 Dr. Catherine Sims discusses abstract 0192 presented at ACR22 Convergence.  0192: Upadacitinib versus Adalimumab on Routine Assessment of Patient Index Data 3 (RAPID3) in Patients with Psoriatic Arthritis      

Can we alter neonatal gut microbiome to prevent spondyloarthritis? Dr Chao discusses Abstract 0868 at the ACR22 Convergence meeting.  Abstract 0868: Spondyloarthritis and Neonatal Factors Affecting the Gut Microbiome JAK vs TNF inhibitor Infections in RA Dr. David Liew discusses abstract 0302 at ACR22 Convergence. Abstract 0302: Risk of Infections Between JAK Inhibitors and TNF Inhibitors Among Patients with Rheumatoid Arthritis Opioid and Neuropathic Use After Initiating btsDMARDs in RA Dr. Julian Segan discusses Abstract 0925 at the ACR22 Convergence meeting. The Dietary Intervention in PsA (DIPSA) StudyDr. Patricia Harkins talks with Professor Lihi Eder about abstract 1007 at the ACR22 Convergence meeting.  Abstract 1007: Metabolic Disorders and Abnormal Dietary Patterns and Their Association with Psoriatic Arthritis Activity: The Dietary Intervention in PsA (DIPSA) Study Treatment Considerations in Axial Spondyloarthritis Dr. Lianne Gensler discusses treatment considerations in Axial SpA. Abstract 0402: Opioid Use and Healthcare Utilization in Adults with PsA and AS Abstract 0388: Incidence Rate and Factors Associated with Fractures Among Older Adults with Ankylosing Spondylitis in the United States Abstract 0544: Bimekizumab Improves Signs and Symptoms, Including Inflammation, in Patients with Active Non-Radiographic Axial Spondyloarthritis: 24-Week Efficacy & Safety from a Phase 3, Multicenter, Randomized, Placebo Controlled Study Abstract 0545: Continuing (Full or Reduced Treatment) versus Withdrawing from Golimumab Treatment in Patients with Non-radiographic Spondylarthritis Who Achieved Inactive Disease: Efficacy and Safety Results from a Placebo-Controlled, Randomized Withdrawal and Retreatment Study (GO-BACK) What lifestyle factors affect TNF inhibitor efficacy in AxSpA? Dr Chao discusses Abstract 1510 at ACR22 Convergence. Abstract 1510: Modifying Lifestyle Factors May Offer the Potential to Enhance the Outcome of Tumour Necrosis Factor Inhibitors in Axial Spondyloarthritis – Data from 14 European Countries    

