Managed Care Cast

Routine preventive screenings and vaccination rates have decreased due to the coronavirus disease 2019 (COVID-19) pandemic, while the Director of the National Cancer Institute recently warned delays in cancer screenings are likely to result in thousands of excess deaths. At the same time, a recent study found the pandemic could create losses of up to $15 billion for primary care practices.

To find out what can be done about these setbacks, and to learn why it is so critical to continue screenings during the pandemic, we spoke with Andrea Gelzer, MD, senior vice president and corporate chief medical officer for AmeriHealth Caritas.

On this episode of Managed Care Cast, Dr. Gelzer discusses the vital role telehealth has played during the pandemic, and how providers and payers can work together to encourage patients to continue routine 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 CMS planning to pay more for at-home dialysis equipment; ACR supports continued use of telemedicine after the COVID-19 pandemic passes; coverage of AIDS 2020, the 23rd International AIDS Conference.

Read more about the stories in this podcast:

CMS Seeks Incentives for At-Home Dialysis in Wake of COVID-19: https://www.ajmc.com/newsroom/cms-seeks-incentives-for-athome-dialysis-in-wake-of-covid19

ACR Position Statement Supports Use of Telemedicine After COVID-19 Crisis: https://www.ajmc.com/newsroom/acr-position-statement-supports-use-of-telemedicine-after-covid19-crisis

Telehealth Growth in April Suggests Continuing Impact of COVID-19: https://www.ajmc.com/contributor/robin-gelburd-jd/2020/07/telehealth-growth-in-april-suggests-continuing-impact-of-covid19

Study Results Show Possible Link Between Medicaid Expansion, Drop in Advanced Breast Cancer: https://www.ajmc.com/newsroom/study-results-show-possible-link-between-medicaid-expansion-drop-in-advanced-breast-cancer-

AIDS 2020: Virtual: https://www.ajmc.com/conferences/aids-2020

A Timeline of COVID-19 Developments in 2020: https://www.ajmc.com/focus-of-the-week/a-timeline-of-covid19-developments-in-2020

Physician and Patient Tools to Improve Chronic Kidney Disease Care: https://www.ajmc.com/journals/issue/2018/2018-vol24-n4/physician-and-patient-tools-to-improve-chronic-kidney-disease-care

Medication access barriers and nonadherence significantly impact medication underuse in the United States. This issue is estimated to cost the country’s healthcare system between $100 billion to $290 billion annually, as patients who underuse medication are more likely to have complications, which can result in costly health care utilization.

Recently, The Pharmacy Quality Alliance (PQA) and National Pharmaceutical Council (NPC) announced 2 research grants funding studies of patients’ real-world medication access barriers. Leveraging the framework devised by the PQA and NPC released in March 2019, researchers at The Johns Hopkins Hospital and University of Rhode Island will investigate this problem and release their findings in 2021.

Oral anticancer therapies have become popular alternatives to more traditional care, such as chemotherapy. However, research shows that adherence to oral anti-cancer therapies can range from 20% to 100%. Several factors contribute to medication non-adherence and access barriers. To learn more, we spoke with Ami Vyas, PhD, an assistant professor of pharmacy practice, specializing in health outcomes research, at The University of Rhode Island.

The last decade has brought great strides in diabetes care. Better insulins and better technology can allow people with diabetes—both type 1 and type 2—to keep their blood sugar from rising and falling in ways that cause long-term damage to their eyesight and vascular systems. New classes of drugs for patients with type 2 diabetes have been shown to cut the risk of heart and renal failure, and more widespread use could help some patients avoid dialysis.

But the good news is not felt by everyone. Amid this progress, the rate of amputations rose 50% between 2009 and 2015. African American patients lose limbs at triple the rate of other groups. 

The mission of the Affordable Care Act—spend more to prevent disease and complications, and save money later—has bypassed many of these patients for one reason: they lack access to care. Fourteen states have not expanded Medicaid, including several Deep South states where diabetes and obesity rates are highest.

The result of these state-level policy decisions is becoming clear. Research presented at the recent meeting of the American Diabetes Association found a 17% decrease in the risk of amputation when patients lived in states that expanded Medicaid. What’s more, the number of hospital admissions for diabetic foot ulcers plummeted in states that expanded Medicaid, while rising 21% in states that rejected expansion.

None of this is news to Foluso Fakorede, MD, who treats patients at risk of limb loss in the Mississippi Delta. Fakorede spoke with The American Journal of Managed Care® about his work in Mississippi, through his practice, Cardiovascular Solutions of Central Mississippi.

Read more:

Diabetes Shouldn't Cost Patients Their Legs: https://www.ajmc.com/contributor/bret-weichmann/2020/01/diabetes-shouldnt-cost-patients-their-legs

Understanding Diabetes Risks Can Save Your Limbs: https://www.ajmc.com/contributor/gerald-niedzwiecki/2019/12/understanding-diabetes-risks-can-save-your-limbs

Heart Failure Coverage Success Seen in Medicaid Expansion States: https://www.ajmc.com/focus-of-the-week/heart-failure-coverage-success-seen-in-medicaid-expansion-states

The significant effect of the COVID-19 pandemic on mental health was spotlighted in a recent collaborative study conducted by the National Alliance of Healthcare Purchaser Coalitions, Total Brain, and One Mind. Compared with before the pandemic began, study findings indicate stark increases in rates of depression, anxiety, and stress, with women shown to be at a greater risk.

