Managed Care Cast

Efforts to ensure that veterans have timely access to healthcare include community partnerships and the Veterans Choice Program, but new research suggests that women veterans may be receiving less care, particularly those who report unstable housing or mental/behavioral health issues,

On this episode of Managed Care Cast, we speak with Laurel A. Copeland, PhD, about the paper “Gender Differences in Newly Separated Veterans’ Use of Healthcare.” The study can be found in the March issue of The American Journal of Managed Care®.

Prior authorizations play a key role in checking on the safety and appropriateness of medical treatments among patients, but when they take too long, efficiency of care suffers.

On this episode of Managed Care Cast, we speak with April Todd, senior vice president, CORE and Explorations for CAQH, on CAQH CORE’s recent approval of a 2-day rule for health plans in requesting additional supporting information from providers and making final determinations on prior authorization requests. CAQH CORE is a multi-stakeholder collaboration aimed at creating healthcare operating rules for electronic administrative transactions and establishing a common foundation for the operational components of value-based payment.

This week, top managed care stories included an additional setback for Medicaid work rules; another study finding more benefits from SGLT2 inhibitors; researchers finding unwanted end-of-life care causes stress.

When implemented as intended, preventive drug lists (PDLs) can help high-deductable health plan members save money by covering preventive medications at lower or no costs. However, after conducting a series of interviews, researchers found this is not always the case among patients with asthma who have PDLs. Some patients were unaware their plans had PDLs, while other PDLs did not cover the cost of asthma medication.

On this episode of Managed Care cast, we speak with Melissa B. Gilkey, PhD, and Alison A. Galbraith, MD, MPH, about their paper, "Preventive Drug Lists as Tools for Managing Asthma Medication Costs." The study can be found in the February issue of The American Journal of Managed Care®.

Although genomic testing is recognized in national oncology guidelines as key to determining the right therapy for metastatic colorectal cancer (MCC), overall biomarker testing rates remain poor. On this episode of Managed Care Cast, we speak with one of the authors of a recent study about this issue published in JCO Precision Oncology. Stuart Goldberg, MD, a hematologist oncologist at the John Theurer Cancer Center at Hackensack University Medical Center, discusses real-world testing of biomarkers in MCC by mining electronic health records.

Goldberg is also the hospital’s first chief of the Division of Outcomes and Value Research, and the episode also discusses the relationship between value-based medicine and precision medicine and the promise of delivering improved outcomes at lower costs by avoiding ineffective therapies through the use of specialized testing and diagnostics.

On this episode of Managed Care Cast, we speak with John Showalter, MD, chief product officer at Jvion and an internal medicine physician, and Soy Chen, MS, director of data science at Jvion and part of their data science team. We discuss their research about using applied machine learning to predict healthcare utilization based on social determinants of health, appearing in the January 2019 Health IT issue of The American Journal of Managed Care®.

Nearly 75% of Americans will consider healthcare a main factor when they vote in the 2020 presidential election, according to a survey published by Wolters Kluwer late last year. The survey, called Mending HealthCare in America 2020: Consumers & Cost, showed alignment and deep divisions among patients and providers, with issues around transparency, cost, and care variability causing concern. On this episode of the podcast, we speak with Peter Bonis, MD, chief medical officer, Clinical Effectiveness, Wolters Kluwer, Health.

On this episode of Managed Care Cast, we speak with Kashyap Patel, MD, the chief executive officer of Carolina Blood and Cancer Care Associates—a leading OCM practice—and associate editor of Evidence-Based Oncology™ (EBO), as well as Tennessee Oncology’s Stephen M. Schleicher, MD, MBA, to discuss Oncology Care First.

On this Managed Care Cast, we speak with a health policy researcher who got the idea for a study about medical billing appearing in the December 2019 issue of The American Journal of Managed Care® after she received one that was unexpected. While efforts to abate surprise medical billing, such as the kind that come from out-of-network emergency department visits, are currently being debated in Washington, DC, the kind of billing discussed here occurs when patients struggle to understand the difference between preventive health services, which are covered at no cost under the Affordable Care Act, and billing for services at a doctor’s visit for an illness, condition, or injury.

Katie Schmitz, a graduate student pursuing a master’s degree in health communication from Purdue University, is one of the coauthors of "Preventive/Office Visit Patient Knowledge and Their Insurance Information Gathering Perceptions."

Read the full paper: https://www.ajmc.com/journals/issue/2019/2019-vol25-n12/preventiveoffice-visit-patient-knowledge-and-their-insurance-information-gathering-perceptions

On this episode of KOL Corner, Amy Ellis, director of quality and value-based care at Northwest Medical Specialties, talks with Amanda Hodges, BSN, RN, OCN, the director of implementation of ReVital Cancer Implementation.