Managed Care Cast

Wanting to provide the best treatment available, help people live their healthiest lives, and alleviate the health care burden on providers, Intermountain Healthcare, a Utah-based not-for-profit system of 33 hospitals in 7 states, and Story Health, a California-based health technology and services company, have partnered to disseminate specialty care for patients living with heart failure in rural areas.

Goals of this new partnership include ensuring patients get the care they need in a sustainable manner, increasing health system efficiency by preventing unnecessary hospitalizations, and getting high-quality care from urban population centers to rural patients while saving costs to the health care system and saving patients and their families time and convenience.

On this episode of Managed Care Cast, we speak with Tom Stanis, CEO and co-founder of Story Health, and Phillip Wood, Intermountain Ventures program director on how their partnership came about, how it is going so far, and the future of their collaboration.

On this episode of Managed Care Cast, we speak with Reverend Paul Abernathy, chief executive officer of the Neighborhood Resilience Project and board member of UPMC for You, who discusses his experiences in promoting health and resiliency in trauma-affected communities, as well as challenges related to access and accessibility of care and medical mistrust.

To mark the publication of The American Journal of Managed Care®’s 12th annual health IT issue, on this episode of Managed Care Cast, we speak with Christopher M. Whaley, PhD, health care economist at the RAND Corporation, who focuses on health economics issues, including the influence of the COVID-19 pandemic on health care delivery. In particular, he examines how existing technology has pivoted to become a backbone for virtual care delivery while its ongoing evolvement has highlighted inequities in care delivery, making access and lack thereof divisive issues.

In their article in the health IT issue, “Differences in Telehealth During COVID-19 Between Commercial and Medicaid Enrollees,” Whaley and his co-authors compare rates of telehealth and in-person evaluation and management visits between individuals with commercial insurance through the California Public Employees’ Retirement System, or CalPERS, and those with publicly funded coverage through the California Medicaid program, with implications for equitable access to telehealth and development of policies to guide its ongoing and future use.

The editors of The American Journal of Managed Care® reflect on the past year and discuss what they’re looking forward to in 2023.

High-deductible health plans (HDHPs) have gained traction in recent years as a means to reduce unnecessary health care spending. The monthly premiums are low, but the high deductibles can lead to higher downstream costs for individuals and families. Potential downsides include the risk of patients deterring or avoiding necessary care.

A team headed by Matthew D. Eisenberg, PhD, from the Johns Hopkins Bloomberg School of Public Health, recently investigated the impact of HDHPs through the lens of the ongoing epidemic of substance use disorder, or SUD, in the United States. The article detailing their study’s findings appears in the October issue of The American Journal of Managed Care®.

On this episode of Managed Care Cast, we speak with Dr Eisenberg on his team’s findings that these plans may have reduced SUD service use through the shifting of costs to their members, thereby exacerbating this already troubling epidemic that has resulted in declines in life expectancy and increases in drug- and alcohol-related deaths.

Teams from the Mass General Brigham health system and the Commonwealth Care Alliance, both in Massachusetts, have collaborated on a value-based care initiative with the principal goals of improving patient clinical outcomes, reducing unnecessary health care utilization, and making care more accessible. iCMP PLUS (Patients Linked to Urgent Support) is an integrated care management program providing intensive, multidisciplinary care to the highest-risk dual-eligible patients with Medicaid ACO coverage who have complex medical needs and high health care costs. Care team members meet patients where they are, demonstrating the effectiveness of community-based care management support programs.

On this episode of Managed Care Cast, we speak with Jack Rowe, MD, MPH, and Lori Tishler, MD, MPH, 2 authors of “Intensive Care Management of a Complex Medicaid Population: A Randomized Evaluation,” published in the September issue of The American Journal of Managed Care®, about their findings on the program’s effectiveness from its early phase of implementation.

The Inflation Reduction Act, signed this month, extends the premium tax credits for health insurance purchased through the health care marketplace for another 2 years. The credits were included in the 2021 American Rescue Plan Act, and were due to expire at the end of this year.

Vicki Fung, PhD, is associate investigator at the Mongan Institute Health Policy Center, Mass General Research Institute, and lead author of “Premium Tax Credits in the American Rescue Plan and Off-Marketplace Enrollees,” published in the August issue of The American Journal of Managed Care®. On this episode of Managed Care Cast, she details how the expanded premium tax credits help individuals purchasing insurance coverage through the marketplace. She also addresses the important ways these plans differ from employee-purchased coverage and the benefits and drawbacks of each and the difficulties involved when deciding whether or not to switch coverage.

As more and more biosimilars enter different markets around the globe, payers and practices will need to consistently evaluate the economics of covering biosimilars and take a stance on whether to support their adoption.

Both payers and practices can play a big role in encouraging biosimilar adoption, and health care institutions that have already begun pushing for more biosimilar use, such as Emory Healthcare, have seen substantial savings.

On this episode of Managed Care Cast, we speak with Ryan Haumschild, PharmD, MS, MBA, the director of pharmacy services at Emory Healthcare and the Winship Cancer Institute. Haumschild is also an Advisory Board member for The American Journal of Managed Care® and its sister site, The Center for Biosimilars®. The interview took place at the The Institute of Value-Based Medicine® (IVBM), hosted by Emory Healthcare, on July 18 in Atlanta, Georgia. Haumschild was chair of the event and gave a presentation on the current pharmacoeconomics of biosimilars and his predictions for how the market will develop in the future.

The episode discussed how the pharmacoeconomics of biosimilars have evolved and different strategies that health care institutions can implement to reap the benefits of biosimilar savings.

We also talked about how stakeholders can collaborate to promote biosimilars and how technology can be used to assist this mission.

Even before the pandemic began in 2020, the number of health care organizations appointing chief health equity officers had started to grow. Is this a role for 1 person only or do initiatives to tackle health care disparities and other issues begin at a higher level? And how can change really be accomplished so there is a measurable effect on health outcomes?

In this episode of Managed Care Cast, we speak with Sachin Jain, MD, MBA, who joined SCAN Group and Health Plan 2 years ago as president and CEO. He discusses an effort, recently described in an article in Harvard Business Review, about how SCAN made 10% of senior managers’ annual bonuses dependent on how well the gap in medication adherence among diverse populations was reduced.

The former CareMore executive shares why executives at the top of organizations need to champion and lead initiatives to reduce health care disparities and do more than “virtue signaling” on health equity issues.

Today we are bringing you part 2 of a 2-part sponsored podcast series discussing treatment goals in insterstitial lung disease (ILD). The discussion was moderated by Ryan Haumschild, PharmD, director of Pharmacy Services at Emory Healthcare and Winship Cancer Institute.

The conversation for today’s podcast includes an in-depth review of treatment landscape of systemic sclerosis ILD as well as a discussion on unmet needs and emerging therapies in ILD.