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.

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.

With Oncology Care Model performance period 4 results out now, it’s a transformative point in the model in which practices that have not yet achieved a performance-based payment have to either enter 2-sided risk or leave the model. To dive into the most recent results and their implications, we spoke with Charles Saunders, MD, chief executive officer of Integra Connect.

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.

Reference-based pricing has been touted as a way to contain healthcare costs while ensuring quality of care. We talk with with David Henka, chief executive officer of ActiveRADAR, to dig deeper into how the method is used in practice and what program results have shown.

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.

To date, most alternative payment models (APMs) that have emerged in the shift toward value-based care have been initiated by payers and focused on primary care providers. However, there has recently been a new wave of payment reform in which providers, mostly specialists, are designing and implementing their own APMs in their practices. A study published in the September issue of The American Journal of Managed Care® analyzed some of these new payment models to gain insight into what providers are prioritizing in their APMs.

Relationships in healthcare are important and trust is crucial to those relationships. However, it has been on the decline in the United States. We speak with the executive vice president of the ABIM Foundation and representatives from the 8 winning organizations of the foundation's Trust Practice Challenge about the programs they implemented to rebuild trust.

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 the author of a new book that discusses the price and cost of American healthcare. Martin Makary, MD, MPH, a surgical oncologist and chief of the Johns Hopkins Islet Transplant Center, talked about what he found while writing The Price We Pay: What Broke American Health Care—and How to Fix It. Makary discusses spurious billing practices, overtreatment, and the opioid issue, as well as efforts by some providers and employers to reshape primary care.

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 advocates for addressing social determinants of health (SDOH) look to get buy in from stakeholders, there's a need for building evidence base to show that initiatives addressing these determinants work.

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.