Frailty in Vasculitis Dr. Patricia Harkins sits down with Professor Sebastian Sattui to discuss Abstract 0444, Prevalence of Frailty and Associated Factors in Patients with Vasculitis, being presented on Saturday at ACR22 Convergence. Lupus, Sex and STDs Dr. Kathryn Dao discusses abstract 0939 presented at the ACR22 Convergence meeting in Philadelphia, PA. Abstract 0939: Pilot Study: A Novel Method for Cervical Health Monitoring in African American Women with Systemic Lupus Erythematosus (SLE) Using a Self- Sampling Brush to Assess Cervical HPV Infection and Cervical Cytology Much gusto for GUSTO: Efficacy of Tocilizumab Monotherapy for Giant Cell Arteritis Dr. Richard Conway discusses abstract 0470, being presented during Poster Session A on Saturday, November 12, 2022 at the ACR 2022 meeting.  Abstract 0470: Long-term Efficacy of Tocilizumab Monotherapy After Ultra-short Glucocorticoid Administration to Treat Giant Cell Arteritis – One Year Follow-up of the GUSTO Trial NSAIDs and CV risk in Inflammatory Arthritis Dr. Richard Conway discusses abstract 1207, being presented during Poster Session C on Sunday, November 13, 2022 at the ACR 2022 meeting.  Abstract 1207: Risk Factors for Major Cardiovascular Events (MACE) in Inflammatory Arthritis: A Time-dependent Analysis on the Inflammatory Burden, Use of DMARDs, NSAIDs, and Steroid Should You Repeat the ENA Panel? Dr. Kathryn Dao discusses abstract 0725, presented at ACR22 Convergence.  Abstract 0725: Utility of Repeat Extractable Nuclear Antigen Antibody Testing- a Retrospective Audit To Beta Block or Not in GCA and Large Vessel Vasculitis Dr. Patricia Harkins discusses abstract 0477 presented on Saturday, November 12, 2022, at ACR22 Convergence. Abstract 0477: Can Beta-blockers Prevent Aortic Dilation in Patients with Giant Cell Arteritis and Large Vessel Vasculitis? A Novel Treatment Response Measurement Tool for Lupus Dr. Kathryn Dao discusses abstract 2054 with Dr. Eric Morand at the ACR22 Convergence meeting. Abstract 2054: Towards a Novel Clinician-Reported Outcome Measure for SLE – Outcomes of an International Consensus Process Sarilumab in Polymyalgia Rheumatica: Results from Phase 3 Trial Dr. Michael Putman interviews Dr. Robert Speira about abstract 1676 presented at the ACR22 Convergence meeting in Philadelphia, PA.  Abstract 1676: Sarilumab in Patients with Relapsing Polymyalgia Rheumatica: A Phase 3, Multicenter, Randomized, Double Blind, Placebo Controlled Trial (SAPHYR) Welcome to ACR 2022 Dr. Jack Cush, Executive Editor of RheumNow, welcomes you to Philadelphia for ACR22 Convergence! 2022 ACR/EULAR Classification Criteria for GCA Dr. Michael Putman discusses interesting take-home messages from the Vasculitis Investigators Meeting at ACR22 Convergence regarding the 2022 ACR/EULAR Classification Criteria for GCA. Gender in AxSpa Dr. Peter Nash, Philadelphia Do Disease Activity Measures Really Capture AS in Women? Dr. Rachel Tate interviews Dr. Sinead Mcguire about Abstract 0406, presented at ACR22 Convergence in Philadelphia, PA. Abstract 0406: https://acrabstracts.org/abstract/are-the-basdai-basfi-capturing-the-full-impact-of-disease-activity-on-quality-of-life-in-women-with-axial-spondyloarthritis/ Dr Aurelie Najm  Opoids and health care utilization in PsA and AS Abstract 402 Poor Medication Adherence in SLE  and How to Improve It Dr. Janet Pope discusses three abstracts presented at the ACR22 Convergence meeting in Philadelphia, PA. 0343: Severe Non-adherence to Hydroxychloroquine Is Associated with Flares, Early Damage, and Mortality in Systemic Lupus Erythematosus: Data from 660 Patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort 0115: Facilitators of Immunosuppressive Medication Adherence in Systemic Lupus Erythematosus: A Qualitative Study of Racial Minority Patients, Lupus Providers and Clinic Staff 0063: Implementability of a SLE Medication Adherence Intervention Sputum anti-CCP the new diagnostic test in at-risk RA? Dr. Aurelie Najm discusses abstract 0533 at the ACR22 Convergence meeting in Philadelphia, PA. Abstract 0533: Sputum RA-Associated Autoantibodies Independently Associate with Future Development of Classified RA in an At-Risk Cohort of Individuals with Systemic Anti-CCP Positivity Drs Cush and Fava:  Urinary Biomarkers in Lupus Dr. Jack Cush interviews Dr. Andrea Fava about Abstract 536 at the ACR22 Convergence meeting in Philadelphia, PA. Abstract 0536: Change in Urinary Biomarkers at Three Months Predicts 1-year Treatment Response of Lupus Nephritis Better Than Proteinuria Social Media in Rheumatology Academia Dr. Kathryn Dao, Dallas Jorena Lim, third-year medical student, UTSW, Dallas Abstract 0220 Treatment Choices and Mortality in RA ILd Dr. Julian Segen, Philadephia Dr. Bryant England, Philadephia Dr Tate PsA Cycling or Switching MOAs with Dr  Ogdie Abstracts 1600 and 402. Dr Cassy Sims The Impact of Upacitinib vs  Adalimumab in Psoriatic Arthritis using RAPID Abstract 192. Urinary Biomarkers in Lupus Dr. Jack Cush interviews Dr. Andrea Fava about Abstract 536 at the ACR22 Convergence meeting in Philadelphia, PA. Abstract 0536: Change in Urinary Biomarkers at Three Months Predicts 1-year Treatment Response of Lupus Nephritis Better Than Proteinuria Dr Janet Pope Switching from a JAK Inhibiter Abstract 0274. Dr Yusof Effect of voclosporin in Class 5 lupus nephritis Abstract 0355. Best of PsA Dr. Rachel Tate Drs Yusof and Sexena Breakthrough COVID infection in a lupus cohort during Omicron era Session # 12S119. PsA Cycling or Switching MOAs Dr. Rachel Tate interviews Dr. Alexis Ogdie at ACR22 Convergence in Philadelphia, PA.  Abstract 1600: The Impact of Second-Line Therapeutic on Disease Control After Discontinuation of First Line TNF Inhibitor in Patients with PsA: Analysis from the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry Abstract 402: Opioid Use and Healthcare Utilization in Adults with PsA and AS Urine Proteomics in SLE with Dr. Michelle Petri Dr. Michelle Petri discusses abstract 0536, Change in Urinary Biomarkers at Three Months Predicts 1-year Treatment Response of Lupus Nephritis Better Than Proteinuria, being presented Saturday at ACR22 Convergence.

