Managed Care Cast

Every week, The American Journal of Managed Care® recaps the top managed care news of the week.

This week, the top managed care news included reports of 2 vaccines’ efficacy against coronavirus disease 2019 (COVID-19); a study finds no risk reduction in cardiac events with fish oil; calls for long-term follow-up to understand effects of lingering COVID-19.

Read more about the stories in this podcast:

What We’re Reading: Pfizer Vaccine 95% Effective; At-home COVID-19 Test Approved; Amazon Launches Online Pharmacy: https://www.ajmc.com/view/what-we-re-reading-pfizer-vaccine-95-effective-at-home-covid-19-test-approved-amazon-launches-online-pharmacy

What We're Reading: Vaccines in EUA Process; Alkermes Receives CRL; California Tightens Restrictions: https://www.ajmc.com/view/what-we-re-reading-vaccines-in-eua-process-alkermes-receives-crl-california-tightens-restrictions

Fish Oil Debate Continues as Study Finds No Risk Reduction From Omega-3 Combo: https://www.ajmc.com/view/debate-over-fish-oil-therapy-continues-new-results-find-no-risk-reduction-from-omega-3-combo

Long-term Follow-up Needed to Understand Effects When COVID-19 Lingers, Fauci Says: https://www.ajmc.com/view/long-term-follow-up-needed-to-understand-effects-when-covid-19-lingers-fauci-says

Driving Transparency, Payment Reform in Employer Health Care Coverage: https://www.ajmc.com/view/driving-transparency-payment-reform-in-employer-health-care-coverage

Paper of the Week: Effects of Health Education on Glycemic Control During Holiday Time in Patients with Type 2 Diabetes Mellitus: https://www.ajmc.com/view/jan08-2785p45-51

The coronavirus disease 2019 (COVID-19) pandemic has required health care systems to overhaul their ways of delivering care to patients in order to keep patients, families, and clinicians safe. For medical home visit programs accustomed to visiting patients in person, this task has required creative use of new technologies and relied on regulatory flexibility to facilitate their work.

On this episode of Managed Care Cast, we’re talking with the authors of a Commentary article published in our November issue. The article, “Medical Home Visit Programs During COVID-19 State of Emergency,” describes the experience of reimagining how a home health program can deliver care amid the coronavirus disease 2019 pandemic.

The authors, from Northwell Staten Island University Hospital in Staten Island, New York, are Dr Donna Seminara, Dr Anita Szerszen, Dr John R. Maese, and Dr Zeel Shah.

As the health care industry continues to combat health and cost-related issues exacerbated by the COVID-19 pandemic, employers remain a key figure in the pursuit for higher value care. Recently, the Leapfrog Group partnered with the Health Transformation Alliance, or HTA, to help delineate high-value health care services with a particular focus on transparency and payment reform.

On this episode of Managed Care Cast, we speak with Leah Binder, president and chief executive officer of the Leapfrog Group, about her organization’s partnership with the HTA, the significance of their 20th anniversary this year, and how transparency and employer leverage may shape the transition toward value-based health care.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week.

This week, the top managed care news included the Supreme Court signaling willingness to uphold the Affordable Care Act; Pfizer’s coronavirus disease 2019 vaccine shows 90% efficacy; racial disparities in lung cancer screenings and prescribing biologics.

Read more about the stories in this podcast:

Supreme Court Signals Willingness to Uphold ACA: https://www.ajmc.com/view/supreme-court-signals-willingness-to-uphold-aca

Pfizer Says Vaccine 90% Effective; Biden Team Announces COVID-19 Transition Panel: https://www.ajmc.com/view/pfizer-says-vaccine-90-effective-biden-team-announces-covid-19-transition-panel

Lung Cancer Screening Criteria Miss Young, High-Risk Black Smokers: https://www.ajmc.com/view/lung-cancer-screening-criteria-miss-young-high-risk-black-smokers

Black Patients With RA Less Likely Than White Counterparts to Be Prescribed a Biologic: https://www.ajmc.com/view/black-patients-with-ra-less-likely-than-white-counterparts-to-be-prescribed-a-biologic

Lung Cancer Screening Criteria Miss Young, High-Risk Black Smokers: https://www.ajmc.com/view/lung-cancer-screening-criteria-miss-young-high-risk-black-smokers

Bang for the Buck: How Health Care Innovation Affects Life Expectancy and Patient Well-Being: https://www.ajmc.com/view/bang-for-the-buck-how-health-care-innovation-affects-life-expectancy-and-patient-well-being

Paper of the Week—Beyond Black and White: Race/Ethnicity and Health Status Among Older Adults: https://www.ajmc.com/view/beyond-black-and-white-raceethnicity-and-health-status-among-older-adults

As the costs of cancer care continue to rise in the United States, eyes are increasingly turning to payment reform. Research by the Northeast Business Group on Health found that in 2015, employers spent $125 million on cancer care, and since then, cancer therapy costs have increased substantially with greater use of immunotherapy and the introduction of chimeric antigen receptor T-cell therapies that can easily cost half a million dollars for treatment.

