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 panel mostly endorsed the use of patient-reported outcomes for coverage of chimeric antigen receptor T-cell therapy; the US Preventive Services Task Force released new recommendations for cervical cancer screening; research found accountable care organization penetration may be changing how physicians work.

Read more about the stories in this podcast:

Many Questions to Ask in Setting National Coverage for CAR T Therapies: https://www.ajmc.com/focus-of-the-week/many-questions-to-ask-in-setting-national-coverage-for-cart-therapies

MEDCAC Panel Mostly Endorses PROs for CAR T Therapies: https://www.ajmc.com/newsroom/medcac-panel-mostly-endorses-pros-for-car-t-therapies

USPSTF Updates Cervical Cancer Screening Recommendations: https://www.ajmc.com/newsroom/uspstf-updates-cervical-cancer-screening-recommendations

ACO Penetration Linked to Decreased Work Hours, Less Self-Employment: https://www.ajmc.com/focus-of-the-week/aco-penetration-linked-to-decreased-work-hours-less-selfemployment

Substituting Brand-Name Combinations for Generics Could Have Saved Medicare $925 Million in 2016: https://www.ajmc.com/focus-of-the-week/substituting-brandname-combinations-for-generics-could-have-saved-medicare-925-million-in-2016

Payment Reform Reveals Value of Diabetes Educators in Driving Down Healthcare Costs, Joslin's Gabbay Says: https://www.ajmc.com/conferences/aade2018/payment-reform-reveals-value-of-diabetes-educators-in-driving-down-healthcare-costs-joslins-gabbay-says

American Association of Diabetes Educators 2018: https://www.ajmc.com/conferences/aade2018

Evidence-Based Oncology—August 2018: https://www.ajmc.com/journals/evidence-based-oncology/2018/august-2018

Currently, 30 million people in the United States have diabetes and the American Diabetes Association estimates that the total economic cost of disease was $327 billion in 2017. An additional 84 million American adults have prediabetes, and 90% of them don’t know they have it, according to the CDC.

Given the high cost of treating diabetes and the large population with prediabetes, which puts them at an increased risk of developing type 2 diabetes, prevention has become a point of focus. At the annual meeting of the American Association of Diabetes Educators, held August 17 to 20, prevention and delay of type 2 diabetes was one of the 2018 priority topics.

Today, we’re taking a look back to 2017, when The American Journal of Managed Care® convened a panel of experts to discuss diabetes prevention and the use of technology.

Read more about the stories in this podcast:

Peer Exchange—Technology in Diabetes Care: From Prevention to Disease Management: https://www.ajmc.com/peer-exchange/technology-in-diabetes-care-from-prevention-to-disease-management

American Association of Diabetes Educators 2018 coverage: https://www.ajmc.com/conferences/aade2018

CDC—Prediabetes: Your Chance to Prevent Type 2 Diabetes: https://www.cdc.gov/diabetes/basics/prediabetes.html

American Diabetes Association—Statistics About Diabetes: http://www.diabetes.org/diabetes-basics/statistics/

How Technology Can Make CMS' Diabetes Prevention Program Viable: https://www.ajmc.com/journals/evidence-based-diabetes-management/2018/march-2018/how-technology-can-make-cms-diabetes-prevention-program-viable

April 1 Brings Day One of the Medicare Diabetes Prevention Program, and Challenges for Health Plans: https://www.ajmc.com/newsroom/april-1st-brings-day-one-of-the-medicare-diabetes-prevention-program-and-challenges-for-health-plans

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 CMS outlining a plan to encourage Medicare accountable care organizations to take on more risk, faster; a study found substantial growth in Medicaid managed care enrollment; an analysis showed nearly 1 in 5 inpatient hospital stays includes a claim from an out-of-network provider.

