Heard at ISPOR: Debating the Benefits and Pitfalls of the QALY by Managed Care Cast

We sit down with David Smith, the executive director of the Medicaid Transformation Project, to get an update about the integration challenges health systems are facing, including system issues, infrastructure issues, coding and payment issues, and more.

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 news included the FDA's approval of a $2.1 million gene therapy; a study revealing that the worldwide need for palliative care will nearly double by 2060; the FDA granting priority review to Amarin’s Vascepa for a cardiovascular indication.

Read more about the stories in this podcast:

FDA Approves Gene Therapy With $2.1M Price Tag for Spinal Muscular Atrophy in Pediatric Patients: https://www.ajmc.com/newsroom/fda-approves-gene-therapy-with-21m-price-tag-for-spinal-muscular-atrophy-in-pediatric-patients

Serious Health-Related Suffering to Nearly Double by 2060, Highlighting Need to Ramp Up Palliative Care Efforts: https://www.ajmc.com/focus-of-the-week/serious-healthrelated-suffering-to-nearly-double-by-2060-highlighting-need-to-ramp-up-palliative-care-efforts

What We're Reading: FDA Grants Priority Review for Amarin's Vascepa; HHS Rule Challenged; Military Mental Health Proposal: https://www.ajmc.com/newsroom/what-were-reading-fda-grants-priority-review-for-amarins-vascepa-hhs-rule-challenged-military-mental-health-proposal

Amarin's High-Dose Fish Oil Pill Cuts Total CV Event Risk 30% in Study: https://www.ajmc.com/conferences/acc-2019/amarins-highdose-fish-oil-pill-cuts-total-cv-event-risk-30-in-study

The American Journal of Managed Care—May 2019: https://www.ajmc.com/journals/issue/2019/2019-vol25-n5

Open Doors to Primary Care Should Add a “Screen” to Reduce Low-Value Care: https://www.ajmc.com/journals/issue/2019/2019-vol25-n5/open-doors-to-primary-care-should-add-a-ldquoscreenrdquo-to-reduce-lowvalue-care

American Society of Clinical Oncology Annual Meeting 2019: https://www.ajmc.com/conferences/asco-2019

In the first of a series of interviews with key opinion leaders, Amy Ellis, director of quality and value-based care at Northwest Medical Specialties, discusses practice transformation with Jess Quiring, a patient navigator at New Mexico Cancer Center.

During the converation, Quiring explained how her practice modified the depression and distress screening tools for the different populations it treated. For instance, it changed the language based on what was more acceptable to Native Americans receiving treatment. She also explained the various programs the practice offers to patients, such as yoga, an art workshop, and meal preparation assistance, as well as several support groups.

Exploring the Increased Prevalence, Evolving Role of Physician Assistants by Managed Care Cast

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 news included a study questioning the Hospital Readmissions Reduction Program; FDA issuing a warning about do-it-yourself artificial pancreas systems; measles cases reach the highest level since 1994.

Read more about the stories in this podcast:

Study Questions Penalizing, Incentivizing PCPs for Readmission Rates: https://www.ajmc.com/focus-of-the-week/study-questions-penalizing-incentivizing-pcps-for-readmission-rates

FDA Issues Warning on Do-It-Yourself Artificial Pancreas: https://www.ajmc.com/newsroom/fda-issues-warning-on-do-it-yourself-artificial-pancreas

What We're Reading: Tobacco Age Legislation; Most Measles Cases Since 1994; Hidden Dangers of Heart Device: https://www.ajmc.com/newsroom/what-were-reading-tobacco-age-legislation-most-measles-cases-since-1994-hidden-dangers-of-heart-device

Alkermes' Novel Schizophrenia Drug Shows Less Weight Gain, Addressing Top Patient Complaint: https://www.ajmc.com/conferences/apa-2019?rel=0/alkermes-novel-schizophrenia-drug-shows-less-weight-gain-addressing-top-patient-complaint

