Managed Care Cast

What Health Inequities Are Really Costing Your Company: Wayne Rawlins, MD by Managed Care Cast

Scalable Strategies Boost Heart Failure Prescription Fills: Weston Blakeslee, PhD by Managed Care Cast

Grocery Card Use Associated With Increased Care Among Dual-Eligible Beneficiaries: Jennifer L. Kowalski, MS by Managed Care Cast

Managed Care Cast News Roundup: February 10, 2026 by Managed Care Cast

Kristi Martin, a longtime Washington, DC–based policy strategist with deep experience implementing major legislation like the Affordable Care Act and the Inflation Reduction Act, explores how the Orphan Drug Act, passed in 1983 as a bipartisan, patient-driven effort, transformed rare disease treatment by aligning scientific advances, government investment, and market incentives, but that reform may now be necessary—rethinking incentives for blockbuster drugs, refining orphan eligibility, and shifting toward more targeted, evidence-based negotiation.

The American Journal of Managed Care® (AJMC) kicks off its 2026 author podcast series with Nate C. Apathy, PhD, guest editor of AJMC’s 15th Health Information Technology (IT) special issue. He is an assistant professor of health policy and management at the University of Maryland School of Public Health and an affiliated research scientist at the Regenstrief Institute in Indianapolis, Indiana.

To set the stage for this milestone issue, Apathy reflects on the most significant health IT advancements of the past 15 years before zeroing in on developments from 2025. He then explores the issue’s central themes, including artificial intelligence (AI) and telehealth.

As highlighted in this year’s Health IT issue, Apathy explains that AI has the potential to reduce administrative and clinical burdens and has been rapidly adopted by clinicians. At the same time, AI presents challenges, including maintaining clinical vigilance and managing costs. He also underscores the benefits of telehealth, particularly when tailored to specific clinical contexts.

Despite the pace of technological innovation, Apathy emphasizes that success in health IT ultimately depends on building trust and strong relationships, as well as closely aligning solutions with user needs. Looking ahead, he hopes health IT tools will become more intuitive, seamlessly supporting equity, access, and high-quality care while enabling greater personalization.

On this episode of Managed Care Cast, The American Journal of Managed Care® spoke with David Muhlstein, PhD, JD, founder and CEO of Simple Healthcare, about his recent articles highlighting Transparency in Coverage (TIC) files and ghost rates from 119 insurers, including 3 national commercial payers.

Aetna, Cigna, and United Healthcare TIC files were more than 90% ghost rates—billing codes for procedures that would never be performed by a specific physician. For example, there were billing codes for heart surgery performed by a psychiatrist, Muhlstein said. These ghost rates increase the size of TIC files, making them difficult to evaluate for consumers, researchers, and analysts. Data files of this size muddle the true aim of the TIC files to provide actual transparency that would allow consumers to compare the prices of health care services and choose more affordable options.

The latest news from The American Journal of Managed Care.

On today’s episode, AJMC® spoke with Dr. Sachin Jain, president and CEO of SCAN Group and Health Plan, about his 10 predictions for the health care industry in 2026. Jain breaks down his predictions and what they could mean in both the short and long term for Americans and how they may shape access, affordability, and accountability across the US health care system.

To wrap up this year's author podcast series, The American Journal of Managed Care® speaks with Angela Liu, PhD, MPH, assistant research professor at the Johns Hopkins Bloomberg School of Public Health, about her December 2025 study, "Mental Health Care Use After Leaving Medicare Advantage for Traditional Medicare."

Her research analyzed Medicare beneficiaries with mental health diagnoses who switched from Medicare Advantage (MA) to traditional Medicare (TM), examining their use of mental health services in the year before and after the switch.

In this Managed Care Cast episode, Liu discusses what inspired her research, highlights the key findings, and explores ways to improve equitable access to mental health services for Medicare beneficiaries.