The federal government is taking the lead with the Oncology Care Model, which will transition into Oncology Care First in 2022 after a 1-year extension due to the coronavirus disease 2019 pandemic, but commercial payers are also testing payment reform models.

Speakers who participated in the Quality Cancer Care Alliance’s Fall Leadership Summit, weighed in on the payment reform space for cancer care.

Learn more:

Speaking of Employers: Purchasers Detail the Challenges of Getting a Handle on Oncology Care Costs

https://www.ajmc.com/view/speaking-of-employers-purchasers-detail-the-challenges-of-getting-a-handle-on-oncology-care-costs

Three Ways COVID-19 Makes the Oncology Care First Model More Attractive: https://www.ajmc.com/view/three-ways-covid-19-makes-the-oncology-care-first-model-more-attractive

Infrastructure of OCM Helps Practices Through COVID-19, Chong Says: https://www.ajmc.com/view/infrastructure-of-ocm-helps-practices-through-covid-19-chong-says

A Closer Look at 3 Oncology Payment Reform Projects: https://www.ajmc.com/view/a-closer-look-at-three-oncology-payment-reform-projects

Cancer Does Not Stop for COVID-19, but Reform Becomes a Challenge: https://www.ajmc.com/view/cancer-does-not-stop-for-covid-19-but-reform-becomes-a-challenge

Community Oncology Alliance Payment Reform Brief Details 35 Oncology Payment Models Underway or Planned Across Country: https://communityoncology.org/community-oncology-alliance-coa-payment-reform-brief-details-35-oncology-payment-models-underway-or-planned-across-country/

EDIT: This podcast has been updated as of 11:45 am EST.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week.

This week, the top news in managed care included top health care takeaways from the 2020 general election; a Q&A with William Shrank, MD, MSHS, on connecting Medicare Advantage providers and patients; Managed Care Cast discusses balancing evidence with action amid the coronavirus disease 2019 pandemic.

Read more about the stories in this podcast:

Top 5 Health Care Takeaways From the 2020 General Election: https://www.ajmc.com/view/top-5-health-care-takeaways-from-the-2020-general-election

Medicare Advantage Providers, Patients Connect Without a Playbook: A Q&A With William H. Shrank, MD, MSHS: https://www.ajmc.com/view/medicare-advantage-providers-patients-connect-without-a-playbook-a-q-a-with-william-h-shrank-md-mshs

Balancing Evidence With Action: Dr Patricia Salber Interviews Dr Denise Basow: https://www.ajmc.com/view/balancing-evidence-with-action-dr-patricia-salber-interviews-dr-denise-basow

Libtayo Accepted for FDA Priority Review in NSCLC With PD-L1 Expression: https://www.ajmc.com/view/libtayo-accepted-for-fda-priority-review-in-nsclc-with-pd-l1-expression

Paper of the Week: Second-line and Third-line Chemotherapy for Lung Cancer: Use and Cost: https://www.ajmc.com/view/may08-3181p297-306

With the coronavirus disease 2019 pandemic, new research is quickly being released as more and more is learned. However, the flood of new research needs to be balanced with appropriate review before action is taken.

In the latest Managed Care Cast, Denise Basow, MD, president and CEO of clinical effectiveness at Wolters Kluwer, speaks with Patricia Salber, MD, MBA, of The Doctor Weighs In, about the onslaught of information, the risk of misinformation, the wide range of information sources available, and more.

Read more:

Experts Discuss Myths of COVID-19 and Clarify Misunderstandings: https://www.ajmc.com/view/experts-discuss-myths-of-covid-19-and-clarify-misunderstandings

Study Dispels Misinformation on Contact Lens, Spectacle Use and COVID-19: https://www.ajmc.com/view/study-dispels-misinformation-on-contact-lens-spectacle-use-and-covid19

In Wake of Measles Outbreaks, Another Study Dispels Myths Surrounding MMR Vaccine: https://www.ajmc.com/view/in-wake-of-measles-outbreaks-another-study-dispels-myths-surrounding-mmr-vaccine

Every week, The American Journal of Managed Care® recaps the top managed care news of the week.