Adam Simmons on Patient Preferences When Taking Antipsychotic Medications: https://www.ajmc.com/conferences/apa-2019/adam-simmons-on-patient-preferences-when-taking-antipsychotic-medications

American Psychiatric Association 2019 Annual Meeting: https://www.ajmc.com/conferences/apa-2019

Panelists Debate the Role of ICER: Useful Overseer of Prices, or Oppressor of Choice? https://www.ajmc.com/conferences/ispor-2019/panelists-debate-the-role-of-icer-useful-overseer-of-prices-or-oppressor-of-choice-

ISPOR 2019 Annual Meeting: https://www.ajmc.com/conferences/ispor-2019

As the cost of healthcare continues to rise, employers are getting more involved in their employees’ health and identifying ways they can intervene to help get employees who have chronic conditions healthy or access to care they need and also keep employees who are already healthy from getting sick.

At the Midwest Business Group on Health (MBGH)’s 39th annual conference, Cheryl Larson, president and chief executive officer of MBGH, and Denise Giambalvo, vice president of MBGH, discussed a range of topics affecting employers, including trust with employees, popular initiatives, the cost of specialty drugs, and various proposals and policies from the Trump administration, such as getting rid of drug rebates and including drug prices in TV ads.

Read coverage from the Midwest Business Group on Health’s annual conference: https://www.ajmc.com/conferences/mbgh-2019

Patients with Parkinson disease can suffer complications in the hospital if the individualized, highly structured care plans that manage their disease are not followed. We interviewed neurologist Hooman Azmi, MD, the co-author of Parkinson's Disease for the Hospitalist: Managing the Complex Care of a Vulnerable Population, about what it takes to improve patient care for this population. He is the director of the Division of Movement Disorders at Hackensack University Medical Center and is also a member of the neuro-oncology team at the John Theurer Cancer Center at Hackensack UMC.

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 news included 44 states suing drug makers for price fixing; Gilead pledging to donate pre-exposure prophylaxis for up to 200,000 people for up to 11 years; Philadelphia soda tax reduced consumption of sugary drinks.

Read more about the stories in this podcast:

What We're Reading: Drug Makers Accused of Price-Fixing; Washington State Public Option Insurance; Vaccine Exemptions Stall: https://www.ajmc.com/newsroom/what-were-reading-drug-makers-accused-of-pricefixing-washington-state-public-option-insurance-vaccine-exemptions-stall

Reactions Are Mixed as Gilead Announces PrEP Donations, Early Launch of Generic: https://www.ajmc.com/newsroom/reactions-are-mixed-as-gilead-announces-prep-donations-early-launch-of-generic

Sales of Sweetened Drinks Fell 38% After Philadelphia Beverage Tax: https://www.ajmc.com/newsroom/sales-of-sweetened-drinks-fell-38-after-philadelphia-beverage-tax

Chemotherapy Demand Will Rise Significantly by 2040, and Workforce Will Need to Expand With It: https://www.ajmc.com/focus-of-the-week/chemotherapy-demand-will-rise-significantly-by-2040-and-workforce-will-need-to-expand-with-it

ISPOR 2019 (Coverage starting May 20): https://www.ajmc.com/conferences/ispor-2019

Sign up: ISPOR 2019—On Location Interviews, Day 1: https://www.ajmc.com/onlocation/2019/ispor-2019-on-location-interviews-day-1

Sign up: ISPOR 2019—On Location Interviews, Day 2: https://www.ajmc.com/onlocation/2019/ispor-2019-on-location-interviews-day-2

Sign up: ISPOR 2019—On Location Interviews, Day 3: https://www.ajmc.com/onlocation/2019/ispor-2019-on-location-interviews-day-3

American Psychiatric Association 2019 Annual Meeting (Coverage starting May 19): https://www.ajmc.com/conferences/apa-2019

Newsletter Sign-up: https://www.ajmc.com/email-profile

Do Machine-Readable Directories Improve Provider Directory Accuracy? by Managed Care Cast