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 finding slow progress in reducing low-value care; a study finding savings by accountable care organizations may be overstated; CMS proposing a rule to allow for electronic prior authorization in Part D drugs.

Read more about the stories in this podcast:

Analysis Finds Progress in Reducing Spending on Low-Value Services Positive but Sluggish: https://www.ajmc.com/focus-of-the-week/analysis-finds-progress-in-reducing-spending-on-lowvalue-services-positive-but-sluggish

Savings of MSSP ACOs May Be Overstated, Annals Study Finds: https://www.ajmc.com/newsroom/savings-of-mssp-acos-may-be-overstated-annals-study-finds

CMS Proposes Electronic Prior Authorization for Part D Drugs: https://www.ajmc.com/newsroom/cms-proposes-electronic-prior-authorization-for-part-d-drugs

FDA Approves Liraglutide for Youth With Type 2 Diabetes: https://www.ajmc.com/newsroom/fda-approves-liraglutide-for-youth-with-type-2-diabetes

What We're Reading: Texas' Surprise Medical Bill Protection; Student Nicotine Testing; WIC Program Lowered Childhood Obesity: https://www.ajmc.com/newsroom/what-were-reading-texas-surprise-medical-bill-protection-student-nicotine-testing-wic-program-lowered-childhood-obesity

Seema S. Sonnad Emerging Leader in Managed Care Research Award: https://www.ajmc.com/about/ajmc/sss-elmcr-award

Value-based care has been a big prerogative of CMS for the last decade, and it's not going away, Brian Kern, a lawyer with Frier Levitt, told Amy Ellis, director of quality and value-based care at Northwest Medical Specialties. The government programs, such as the Bundled Payments for Care Improvement, Medicare Shared Savings Program, and Oncology Care Model, are important because practices learn from them and hopefully take these similar models to private payers, which transform healthcare.

Through these value-based care programs, data analytics is crucial to help physicians understand cost, improve outcomes, and increase patient satisfaction.

Today we’re speaking with Dr Mark Simon, the chief medical officer of OB Hospitalist Group. OB Hospitalist contracts with hospitals across the United States to create OB emergency departments. The group employs more than 600 experienced OBs who are available 24 hours a day, 7 days a week to ensure that an OB is always in the hospital, rather than on call. OB Hospitalist also works with hospitals to reduce costs by being an outsourced provider of obstetricians.

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 Community Oncology Alliance submitting an alternative to the Oncology Care Model; more study results demonstrating diabetes drugs can prevent renal failure; US task force recommending pre-exposure prophylaxis for HIV prevention.

Read more about the stories in this podcast:

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

DECLARE Shows Diabetes Drug Farxiga Prevented Renal Decline, Even for Those With Good Kidney Health: https://www.ajmc.com/conferences/ada-2019/declare-shows-diabetes-drug-farxiga-prevented-renal-decline-even-for-those-with-good-kidney-health

More CV, Renal Outcomes at ADA: CREDENCE, CARMELINA, CAROLINA: https://www.ajmc.com/conferences/ada-2019/more-cv-renal-outcomes-at-ada-credence-carmelina-carolina

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

79th Scientific Sessions of the American Diabetes Association: https://www.ajmc.com/conferences/ada-2019

USPSTF Issues Recommendation Statements on PrEP, Screening for HIV: https://www.ajmc.com/newsroom/uspstf-issues-recommendation-statements-on-prep-screening-for-hiv

Teaching Hospitals Have Similar or Lower Costs of Care as Nonteaching Hospitals for Medicare Patients: https://www.ajmc.com/focus-of-the-week/teaching-hospitals-have-similar-or-lower-costs-of-care-as-nonteaching-hospitals-for-medicare-patients

Dr David Blumenthal Tells Employers to Get Tough, Get Smart, Get Informed on Healthcare: https://www.ajmc.com/newsroom/dr-david-blumenthal-tells-employers-to-get-tough-get-smart-get-informed-on-healthcare

The rate of innovation in oncology has been impressive, with novel therapies, such as chimeric antigen receptor T-cell therapies, and new diagnostics that make it easier to understand which patients will benefit from certain targeted therapies. With all of these innovations coming to market and being tested in clinical trials, it might make sense that some people are ready to move on from the treatments of the past.

In a new commentary published in the June issue of The American Journal of Managed Care®, Bruce Feinberg, DO, of Cardinal Health, explains why people shouldn’t count out chemotherapy just yet. In the latest podcast interview, Feinberg explains his views on chemotherapy and how important it still is in cancer care.

Reports of the Demise of Chemotherapy Have Been Greatly Exaggerated: www.ajmc.com/journals/issue/2019/2019-vol25-n6/reports-of-the-demise-of-chemotherapy-have-been-greatly-exaggerated

Phase 3 TAILORx Results Confirm Chemotherapy Unnecessary in 70% of Women With Early-Stage Breast Cancer: https://www.ajmc.com/conferences/asco-2018/phase-3-tailorx-results-confirm-chemotherapy-unnecessary-in-70-of-women-with-earlystage-breast-cancer

TAILORx Results May Mitigate Financial Toxicity: https://www.ajmc.com/contributor/molly-macdonald/2018/06/tailorx-results-may-mitigate-financial-toxicity

The burden of medical expenses, whether incurred through a catastrophic illness or surprise medical bills, affects the uninsured and insured alike. A 5-year-old charity called RIP Medical Debt buys medical debt incurred, so far, by more than 250,000 Americans. We talk to one of the cofounders and coauthors of "End Medical Debt," the book they wrote about the issue.

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 American Society of Clinical Oncology discussing drug pricing; community oncologists seeking a delay in taking on downside risk in the Oncology Care Model; CDC finding a drop in new diabetes cases in the United States.

Read more about the stories in this podcast:

ASCO Town Hall Brings Tense Conversation About Drug Pricing: https://www.ajmc.com/conferences/asco-2019/asco-town-hall-brings-tense-conversation-about-drug-pricing

Cannabis Risks and Benefits in Cancer Symptom Management: Much Remains Unknown: https://www.ajmc.com/conferences/asco-2019/cannabis-risks-and-benefits-in-cancer-symptom-management-much-remains-unknown

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

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

Data Show New US Diabetes Cases Are Taking a Dip: https://www.ajmc.com/newsroom/data-show-new-us-diabetes-cases-are-taking-a-dip

American Diabetes Association 2019: https://www.ajmc.com/conferences/ada-2019

Seema Verma Envisions a US Health System That Shares Data, Is Truly Value-Based: https://www.ajmc.com/focus-of-the-week/seema-verma-envisions-a-us-health-system-that-shares-data-is-truly-valuebased

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