On this episode of Managed Care Cast, we speak with the author of a new book that discusses the price and cost of American healthcare. Martin Makary, MD, MPH, a surgical oncologist and chief of the Johns Hopkins Islet Transplant Center, talked about what he found while writing The Price We Pay: What Broke American Health Care—and How to Fix It. Makary discusses spurious billing practices, overtreatment, and the opioid issue, as well as efforts by some providers and employers to reshape primary care.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included a huge ruling against one opioid maker and a settlement offer from another; an expert panel calling for broader screening for hepatitis C; a review showing there are more fatal events linked to a multiple sclerosis drug than previously known.

Read more about the stories in this podcast:

What We're Reading: Purdue Pharma Settlement; HCV Screening; Medicare for All Support: https://www.ajmc.com/newsroom/what-were-reading-purdue-pharma-settlement-hcv-screening-medicare-for-all-support

Fatal AEs Associated With Alemtuzumab for MS May Occur More Frequently Than Previously Thought: https://www.ajmc.com/newsroom/fatal-aes-associated-with-alemtuzumab-for-ms-may-occur-more-frequently-than-previously-thought

FDA Grants Fast Track Designation for Dapagliflozin to Prevent Kidney Failure: https://www.ajmc.com/newsroom/fda-grants-fast-track-designation-for-dapagliflozin-to-prevent-kidney-failure-

5 Things to Look for at the European Society of Cardiology 2019 Congress: https://www.ajmc.com/newsroom/5-things-to-look-for-at-the-european-society-of-cardiology-2019-congress

Keeping Glucose in Range, With the Right Tools and Treatment for Management: https://www.ajmc.com/focus-of-the-week/keeping-glucose-in-range-with-the-right-tools-and-treatment-for-management

IVBM: Advancing Oncology Quality Through Value-Based Care: https://www.ajmc.com/meetings/ivbm-philadelphia-2019-09-19

As advocates for addressing social determinants of health (SDOH) look to get buy in from stakeholders, there's a need for building evidence base to show that initiatives addressing these determinants work.

To discuss the importance of both quantifying and communicating the return on investment of these initiatives, we spoke with Susan Mani, MD, vice president of Clinical Transformation and Ambulatory Quality at LifeBridge Health.

Read more about building an evidence base for SDOH initiatives

Building the Evidence Base to Quantify, Communicate the ROI of SDOH Initiatives: www.ajmc.com/conferences/whcc-2019/building-the-evidence-base-to-quantify-communicate-the-roi-of-sdoh-initiatives

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week in managed care, the top news included outcomes results in treating heart failure; US prevention experts said more women should get BRCA testing; the American Heart Association offered an advisory on treating high triglycerides with prescription omega-3 fatty acids.

Read more about the stories in this podcast:

AstraZeneca's Dapagliflozin Meets Primary End Point in Heart Failure Trial: https://www.ajmc.com/newsroom/astrazenecas-dapagliflozin-meets-primary-end-point-in-heart-failure-trial

FDA's Fast Track Designation for Empagliflozin in Heart Failure Points to New Paradigm: https://www.ajmc.com/newsroom/fdas-fast-track-designation-for-empagliflozin-in-heart-failure-points-to-new-paradigm

More Women May Be Screened for BRCA Mutations Following USPSTF Guideline Update: https://www.ajmc.com/newsroom/more-women-may-be-screened-for-brca-mutations-following-uspstf-guideline-update

Evidence-Based Oncology - August 2019: https://www.ajmc.com/journals/evidence-based-oncology/2019/august-2019

Prescription Omega-3 Fatty Acids Effectively Reduce Triglycerides, AHA Says in Advisory: https://www.ajmc.com/focus-of-the-week/prescription-omega-3-fatty-acids-effectively-reduce-triglycerides-aha-says-in-advisory

Neighborhood Characteristics Linked to Premature Mortality Rates: https://www.ajmc.com/focus-of-the-week/neighborhood-characteristics-linked-to-premature-mortality-rates

Costs, Quality, Access, and More: The Challenges of Providing Healthcare to Employees: https://www.ajmc.com/managed-care-cast/costs-quality-access-and-more-the-challenges-of-providing-healthcare-to-employees

​​​​​​​Employers Compendium: https://www.ajmc.com/compendium/employers

Employers are the single largest provider and purchaser of healthcare insurance in the United States and they represent a potential force for change in the US healthcare system. In order to control costs and provide better care to their employees, employers have been banding together through local coalitions. Many coalitions across the country have coalesced under the National Alliance of Healthcare Purchaser Coalitions.

At the National Alliance’s recent Leadership Summit, held at the end of June in Pittsburgh, we spoke with some of the leaders about key issues facing employers in healthcare and how those top concerns may have changed over the past few years.

Read more:

Employers Compendium: https://www.ajmc.com/compendium/employers

National Alliance of Healthcare Purchaser Coalitions partner page: https://www.ajmc.com/partners/national-alliance

Greater Philadelphia Business Coalition on Health partner page: https://www.ajmc.com/partners/gpbch

National Alliance of Healthcare Purchaser Coalitions’ 2019 Leadership Summits conference page: https://www.ajmc.com/conferences/leadership-summits-2019

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included the Trump administration looking to bar legal immigrants from using public benefits; a study in The American Journal of Managed Care® finding that a law to limit surprise medical bills is working; data on Affordable Care Act enrollment showing the effect of subsidies.

