Managed Care Cast

Sexual orientation and gender identity change efforts (SOGICE), more commonly known as conversion therapy, is a discredited practice opposed by a number of medical, mental health, and human rights organizations, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry.

Yet annually, the practice’s harms lead to estimated direct and indirect costs of $9.23 billion in the United States, according to a new study published in JAMA Pediatrics.

SOGICE can take the form of individual or group psychotherapy, inpatient treatment, or administration by religious leaders, while many individuals undergo multiple modalities, typically as youths. The practice relies on the false belief that being LGBTQ+ is pathologic, and its enforcers promote sexual and gender identify rejection often to the mental health detriment of recipients.

Currently, 25 states; Washington, DC; and Puerto Rico all have bans in place prohibiting SOGICE for minors. However, unlicensed individuals, like religious practitioners, are not regulated, and all states allow the practice in adults.

As part of the analysis, researchers also investigated the economic and humanistic outcomes of affirmative therapy. Essentially the opposite of SOGICE, affirmative therapy is defined as “psychotherapy validating the positive expression of sexual and gender identities and recognizing the association of macrolevel forces, such as heterosexism and homophobia, with well-being.”

The systematic literature review and economic evaluation was carried out by Cytel, a clinical trial company, and The Trevor Project, a nonprofit dedicated to suicide prevention among LGBTQ+ youths.

On this episode of Managed Care Cast, we speak with lead study author Anna Forsythe, PharmD, MSc, MBA, vice president of value and access at Cytel.

On this episode of Managed Care Cast, we speak with Tim Gronniger, the CEO of Caravan Health, about what to look for as accountable care organizations (ACOs) and policy makers try to encourage more providers to join value-based care arrangements.

Since 1999, nearly 841,000 Americans have died of drug overdoses, according to data from the CDC, while opioids serve as the main driver of these deaths. Synthetic opioids account for 73% of opioid-involved overdose deaths.

The COVID-19 pandemic exacerbated the opioid epidemic as individuals encountered disruptions in routine treatment, alongside steep increases in depression and anxiety rates.

One group of individuals susceptible to opioid use disorder are those with chronic, non-cancer pain. Although interventions such as full mu agonist chronic opioid analgesic therapy (COAT) cessation exist for this population, data show this practice can actually impede vocational and social return to function and to increase length of disability.

In a study published in the October issue of The American Journal of Managed Care® (AJMC®) Marcelina Jasmine Silva DO, and colleagues outlined outcomes from the Focus on Opioid Transitions (FOOT Steps) Program, which was created to help patients with chronic non-cancer pain cease COAT reliance.

On this episode of Managed Care Cast, Silva discusses the findings of this pilot study and elaborates on the success of combining interventions that are typically applied individually.

Human papillomavirus, or HPV, is the most common sexually transmitted infection in the United States and causes the majority of cervical cancer cases in the country.

But screening for HPV can catch the virus early and potentially prevent it from developing into cervical cancer. In addition, safe and effective vaccines against HPV exist, essentially making cervical cancer a preventable disease.

However, uptake of HPV vaccines remains sporadic throughout the United States compared with other nations like the United Kingdom, where cervical cancer is nearly eliminated in young women.

Furthermore, despite its prevalence, an HPV diagnosis gap exists among racial groups in the US, as White women are 3 times more likely to be told they have HPV than Black women.

To dig deeper into racial disparities in HPV, Leslie Cofie, PhD, MPH, an assistant professor of health education and promotion at the College of Health and Human Performance, East Carolina University, conducted a study to understand HPV vaccination uptake among foreign-born Blacks in the US.

Cofie’s most recent area of research focuses on understanding how the social networks, or relationships, of Black immigrants may influence their cancer preventive behaviors, including those related to HPV.

On this episode of Managed Care Cast, Cofie discusses his past research, steps to increase HPV vaccine uptake in the future, and the potentially detrimental impact the COVID-19 pandemic may have on the fight against HPV.

This episode of Managed Care Cast is part of the new AJMC® Podcast Prevention Series, bringing you the latest news on prevention advancements in disease.

Providers who treat high-need, high-cost patients can face challenges to deliver efficient and effective care. Health centers funded by the Health Resources and Services administration (HRSA)—otherwise known as federally qualified health canters or FQHCs— provide care to nearly 30 million Americans, many of whom are uninsured or underinsured.

Because data on these patients’ complexity and utilization patterns are limited, researchers set out to better define these patient populations using information from the 2014 Health Center Patient Survey.