CF 246: Healthcare Utilization for Spine Pain & Sensorimotor Retraining on Pain Intensity Today we're going to talk about Healthcare Utilization for Spine Pain & Sensorimotor Retraining on Pain Intensity But first, here's that sweet sweet bumper music Purchase Dr. Williams's book, a perfect educational tool and chiropractic research reference for the daily practitioner, from... The post Healthcare Utilization for Spine Pain & Sensorimotor Retraining on Pain Intensity appeared first on Chiropractic Forward.

Guest: Manpreet Mundi, MD Despite the increasing prevalence of home enteral nutrition over the last few decades, there has not been an equal rise in the number of studies being conducted in this population, which makes it difficult to develop guidelines and answer key clinical questions. So to help address this gap, the home enteral nutrition team at Mayo Clinic conducted a retrospective analysis of patients who utilized peptide-based diets, and now, Dr. Manpreet Mundi is here to share the results of that analysis.

Guest: Manpreet Mundi, MD Despite the increasing prevalence of home enteral nutrition over the last few decades, there has not been an equal rise in the number of studies being conducted in this population, which makes it difficult to develop guidelines and answer key clinical questions. So to help address this gap, the home enteral nutrition team at Mayo Clinic conducted a retrospective analysis of patients who utilized peptide-based diets, and now, Dr. Manpreet Mundi is here to share the results of that analysis.

Guest: Manpreet Mundi, MD Despite the increasing prevalence of home enteral nutrition over the last few decades, there has not been an equal rise in the number of studies being conducted in this population, which makes it difficult to develop guidelines and answer key clinical questions. So to help address this gap, the home enteral nutrition team at Mayo Clinic conducted a retrospective analysis of patients who utilized peptide-based diets, and now, Dr. Manpreet Mundi is here to share the results of that analysis.

Guest: Manpreet Mundi, MD Despite the increasing prevalence of home enteral nutrition over the last few decades, there has not been an equal rise in the number of studies being conducted in this population, which makes it difficult to develop guidelines and answer key clinical questions. So to help address this gap, the home enteral nutrition team at Mayo Clinic conducted a retrospective analysis of patients who utilized peptide-based diets, and now, Dr. Manpreet Mundi is here to share the results of that analysis.

