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 the elimination of the Affordable Care Act's individual mandate; a new gene therapy for inherited vision loss that could cost $1 million; and a study found that social isolation can increase the risk of type 2 diabetes.

Read more about the stories in this podcast:

What We're Reading: GOP Tax Bill Passes; Healthcare Deals; Discussing High Drug Prices: www.ajmc.com/newsroom/what-were-reading-gop-tax-bill-passes-healthcare-deals-discussing-high-drug-prices

FDA Approves Gene Therapy for Inherited Vision Loss: www.ajmc.com/newsroom/fda-approves-gene-therapy-for-inherited-vision-loss

What We're Reading: GOP Tax Bill Passes; Healthcare Deals; Discussing High Drug Prices: www.ajmc.com/newsroom/what-were-reading-gop-tax-bill-passes-healthcare-deals-discussing-high-drug-prices

Links Between Social Isolation, Type 2 Diabetes Show Need for Friendships: www.ajmc.com/newsroom/links-between-social-isolation-type-2-diabetes-show-need-for-friendships

Evidence-Based Oncology—December 2017: www.ajmc.com/journals/evidence-based-oncology/2017/december-2017

Are cancer drug costs a problem? Of course, and oncologists can do more to impact them, said Dr. Michael Kolodziej, who was the keynote speaker at The American Journal of Managed Care’s annual Patient-Centered Oncology Care® (PCOC®) meeting, which was held in November in Philadelphia. Dr Kolodziej is the current vice president and chief innovation officer at ADVI. Prior to his current position, he worked for Flatiron Health and spent 3 years at Aetna.

In this interview, recorded at the end of the first day of PCOC, Torrie Fields, senior program manager at Blue Shield of California, and Dr Kolodziej discuss the move to value-based care in oncology, what practices need to do to be successful, and the role of team-based care.

See coverage from PCOC: http://www.ajmc.com/conferences/pcoc-2017

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 coverage from the 59th American Society of Hematology Annual Meeting and Exposition; recommendations on the use of diabetes drugs with cardiovascular indications; and a new study found that despite changes in insurance plans to give consumers more clout, unnecessary medical spending remains a problem.

Read more about the stories in this podcast:

What We're Reading: Medical Device Approval; Medical Laboratories Sue Government; ACA Sign-Up Deadline: www.ajmc.com/newsroom/what-were-reading-medical-device-approval-medical-laboratories-sue-government-aca-signup-deadline

CAR T Progress: Global Submissions for Kymriah, 42% Ongoing Response With Yescarta in ZUMA-1 Patients: www.ajmc.com/conferences/ash-2017/car-t-progress-global-submissions-for-kymriah-42-ongoing-response-with-yescarta-in-zuma1-patients-

Dr Stephen Schuster Outlines CAR T Results Seen in Leukemia, Lymphoma, and Myeloma: www.ajmc.com/conferences/ash-2017/dr-stephen-schuster-outlines-car-t-results-seen-in-leukemia-lymphoma-and-myeloma

American Society of Hematology coverage: www.ajmc.com/conferences/ash-2017

ADA 2018 Standards Address Drugs With CV Benefits, Hold Firm on Blood Pressure: www.ajmc.com/newsroom/ada-2018-standards-address-drugs-with-cv-benefits-hold-firm-on-blood-pressure

Impact of Consumer-Directed Health Plans on Low-Value Healthcare: www.ajmc.com/journals/issue/2017/2017-vol23-n12/impact-of-consumerdirected-health-plans-on-lowvalue-healthcare

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Overuse of medical services has been a costly issue in US healthcare for decades. Now in its fifth year, the Choosing Wisely initiative from ABIM Foundation seeks to increase conversations between physicians and patients to help them make wise decisions about appropriate care and reduce the use of low-value services.

Learn more about Choosing Wisely: http://www.choosingwisely.org/

Choosing Wisely Brings Lots of Energy, but No Growth in Awareness: www.ajmc.com/focus-of-the-week/choosing-wisely-brings-lots-of-energy-but-no-growth-in-awareness

Physician Perceptions of Choosing Wisely and Drivers of Overuse: www.ajmc.com/journals/issue/2016/2016-vol22-n5/physician-perceptions-of-choosing-wisely-and-drivers-of-overuse

Despite efforts by Republicans to scale back the Affordable Care Act, there is another movement to push the healthcare industry further left and into a single-payer system.

In the latest Managed Care Cast, Donald M. Berwick, MD, MPP, FRCP, president emeritus and senior fellow of the Institute for Healthcare Improvement and a former administrator of CMS, and Patricia Salber, MD, MBA, of The Doctor Weighs In, discuss the idea of single-payer system and misconceptions about the concept, such as that is means the government will run healthcare. Some countries have chosen government-run healthcare in addition to a single-payer system, but the United States has been discussing a single-payer environment, which is a discussion around payment, not care delivery.