This week, the top managed care news included updates on coronavirus disease 2019 therapies and vaccine candidates; a discussion on keeping physicians independent through value-based care; an overview of the 2020 Community Oncology Alliance Virtual Payer Exchange Summit.

Read more about the stories in this podcast:

What We’re Reading: COVID-19 Vaccine Trials to Restart; Record 2-Day Infections; Stress-Reducing Strategies: https://www.ajmc.com/view/what-we-re-reading-astrazeneca-j-j-covid-19-trials-to-restart-record-2-day-infection-stress-reducing-strategies

What We're Reading: Eli Lilly Ends Antibody Trial; Pros, Cons of Telehealth; AAP Issues New Opioid Guidelines: https://www.ajmc.com/view/what-we-re-reading-eli-lilly-ends-antibody-trial-pros-cons-of-telehealth-aap-issue-new-opioid-guidelines

What We’re Reading: Hospitals Strained; Pfizer Trial Enrollment; Variation in Virus Mitigation: https://www.ajmc.com/view/what-we-re-reading-hospitals-strained-pfizer-trial-enrollment-variation-in-virus-mitigation

Researchers Warn of Heightened Risk of HIV With Certain COVID-19 Vaccines: https://www.ajmc.com/view/researchers-warn-of-heightened-risk-of-hiv-with-certain-covid-19-vaccines

Keeping Physicians Independent: Dr Patricia Salber Interviews Dr Farzad Mostashari: https://www.ajmc.com/view/keeping-physicians-independent-dr-patricia-salber-interviews-dr-farzad-mostashari

Community Oncology Alliance Conference Coverage: https://www.ajmc.com/conference/coa

Paper of the Week: Value-Based Insurance Design for Diabetes Mellitus: Approaches to Optimal Pharmacoeconomic Implementation: https://www.ajmc.com/view/a319_10dec_fendrick_s314to22

The company Aledade was created 6 years ago to help physicians stay independent by implementing a value-based care business model. In this episode of Managed Care Cast, Patricia Salber, MD, MBA, of The Doctor Weighs in, speaks with Aledade co-founder, Farzad Mostashari, MD, about what his company has accomplished and why these efforts are important for all stakeholders.

Read more about Aledade, accountable care organizations (ACOs), and value-based care:

Mostashari, Gilfillan Highlight the Spillover Effect of ACOs Across the Entire Healthcare System: https://www.ajmc.com/view/mostashari-gilfillan-highlight-the-spillover-effect-of-acos-across-the-entire-healthcare-system

MedPAC's MIPS Vote Meant to Encourage Physicians Into High-Risk Payment Models, Says Aledade's Broome: https://www.ajmc.com/view/medpacs-mips-vote-meant-to-encourage-physicians-into-highrisk-payment-models-says-aledades-broome

ACOs and Healthcare Transformation: Dr Patricia Salber Interviews Travis Broome: https://www.ajmc.com/view/acos-and-healthcare-transformation-dr-patricia-salber-interviews-travis-broome

5 Things About Aledade (and Its ACOs): https://www.ajmc.com/view/5-things-about-aledade-and-its-acos

Every week, The American Journal of Managed Care® recaps the top managed care news of the week.

This week, the top managed care news included coronavirus disease 2019 (COVID-19) delays in breast cancer surgery; targeted therapies associated with decreased mortality risk for non–small cell lung cancer; an inside look at a patient’s perspective of early-onset Parkinson disease.

Read more about the stories in this podcast:

Cancer Care Delays in COVID-19 Could Lead to Higher Morbidity, Mortality: https://www.ajmc.com/view/cancer-care-delays-in-covid-19-could-lead-to-higher-morbidity-mortality

Propelled by Targeted Therapies, NSCLC Mortality Fell Between 2013 to 2016: https://www.ajmc.com/view/propelled-by-targeted-therapies-nsclc-mortality-fell-between-2013-to-2016

A Patient Perspective on Early-Onset Parkinson Disease: https://www.ajmc.com/view/a-patient-perspective-on-early-onset-parkinson-disease

CHEST 2020 Annual Meeting: https://www.ajmc.com/conference/chest

The Academy of Managed Care Pharmacy Nexus: https://www.ajmc.com/conference/amcp-nexus

The American Society of Nephrology's Kidney Week: https://www.ajmc.com/conference/asn

Paper of the Week: Medical Home Transformation and Breast Cancer Screening: https://www.ajmc.com/view/medical-home-transformation-and-breast-cancer-screening