This episode describes healthcare Utilization and Disabled Veteran Status as it relates to approved versus denied benefits. Veterans denied VA disability compensation experience social isolation. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/dr-clarence-alford/message

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association’s four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 20 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. This issue will review: Normalization of functional beta cell capacity after weight loss in type 2 diabetes Screening for glucose intolerance and diabetes in patients with coronary artery disease Trends Prescribing Preferences for SGLT2 Inhibitors and GLP-1 Receptor Agonists, 2013–2018 Impact of a Telephone Intervention to Improve Diabetes Control on Healthcare Utilization and Cost for Adults in South Bronx, New York – Efficacy and Safety of Dapagliflozin Plus Saxagliptin Versus Insulin Glargine Over 52 Weeks as Add‐on to Metformin With or Without Sulfonylurea in Patients With Type 2 Diabetes The Association Between Poor Glycemic Control and Health Care Costs in People With Diabetes For more information about each of ADA’s science and medical journals, please visit www.diabetesjournals.org. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Director, Family Medicine Residency Program, Chair-Department of Family Medicine, Abington Jefferson Health

On this episode of Managed Care Cast, we speak with John Showalter, MD, chief product officer at Jvion and an internal medicine physician, and Soy Chen, MS, director of data science at Jvion and part of their data science team. We discuss their research about using applied machine learning to predict healthcare utilization based on social determinants of health, appearing in the January 2019 Health IT issue of The American Journal of Managed Care®.

As 2018 draws to a close, The American Journal of Managed Care® (AJMC®)'s co-editors-in-chief, A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan, and Michael E. Chernew, PhD, director of the Healthcare Markets and Regulation Lab at Harvard Medical School, recapped their favorite AJMC® papers published in 2018, identified events from the year that are likely to impact future research in the journal, and looked ahead to 2019 with healthcare and health policy predictions. Read more about the papers and news events mentioned: Financial Burden of Healthcare Utilization in Consumer-Directed Health Plans: https://www.ajmc.com/journals/issue/2018/2018-vol24-n4/financial-burden-of-healthcare-utilization-in-consumer-directed-health-plans A Randomized, Pragmatic, Pharmacist-Led Intervention Reduced Opioids Following Orthopedic Surgery: https://www.ajmc.com/journals/issue/2018/2018-vol24-n11/a-randomized-pragmatic-pharmacistled-intervention-reduced-opioids-following-orthopedic-surgery Overall US Healthcare Spending Growth Slowed for Second Year, CMS Says: https://www.ajmc.com/focus-of-the-week/overall-us-healthcare-spending-growth-slows-for-second-year-cms-says Levers to Reduce Use of Unnecessary Services: Creating Needed Headroom to Enhance Spending on Evidence-Based Care: https://www.ajmc.com/journals/issue/2018/2018-vol24-n8/levers-to-reduce-use-of-unnecessary-services-creating-needed-headroom-to-enhance-spending-on-evidencebased-care Addressing Low-Value Care and a Better Benefit Design at the V-BID Summit: https://www.ajmc.com/managed-care-cast/addressing-lowvalue-care-and-a-better-benefit-design-at-the-vbid-summit Federal Judge Strikes Down Affordable Care Act: https://www.ajmc.com/newsroom/federal-judge-strikes-down-affordable-care-act In the Wake of ACA Ruling, the Only Thing Certain Is Uncertainty: https://www.ajmc.com/focus-of-the-week/in-the-wake-of-aca-ruling-the-only-thing-certain-is-uncertainty

The September issue of The American Journal of Managed Care® highlighted research into social determinants of health and ways to address social determnants in the health system. In a commentary, Dhruv Khullar, MD, MPP, and Rainu Kaushal, MD, MPH, both of the Weill Cornell Department of Health Policy and Research, outlined how health systems can utilize data-sharing networks to deliver targeted care to high-need, high-cost patients. In this interview, Khullar outlines the idea of precision health, challenges the industry faces when trying to share data, and what steps can be taken to implement such care. Learn more about drug prices in the United States and efforts to lower them: “Precision Health” for High-Need, High-Cost Patients: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/precision-health-for-highneed-highcost-patients Language Barriers and LDL-C/SBP Control Among Latinos With Diabetes: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/language-barriers-and-ldlcsbp-control-among-latinos-with-diabetes Food Insecurity, Healthcare Utilization, and High Cost: A Longitudinal Cohort Study: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/food-insecurity-healthcare-utilization-and-high-cost-a-longitudinal-cohort-study Health Literacy, Preventive Health Screening, and Medication Adherence Behaviors of Older African Americans at a PCMH: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/health-literacy-preventive-health-screening-and-medication-adherence-behaviors-of-older-african-americans-at-a-pcmh