On this episode of Managed Care Cast, we speak with Michael Thompson, president and CEO of the National Alliance, and Louis Gagnon, CEO of Total Brain, on their findings and how employers can optimize how they monitor and support mental health in their respective workforce.

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 CMS proposing rules for value-based contracting in Medicaid; claims data highlighting racial disparities in COVID-19 effects; an interview with Anthony Fauci, MD, on the progress made against HIV.

Read more about the stories in this podcast:

CMS Issues Rules to Promote Value-Based Contracting, Pay for High-Cost Therapies in Medicaid: https://www.ajmc.com/newsroom/cms-issues-rules-to-promote-valuebased-contracting-pay-for-highcost-therapies-in-medicaid

Medicare Claims Data Further Highlight Pandemic's Toll on Racial Minorities: https://www.ajmc.com/focus-of-the-week/medicare-claims-data-further-highlight-pandemics-toll-on-racial-minorities

What Is Being Done to Assess the Disproportionate Effect of COVID-19 on Minority, Rural Communities? https://www.ajmc.com/focus-of-the-week/what-is-being-done-to-assess-the-disproportionate-effect-of-covid19-on-minority-rural-communities

Fauci: Countless Lives Have Been Saved, but an HIV Vaccine and Cure Remain Elusive: https://www.ajmc.com/interviews/fauci-countless-lives-have-been-saved-but-a-vaccine-and-cure-remain-elusive

PwC Provides 3 Spending Scenarios to Address Implications of COVID-19 on the 2021 Medical Cost Trend: https://www.ajmc.com/focus-of-the-week/pwc-provides-3-spending-scenarios-to-address-implications-of-covid19-on-the-2021-medical-cost-trend

Infectious Diseases and Anemia in a Sample of Out-of-Treatment Drug Users: https://www.ajmc.com/journals/issue/1998/1998-09-vol4-n9/sep98-1074p1257-1264

Older and poorer Americans are disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. In this episode of Managed Care Cast, we speak with Richard Shinto, MD, MBA, president and CEO of InnovaCare Health, about the company’s care of their Medicare Advantage and Medicaid beneficiaries in Puerto Rico during the COVID-19 pandemic. He last spoke with us in 2018 about the effect that Hurricane Maria had on the organization and its members. In today’s podcast, he shares how coping with the aftermath of the 2017 hurricane assisted them with the pandemic.

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 more details about the COVID-19 vaccine process; attempts to reinforce social distancing amid reopening; a recap of the American Diabetes Association 2020 Virtual Scientific Sessions.

Read more about the stories in this podcast:

US Releases More Details About COVID-19 Vaccine Process, Says Some Doses Will Be Free: https://www.ajmc.com/newsroom/us-releases-more-details-about-covid19-vaccine-process-says-some-doses-will-be-free

With States Reopening, CDC Tries to Reinforce Social Distancing Guidance: https://www.ajmc.com/newsroom/with-states-reopening-cdc-tries-to-reinforce-social-distancing-guidance

American Diabetes Association 2020 Virtual Scientific Sessions: https://www.ajmc.com/conferences/ada-2020

What We're Reading: Drug Price TV Ruling Upheld; WHO Ends Hydroxychloroquine Study; Caution Issued on Rally Attendance: https://www.ajmc.com/newsroom/what-were-reading-drug-prices-not-required-in-tv-ads-who-ends-study-of-hydroxychloroquine-caution-issued-on-rally-attendance-

FDA Approves Second Biomarker-Based Indication for Pembrolizumab: https://www.ajmc.com/newsroom/fda-approves-second-biomarkerbased-indication-for-pembrolizumab

Effectiveness and Cost-Effectiveness of Diabetes Prevention Among Adherent Participants: https://www.ajmc.com/journals/issue/2013/2013-1-vol19-n3/effectiveness-and-cost-effectiveness-of-diabetes-prevention-among-adherent-participants

The ramifications of the COVID-19 pandemic has caused uncertainty among employers nationwide adjusting to this new normal. Notably, viable health care coverage has emerged as an essential necessity, with employees seeking favorable benefits. A recent analysis by Willis Towers Watson indicates that individual markets, once characterized as volatile, have emerged as an option now associated with stability and growth.

On this episode of Managed Care Cast, we speak with John Barkett, MBA, senior director of Policy Affairs in Benefits Delivery and Administration for Willis Towers Watson, on the current outlook of individual markets in private exchange solutions amid the pandemic.

In this episode of Managed Care Cast, we speak with the lead author of a study in the June issue of The American Journal of Managed Care® about the nationwide dearth of suppliers of the Medicare Diabetes Prevention Program, which aims to reach older adults with prediabetes. Natalie D. Ritchie, associate research scientist in the Denver Health and Hospital Authority Office of Research and an assistant professor at the University of Colorado School of Medicine and College of Nursing, discussed her thoughts on why not enough suppliers are offering the program. The study ("Medicare Diabetes Prevention Program: Where Are the Suppliers?") can be found at ajmc.com/link/4659.