Managed Care Cast

Addressing the Complexities of Value-Based Payment Models 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 CMS pushing for bundled payments in radiation oncology; reports detailing deficiencies in hospice care; a study finding widening disparities in life expectancy among white Americans.

Read more about the stories in this podcast:

CMS Proposes Bundled Payments for Radiation Oncology: https://www.ajmc.com/newsroom/cms-proposes-bundled-payments-for-radiation-oncology

OIG Reports Find Deficiencies in Hospice Care and Resulting Harms to Patients: https://www.ajmc.com/focus-of-the-week/oig-reports-find-deficiencies-in-hospice-care-and-resulting-harms-to-patients

Study Reveals Declining Life Expectancy Among White Americans That Defies Easy Answers: https://www.ajmc.com/focus-of-the-week/study-reveals-declining-life-expectancy-among-white-americans-that-defies-easy-answers

Systolic, Diastolic BP Both Predict Cardiovascular Events, Kaiser Permanente Study Finds: https://www.ajmc.com/newsroom/systolic-diastolic-bp-both-predict-cardiovascular-events-kaiser-permanente-study-finds

Number of Manufacturers and Generic Drug Pricing From 2005 to 2017: https://www.ajmc.com/journals/issue/2019/2019-vol25-n7/number-of-manufacturers-and-generic-drug-pricing-from-2005-to-2017

Pharmaceutical manufacturers sought to improve patient access to treatments through the use of co-payment assistance cards. But, while these cards reduce the out-of-pocket cost for enrollees, employers worry that they could result in increased medication use and associated expenditures, thus negating efforts made with benefit designs. To mitigate the issue, pharmacy benefit managers have introduced co-pay accumulator adjustment programs, which prevent pharmaceutical manufacturer subsidies put toward a patient’s out-of-pocket costs from counting toward the deductible. As a result, high-deductible health plan enrollees could face a sharp spike in out-of-pocket costs when the manufacturer subsidy limits are reached, but the patient has not reached their deductible.

Despite the lack of data around how these programs affect patient outcomes, they have become popular among employers.

Bruce Sherman, MD, FCCP, chief medical officer of the National Alliance of Healthcare Purchasers Coalition, discusses the findings of a paper in the July issue of The American Journal of Managed Care® on the impact of co-pay accumulator adjustment programs on specialty drug use.

Read the paper: https://www.ajmc.com/journals/issue/2019/2019-vol25-n7/impact-of-a-copay-accumulator-adjustment-program-on-specialty-drug-adherence

Just halfway through the year, and 2019 has been busy for biosimilars with new guidance and approvals, but the loss of a big advocate of biosimilars from the FDA. In this episode of Managed Care Cast, Kelly Davio, senior editor of The Center for Biosimilars®, a sister site of The American Journal of Managed Care®, discusses new approvals, what the loss of Scott Gottlieb, MD, as FDA commissioner means, the reality of pay-for-delay deals, and more.

Learn more about biosimilars at centerforbiosimilars.com.

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 uncertainty surrounding the fate of the Affordable Care Act's individual mandate; a study finding Medicare beneficiaries may be paying more for some generics than brand-name drugs; the Trump administration proposing 5 new payment models to transform kidney disease care.

Read more about the stories in this podcast:

Appeals Court Shows Uncertainty Over Constitutionality of ACA's Individual Mandate: https://www.ajmc.com/focus-of-the-week/appeals-court-shows-uncertainty-over-constitutionality-of-acas-individual-mandate

Medicare Beneficiaries May Pay More for Some Generics Than Brand-Name Drugs: https://www.ajmc.com/focus-of-the-week/medicare-beneficiaries-may-pay-more-for-some-generics-than-brandname-drugs

Despite Growth, Uptake of Downside Risk in ACO Contracts Remains Low: https://www.ajmc.com/focus-of-the-week/despite-growth-uptake-of-downside-risk-in-aco-contracts-remains-low

HHS Unveils 5 New Payment Models to Transform Kidney Disease Care: https://www.ajmc.com/newsroom/hhs-unveils-5-new-payment-models-to-transform-kidney-disease-care

Evidence-Based Diabetes Management—June 2019: https://www.ajmc.com/journals/evidence-based-diabetes-management/2019/june-2019

While many women in healthcare report experiencing subtle or not-so-subtle bias and microaggressions at work, a recently published study sought to determine how healthcare professionals associate men and women with career and family, and also how surgeons associate men and women with surgery and family medicine. In this podcast, we speak with the lead author, Arghavan Salles, MD, PhD, about the findings, as well as other issues affecting women in healthcare.