Jane Ferguson: Hello. Welcome to episode 19 of Getting Personal: Omics of the Heart, the issue from August 2018. I am Jane Ferguson, and this podcast is brought to you by the Circulation: Genomic and Precision Medicine Journal and the American Heart Association Council on Genomic and Precision Medicine. Before I dive into the papers from this month, a reminder that early bird registration for AHA Scientific Sessions runs until September 4th, so go register now if you haven't already to take advantage of reduced rates. The meeting will be held in Chicago from November 10th through 12th, and it's the first year of the new three-day meeting format. It's already promising to be a really great meeting, and I'm hoping to see a lot of you there.     The August issue has a number of really interesting papers. First up, Gardar Sveinbjornsson, Eva Olafsdottir, Kari Stefansson, and colleagues from deCODE genetics-Amgen report that variants in NKX2-5 and FLNC cause dilated cardiomyopathy and sudden cardiac death. This team leveraged available DNA samples from the Icelandic population to carry out a genome-wide association study in 424 cases of dilated cardiomyopathy and over 337,000 controls. They applied whole genome sequencing to all of these samples, allowing them to identify common and rare variants. In total, they tested over 32 million variants.     They found two variants that were significantly associated with DCM at genome-wide significance, a missense variant in NKX2-5 and a frameshift in FLNC, both associated with heart failure and sudden cardiac death. Further, the NKX2-5 variant was associated with atrioventricular block and atrial septal defect. Although these variants are rare and not documented in other populations, they are significant contributors to familial DCM in Iceland. Because of the unique population structure of Iceland and known genealogy, the researchers were able to trace the NKX2-5 variant back to a common ancestor born in 1865. They traced the FLNC variants to a common ancestor born in 1595.     While the specific variants identified in this study may not be present in other populations, they are located in genes with known relevance for cardiac function. NKX2-5 encodes a cardiac transcription factor, which is required for embryonic cardiac development, and other variants in this gene have been associated with cardiac dysfunction in other populations. FLNC encodes filamin-C, a muscle cross-linking protein. Variants in FLNC have previously been ascribed to associate with myofibrillar myopathy, muscular dystrophy, and cardiomyopathy. This study adds to our knowledge of the genetics of dilated cardiomyopathy and supports screening for NKX2-5 and FLNC variants, particularly in the Icelandic population, which would allow for early intervention and monitoring in carriers.     Staying with the topic of dilated cardiomyopathy, Inken Huttner, Louis Wang, Diane Fatkin, and colleagues from the Victor Chang Cardiac Research Institute in Australia report that an A-band titin truncation in zebrafish causes dilated cardiomyopathy and hemodynamic stress intolerance. We actually talked to Dr. Wang about this research last year when he was presenting this as a finalist for the FGTB Young Investigator Award. You can go back in the archives to episode 10 from November 2017 if you'd like to hear more.     Titin mutations are responsible for a large number of cases of dilated cardiomyopathy, but there are also individuals with titin mutations that remain asymptomatic. This group used zebrafish as a model of human titin mutations and generated fish with a truncating variant in the A-band of titin, as has been identified in families with DCM. They found that homozygous mutants had a severe cardiac phenotype with premature death, but that heterozygous carriers survived into adulthood and developed spontaneous DCM. Prior to onset of DCM, the heterozygous fish had reduced baseline ventricular systolic function and reduced contractile response to hemodynamic stress, as well as ventricular diastolic dysfunction.     Overall, the mutant fish displayed impaired ability to mount stress responses, which may have contributed to development of disease. Extrapolating this to humans, this could suggest that hemodynamic stress may be a factor that contributes to timing and severity of disease in individuals with titin variants. Hemodynamic stress can be exerted by exercise, pregnancy, and other diseases contributing to ventricular volume overload. Modifying these hemodynamic stressors in at-risk subjects could potentially help to modulate the severity of DCM phenotypes.     Moving on to the topic of coronary artery disease, Vinicius Tragante, Daiane Hemerich, Folkert Asselbergs, and colleagues from University Medical Center Utrecht in the Netherlands report on druggability of coronary artery disease risk loci. This group was interested in using results from genome-wide association studies for CAD to identify new targets that may be amenable for drug repurposing. They used results from published GWAS for CAD and created a pipeline to integrate these loci with data on drug-gene interactions, chemical interactions, and potential side effects. They also calculated a druggability score based on the gene products to prioritize targets that are accessible and localized to increase the chance of a drug being able to find the target without affecting core systemic processes or housekeeping genes.     Their pipelines allowed them to identify three possible drug-gene pairs, including pentolinium to target CHRNB4, adenosine triphosphate to target ACSS2, and riociguat to target GUCY1A3. They also identified three proteins to be prioritized for drug development, including leiomodin 1, huntingtin-interacting protein 1, and protein phosphatase 2, regulatory subunit b-double prime, alpha). While these predictions were all made in silico and need to be extensively tested in clinical trials, the pipeline did identify many current therapies for CAD and myocardial infarction, including statins, PCSK9 inhibitors, and angiotensin II receptor blockers. These positive controls support that this method can successfully discover effective CAD therapies.     