Managed Care Cast

Nurse Practitioners: Taking on New Roles as Physician Shortage Grows 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 patient advocates, providers, payers, and pharma commenting on the Trump administration's drug pricing plan; a survey that found physicians and payers believe progress toward value-based care is slowing; a study that questions the standards of evidence for breakthrough therapy approvals.

Read more about the stories in this podcast:

From Patient Advocates to Pharma, Groups Weigh in on Trump Blueprint for Drug Costs: https://www.ajmc.com/newsroom/from-patient-advocates-to-pharma-groups-weigh-in-on-trump-blueprint-for-drug-costs

Novartis Will Freeze Drug Prices Through End of 2018, CEO Says: https://www.ajmc.com/newsroom/novartis-will-freeze-drug-prices-through-end-of-2018-ceo-says

What We're Reading: 340B Lawsuit to Be Refiled; Digging Into Breakthrough Approvals; Screen Time and ADHD: https://www.ajmc.com/newsroom/what-were-reading-340b-lawsuit-to-be-refiled-digging-into-breakthrough-approvals-screen-time-and-adhd

Pause in Risk Adjustment Payments Announced, CMS Blames District Court's Decision: https://www.ajmc.com/newsroom/pause-in-risk-adjustment-payments-announced-cms-blames-district-courts-decision

Doctors, Payers Think Transition to Value-Based Care Has Slowed, Survey Says: https://www.ajmc.com/newsroom/doctors-payers-think-transition-to-valuebased-care-has-slowed-survey-says

Do Breakthrough Therapies Need More Rigorous Evaluation? https://www.ajmc.com/newsroom/do-breakthrough-therapies-need-more-rigorous-evaluation-

Evidence-Based Oncology - July 2018: https://www.ajmc.com/journals/evidence-based-oncology/2018/july-2018

There are concerns that cancer care costs may increase as the site of provider-administers cancer drugs shifts from physician officers to hospital outpatient departments. Researchers in the July issue of The American Journal of Managed Care examined chemotherapy-related spending in Medicare Part B after controlling for patient characteristics, such as cancer type, and explored differences in chemotherapy utilization patterns between the 2 settings.

In this interview, lead author Yamini Kalidindi, a research assistant at Pennsylvania State University and a graduate student in the department of health policy and administration, explains why the findings of her study differ from previous research and highlights the importance of considering patient characteristics such as cancer type.

Read the paper in the July issue:

Differences in Spending on Provider-Administered Chemotherapy by Site of Care in Medicare: https://www.ajmc.com/journals/issue/2018/2018-vol24-n7/differences-in-spending-on-provideradministered-chemotherapy-by-site-of-care-in-medicare

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 additional moves by the Trump administration to unravel the Affordable Care Act; Pfizer canceled a round of drug price increases after speaking to the president; advocates for 340B sound the alarm on efforts to reform the program.

Read more about the stories in this podcast:

Pause in Risk Adjustment Payments Announced, CMS Blames District Court's Decision: https://www.ajmc.com/newsroom/pause-in-risk-adjustment-payments-announced-cms-blames-district-courts-decision

CMS Cuts Budget for ACA Marketing to $10 Million for 2019 Plan Year: https://www.ajmc.com/newsroom/cms-cuts-budget-for-aca-marketing-to-10-million-for-2019-plan-year

What We're Reading: Pfizer Halts Price Increases; Azar's Attention Is Split; VA Pick Clears First Hurdle: https://www.ajmc.com/newsroom/what-were-reading-pfizer-halts-price-increases-azars-attention-is-split-va-pick-clears-first-hurdle

340B Health Says Changing Hospital Eligibility Will Slash Program: https://www.ajmc.com/newsroom/340b-health-says-changing-hospital-eligibility-will-slash-program

Highmark Reaches Value-Based Contract for Empagliflozin, Fixed-Dose Combinations: https://www.ajmc.com/newsroom/highmark-reaches-valuebased-contract-for-empagliflozin-fixeddose-combinations

Providing an open channel of communication between pharmacists and patients, medication therapy management (MTM) allows pharmacists to optimize medications for their patients and patients to take an active role in their healthcare. As MTM services help pharmacists better understand how different medications interact with each other, MTM has been recommended as a way to identify and prevent opioid misuse.

