Managed Care Cast

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

Outcomes for patients with cancer are continuously improving, but the increasingly complex healthcare system, new payment and delivery models that place more risk on practices, and rising costs of therapies has made it difficult for independent oncology practices to thrive and survive. However, independent practices present an important part of cancer care, delivering care to patients who are not near large hospital-based systems at lower costs.

Sibel Blau, MD, explains how Quality Cancer Care Alliance is bringing together independent practices and helping them succeed by providing them with best business models, practice efficiencies, and financial advantages.

Read more about the stories in this podcast:

Data and Collaboration Are Key for Value-Based Care Success: https://www.ajmc.com/journals/evidence-based-oncology/2018/december-2018/data-and-collaboration-are-key-for-valuebased-care-success

Strategies for Fighting Consolidation in Community Oncology: https://www.ajmc.com/conferences/coa-2019/strategies-for-fighting-consolidation-in-community-oncology

Dr Ray Page Details Using Triage Pathways and Scaling Them Across Multiple Practices: https://www.ajmc.com/interviews/dr-ray-page-details-using-triage-pathways-and-scaling-them-across-multiple-practices

Barry Russo on How Community Oncology Practices Can Work Together and Learn From Each Other: https://www.ajmc.com/interviews/barry-russo-on-how-community-oncology-practices-can-work-together-and-learn-from-each-other

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 HHS announcing a finalized rule requiring the disclosure of drug prices in television ads; a report finding high satisfaction with employer health coverage despite the cost; a study finding heart failure is surging among young adults.

Read the articles in this podcast:

HHS Finalizes Rule Requiring Disclosure of Drug Prices in TV Ads: https://www.ajmc.com/newsroom/hhs-finalizes-rule-requiring-disclosure-of-drug-prices-in-tv-ads

High Satisfaction With Employer Coverage, but Financial Challenges Persist: https://www.ajmc.com/focus-of-the-week/high-satisfaction-with-employer-coverage-but-financial-challenges-persist

Amgen, Syapse Join Forces for Precision Medicine in Oncology: https://www.ajmc.com/newsroom/amgen-syapse-join-forces-for-precision-medicine-in-oncology

What We're Reading: Medicaid Fraud Settlement; Heart Failure in Young Adults; FDA Investigates Sunscreen: https://www.ajmc.com/newsroom/what-were-reading-medicaid-fraud-settlement-heart-failure-in-young-adults-fda-investigates-sunscreen

Managing Costs in Diabetes Means Intervening Early to Avoid Complications Later, Experts Say: https://www.ajmc.com/focus-of-the-week/managing-costs-in-diabetes-means-intervening-early-to-avoid-complications-later-experts-say

Dr Rebekah Gee Offers an Inside Look at Louisiana's Subscription Payment Model for HCV Drugs: https://www.ajmc.com/managed-care-cast/dr-rebekah-gee-offers-an-inside-look-at-louisianas-subscription-payment-model-for-hcv-drugs

The Louisiana Department of Health and Corrections announced in March 2019 their selection of Asegua Therapeutics, a subsidiary arm of Gilead Sciences, as their pharmaceutical partner for the state’s subscription model for hepatitis C virus treatment.

The alternative payment model, the first of its kind in the United States, was first announced in August 2018 by the Louisiana Department of Health, who explained that HCV infections are a public health crisis within the state. Though highly effective antiviral treatment exists that can largely cure patients with HCV, the price of the treatments remains high, and Medicaid patients and the Department of Corrections population are unable to access the therapies.

Under this model, instead of paying for each prescription individually, the state would pay a subscription fee to the drug company whereby the state would then receive unlimited access to the drug, similar to how consumers pay a monthly fee to stream unlimited television shows and movies.

Today, we’re speaking with Dr Rebekah Gee, secretary of the Louisiana Department of Health and one of the key leaders in bringing this alternative payment model to fruition.