Staying on the topic of drugs, Kishan Parikh, Michael Bristow, and colleagues from Duke University report on dose response of beta-blockers in adrenergic receptor polymorphism genotypes. Two clinical trials have reported pharmacogenomic interactions between beta-blockers and beta-1 adrenergic receptor genotype in the setting of heart failure with reduced ejection fraction. In a retrospective analysis in almost 2,000 subjects from the BEST and HF-ACTION studies, the authors analyzed whether genotype at the Arg389Gly polymorphism in beta-1 adrenergic receptor, or an indel in the alpha-2C adrenergic receptor interacted with drug dose to affect mortality and hospitalization.     They found that ADRB1 genotype affected mortality in response to drug dose with less all-cause mortality in high versus no or low-dose beta-blockers in individuals homozygous for arginine at position 389, but not in individuals carrying a glycine at that position. In individuals on high-dose beta-blockers, genotype did not affect outcomes, but there was a significant difference by genotype in all-cause mortality in individuals on no or low-dose beta-blockers. These data support the guideline recommendations to use high-target doses of beta-blockers in HFrEF.     Switching gears towards precision medicine and genotype-guided approaches, Laney Jones, Michael Murray, and colleagues from Geisinger were interested in the patient's perspective. In their paper, Healthcare Utilization and Patients’ Perspectives After Receiving a Positive Genetic Test for Familial Hypercholesterolemia, they explored the impact of providing genotype test results for familial hypercholesterolemia to subjects participating in the MyCode Community Health Initiative. In MyCode, exome sequencing is conducted in participants, and results are returned for pathogenic and likely pathogenic variants in genes representing actionable conditions based on American College of Medical Genetics secondary findings and recommendations.     It is estimated that 3.5% of MyCode participants will be carriers of such variants, and this number may increase as more variants are discovered. In this pilot study, the authors screened for individuals with mutations in LDLR, APOB, or PCSK9, consistent with FH. They identified 28 individuals, of which 23 were eligible for inclusion in the study. Only five of the 23 subjects had previously been diagnosed with FH. Receipt of genetic test results led to change in medications in 39% of individuals. 96% of the subjects had previous LDL measurements, but only four subjects had ever met LDL goals. After genetic test results, three individuals met their LDL goals.     Seven individuals consented to participate in interviews about their experience. Almost all of these subjects already had a personal or family history of high cholesterol or heart disease, and all subjects felt that they were being adequately treated. Only three of the seven subjects mentioned using diet and exercise to control their high cholesterol, with most individuals being relatively unconcerned because they felt their medication was effective in controlling disease risk.     While the numbers studied here are too small for any statistical testing or inference, the paper describes the results from the interviews, including some excerpts from patients, which really highlight the complexities of returning results and of helping patients understand what their results mean. Given increasing genetic testing and returning of results, studies like this are really important to help us figure out the most effective ways to communicate results and support patients and their care providers.     Also from a patient-centric perspective, we have an article from Susan Christian, Joseph Atallah, and colleagues from the University of Alberta in Canada on when to offer predictive genetic testing to children at risk of an inherited arrhythmia or cardiomyopathy, the family perspective. This article considers the timing of cascade testing to predict inherited arrhythmias and cardiomyopathy in children of affected individuals. European and North American guidelines differ on when or if they recommend genetic testing in children.     In this study, surveys were circulated to foundations and patient groups to solicit familial perspectives on when genetic testing should be offered to children. In total, 213 individuals responded. In the case of long QT syndrome, 92% of respondents thought testing should be offered before the age of five, while 77% of respondents thought genetic testing should be offered before the age of 10 for hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy.     Overall, the potential benefits of genetic testing, including guiding therapies, sport participation, and decreasing worry were ranked more highly than potential risks of discrimination or increasing worry that could occur from genetic testing. Overall, the responses indicated that families would welcome the option of genetic testing for at-risk children from a young age and support initiating early discussions with families to explore costs and benefits of early genetic testing.     Finally in this issue, we have a review from Paul Franks and Nicholas Timpson from Lund University and the University of Bristol entitled Genotype-Based Recall in Complex Cardiometabolic Traits. This review looks at the increasing practice of selecting samples or individuals from larger cohorts or biobanks based on their genotype to carry out additional studies. The article focuses on examples of such genotype-based recall studies in cardiometabolic disease, highlights approaches and new methods, and discusses the ways these types of studies can be used to extend and supplement randomized trials and large population-based studies.     As always, you can find all the articles, accompanying editorials, and video summaries online. Our website recently underwent some redesigns and has moved. You should be redirected if you have the older site bookmarked, but you can also find us directly at ahajournals.org/journal/circgen. Also, thanks to everyone who participated in the Twitter poll last month. You were pretty evenly split on what you want to hear in the podcast, but please continue to leave suggestions and feedback on what we're doing and where we can improve things. That's it for the August issue of Circulation: Genomic and Precision Medicine. Thanks for listening, and tune in next month for more.    