In an effort to provide greater incentive for Part D sponsors to use MTM programs, the Center for Medicare and Medicaid Innovation launched in January 2017 the 5-year Part D Enhanced Medication Therapy Management (eMTM) Model. The model is assessing whether incentives, such as payment and regulatory flexibilities, will result in enhancements in the MTM program, ultimately leading to improved patient outcomes and reduced costs.

In this podcast, we speak with Brian Litten, JD, chief strategic officer, Tabula Rasa HealthCare; and Calvin Knowlton, BScPharm, MDiv, PhD, chief executive officer and founder of Tabula Rasa HealthCare, to get more insight into MTM and the eMTM model.

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 federal judge blocking Kentucky’s Medicaid work requirements; CMS announced it would launch a demonstration to encourage Medicare Advantage providers to take on more risk; and researchers identify racial disparities in HIV incidence and recommended a 5-part plan of action.

Read more about the stories in this podcast:

Federal Judge Blocks Kentucky's Medicaid Work Requirements: https://www.ajmc.com/newsroom/federal-judge-blocks-kentuckys-medicaid-work-requirements

Kentucky Cuts Medicaid Vision, Dental Benefits Following Block to Work Requirements: https://www.ajmc.com/newsroom/kentucky-cuts-medicaid-vision-dental-benefits-following-block-to-work-requirements

CMS Will Waive MIPS for Doctors Who Agree to More Medicare Advantage Risk: https://www.ajmc.com/newsroom/cms-will-waive-mips-for-doctors-who-agree-to-more-medicare-advantage-risk

Health Organizations Urge HHS to Recognize MA Providers in MACRA: https://www.ajmc.com/newsroom/health-organizations-urge-hhs-to-recognize-ma-providers-in-macra

Researchers Highlight Disproportionate HIV Incidence Among African Americans, Recommend Plan of Action: https://www.ajmc.com/newsroom/researchers-highlight-disproportionate-hiv-incidence-among-african-americans-recommend-plan-of-action

Feedback on the Direction, Challenges of the OCM: https://www.ajmc.com/focus-of-the-week/feedback-on-the-direction-challenges-of-the-ocm

Implementing Alternative Payment Models for Improved Population Health: Experiences From the OCM: https://www.ajmc.com/interactive-tools/experiences-from-the-ocm

Health disparities stemming from social, economic, and environmental factors have become a growing target in healthcare with payers, providers, and policy makers turning their attention on how to address those nonmedical factors that impact an individual’s overall health and health outcomes outside of the medical setting.

While the importance of addressing social determinants of health is becoming more clear, there are still challenges for this new field—delving into the arena can be daunting for health systems and there is not much evidence yet on best practices for screening patients and getting them to the right resouces.

In this podcast, we talk to Clifford Goodman, PhD, of The Lewin Group; Shantanu Agrawal, MD, MPhil, of National Quality Forum; and Rachel Gold, PhD, MPH, of the Kaiser Permanente Center for Health Research.

Read more about the stories in this podcast:

Doctors Talk About How Social Determinants Affect Their Work With Patients: https://www.ajmc.com/focus-of-the-week/doctors-talk-about-how-social-determinants-affect-their-work-with-patients

Physicians Call for Action on Social Determinants of Health: https://www.ajmc.com/newsroom/physicians-call-for-action-on-social-determinants-of-health

Humana's "Bold Goal" Update Finds More Healthy Days for Medicare Members in 4 Cities: https://www.ajmc.com/focus-of-the-week/humanas-bold-goal-update-finds-more-healthy-days-for-medicare-members-in-4-cities

A Health Plan's Investigation of Healthy Days and Chronic Conditions: https://www.ajmc.com/journals/issue/2017/2017-vol23-n10/a-health-plans-investigation-of-healthy-days-and-chronic-conditions

