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 started planning for life after the Oncology Care Model; a judge blocked a rule requiring immigrants to have health coverage; Election Day brought news for Medicaid work rules.

Read more about the stories in this podcast:

CMS, CMMI Seek Feedback on Oncology Care First, Successor to OCM: https://www.ajmc.com/newsroom/cms-cmmi-seek-feedback-on-oncology-care-first-successor-to-ocm

Electronic PROs a Proposed Feature of Successor Model in Oncology Care: https://www.ajmc.com/focus-of-the-week/electronic-pros-a-proposed-feature-of-successor-model-in-oncology-care

What We're Reading: Trump's Immigrant Health Insurance Rule Blocked; Tips to Choose a Health Plan; FDA Advises Zantac Recalls: https://www.ajmc.com/newsroom/what-were-reading-trumps-immigrant-health-insurance-rule-blocked-tips-to-choose-a-health-plan-fda-advises-zantac-recalls

What We're Reading: Democrats Win With Medicaid Work Rule Promise; Trump Says No to Pelosi Plan; UnitedHealthcare Biosimilar Switching: https://www.ajmc.com/newsroom/what-were-reading-democrats-win-with-medicaid-work-rule-promise-trump-says-no-to-pelosi-plan-unitedhealthcare-biosimilar-switching

Final ICER Report Finds Empagliflozin More Cost Effective Than Oral Semaglutide for Type 2 Diabetes: https://www.ajmc.com/focus-of-the-week/final-icer-report-finds-empagliflozin-more-costeffective-than-oral-semaglutide-for-type-2-diabetes

UnitedHealthcare Patients Will Switch to Biosimilar Epoetin Alfa in 2020: https://www.centerforbiosimilars.com/news/unitedhealthcare-patients-will-switch-to-biosimilar-epoetin-alfa-in-2020

In 2002, Bill Allman, working for Washington State, heard from a widow with a $75,000 bill from Medicaid, which was incurred as part of his long-term care costs. Like Allman, the man was a veteran. On this episode of Managed Care Cast, we learn how Allman, who is retiring at the end of 2019, launched a program to connect veterans to health benefits they didn't know they had, and in the process, figured out that states could reduce Medicaid spending.

In 2018, the Ochsner Accountable Care Network was able to reduce expected costs of care by more than $12.78 million for its Medicare beneficiaries, and it increased its savings 12% over 2017. This comes amidst research and claims that accountable care organizations may not be successful at reducing costs while improving outcomes.

David Carmouche, MD, president of the Ochsner Health Network and executive director of the Ochsner Accountable Care Network, explains how the Ochsner accountable care organization (ACO) was able to find success and how other ACOs can get over the learning curve to achieve savings.

Learn more about Ochsner

https://www.ajmc.com/partners/ochsner

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 average Affordable Care Act premiums falling 4%; the FDA approving a triple combination treatment for cystic fibrosis; House Republicans releasing part 1 of their healthcare plan.

Read more about the stories in this podcast:

While Waiting for ACA Decision, HHS Says 2020 Benchmark Plan Premiums Mostly Lower: https://www.ajmc.com/newsroom/while-waiting-for-aca-decision-hhs-says-2020-benchmark-plan-premiums-mostly-lower

FDA Approves Novel Triple Combination Therapy for Cystic Fibrosis: https://www.ajmc.com/newsroom/fda-approves-novel-triple-combination-therapy-for-cystic-fibrosis

What We're Reading: Republicans Release Health Plan; J&J's Talc Problems; House Panel to Consider Vape Tax: https://www.ajmc.com/newsroom/what-were-reading-republicans-release-health-plan-jjs-talc-problems-house-panel-to-consider-vape-tax

Blood Supply Falls Short of Need in Most Countries, Study Finds: https://www.ajmc.com/newsroom/blood-supply-falls-short-of-need-in-most-countries-study-finds

Black Patients With Diabetes May Have Greater Hospital Readmission Risk, Study Finds: https://www.ajmc.com/newsroom/black-patients-with-diabetes-may-have-greater-hospital-readmission-risk-study-finds

Patient-Centered Oncology Care®—Innovation and Quality: New Directions in Value-Based Care: https://www.ajmc.com/pcoc-philadelphia-2019-11-08

Healthcare is increasingly trying to use big data and clinical pharmacists are no exception. On today's episode of Managed Care Cast, we talk with an assistant professor at Geisinger’s Center for Pharmacy Innovation and Outcomes about his work with big data.

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 a new guide that balances curbs on opioid abuse with the needs of patients with chronic pain; HHS proposed reforming antikickback rules to help boost value-based care; a report found flaws with Medicaid work requirements.

Who will care for America's growing aged population in the coming decades? Today on the podcast, we're speaking with PHI, a New York-based nonprofit organization that works to improve long-term services and care for the elderly and those with disabilities by focusing on the job quality of those providing day-to-day hands-on care—low-paid home health care aides and nursing assistants.

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 an effort by the Trump administration to bolster Medicare Advantage; an abortion case from Louisiana reached the Supreme Court; the study of adapting to changing oxygen levels wins the Nobel Prize.

Read more about the stories in this podcast:

Trump Executive Order Bolsters Medicare, MA to Compete Against "Medicare for All" Proposals: https://www.ajmc.com/newsroom/trump-executive-order-bolsters-medicare-ma-to-compete-against-medicare-for-all-proposals

What We're Reading: Abortion Access Appeal; Trump to Suspend Visas for Uninsured Immigrants; Vape Ban in Oregon: https://www.ajmc.com/newsroom/what-were-reading-abortion-access-appeal-trump-to-suspend-visas-for-uninsured-immigrants-vape-ban-in-oregon

Nobel Prize Honors 3 Who Showed How Cells Adapt to Oxygen Levels: https://www.ajmc.com/focus-of-the-week/nobel-prize-honors-3-who-showed-how-cells-adapt-to-oxygen-levels

California Becomes First State to Make HIV Prevention Medication Accessible Without a Prescription: https://www.ajmc.com/newsroom/california-becomes-first-state-to-make-hiv-prevention-medication-accessible-without-a-prescription-

Psych Congress 2019: https://www.ajmc.com/conferences/psychcongress-2019

This month’s issue of The American Journal of Managed Care® took a look at differences in coverage of orphan and nonorphan drugs to get insight into variation in orphan drug coverage across the largest commercial plans in the United States. The study, which analyzed a data set of private health plan coverage decisions for specialty drugs in 3 ways, found that health plans restrict access to orphan drugs about one-third of the time and that restrictions vary across plans. To get more insight into the findings, and the reasons behind these trends, we sat down with James Chambers, PhD, associate professor of medicine at Tufts Medical Center Institute for Clinical Research and Health Policy Studies.

Exploring the Rise of Obesity-Related Cancers: A Conversation With Dr Debra Patt by Managed Care Cast