This week The Rounds Table is packed with new content. Kieran Quinn co-hosts the episode with Jonathan Gravel. Jon covers new evidence on treatment for opioid use disorder. Kieran covers an article on the effect of provider affiliation with a primary care network on acute healthcare utilization. The episode also features special guests David Juurlink ...The post Summer Replay – Seeking a High: Opioid Relapse Prevention & Primary Care Networks and Acute Healthcare Utilization appeared first on Healthy Debate.

This week The Rounds Table is packed with new content. Kieran Quinn co-hosts the episode with Jonathan Gravel. Jon covers new evidence on treatment for opioid use disorder. Kieran covers an article on the effect of provider affiliation with a primary care network on acute healthcare utilization. The episode also features special guests David Juurlink ... The post Summer Replay – Seeking a High: Opioid Relapse Prevention & Primary Care Networks and Acute Healthcare Utilization appeared first on Healthy Debate.

This week The Rounds Table is packed with new content. Kieran Quinn co-hosts the episode with Jonathan Gravel. Jon covers new evidence on treatment for opioid use disorder. Kieran covers an article on the effect of provider affiliation with a primary care network on acute healthcare utilization. The episode also features special guests David Juurlink ...The post Seeking a High: Opioid Relapse Prevention & Primary Care Networks and Acute Healthcare Utilization appeared first on Healthy Debate.

This week The Rounds Table is packed with new content. Kieran Quinn co-hosts the episode with Jonathan Gravel. Jon covers new evidence on treatment for opioid use disorder. Kieran covers an article on the effect of provider affiliation with a primary care network on acute healthcare utilization. The episode also features special guests David Juurlink ... The post Seeking a High: Opioid Relapse Prevention & Primary Care Networks and Acute Healthcare Utilization appeared first on Healthy Debate.