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, we recap the top managed care news from the first half of 2019, including outcomes from some of the biggest diabetes trials, research into the annual Medicare wellness visit, and an experimental treatment in Parkinson disease.

Read more about the stories in this podcast:

Medicare Annual Wellness Visit Association With Healthcare Quality and Costs: https://www.ajmc.com/journals/issue/2019/2019-vol25-n3/medicare-annual-wellness-visit-association-with-healthcare-quality-and-costs

Cardiovascular Prevention Guidelines Call for Less Aspirin, More SGLT2s, GLP-1s for Type 2 Diabetes: https://www.ajmc.com/conferences/acc-2019/cardiovascular-prevention-guidelines-call-for-less-aspirin-more-sglt2s-glp-1s-for-type-2-diabetes

New Treatment May Have the Potential to Slow, Stop, or Reverse Parkinson Disease: https://www.ajmc.com/newsroom/new-treatment-may-have-the-potential-to-slow-stop-or-reverse-parkinson-disease

Oral Semaglutide Meets CV Safety Mark, Reduces Events in High-Risk T2D Patients: https://www.ajmc.com/conferences/ada-2019/oral-semaglutide-meets-cv-safety-mark-reduces-events-in-highrisk-t2d-patients

Novo Nordisk Seeks Oral Semaglutide Approval, CV Indications on New Drug and Injectable: https://www.ajmc.com/newsroom/novo-nordisk-seeks-oral-semaglutide-approval-cv-indications-on-new-drug-and-injectable-

CREDENCE: Canagliflozin Cuts Risk of Renal Failure, Death 30% in Patients With Type 2 Diabetes, CKD: https://www.ajmc.com/newsroom/credence-canagliflozin-cuts-risk-of-renal-failure-death-30-in-patients-with-type-2-diabetes-ckd

Working Toward More Transparency in Healthcare 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 President Trump issuing an executive order for more healthcare transparency; provisional data indicating that overdose deaths may be falling; the Supreme Court agreeing to hear insurers' Affordable Care Act lawsuit.

Read more about the stories in this podcast:

Trump Issues Executive Order Intended to Require Disclosure of Negotiated Rates Between Insurers, Hospitals: https://www.ajmc.com/newsroom/trump-issues-executive-order-intended-to-require-disclosure-of-negotiated-rates-between-insurers-hospitals

Provisional Data Predict Overdose Death Rates Will Fall for First Time in Decades: https://www.ajmc.com/newsroom/provisional-data-predict-overdose-death-rates-will-fall-for-first-time-in-decades

What We're Reading: Supreme Court to Hear ACA Suit; Missouri Abortion Clinic; City of Hope Investment: https://www.ajmc.com/newsroom/what-were-reading-supreme-court-to-hear-aca-suit-missouri-abortion-clinic-city-of-hope-investment

Nearly 5.4 Million Cancer Survivors Suffer From Chronic Pain: https://www.ajmc.com/focus-of-the-week/nearly-54-million-cancer-survivors-suffer-from-chronic-pain

MIT Group Brings Together Stakeholders to Brainstorm How to Pay for Curative Therapies Over Time: https://www.ajmc.com/journals/evidence-based-oncology/2019/june-2019/mit-group-brings-together-stakeholders-to-brainstorm-how-to-pay-for-curative-therapies-over-time-

Two-Sided Risk in the Oncology Care Model: https://www.ajmc.com/journals/evidence-based-oncology/2019/june-2019/twosided-risk-in-the-oncology-care-model

NCCN's Putnam Serving as Point of Contact for Payers, Employers to Keep Cancer Care "Accessible": https://www.ajmc.com/journals/evidence-based-oncology/2019/june-2019/nccns-putnam-serving-as-point-of-contact-for-payers-employers-to-keep-cancer-care-accessible

Evidence-Based Oncology—June 2019: https://www.ajmc.com/journals/evidence-based-oncology/2019/june-2019

Today on Managed Care Cast, we speak with Benjamin Isgur, leader of PwC’s Health Research Institute, about their latest report, Medical Cost Trend Report 2020: Beyond the Numbers. We talk about what is making the medical cost trend start to move upwards and what employers are trying to do about it.