Managed Care Cast

As we enter an era of megamergers like the one between CVS Health and Aetna, The American Journal of Managed Care® convened its Oncology Stakeholder Summit to discuss the history of mergers and acquisitions, the reasons behind them, and what they mean for different stakeholders.

A study published in this month's issue of The American Journal of Managed Care® estimated standardized episode-level spending for patients across subcategories of care for each hospital referral region—defined by the Dartmouth Atlas—in order to identify the greatest opportunities for cost savings under the Oncology Care Model (OCM).

Who sets the price for medications and other supplies used in hospitals and why are there shortages of some of these items? Martin Makary, MD, MPH, a surgical oncologist and chief of the Johns Hopkins Islet Transplant Center as well as executive director of Choosing Wisely, discussed this issue and its ramifications for healthcare costs.

As the opioid epidemic continues to claim tens of thousands of lives each years, stakeholders from around the country are launching efforts to enforce appropriate prescribing patterns and identify those most at risk for opioid misuse and abuse.

A lot of healthcare is simply exchange of information, but the current healthcare system doesn’t allow for that exchange to happen in a convenient way. The Network for Excellence in Health Innovation (NEHI) has released a new roadmap that reinvents healthcare in the United States through the use of technology.

This month's issue of The American Journal of Managed Care® features a study that examined the effectiveness of a high-intensity, community-based care management program for Medicare patients with complex medical and social needs. We sat down with 2 of the study's researchers—Purvi Sevak, PhD, senior researcher at Mathematica, and Cara Stepanczuk, MPA, researcher in the health unit at Mathematica—to discuss the study findings and their implications.

This fall, The American Journal of Managed Care® convened a panel of experts on migraine to discuss calcitonin gene-related peptide (CGRP) inhibitors, an emerging therapy for the condition, which affects 39 million people in the United States.

A survivor of chronic lymphocytic leukemia who participated in the first chimeric antigen receptor T-cell trial in 2010 looks back at his experience and also discusses his views on how patient-reported outcomes (PROs) should be used, if at all, by CMS.

Research in the October issue of The American Journal of Managed Care® measured changes in ordering rates for 4 resource use measures before and after dissemination of physician feedback reports.

CMS’ accountable care organization program, the Medicare Shared Savings Program (MSSP), could potentially be undergoing some big changes. During the recent fall 2018 meeting of the National Association of ACOs (NAACOS), the proposed changes were top of mind. Attendees were most concerned about how the faster timeline to taking on risk would impact participation, but were pleased with changes to the benchmark and risk adjustment.

Employers may not look forward to purchasing healthcare, but they are in the position to transform the market. More employers are getting more involved in healthcare by championing alternative payment models and other services to their employees.


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