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Jaime is a freelance writer for The American Journal of Managed Care® (AJMC®), where she previously worked as an assistant editor.

She has a BA in print journalism from Penn State University. You can connect with Jaime on 

Articles

This analysis found that the 3000 patients with hemophilia had higher rates of pain, depression, and anxiety medication use.

Use of Pain, Depression, Anxiety Meds Higher Among Patients With Hemophilia

Former NBA star Magic Johnson has partnered with GSK to educate the public about this virus, specifically in seniors and those at high-risk for contracting a severe form of RSV.

 Raising Awareness About RSV in Older Adults

Mary is the associate editorial director for The American Journal of Managed Care® (AJMC®), The Center for Biosimilars®, and Evidence-Based Oncology™. She joined AJMC® in 2013 and oversees speaker recruitment and panel preparations for AJMC®'s premier annual oncology meeting, Patient-Centered Oncology Care®.

She has a BA in communications and philosophy from Loyola University New Orleans. You can connect with Mary on 

Based on promising results, the biotech IMV has moved into phase 2b trials with a cancer vaccine composed of survivin epitopes that uses the company’s proprietary delivery system to elicit persistent immune responses.

Delivery Matters: In Early Studies, DPX Technology Allows  Vaccines to Persist When Cancer Pushes Back 

Between 2019 and 2020, there were 97 reported shortages among sponsor-reported antiseizure medications in Australia, 93% of which were generic brands.

Shortages of Antiseizure Meds Continue, More Common Among Generics: Australian Report

The American Journal of Managed Care provides insights into the latest news and research in managed care across multimedia platforms.

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1rem

Compendium

 Medicare compendium is a comprehensive resource for clinical news and expert insights on issues that affect Medicare beneficiaries with a focus on polypharmacy, reimbursement challenges, and other topics related to seniors.

In January of this year, entrepreneur and Dallas Mavericks owner Mark Cuban launched a direct-to-consumer pharmacy called the 

, promising savings by eliminating middlemen and charging cost plus 15% and a pharmacy fee. What if Medicare could do the same? On this episode of Managed Care Cast, we speak with a researcher who coauthored a study out this week that looked at the savings to Medicare Part D if the same model had been employed for some of the most used generic drugs.

Hussain S. Lalani, MD, MPH, an internist and one of the coauthors, discussed the findings of the paper, published Monday in the 

. The analysis compared the price paid by Medicare Part D plans in 2020 with the price of 89 generic drugs sold by the pharmacy in 2022.

The researchers, from Brigham and Women’s Hospital and Harvard Medical School, used the price paid by Medicare Part D plans in 2020 and looked at the price of 89 generic drugs sold by the pharmacy in 2022.

After adjusting for changes in drug costs between 2020 and 2022, the researchers found that Medicare paid more on 77 of the 89 generic drugs: $8.1 billion compared with $4.5 billion. Medicare would have saved as much as $3.6 billion over 1 year.

Listen to an excerpt of the interview above or through one of these podcast services:

How much would have Medicare saved if it had the same ability to purchase generic drugs at the same price as individuals using direct-to-consumer (DTC) pharmacies like the Mark Cuban Cost Plus Drug Company? Billions, as it turns out. 


Generic Drug Savings Possibilities: $3.6 Billion to Medicare Using DTC Pricing

CMS first implemented the Comprehensive Primary Care Plus, or CPC+, Initiative in January 2017. The medical home model is a large-scale redesign effort meant to improve primary care through payer reform and care delivery transformation. However, an interim data analysis of the initiative’s first 3 years among Medicare fee-for-service beneficiaries did not demonstrate improvements in either care continuity or care fragmentation.

On this episode of Managed Care Cast, we speak with Lori Timmins, PhD, senior researcher, and Eugene Rich, MD, senior fellow, both of Mathematica. With their fellow authors, Carol Urato, MA, researcher at Mathematica; Lisa M. Kern, MD, MPH, associate professor of medicine at Weill Cornell Medicine in New York; and Arkadipta Ghosh, PhD, principal researcher at Mathematica, they published their study, “

Primary Care Redesign and Care Fragmentation Among Medicare Beneficiaries

Listen above or through one of these podcast services:

On this episode of Managed Care Cast, Lori Timmins, PhD, and Eugene Rich, MD, discuss the findings of their interim analysis of data from the first 3 years of the Comprehensive Primary Care Plus Initiative, a large-scale effort of primary care redesign meant to improve care fragmentation among Medicare fee-for-service beneficiaries.

