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Managed Care Cast

Examining Variation in Orphan Drug Coverage Among Commercial Plans

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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.

Exploring the Rise of Obesity-Related Cancers: A Conversation With Dr Debra Patt

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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.

Digging Deeper Into the Increasing Use of Telehealth

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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.

Dissecting OCM Performance Period 4 Results and Their Implications

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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.

Examining Physician-Initiated Alternative Payment Models, a New Wave of Payment Reform

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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.

Rebuilding Trust in Healthcare With the ABIM Foundation

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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.

What's Gone Astray in American Healthcare and Pricing

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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.

How Are Oncology Practices Communicating Value-Based Care to Employers and Patients?

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On this episode of Managed Care Cast, we’re bringing you a portion of a panel discussion about the Oncology Care Model, held in July 2019 during a meeting of The Institute for Value-Based Medicine® (IVBM), an initiative of The American Journal of Managed Care®. At IVBM events, we gather thought leaders to share best practices across medicine, pharmacy, and management in regional locations around the country. This podcast is taken from our meeting focusing on Innovation and Quality in Oncology Care.

KOL Corner: Amy Ellis Discusses Viewing Value-Based Care as a Culture With Jeff Hunnicutt

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Transitioning to value-based care is a marathon, not a race, and should be viewed as a mission and a culture, Jeff Hunnicutt, chief executive officer at Highlands Oncology Group, told Amy Ellis, director of quality and value-based care at Northwest Medical Specialties. In order to successfully transform a practice, there needs to be a clear message and set values ingrained in the mindset of staff at the frontline of patient care.

A Discussion on Managing and Treating Type 2 Diabetes

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As a progressive condition, diabetes presents an ongoing challenge for physicians to provide adequate control of patients’ disease, and new agents with novel mechanisms of action help reduce the burden in the management of diabetes.

Addressing the Complexities of Value-Based Payment Models

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As value-based models continue to change the payment landscape in healthcare, the models require more sophisticated data, analytics, and payment structures, which can lead to more administrative burden, as well as siloed data.