Read more about the stories in this podcast:

CMS Plans to Overhaul MSSP Program to Force More Risk on ACOs: https://www.ajmc.com/newsroom/cms-plans-to-overhaul-mssp-program-to-force-more-risk-on-acos

CMS Proposal Is a Start for Making Risk More Appealing to ACOs: https://www.ajmc.com/contributor/travis-broome/2018/08/cms-proposal-is-a-start-for-making-risk-more-appealing-to-acos

Medicaid Managed Care Grew Substantially From 1999 to 2012: https://www.ajmc.com/focus-of-the-week/medicaid-managed-care-grew-substantially-from-1999-to-2012

Nearly 1 in 5 Inpatient Admissions Includes a Claim From an Out-of-Network Provider: https://www.ajmc.com/focus-of-the-week/nearly-1-in-5-inpatient-admissions-includes-a-claim-from-an-outofnetwork-provider

CVS Will Rely on ICER Data as It Seeks to Curb Costs, Implement "Zero-Dollar Drug List": https://www.centerforbiosimilars.com/news/cvs-will-rely-on-icer-data-as-it-seeks-to-curb-costs-implement-zerodollar-drug-list

What We're Reading: Ark. Work Requirements Lawsuit; CVS' Cost Savings Plan; Kavanaugh and Healthcare: https://www.ajmc.com/newsroom/what-were-reading-ark-work-requirements-lawsuit-cvs-cost-savings-plan-kavanaugh-and-healthcare

Choosing Wisely Clinical Decision Support Adherence and Associated Inpatient Outcomes: https://www.ajmc.com/journals/issue/2018/2018-vol24-n8/choosing-wisely-clinical-decision-support-adherence-and-associated-inpatient-outcomes

Optimizing Number and Timing of Doctor's Appointment Reminders: An Interview With Dr John F. Steiner by Managed Care Cast

Health centers have been delivering comprehensive, high-quality preventive and primary healthcare to the country’s most vulnerable populations for more than 50 years.

While health centers started out as a primary care safety net, they are increasingly taking a holistic approach. Kristina Wharton, of the Department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine, explained that these centers quickly branched out into mental health services and dentistry.

Read more about the stories in this podcast:

Ensuring Access to Prescription Medications in the Post-ACA Healthcare Access Landscape: The Essential Role of FQHCs in the Safety Net for the Underinsured: https://www.ajmc.com/journals/supplement/2018/the-patient-assistance-safety-net-how-many-need-help-how-many-are-helped/ensuring-access-to-prescription-medications-in-the-postaca-healthcare-access-landscape-the-essential-role-of-fqhcs-in-the-safety-net-for-the-underinsured

Celebrating America’s Health Centers: Our Healthcare Heroes: https://www.hhs.gov/blog/2018/08/13/celebrating-americas-health-centers-our-healthcare-heroes.html

Health Centers Key in Addressing Opioid Epidemic, and Medicaid Is Crucial, Kaiser Finds: https://www.ajmc.com/newsroom/health-centers-key-in-addressing-opioid-epidemic-and-medicaid-is-crucial-kaiser-finds

Public Health Alarms Raised Over Possible Change in Immigration Policy: https://www.ajmc.com/focus-of-the-week/public-health-alarms-raised-over-possible-change-in-immigration-policy

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, CMS allowing step therapy in Medicare Advantage plans in a bid to allow for drug price negotiation; larger practices with more resources, technology and care management processes have higher readmission rates than smaller practices; studies find that empagliflozin also reduces liver fat in patients with diabetes and nonalcoholic fatty liver disease.

Read more about the stories in this podcast:

CMS Will Allow Medicare Advantage Plans to Use Step Therapy to Negotiate Drug Prices: https://www.ajmc.com/newsroom/cms-will-allow-medicare-advantage-plans-to-use-step-therapy-to-negotiate-drug-prices

CMS Approves Extra Payments for CAR T, Increases Other Payments in Final Rule: https://www.ajmc.com/newsroom/cms-approves-extra-payments-for-car-t-increases-other-payments-in-final-rule

Larger Practices Spend More on, Have Higher Readmission Rates for Medicare Beneficiaries: https://www.ajmc.com/focus-of-the-week/larger-practices-spend-more-on-have-higher-readmission-rates-for-medicare-beneficiaries

Liquid Biopsy Identifies Patients More Likely to Benefit From Immunotherapy in NSCLC: https://www.ajmc.com/newsroom/liquid-biopsy-identifies-patients-more-likely-to-benefit-from-immunotherapy-in-nsclc

Studies Point to Empagliflozin as First Choice for Fatty Liver Disease in T2D: https://www.ajmc.com/newsroom/studies-point-to-empagliflozin-as-first-choice-for-fatty-liver-disease-in-t2d

Discussing Increased Prevalence of NAFLD and NASH, and the Current Lack of Treatments: https://www.ajmc.com/managed-care-cast/discussing-increased-prevalence-of-nafld-and-nash-and-the-current-lack-of-treatments

One of the most common causes of liver disease in the United States is nonalcoholic fatty liver disease, affecting between 30% and 40% of adults, according to the National Institute of Diabetes, and Digestive and Kidney Diseases. It’s a condition in which excess fat is stored in the liver—a buildup that is not caused by heavy alcohol use.

