Managed Care Cast

On this episode of Managed Care Cast, we speak with April Todd, senior vice president, CORE and Explorations for CAQH. We discuss CAQH CORE’s recent approval of a 2-day rule for health plans in requesting additional supporting information from providers and making final determinations on prior authorization requests.

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.

On this episode of Managed Care Cast, we speak with 2 authors of a recent study who researched how useful preventive drug lists are for patients with asthma and parents of children with asthma.

We speak with one of the authors of a recent study examining why overall biomarker testing rates remain poor for metastatic colorectal cancer.

On this episode of Managed Care Cast, we speak with John Showalter, MD, chief product officer at Jvion and an internal medicine physician, and Soy Chen, MS, director of data science at Jvion and part of their data science team. We discuss their research about using applied machine learning to predict healthcare utilization based on social determinants of health, appearing in the January 2019 Health IT issue of The American Journal of Managed Care®.

On this episode of the podcast, we speak with Peter Bonis, MD, chief medical officer, Clinical Effectiveness, Wolters Kluwer Health, which recently released the survey, Mending HealthCare in America 2020: Consumers & Cost.

On this episode of Managed Care Cast, we speak with Kashyap Patel, MD, the chief executive officer of Carolina Blood and Cancer Care Associates—a leading OCM practice—and associate editor of Evidence-Based Oncology™ (EBO), as well as Tennessee Oncology’s Stephen M. Schleicher, MD, MBA, to discuss Oncology Care First.

While efforts to abate surprise medical billing, such as the kind that come from out-of-network emergency department visits, are currently being debated in Washington, DC, the kind of billing discussed here occurs when patients struggle to understand the difference between preventive health services, which are covered at no cost under the Affordable Care Act, and billing for services at a doctor’s visit for an illness, condition, or injury.

Amy Ellis, director of quality and value-based care at Northwest Medical Specialties, and Amanda Hodges, director of implementation for ReVital Cancer Rehabilitation, who acts as a bridge between the oncology world and the rehabilitation world, discuss overcoming barriers in practices to help patients with cancer get the rehab care they need, how patients with cancer can benefit from rehab, and defining value.

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.

Women in the United States suffer from maternal mortality rates not seen elsewhere in developed countries, and nowhere is that more true than among patients served by Medicaid. Although it is a national epidemic, inadequate maternal care disproportionately affects minority women and the 43% of US births financed by Medicaid. On this episode, we speak with an executive vice president of Avia Health Innovation, which is trying to address this issue in conjunction with 30 healthcare systems.

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.

Healthcare is changing due to a combination of technological improvements and rising costs. For instance, more than half of surgical procedures now take place in an outpatient environment, but, as with many things in healthcare, there isn’t a lot of transparency. Today on Managed Care Cast, we speak with Michael Abrams, managing partner of Numerof & Associates, about what we know about patient safety in outpatient settings.

Chronic disease affects most employees in the United States, and today, on World Diabetes Day, Managed Care Cast speaks with the lead author of a study about chronic disease that will appear in the November issue of The American Journal of Managed Care®. Author Maren S. Fragala, PhD, CSCS.D, talks about how employer-sponsored health screenings can help identifiy previously undiagnosed disease, enabling early detection and treatment, and help keep workers healthier.

In addition to being a practicing oncologist, Mark Lewis, MD, a gastrointestinal oncologist at Intermountain Healthcare, has been living with cancer himself with a hereditary tumor syndrome that’s been passed down in his family, giving him a unique experience that has driven his approach to treating his own patients.

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.

In 2002, Bill Allman, working for Washington State, heard from a widow with a $75,000 bill from Medicaid, which was incurred as part of her spouse's long-term care costs. Like Allman, the man was a veteran. On this episode of Managed Care Cast, we learn how Allman, who is retiring at the end of 2019, launched a program to connect veterans to health benefits they didn't know they had, and in the process, figured out that states could reduce Medicaid spending.

Accountable care organizations (ACOs) face a learning curve before they start achieving savings. David Carmouche, MD, president of the Ochsner Health Network and executive director of the Ochsner Accountable Care Network, explains how the Ochsner ACO was able to find success and how other ACOs can get over the learning curve to achieve savings.

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.

Healthcare is increasingly trying to use big data and clinical pharmacists are no exception. On today's episode of Managed Care Cast, we talk with an assistant professor at Geisinger’s Center for Pharmacy Innovation and Outcomes about his work with big data.

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.

Who will care for America's growing aged population in the coming decades? Today on the podcast, we're speaking with PHI, a New York-based nonprofit organization that works to improve long-term services and care for the elderly and those with disabilities by focusing on the job quality of those providing day-to-day hands-on care—low-paid home health care aides and nursing assistants.

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 month’s issue of The American Journal of Managed Care® took a look at differences in coverage of orphan and nonorphan drugs to get insight into variation in orphan drug coverage across the largest commercial plans in the United States. To get more insight into the findings, and the reasons behind these trends, we sat down with James Chambers, PhD, associate professor of medicine at Tufts Medical Center Institute for Clinical Research and Health Policy Studies.

The issue of obesity-related cancers is the focus of this month’s issue of Evidence-Based Oncology™, a sister publication of The American Journal of Managed Care®, and during this week’s podcast, we sat down with Debra Patt, MD, MPH, MBA, vice president of Texas Oncology, about the issue, how the health system is addressing it, and how obesity affects different populations, such as postmenopausal women, differently.

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.

As the prevalence and acceptance of telehealth continues to increase in the United States, a white paper from FAIR Health has offered more insight into just how much growth there's been in recent years. To get more insight into these findings, we sat down with Robin Gelburd, founding president of FAIR 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.