Managed Care Cast

In recent years, predictive models in medicine have become increasingly popular what with the continued integration of artificial intelligence and data technology into health care. However, these models can carry the risk of bias depending on which individuals make up the data sets.

The close relationship between health care and technology also raises a myriad of questions when it comes to regulation, accountability, and model implementation.

In this month’s Health IT issue of the American Journal of Managed Care, Paige Nong, a PhD candidate in public health at the University of Michigan, and colleagues present research on facilitating informed decision making and communicating equity issues when integrating predictive models into care.

On this episode of Managed Care Cast, Nong outlines how the researchers carried out their study, the ethical challenges of combining computer science with health, and next steps for combatting bias in predictive models.

On December 30th, 2021 the No Surprises Act went into effect. Broadly speaking, the act aims to curb surprise bills Americans may incur when they receive care from an out-out-network provider.

In response to the act’s implementation, the American Hospital Association, American Medical Association, and others sued, claiming the law jeopardizes patients’ access to care on the basis that providers and insurers must negotiate these costs when they arise, and if an agreement is not made, an arbitration process for determining fair payment will take place.

On this episode of Managed Care Cast, we speak with Mark Miller, PhD, the executive vice president of health care at Arnold Ventures. In our conversation, Miller lays out how this law came about, its implications for patients, and what might happen if lawsuits against it succeed.

On this episode of Managed Care Cast, we interview the lead author of a paper in the January issue of Health Affairs about what physicians know and don't know regarding their responsibilities to accommodate patients with disabilities when they come in for an office visit.

On this episode of Managed Care Cast, we bring you part 1 of an 8-part video conversation with a payer and a primary health care provider about how they adapted to deliver health care in 2020 and 2021. We sat down with Tunde Sotunde, MD, MBA, the president and CEO of Blue Cross and Blue Shield of North Carolina, the largest insurer in that state covering more than 3.7 million members across all 100 counties, and Alan Story, MD, of Newtown Family Physicians, an independent primary care practice in Catawba County in the western part of the state.

Our conversation, moderated by Allison Inserro, managing editor of AJMC.com, the website of The American Journal of Managed Care®, delves into value-based care, independent care practices, the health care workforce, health equity, and the role of Medicaid.

With key data presented at this year’s 63rd Annual American Society of Hematology Meeting and Exposition showing several CAR T-cell therapies as effective and safe options in the second- and even first-line setting for multiple myeloma and other cancers, discussions on when to best to use these therapies in the real-world setting has garnered increasing attention by payers and providers.

At ASH 2021, we sat down with several key opinion leaders to discuss the use of real-world data for CAR T-cell therapies and its importance in influencing reimbursement and investment strategies by payers.

With key data presented at this year’s 63rd Annual American Society of Hematology Meeting and Exposition showing several CAR T-cell therapies as effective and safe options in the second- and even first-line setting for multiple myeloma and other cancers, discussions on when to best to use these therapies in the real-world setting has garnered increasing attention by payers and providers.

At ASH 2021, we sat down with several key opinion leaders to discuss the use of real-world data for CAR T-cell therapies and its importance in influencing reimbursement and investment strategies by payers.

On this episode of Managed Care Cast, we’re talking with the co-editors-in-chief of The American Journal of Managed Care®, Dr Mark Fendrick and Dr Michael Chernew, and the editor-in-chief of The American Journal of Accountable Care®, Dr Dennis Scanlon. They look back on the past year and discuss the themes and topics they expect to see in the pages of the journals and in the world of health care in 2022.

For more, visit ajmc.com. To get in touch with us, email [email protected] or follow us on Twitter @AJMC_Journal. And if you like the podcast, don’t forget to subscribe and rate us.

When new drugs are approved by the FDA, they can take time to diffuse across the population as clinicians begin to prescribe them. Uptake is not always quick or uniform, due to reasons that can include clinical inertia, provider familiarity, and the cost to patients.

On this episode of Managed Care Cast, we’re talking with the lead author of a study published in our December 2021 issue. The article, “Variation in Early Diffusion of Sacubitril/Valsartan and Implications for Understanding Novel Drug Diffusion,” describes how prescribing of the newly approved heart failure drug spread across the nation. Joining us today is Lauren Gilstrap, MD, MPH, of Dartmouth-Hitchcock Medical Center and The Dartmouth Institute for Health Policy and Clinical Practice.

In addition to shining a light on health disparities, medical misinformation, and public health infrastructure, the COVID-19 pandemic has also propelled calls for the transition to value-based care in the United States.

To discuss this topic, among others, we sat down with Mara McDermott, the executive director of the Value Based Care Coalition, formerly known as the Next Gen ACO Coalition.

On this episode of Managed Care Cast, McDermott discusses the organization’s recent re-brand, how its goals align with the Center for Medicare and Medicaid Innovation’s strategic refresh, and the future of value-based care.

In November, the Pharmacy Quality Alliance (PQA) and Patient Advocate Foundation (PAF) announced a collaboration aimed at developing a patient-centered outcomes research agenda to improve social determinants of health screenings and interventions in pharmacy settings.

The year-long project received funding from the Eugene Washington PCORI Engagement Awards program and will feature an in-person workshop held in conjunction with the PQA Annual Meeting in May.

To learn more about this initiative, why it is needed, and how it will be carried out, The American Journal of Managed Care® (AJMC®) spoke with Melissa Castora-Binkley, PhD, the senior director of research at PQA and Rebekah Angove, PhD, vice president for patient experience at PAF.

In this episode of Managed Care Cast, Castora-Binkley and Angove discuss why pharmacists are in a unique position to help address social determinants of health and the importance of incorporating patients’ perspectives into research agendas.