Despite how common nonalcoholic fatty liver disease (NAFLD) is, there are currently no approved medications on the market. In this podcast, we talk to a clinician involved with a program that uses lifestyle management and a patient advocate, who is trying to shape policy to help patients with NAFLD and its more extreme version, nonalcoholic steatohepatitis (NASH).

Read more about NAFLD and NASH:

Studies Point to Empagliflozin as First Choice for Fatty Liver Disease in T2D: https://www.ajmc.com/newsroom/studies-point-to-empagliflozin-as-first-choice-for-fatty-liver-disease-in-t2d

Drug Approvals That Dr Aimee Tharaldson Is Keeping an Eye on for 2019: https://www.ajmc.com/conferences/amcp-2018/drug-approvals-that-dr-aimee-tharaldson-is-keeping-an-eye-on-for-2019

Analyzing the Near-Term Pipeline for Specialty Drugs: https://www.ajmc.com/conferences/amcp-2017/analyzing-the-near-term-pipeline-for-specialty-drugs

Dr Aimee Tharaldson: We're Keeping an Eye on Future NASH Treatments: https://www.ajmc.com//conferences/amcp-2017/dr-aimee-tharaldson-were-keeping-an-eye-on-future-nash-treatments

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 report that found quality issues and fraud in Medicare’s hospice program; the Trump administration expanded short-term health plans; cancer screening rates are falling short of targets.

Read more about the stories in this podcast:

Report Finds Medicare Hospice Program Beset With Quality, Care Issues: https://www.ajmc.com/newsroom/report-finds-medicare-hospice-program-beset-with-quality-care-issues

Trump Administration Finalizes Rule for Short-Term, Limited Duration Health Plans: https://www.ajmc.com/newsroom/trump-administration-finalizes-rule-for-shortterm-limited-duration-health-plans

What We're Reading: Part D Premiums; US Healthcare Spending; Consequences of Sudden Inactivity: https://www.ajmc.com/newsroom/what-were-reading-part-d-premiums-us-healthcare-spending-consequences-of-sudden-inactivity

Cancer Screening Rates in the US Fall Short of Healthy People 2020 Targets: https://www.ajmc.com/focus-of-the-week/cancer-screening-rates-in-the-us-fall-short-of-healthy-people-2020-targets

FDA Approves Freestyle Libre CGM With 14-Day Sensor: https://www.ajmc.com/newsroom/fda-approves-freestyle-libre-cgm-with-14day-sensor

Review Finds VBID Programs Improved Adherence at No Added Cost: https://www.ajmc.com/contributor/vbid-center/2018/08/review-finds-vbid-programs-improved-adherence-at-no-added-cost

Advancing Precision Oncology With the Syapse Precision Medicine Council 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 stories included CMS reversing its decision to suspend the risk adjustment payment program; out-of-pocket costs and copayment accumulators put an HIV prevention drug out of reach for patients; research finds geography can determine posttreatment imaging for women with breast cancer.

Read more about the stories in this podcast:

What We're Reading: Resuming Risk Adjustment Program; New Endometriosis Drug; Lilly Denounces Drug Imports: https://www.ajmc.com/newsroom/what-were-reading-resuming-risk-adjustment-program-new-endometriosis-drug-lilly-denounces-drug-imports

PrEP for HIV Prevention: Essential for Ending the Epidemic, but Out of Reach for Many: https://www.ajmc.com/focus-of-the-week/prep-for-hiv-prevention-essential-for-ending-the-epidemic-but-out-of-reach-for-many

Geography Influences Type of Posttreatment Imaging Received After Early Breast Cancer: https://www.ajmc.com/newsroom/geography-influences-type-of-posttreatment-imaging-received-after-early-breast-cancer

FDA Releases Biosimilar Action Plan: https://www.centerforbiosimilars.com/news/fda-releases-biosimilar-action-plan

The Center for Biosimilars®: https://www.centerforbiosimilars.com/