Dr Shantanu Agrawal: Bringing Together the Community to Tackle Social Determinants of Health: https://www.ajmc.com/conferences/aco-fall2017/dr-shantanu-agrawal-bringing-together-the-community-to-tackle-social-determinants-of-health

Dr Shantanu Agrawal Highlights Progress Being Made to Address Health Inequities: https://www.ajmc.com/conferences/aco-fall2017/dr-shantanu-agrawal-highlights-progress-being-made-to-address-health-inequities

Data Necessary to Appropriately Address Social Determinants of Health: https://www.ajmc.com/conferences/acdc-spring-2018/data-necessary-to-appropriately-address-social-determinants-of-health

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 in managed care, the top stories included HHS Secretary Alex Azar appearing before the Senate Committee on Finance to discuss the administration's plan to drive down prescription drug prices; FDA Commissioner Scott Gottlieb, MD, calling on payers to share data to aid drug innovation; and CMS calling for stricter oversight of Medicaid.

Read more about the stories in this podcast:

Azar Appears Before Senate Committee on Finance to Discuss Drug Innovation, Affordability: https://www.ajmc.com/focus-of-the-week/azar-appears-before-senate-committee-on-finance-to-discuss-drug-innovation-affordability

Gottlieb Calls on Payers to Share Data to Aid Drug Innovation: https://www.ajmc.com/focus-of-the-week/gottlieb-calls-on-payers-to-share-data-to-aid-drug-innovation

CMS Unveiling Stricter Oversight of Medicaid Due to Program Expansion: https://www.ajmc.com/newsroom/cms-unveiling-stricter-oversight-of-medicaid-due-to-program-expansion

What We're Reading: SCOTUS Abortion Ruling; Use of HDHPs Grows; More Seniors Die at Home: https://www.ajmc.com/newsroom/what-were-reading-scotus-abortion-ruling-use-of-hdhps-grows-more-seniors-die-at-home

Dr Robert A. Gabbay Highlights the Development of Joslin Diabetes Center's Clinical Guidelines: https://www.ajmc.com/interviews/dr-robert-a-gabbay-highlights-the-development-of-joslin-diabetes-centers-clinical-guidelines

Evidence-Based Diabetes Management—June 2018: https://www.ajmc.com/journals/evidence-based-diabetes-management/2018/june-2018

Exploring the Current State of Precision Medicine at the ASCO Annual Meeting 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 in managed care, the top stories included Atul Gawande, MD, being named the CEO of the Amazon–Berkshire Hathaway–JPMorgan Chase healthcare venture; the Trump administration finalized rules for creating association health plans; an analysis found some cancer types are represented more than others in the Oncology Care Model.

Read more about the stories in this podcast:

Amazon, Berkshire Hathaway, JPMorgan Chase Announce CEO of Joint Health Company: https://www.ajmc.com/newsroom/amazon-berkshire-hathaway-jpmorgan-chase-announce-ceo-of-joint-health-company

New Rule Allows Creation of Association Health Plans That Skirt ACA Regulations, Protections: https://www.ajmc.com/newsroom/new-rule-allows-creation-of-association-health-plans-that-skirt-aca-regulations-protections

Participation in OCM May Transform Care for Certain Cancer Types More Quickly Than Others: https://www.ajmc.com/newsroom/participation-in-ocm-may-transform-care-for-certain-cancer-types-more-quickly-than-others

Implementing Alternative Payment Models for Improved Population Health: Experiences from the OCM: https://www.ajmc.com/webcast/experiences-from-the-ocm

UpWell Health Survey: 45% of Those With Diabetes Skip Care Due to Costs: https://www.ajmc.com/newsroom/upwell-health-survey-45-of-those-with-diabetes-skip-care-due-to-costs

A Retrospective on the Oncology Care Model: https://www.ajmc.com/journals/evidence-based-oncology/2018/june-2018/a-retrospective-on-the-oncology-care-model

Perspective: FDA/CMS Parallel Review Advances Coverage for Cancer Comprehensive Genomic Profiling: https://www.ajmc.com/journals/evidence-based-oncology/2018/june-2018/perspective-fdacms-parallel-review-advances-coverage-for-cancer-comprehensive-genomic-profiling

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