Investigating How Care Fragmentation May Affect Primary Care Redesign in Medicare

The “muscles” that were created in value-based care programs in the years before the pandemic have been helpful to accountable care organizations (ACOs) in dealing with the turmoil in health care delivery, according to our guest on this week’s Managed Care Cast. 

Tim Gronniger, MPP, MHSA, the CEO of Caravan Health, discusses what may come next (or ideally might come next) as ACOs move forward as the United States adjusts to an endemic phase of COVID-19. We discuss financing and policy and what is needed to achieve CMS’ goal of furthering the shift to ACOs by 2030. 

Gronniger, former chief of staff and director of Delivery System Reform at CMS in the Obama administration, also discusses the company’s recent acquisition by Signify Health.

On this episode of Managed Care Cast, we speak with Tim Gronniger, the CEO of Caravan Health, about what to look for as accountable care organizations (ACOs) and policy makers try to encourage more providers to join value-based care arrangements.

 Caravan Health’s Tim Gronniger on Boosting ACO Participation

Fragmented health care is a known issue for patients and providers, and nowhere is the problem as acute as it is in the over-65 population. Studies have shown that patients who have a strong relationship with a primary care provider (PCP) who coordinates their care have better outcomes. But care provided by specialists has expanded over the past 2 decades, and the average PCP has twice as many specialists involved in the care of their fee-for-service 

 patients as they did 20 years ago, according to research published in 

On this episode of Managed Care Cast, we speak with one of the coauthors of the study, "

Trends in Outpatient Care for Medicare Beneficiaries and Implications for Primary Care, 2000 to 2019

," which illustrates the changing trends in a PCP’s panel of Medicare patients and how that translates to an increased workload for primary care doctors.

Michael L. Barnett, MD, MS, an assistant professor in the Department of Health Policy and Management at the Harvard TH Chan School of Public Health, is also an assistant professor of medicine at Brigham and Women’s Hospital in Boston. He earned his medical degree from Harvard Medical School and holds a master of science in health policy and management from the Harvard TH Chan School of Public Health.

On this episode of Managed Care Cast, we speak with one of the coauthors of a study that illustrates the changing outpatient trends in a primary care provider’s (PCP) panel of Medicare patients and how that translates to an increased workload for primary care doctors.










Specialist Care in Medicare FFS Adding to Growing Complexity of PCP Work Burden

, Charlie Wray, DO, MS, and colleagues examined experiences and opinions of nearly 150,000 Americans representing the 5 major forms of health insurance coverage.

Specifically, the researchers used survey data from the 2016-2018 Behavioral Risk Factor Surveillance System and compared access to care, cost of care, and reported satisfaction among those with public or private insurance.

Representing the experiences of over 61 million US adults, respondents included Medicaid and 

 beneficiaries, those with Veterans Health Administration or military coverage, and those with individually purchased and employer-sponsored coverage.

On this episode of Managed Care Cast, Wray, an assistant professor of medicine at the University of California San Francisco, describes the surprising findings of the teams’ analyses, and offers some solutions to improving the quality of health insurance coverage in the United States.

On this episode of Managed Care Cast, Charlie Wray, DO, MS, an assistant professor of medicine at the University of California San Francisco, outlines the findings of a paper he coauthored which assessed Americans' experiences with their insurance providers. 

Is Private Health Insurance Really Superior to Public Programs?

A health system transformational leadership framework and management system made visible and eliminated defects in value and was associated with reduced annual Medicare expenditures and increased quality between 2017 and 2020.

Eliminating Defects in Value: Turnaround of an MSSP ACO

Health plans use data to decide on quality improvement initiatives. Having a dashboard that characterizes how equitably plans are serving their enrollees would promote health equity.

Development of a Medicare Plan Dashboard to Promote Health Equity

Over the next 18 to 24 months, Humana is exiting the commercial health plan business to focus on government-funded programs, like Medicare Advantage, and specialty businesses.

Humana Leaving Commercial Business, Will Focus on Government-Funded Programs

Coverage from the Institute for Value-Based Medicine® session with Astera Cancer Care in Edison, New Jersey, held November 3, 2022.