They also speculate on the steps of getting from the current multipayer system in the United States to single-payer system and what individual states are doing to investigate the possibility of setting up a single-payer system.

This week, the top managed care news included a new proposal from CMS that insurers warn will cause confusion; a new review examines the prevalence and cost of chronic conditions in Medicaid; and a study finds 42% of all new US cancer cases in 2014 were due to potentially modifiable exposures.

Read more about the stories in this podcast:

Health Insurers to CMS: Your Changes Will Confuse Consumers, Hurt Markets: www.ajmc.com/newsroom/health-insurers-to-cms-your-changes-will-confuse-consumers-hurt-markets

Identifying the Most Prevalent and Costly Chronic Conditions in Medicaid: www.ajmc.com/newsroom/identifying-the-most-prevalent-and-costly-chronic-conditions-in-medicaid

Leading Diabetes Groups Publish Consensus Statement on "Beyond A1C" Measures to Guide FDA, Researchers: www.ajmc.com/newsroom/leading-diabetes-groups-publish-consensus-statement-on-beyond-a1c-measures-to-guide-fda-researchers

Significant Amount of Cancer Cases Attributable to Potentially Modifiable Risk Factors: www.ajmc.com/focus-of-the-week/significant-amount-of-cancer-cases-attributable-to-potentially-modifiable-risk-factors

Impact of Health Reform on Young Adult Prescription Medication Utilization: www.ajmc.com/journals/issue/2017/2017-vol23-n11/impact-of-health-reform-on-young-adult-prescription-medication-utilization

This week, the top managed care stories included a new rule from CMS to address drug costs for seniors; a campaign to get payers to fund the artificial pancreas is working; and a new survey identifies how Americans prefer to treat pain.

Read more about the stories in this podcast:

New CMS Rule Takes Aim at Drug Costs for Seniors, Opioid Crisis: www.ajmc.com/focus-of-the-week/new-cms-rule-takes-aim-at-drug-costs-for-seniors-opioid-crisis

JDRF Announces Anthem Policy Change on Medtronic Artificial Pancreas: www.ajmc.com/newsroom/jdrf-announces-anthem-policy-change-on-medtronic-artificial-pancreas

Survey Identifies Americans' Preferences for Pain Management: www.ajmc.com/newsroom/survey-identifies-americans-preferences-for-pain-management

ASCO's TAPUR Study Expands to Enroll Patients Receiving Immunotherapy: www.ajmc.com/newsroom/ascos-tapur-study-expands-to-enroll-patients-receiving-immunotherapy

Changes in Cardiovascular Care Provision After the Affordable Care Act: www.ajmc.com/journals/issue/2017/2017-vol23-n11/changes-in-cardiovascular-care-provision-after-the-affordable-care-act

This week, the top stories in managed care included new hypertension guidelines lowering the threshold for high blood pressure, Trump nominating a new HHS secretary, and many consumers now have access to less expensive Affordable Care Act plans.

High Blood Pressure Starts at 130/80, New Guidelines Say: www.ajmc.com/conferences/aha-2017/80-new-guidelines-say

Trump Nominates Alex Azar, Former Lilly Executive, to Lead HHS: www.ajmc.com/newsroom/trump-nominates-alex-azar-former-lilly-executive-to-lead-hhs

Kaiser Analysis: For Many, Health Coverage Costs Less Than Individual Mandate Penalty: www.ajmc.com/focus-of-the-week/kaiser-analysis-for-many-health-coverage-costs-less-than-individual-mandate-penalty

Patient-Centered Oncology Care: www.ajmc.com/conferences/pcoc-2017/

This week, the top managed care stories included a vote in Maine to expand Medicaid and other election day 2017 results; CMS issued final rules for the Diabetes Prevention Program; and a report from the American Society of Clinical Oncology highlighted the link between alcohol consumption and cancer.

Read more about the stories in this episode:

Maine Votes by Ballot Measure to Expand Medicaid, but the Governor Remains Opposed: www.ajmc.com/focus-of-the-week/maine-votes-by-ballot-measure-to-expand-medicaid-but-the-governor-remains-opposed

Final Medicare DPP Rule Adjusts Maintenance Period, Excludes Digital Providers: www.ajmc.com/newsroom/final-medicare-dpp-rule-adjusts-maintenance-period-excludes-digital-providers

ASCO: Alcohol Linked to Several Types of Cancer: www.ajmc.com/newsroom/asco-alcohol-linked-to-several-types-of-cancer

American College of Rheumatology 2017 Annual Meeting: www.ajmc.com/conferences/acr-2017

Patient-Centered Oncology Care®: www.ajmc.com/meetings/pcoc17#register

Suzanne Delbanco, PhD, MPH, of Catalyst for Payment Reform, and Patricia Salber, MD, MBA, of The Doctor Weighs In, discuss payment reform in the healthcare industry, including quality measurements and accountable care organizations.