Managed Care Cast

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

Opaque benchmarks, payment lags of 12 to 18 months, and rules that changed mid-model led American Oncology Network (AON) to exit the Enhancing Oncology Model (EOM), according to AON Chief Medical Officer Stephen "Fred" Divers, MD.

In this inaugural episode of The Business of Value, Divers tells host Lalan Wilfong, MD, chief medical officer of Navista, how 505(b)(2) drugs complicated practice finances, why retrospective data limited the ability to improve, and why other payers did not follow Medicare's lead. He also explains how AON is pursuing other value-based arrangements built on real-time data and what practices should know before joining similar models.

Community oncology practices can close the gap between innovation and implementation by building patient feedback into real-time clinical pathways, using AI to speed up physician decision-making, and better supporting caregivers of patients on CAR T and bispecific therapies, according to leaders from the American Oncology Network (AON).

In the first of 2 podcasts from Patient-Centered Oncology Care 2026, Melody Chang, RPh, MBA, BCOP, is joined by Fred Divers, MD; Puneeth Indurlal, MD; and Brooke Peters, PharmD. They recap their PCOC panels and explain how the discussions connect to AON's work on clinical trials, rural access, and caregiver education.

This week's Managed Care Cast episode features a conversation between The American Journal of Managed Care® (AJMC®) and Grace Mackleby, PhD, a research scientist at the USC Schaeffer Center, about her study, "Plan Switching Among Medicare Advantage Enrollees Dually Eligible for Medicaid," published in the September 2026 issue of AJMC.

The study examined how often beneficiaries switched from one Medicare Advantage (MA) plan to another or from MA to traditional Medicare (TM). It compared enrollees dually eligible for Medicaid with those eligible for Medicare only. Mackleby explained that dually eligible beneficiaries account for about one-fifth of the Medicare population and tend to have more chronic conditions, higher costs, and greater needs; they are also subject to different rules on when they can switch plans.

Mackleby and coauthors Angela Liu, PhD, and Erin Trish, PhD, used administrative Medicare enrollment data to track switching from 2016 to 2022. She highlighted 3 main results. First, about 22% of fully dually eligible enrollees switched MA plans in 2022, up from about 12% in 2016. Second, these enrollees were roughly 6 times more likely to switch to another MA plan than TM. Third, dually eligible beneficiaries overall switched MA plans more often than those eligible for Medicare only.

The study did not examine causes, but Mackleby pointed to 2 likely drivers: the growing number of available MA plans and the strong competition among insurers, which have heavily marketed supplemental benefits such as flex cards and dental coverage. For non–dually eligible beneficiaries, she added, it is difficult in most states to obtain Medigap coverage after enrolling in MA, which makes returning to TM financially unappealing.

Switching also varied by race and ethnicity. Black, Hispanic, and American Indian/Alaska Native fully dually eligible enrollees switched MA plans more often than non-Hispanic White enrollees. Mackleby said geography may play a role. However, higher switching could also indicate lower satisfaction with available plans, which warrants further study, she noted.

Looking ahead, Mackleby emphasized the need to understand whether switching helps or harms beneficiaries, including its effects on access to care and cost sharing. She also called for research on how switching shapes market performance.

"I think looking at it from a beneficiary welfare perspective is going to be really important, and then also looking at it from a market perspective is going to be important too," Mackleby concluded.

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

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

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

Health-system pharmacy is entering a decade of change, and Future-Proofing Pharmacy is built to keep asking what that future should look like. In this debut episode, host Mark Makhinson, PharmD, senior director of outpatient and specialty pharmacy at Mount Sinai Health System, introduces the podcast's mission: exploring how pharmacy leaders can build organizations that are clinically meaningful, scalable, and ready to adapt, rather than simply reacting to financial pressure, workforce shifts, and drug shortages as they arise.

Makhinson lays out the questions the series will return to throughout its run, including what a health system pharmacy enterprise looks like in 2035, where artificial intelligence can meaningfully help, and where human judgment should remain central.

Episode 1 kicks off with Nilesh Desai, PharmD, chief pharmacy officer at University of Miami Health System, who shares the pharmacy enterprise he would build from scratch in 2035 and the lessons that shaped his thinking during a major pharmacy transformation at Baptist Health, including the development of a consolidated pharmacy service center.

This week's Managed Care Cast episode features a conversation between The American Journal of Managed Care® and August 2026 authors Jeff Romine, PhD, and Kofi Essel, MD, MPH, about their study, "Insurance-Provided Grocery Assistance and Health Care Outcomes Among Patients With Diabetes."

It examined the association between a commercial health plan's grocery assistance benefit and health care use and outcomes among members with type 2 diabetes, offering evidence in a space where prior food-as-medicine research has centered largely on Medicare and Medicaid populations.

The benefit provided members between $1200 and $3000 annually, distributed across pay periods on a card usable at a range of grocery chains. Purchases excluded alcohol, tobacco, and preprepared foods, with an emphasis on fruits, vegetables, and other healthy items. Essel noted the design was a deliberate light touch, requiring no dietitian or health coach support, which he said made it more scalable than medically tailored meal programs that have driven much of the existing food as medicine literature. Romine, an economist by training, added that the appeal of studying a lighter intervention was the chance to observe how members made decisions about food and health without the more rigid structure of prior research.

To evaluate the benefit, the team used a difference-in-differences design, comparing changes in utilization and clinical outcomes over time for members receiving the benefit against a control group of members with type 2 diabetes who were not eligible. Romine highlighted 3 main results: a 3.1% decrease in diabetes complications, no significant change in overall health care utilization, and improved medication adherence. He said the utilization finding was a positive surprise, since it suggested members retained access to needed care even within a narrower network.

Essel pointed to a secondary finding as especially notable: the largest reduction in diabetes complications occurred among members living in lower socioeconomic areas, indicating a potential role for grocery assistance in narrowing health disparities. He emphasized that Elevance Health's approach to food as medicine considers both diet-related chronic conditions and social drivers of health such as food and nutrition insecurity, rather than treating them as separate levers.

Looking ahead, Essel said future iterations of the benefit could be strengthened by tailoring groceries to individual cultural and dietary needs, adding nutrition education such as medical nutrition therapy or culinary counseling, and integrating the benefit more closely with primary care and specialist providers.

"We are incredibly excited to see what we've seen here, and we can continue to build off of these learnings across the board," Essel concluded.

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