With the cost of healthcare rising, consumers are being asked to shoulder more of the financial burden and make more cost-conscious decisions regarding their healthcare. One method to do this is through the use of consumer-directed health plans, which are high-deductible health plans coupled with a health savings account or a health reimbursement arrangement. Neeraj Sood, PhD, co-authored a paper in the April issue of The American Journal of Managed Care (AJMC) evaluating the impact of enrollment in consumer-directed health plans on financial burden associated with healthcare utilization. Read Sood's paper “Financial Burden of Healthcare Utilization in Consumer-Directed Health Plans” in the April issue of AJMC: http://www.ajmc.com/journals/issue/2018/2018-vol24-n4/financial-burden-of-healthcare-utilization-in-consumer-directed-health-plans

It's time for another season of PT Inquest! This first paper does not bode well for the idea of seeing a PT early making much of a difference in long term costs and outcomes for acute low back pain in older patients. How was this study conducted? What does this mean for physical therapists? As a profession, are we promoting ourselves in spite of the research? Are there ethical implications? Is there a roadmap forward? Is JW becoming the weakest member of his family?! Subsequent healthcare utilization associated with early physical therapy for new episodes of low back pain in older adults. Karvelas DA, Rundell SD, Friedly JL, Gellhorn AC, Gold LS, Comstock BA, Heagerty PJ, Bresnahan BW, Nerenz DR, Jarvik JG. Spine J. 2016 Oct 17. pii: S1529-9430(16)31013-0. doi: 10.1016/j.spinee.2016.10.007. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

Functional decline in an elderly person can be the first indicator of a chronic condition ready to snowball out of control. Patricia Zinkus, director of case management at Fallon Community Health Plan, and Susan Legacy, FCHP's senior manager of case management, describe how their collaborative multidisciplinary intervention monitors for these changes, and why the program's social component is just as critical as home visits and case management outreach. Ms. Zinkus and Ms. Legacy will share details from FCHP's risk-sharing model during "Identifying Functional Decline in Chronic Care Patients To Reduce Preventable Healthcare Utilization," 45-minute webinar on April 27, 2011.

More than a third of healthcare organizations have launched nurse advice lines to reduce avoidable emergency room use and direct patients to the most appropriate care venue, according to a July 2010 survey by the Healthcare Intelligence Network. The staffing and operation of Optima Health's nurse advice line is influenced by many factors, explains Patricia Curtis, director of operations, clinical care services for Optima Health. Curtis describes the distinct responsibilities of the LPNs and RNs who staff the advice line as well as the diverse needs of the member populations who call the advice line. Curtis will share how Optima's nurse advice line has evolved from a call center that supported a staff model HMO to a critical component of the organization's effort to improve the efficiency of healthcare utilization during "Maximizing the Nurse Advice Line To Ensure Appropriate Healthcare Utilization," a 45-minute webinar on January 6, 2011.

The dismal economy of 2009 has been a bright spot for health coaching and other health improvement programs, notes Dr. Jim Reynolds, chief medical officer for Health Fitness Corporation. Dr. Reynolds also compares early results from a Massachusetts' smoking cessation program for Medicaid beneficiaries with outcomes in commercial populations, and describes what Year 1 of a coaching program for improved medication adherence might yield in the way of behavior change and cost impacts. Dr. Reynolds and Dr. Elizabeth Rula, clinical research manager at the Center for Health Research at Healthways Inc., shared how their organizations respond to the challenges of evaluating and reporting on health coaching ROI during the January 13, 2010 webinar, "Health Coaching Evaluation: Measuring the ROI on Healthcare Utilization and Costs."

Guest: Steven Kravet, MD, MBA Host: Lee Freedman, MD How does the relationship between health utilization and the availability of primary care providers impact health care utilization trends? Steven Kravet, MD, MBA, assistant professor of medicine at the Johns Hopkins University School of Medicine, explores potential opportunities to relieve some of the logistical and financial burdens of our health care system with host Dr. Lee Freedman.