Breaking New Ground in Episodes of Care, Including CAR T-Cell Therapy

Improved outcomes associated with fidaxomicin compared with vancomycin suggest benefits from its greater use in Medicare patients, although uptake remains low despite its recommended use.

Updated Clinical Practice Guidelines for CDI Show Improved Outcomes, but Adherence Issues Remain

There are several shortcomings with current value-based payment models available for the management of chronic kidney disease (CKD), but some incentives, such as the Kidney Transplant Bonus, show the potential benefits of a pay it forward approach that can be impactful for other sectors of health care, said Daniel E. Weiner, MD, MS, board certified nephrologist and lead navigator at Tufts Clinical and Translational Science Institute.

American Society of Nephrology (ASN) Kidney Week 2022 meeting

Push the Right Buttons for Better Kidney Disease Care: Value-Based Models

Can you speak on benefits and challenges of the value-based payment models available for CKD that you will address during your session at Kidney Week 2022?

I think I’ll first sort of mention the shortcomings of it. [For] the value-based payment models, most of the ones that exist are all based on Medicare fee-for-service (FFS), which, until recently actually [covered] the majority of patients on dialysis, the vast majority of patients on dialysis—that's not the case anymore.

You have this huge movement to Medicare Advantage and now it's a minority of patients on dialysis that are Medicare FFS. So, the models, I think that were very well intentioned, are only getting a very small proportion of the population. And so I don't know how successful they'll be, because the vast majority of people are not going to be Medicare FFS in 1, 2, 5, 8 years. So, you're missing an opportunity here to change things.

I think the other big factor with that is when people are doing Medicare Advantage or other payers, they bounce around from payer to payer. So, an individual payer doesn't have the same incentives to prevent people from progressing. If you have good metrics in place, they may have incentives there to be able to do that, but if it's going to cost a lot of money to prevent something that can be somebody else's problem later on from a payer perspective, you have some misalignment there. And we know that people change payers exceptionally frequently. So, that's a really difficult thing.

That stated, the models actually are pretty interesting, and you can broadly divide them up into 2 sets. There's the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model, which is a mandatory model, and there's the Kidney Care Choices (KCC) Models, which are voluntary models. ETC only applies to patients on dialysis and I think it may be limited ultimately in what it accomplishes. It uses pretty much a brute force approach to push more people onto the transplant waiting list and into home dialysis.

These are good things, but it's a fairly brute force model with pretty heavy risk and pretty heavy downside for nephrologists and dialysis units. Critically, it also doesn't expand silos—it's locked into the dialysis silo, in some senses it’s reinforcing that.

The much more interesting models are the ones in the KCC program and those are voluntary models. I think the most exciting thing there, particularly philosophically, is something called the Kidney Transplant Bonus. So, this is an up to $15,000 bonus that gets paid out over 3 years if a beneficiary who's within one of these programs gets a kidney transplant.

The interesting thing is that the kidney transplant recipient oftentimes isn't going to be cared for by the nephrologist who’s in the model. So, it really speaks towards success, making sure that patients are informed, that they're in the best possible shape to get the transplant, that you are promoting this transplant process.

It will still count even if it's a preemptive transplant, and it's a way of getting around the fact that care systems are going to change, but what you do 3 years earlier still can have tremendous impacts down the road. And I just thought that was incredibly clever and it's really incentivizing the right way. It's incentivizing investment at an earlier time point for a huge payoff for the patients later on. And I haven't seen that too much in other models where it's taking this sort of long approach.

I think that has relevance elsewhere in the health care system, and I'm not smart enough to figure out how to design this, but if you can develop systems where people are paying it forward, regardless of if they're changing health insurers or changing providers, so on and so forth, but where care that is done now that will impact beneficially a patient and their families years from now, there's some reward for the care that's done now. I think if we can design a system like that, that would be huge.

It'll take a lot because you're overcoming this fragmented US health care system. And people from Canada or other places laugh at us when we talk about these things, because it's like, well, of course, single payer, we can pay things forward. It's not going to happen in the United States, but if we can figure out a way to cross that different type of silo, and really incentivize the right thing now, when it has a 5-year benefit or a 10-year benefit, that would be a huge innovation, and we're not there yet.

Videos

Daniel E. Weiner, MD, MS, board certified nephrologist and lead navigator at Tufts Clinical and Translational Science Institute, spoke on the limitations and future potential of value-based payment systems for chronic kidney disease (CKD), including the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model and the Kidney Care Choices (KCC) Models.