On this episode of Managed Care Cast, we speak with Nadereh Pourat, PhD, MSPH, associate center director and the director of the health economics and evaluation research program at the UCLA Center for Health Policy Research, and Alex Sripipatana, PhD, MPH, director of the division of data and evaluation at HRSA. Pourat, Sripipatant and colleagues recently published the HRSA-funded study “Intersection of Complexity and High Utilization among health center patients aged 18 to 64” in The American Journal of Managed Care®.

HRSA oversees the Health Center Program and works to identify opportunities to better support this program's mission of providing access to high quality and cost-effective care to historically medically underserved communities. This work is part of the administration's goal of enhancing health center quality and performance. Additional health center research articles can be found on HRSA’s Health Center Research and Evaluation webpage.

There is already an enormous amount of concern and worry about the effect of the pandemic on cancer screening; for instance, a recent report from the American Association for Cancer Research found an 87% drop in breast cancer screening, an 84% decline in cervical cancer screening, and an 80% reduction in colon cancer screening.

On this episode of Managed Care Cast, we discuss how health care inequities will make this problem worse, with Monica Soni, MD, associate chief medical officer at New Century Health. Soni, who previously was the director of specialty care for the Los Angeles County Department of Health Services, the nation’s second-largest municipal health system, delves into how racial disparities in health care and social determinants of health hinder preventing cancer in the first place. She also provides some reaction to President Joe Biden’s Cancer Moonshot announcement.

According to the CDC, 37.3 million individuals in the United States currently have diabetes, while of these, 8.5 million are undiagnosed. In addition, more than 1 in 3 Americans currently have prediabetes—or higher than normal blood sugar levels—but 80% of this population is unaware they even have the condition. The American Diabetes Association estimates diagnosed diabetes costs the country $327 billion annually.

Obesity is a key risk factor for type 2 diabetes. Data from 2018 show 42.4% of the United States population is obese, marking a steep increase from the 30.5% reported in the year 2000.

Type 2 diabetes is preventable, and programs like the National Diabetes Prevention Program (DPP) have been proven to lower disease incidence among those at high risk via dietary changes and other lifestyle interventions.

To learn more about how employers are leveraging the DPP to reduce diabetes rates among their workforce, The American Journal of Managed Care® sat down with Jill Hutt, vice president of member services at the Greater Philadelphia Business Coalition on Health (GPBCH).

On this episode of Managed Care Cast, Hutt explains the Coalition’s efforts to reduce diabetes rates through the DPP, the impact of COVID-19 on diabetes prevention, and how employers looking to get involved in the initiative can join.

On January 1, 2022, California law SB-306 went into effect with the aim of reducing soaring sexually transmitted infection (STI) rates in the state. As part of SB- 306, California now requires health insurance to cover at-home STI testing kits and requires syphilis screening during both the first and third trimester of pregnancy, in addition to other mitigation strategies.

Even before the COVID-19 pandemic, US STI rates were reaching crisis levels, with CDC data showing an increase of nearly 20% of chlamydia cases between 2015 and 2019, an increase of more than 50% of gonorrhea cases within this time window, and an over 70% increase in cases of syphilis. All 3 of these conditions are curable, if detected early enough and treated correctly.

To learn more about SB-306, we spoke with Amy Moy, the chief external affairs officer at Essential Access Health, one of the bill’s co-sponsors.

On this episode of Managed Care Cast, Amy outlines what SB-306 does, how it addresses some of the stigma associated with STI testing, and describes what else is needed to improve the STI epidemic in California and the United States as a whole.

This week’s Managed Care Cast conversation took place on the same day President Joe Biden announced the return of the Cancer Moonshot, a program he initiated when he was vice president in the Obama administration. The reinvigorated program aims to cut cancer deaths by 50% over the next 25 years and to increase cancer screening, which has dropped sharply during the pandemic.

This Friday, February 4, is World Cancer Day, an initiative led by the Union for International Cancer Control (UICC), and this year's theme is about closing care gaps. For this episode of Managed Care Cast, we spoke with Meghan Gutierrez, CEO of the Lymphoma Research Foundation, about financial toxicity, how the pandemic has affected patients’ financial needs when they have cancer, health care disparities and care gaps, and more.

Although racism and bias have been long documented issues affecting health equity, findings of a recent study published in Health Affairs indicates these issues may be more embedded in the US health care system than originally thought.

Examining electronic health records (EHRs) from an urban academic medical center, researchers found that negative descriptors were significantly more likely to appear in the records of Black patients compared with White patients. Other factors—such as insurance type, marriage status, and even the COVID-19 pandemic—influenced the odds of having this potentially stigmatizing language appear in a patient’s EHR.

On this episode of Managed Care Cast, we speak with the first author on the study, Michael Sun, a medical student at the Pritzker School of Medicine at the University of Chicago, on the findings, as well as the steps that can be taken to increase awareness among clinicians of these stigmatizing descriptors.