Read more about the stories in this podcast:

Trump Administration Publishes Final Rule Aimed at Legal Immigrants Using Public Benefits: https://www.ajmc.com/newsroom/trump-administration-publishes-final-rule-aimed-at-legal-immigrants-using-public-benefits

Influence of Out-of-Network Payment Standards on Insurer–Provider Bargaining: California’s Experience: https://www.ajmc.com/journals/issue/2019/2019-vol25-n8/influence-of-outofnetwork-payment-standards-on-insurer-provider-bargaining-californias-experience

What We're Reading: Ebola Vaccine Victory; ACA Numbers Mixed; Scientists Repurpose Old Drugs: https://www.ajmc.com/newsroom/what-were-reading-ebola-vaccine-victory-aca-numbers-mixed-scientists-reurpose-old-drugs

Researchers Say They Developed an Approach to Further Suppress HIV Infection: https://www.ajmc.com/newsroom/researchers-say-they-developed-an-approach-to-further-suppress-hiv-infection

Evidence-Based Oncology - August 2019: https://www.ajmc.com/journals/evidence-based-oncology/2019/august-2019

On this episode of Managed Care Cast, we’re bringing you a portion of a panel discussion about the Oncology Care Model, held in July 2019 during a meeting of The Institute for Value-Based Medicine (IVBM), an initiative of The American Journal of Managed Care®. At IVBM events, we gather thought leaders to share best practices across medicine, pharmacy, and management in regional locations around the country. This podcast is taken from our meeting focusing on Innovation and Quality in Oncology Care.

Read previous coverage of IVBM events:

Managing Costs in Diabetes Means Intervening Early to Avoid Complications Later, Experts Say: www.ajmc.com/journals/evidence-based-diabetes-management/2019/june-2019/managing-costs-in-diabetes-means-intervening-early-to-avoid-complications-later-experts-say

Even With Room for Improvement, OCM Practices Agree: They Would Participate Again; and Practice Transformations Improve Access, Increase Communication in the Shift to Value-Based Cancer Care: www.ajmc.com/journals/evidence-based-oncology/2019/june-2019/institute-for-valuebased-medicine

As Comorbidities Pile Up, True Diabetes Cost Measured by More Than Insulin, Panel Says: www.ajmc.com/newsroom/as-comorbidities-pile-up-true-diabetes-cost-measured-by-more-than-insulin-panel-says-

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included CMS giving chimeric antigen receptor T-cell payments a boost; a US task force announcing that those at risk for pancreatic cancer should be screened; FDA revealing Novartis withheld data about a high-cost gene therapy.

Read more about the stories in this podcast:

CMS Gives CAR T Payments Short-term Boost, Adjusts Hospital Wage Index: https://www.ajmc.com/focus-of-the-week/cms-gives-car-t-payments-shortterm-boost-adjusts-hospital-wage-index

Still No Call for Widespread Screening for Pancreatic Cancer, but USPSTF Says Yes for Those With Known Risk: https://www.ajmc.com/focus-of-the-week/still-no-call-for-widespread-screening-for-pancreatic-cancer-but-uspstf-says-yes-for-those-with-known-risk

What We're Reading: FDA Says Novartis Hid Data; Judge Halts Ark. Abortion Rules; New Phase in Opioid Suits: https://www.ajmc.com/newsroom/what-were-reading-fda-says-novartis-hid-data-judge-halts-ark-abortion-rules-new-phase-in-opioid-suits

One Dose of HPV Vaccine Effective in Preventing Cervical Cancer Compared With Multiple Doses, Researchers Say: https://www.ajmc.com/newsroom/one-dose-of-hpv-vaccine-effective-in-preventing-cervical-cancer-compared-with-multiple-doses-researchers-say

"Not So Different": The Biosimilars Council Says Patent Abuses Are Costing Biosimilar Savings: https://www.centerforbiosimilars.com/podcast/not-so-different-the-biosimilars-council-says-patent-abuses-are-costing-biosimilar-savings

Transitioning to value-based care is a marathon, not a race, and should be viewed as a mission and a culture, Jeff Hunnicutt, chief executive officer at Highlands Oncology Group, told Amy Ellis, director of quality and value-based care at Northwest Medical Specialties. In order to successfully transform a practice, there needs to be a clear message and set values ingrained in the mindset of staff at the frontline of patient care.

As a progressive disease diabetes presents an ongoing challenge for physicians to provide adequate control of patients’ diabetes, and new agents with novel mechanisms of action help reduce the burden in the management of diabetes.

In a recent Peer Exchange discussion, Dr Peter Salgo, of Columbia University College of Physicians and Surgeons and NewYork-Presbyterian Hospital, led a discussion on novel agents and their role in treating patients with and with cardiovascular disease. On the panel was Dr. Om Ganda of Joslin Diabetes Center; Jim Kenney of JTKenney, a managed care consulting practice; and Dr Helena Rodbard, past president of the American College of Endocrinology and past president of the American Association of Clinical Endocrinologists.

Listen to the full discussion: https://www.ajmc.com/peer-exchange/new-classes-for-treatment-of-type-2-diabetes/