Managed Care Cast

Now 3 years into the Oncology Care Model, practices participating in the episode-based model have recently received results from performance period 4, representing care delivered in the first half of 2018. Results from the previous 2 performance periods have some practices concerned because there was little improvement; During both performance period 2 and 3 approximately 30% of practices achieved savings.

With performance period 4 results out now, it’s a transformative point in the model in which practices that have not yet achieved a performance-based payment have to either enter 2-sided risk or leave the model. To dive into the most recent results and their implications, we spoke with Charles Saunders, MD, chief executive officer of Integra Connect. 

Read more about the Oncology Care Model performance period results:

Lessons From the Field: How Practices Are Succeeding Under OCM: https://www.ajmc.com/focus-of-the-week/lessons-from-the-field-how-practices-are-succeeding-under-ocm

Mike Fazio: Practices Are Happier With PP4 Results in the OCM: https://www.ajmc.com/conferences/qcca-fall-2019/mike-fazio-practices-are-happier-with-pp4-results-in-the-ocm

COA Submits OCM 2.0 Proposal: https://www.ajmc.com/newsroom/coa-submits-ocm-20-proposal

COA Urges Delay in Downside Risk Deadline for OCM: https://www.ajmc.com/newsroom/coa-urges-delay-in-downside-risk-deadline-for-ocm

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 Purdue Pharma filing for bankruptcy; new data showing the number of people who get screened for HIV at least once falls far short of what CDC recommends; findings that most US hospital markets are now highly concentrated.

Read more about the stories in this podcast:

What We're Reading: Purdue Pharma Files for Bankruptcy; Rise in Uninsured Immigrants; Spiked CBD in Maryland: https://www.ajmc.com/newsroom/what-were-reading-purdue-pharma-files-for-bankruptcy-rise-in-uninsured-immigrants-spiked-cbd-in-maryland

How Many People Actually Get Screened for HIV? https://www.ajmc.com/newsroom/how-many-people-actually-get-screened-for-hiv

Nearly 75% of US Hospital Markets Highly Concentrated, HCCI Report Shows: https://www.ajmc.com/newsroom/nearly-75-of-us-hospital-markets-highly-concentrated-hcci-report-shows

What We're Reading: Fast Track Designation for Dapagliflozin; California Advocates Against Vaping; Measles Cases Fading: https://www.ajmc.com/newsroom/what-were-reading-fast-track-designation-for-dapagliflozin-california-advocate-against-vaping-measles-cases-fading-

Amgen Posts Updates on Triplet Therapy Using Carfilzomib: https://www.ajmc.com/newsroom/amgen-posts-updates-on-triplet-therapy-using-carfilzomib

Managed Care for Long-Stay Nursing Home Residents: An Evaluation of Institutional Special Needs Plans: https://www.ajmc.com/journals/issue/2019/2019-vol25-n9/managed-care-for-long-stay-nursing-home-residents-an-evaluation-of-institutional-special-needs-plans

Exploring Reference-Based Pricing as a Method for Lowering Healthcare Costs 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 report showing the US uninsured rate rose in 2018; the Trump administration indicating it will ban all flavors of e-cigarettes except for tobacco; new research showing the prevalence of hemophilia is 3 times larger than originally believed.

Read more about the stories in this podcast:

Despite Strong Economy, Census Report Says Uninsured Rate Rose in 2018: https://www.ajmc.com/focus-of-the-week/despite-strong-economy-census-report-says-uninsured-rate-rose-in-2018

What We're Reading: FDA Investigating Juul; Sutter Health Handed Lawsuit; European Doctor Sues FDA: https://www.ajmc.com/newsroom/what-were-reading-fda-investigating-juul-sutter-health-handed-lawsuit-european-doctor-sues-fda

Trump Administration Seeks to Rid Market of Flavored e-Cigarettes: https://www.ajmc.com/newsroom/trump-administration-seeks-to-rid-market-of-flavored-ecigarettes

Prevalence of Hemophilia Worldwide Is Triple That of Previous Estimates, New Study Says: https://www.ajmc.com/focus-of-the-week/prevalence-of-hemophilia-worldwide-is-triple-that-of-previous-estimates-new-study-says-

Employers Recognize Need to Improve Employee Health Experience: https://www.ajmc.com/newsroom/employers-recognize-need-to-improve-employee-health-experience

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

To date, most alternative payment models (APMs) that have emerged in the shift toward value-based care have been initiated by payers and focused on primary care providers. However, there has recently been a new wave of payment reform in which providers, mostly specialists, are designing and implementing their own APMs in their practices. A study published in the September issue of The American Journal of Managed Care analyzed some of these new payment models to gain insight into what providers are prioritizing in their APMs. To get more insight into the study and its findings, we spoke with study author Suhas Gondi, BA, of Harvard Medical School.

Relationships in healthcare are important and trust is crucial to those relationships. However, it has been on the decline in the United States. We speak with the executive vice president of the ABIM Foundation and representatives from the 8 winning organizations of the foundation's Trust Practice Challenge about the programs they implemented to rebuild trust.

Read more:

ABIM Foundation Trust Practice Challenge: https://abimfoundation.org/what-we-do/rebuilding-trust-in-health-care/trust-practice-challenge

5 Things About Medical Mistrust: www.ajmc.com/newsroom/5-things-about-medical-mistrust

From the Editorial Board: Daniel B. Wolfson, MHSA: www.ajmc.com/journals/issue/2019/2019-vol25-n5/from-the-editorial-board-daniel-b-wolfson-mhsa

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 diabetes drug showing positive results in treating heart failure; new lipid guidelines promoting the use of proprotein convertase subtilisin/kexin type 9 inhibitors; and a study finding doctors are more likely to prescribe opioids if they are in a hurry.

Read more about the stories in this podcast:

Dapagliflozin Cuts Risk of CV Death, Worsening of Heart Failure 26%, Whether Diabetes Present or Not: https://www.ajmc.com/newsroom/dapagliflozin-cut-risk-of-cv-death-worsening-of-heart-failure-26-whether-diabetes-present-or-not

New Guidelines Supported by Lipid-Lowering Therapy Studies, Indicating Benefit of PCSK9 Inhibitors: https://www.ajmc.com/focus-of-the-week/new-guidelines-supported-by-lipidlowering-therapy-studies-indicating-benefit-of-pcsk9-inhibitors

Providers More Likely to Prescribe Opioids as the Day Progresses or If They're Running Late: https://www.ajmc.com/focus-of-the-week/providers-more-likely-to-prescribe-opioids-as-the-day-progresses-if-theyre-running-late

Large European Study Links Soda Consumption to Greater Risk of Mortality, Including From Parkinson: https://www.ajmc.com/newsroom/large-european-study-links-soda-consumption-to-greater-risk-of-mortality-including-from-parkinson

IVBM: The Future of Oncology Value-Based Care: https://www.ajmc.com/meetings/ivbm-nashville-2019-10-24

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

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