Along with the peer-review research, journal articles, and news coverage, The American Journal of Managed Careâ„¢ (AJMCâ„¢) has a robust multimedia component that brings together stakeholders from across the healthcare industry to discuss important topics in the world of managed care and delve deeper into topics.
Along with the peer-review research, journal articles, and news coverage, The American Journal of Managed Care™ (AJMC™) has a robust multimedia component that brings together stakeholders from across the healthcare industry to discuss important topics in the world of managed care and delve deeper into topics.
3. Dr Patrick Conway Discusses the Move to Value-Based Care
The pace of payment reform is moving quickly. In an interview with AJMC™, Patrick Conway, MD, MSc, deputy administrator for innovation and quality and chief medical officer at CMS, said he is proud of the pace, but that his concern now is how to maintain it. He also discussed Accountable Health Communities, which was announced just before the interview, and how it links social determinants of health to clinical delivery.
2. Dr Farzad Mostashari Explains the New ACO Benchmarking Rule
At the beginning of 2016, CMS released proposed changes to the benchmarking rule for accountable care organizations (ACOs), and Farzad Mostashari, MD, CEO of Aledade, explained what the proposed changes mean. ACOs had been concerned that they would be expected to also be doing better than themselves in order to get savings, but the new proposed rule explains that there will be a transition to setting a benchmark so that ACOs just have to be better than their neighbors. The important thing about the rule is that CMS has made it clear that it is listening to concerns and that it is determined to continue working to get the ACO program right.
1. Marilyn Tavenner: Affordability the Biggest Challenge Facing Insurers
At the annual Institute & Expo of America’s Health Insurance Plans (AHIP), Marilyn Tavenner, president and CEO of AHIP, spoke with AJMC™ on a broad range of topics. This is currently a turbulent time for insurers, who are enthusiastic about moving to alternative payment models and value-based care, but realize there needs to be a lot of physician education to ensure the success of these new payment models. Insurers also remain concerned about costs, not just the cost of drugs, but also the cost of services and how these can remain affordable for consumers.
A collection of multiple stakeholder perspectives on important issues in clinical and policy developments are presented in AJMC™’s Peer Exchange series.
3. Limitations of ICER’s Value Assessment Framework Tool
In the Spring 2016 Oncology Stakeholder Summit, experts discussed value and cost in cancer care. During this segment of the Peer Exchange, Alan Balch, PhD, CEO of the Patient Advocate Foundation, highlighted the Institute for Clinical and Economic Review’s Value Assessment Framework tool. The tool aims to help stakeholders make more informed decisions about new cancer therapies with a care value component and the health system value cost. However, cost—benefit analyses have limitations. When it comes to a person’s life, people are willing to spend a lot of money. They may value life more than the analysis takes into account.
2. Oral Oncolytics: A Look Ahead
In the Peer Exchange, Oral Oncolytics: Exploring Challenges in Cost Adherence and Management, experts looked into the future at the outlook in cancer as more oral agents are developed. The panelists also discuss coverage for these new treatment options. One thing that was considered were partnerships where manufacturers take accountability for the outcomes of the drugs. But, the panelists admit, the hard part is coming to a consensus on reasonable outcomes.
1. Value-Based Tools and Real-World Evidence in Oncology
In another segment in Oral Oncolytics: Exploring Challenges in Cost Adherence and Management, the experts discussed initiatives by the National Comprehensive Cancer Network and the American Society of Clinical Oncology to evaluate oral oncolytics. However, these frameworks are still in their infancy and require some adjustments. In addition, few physicians are actually paying attention to these tools when they make treatment decisions.
Managed Care Cast
3. Podcast: PCDC 2016 Faculty Key Takeaways
AJMC™ only recently delved into the world of podcasting, and we kicked off with a recap of the 2016 annual meeting of Patient-Centered Diabetes Care®. In this podcast, faculty provided listeners with a key takeaway from their session or panel.
2. Healthcare Price Transparency: Mandi Bishop Interviews Jeanne Pinder
Managed Care Cast has special guest hosts, one of whom is Mandi Bishop, chief evangelist and co-founder of Aloha Health. In her first podcast interview, Mandi spoke with Jeanne Pinder, who founded Clear Health Costs. The 2 discussed the challenge of understanding what healthcare services cost and how Clear Health Costs is addressing the issue.
1. Drug Formulary Exclusions: Dr Patricia Salber Interviews Dr James Chambers
The other guest host of Managed Care Cast is Patricia Salber, MD, MBA, of The Doctor Weighs In. For her first podcast, Dr Salber interviewed James D. Chambers, PhD, who published research in AJMC™ regarding the impact of formulary drug exclusion policies. The 2 discussed the findings of the research as well as the next step.
The Managed Care Insights program features expert opinions on multiple areas of focus and are typically tied to a Peer Exchange.
3. Comparison of Guidelines From ADA and AACE
As part of the series Updates in the Management of Type 2 Diabetes Mellitus and Comorbid Dyslipidemia, Zachary T. Bloomgarden, MD, MACE, discussed the treatment options available for the management of diabetes. He looked specifically at the clinical guidelines that had been released by the American Diabetes Association and the American Association of Clinical Endocrinologists and outlined the differences between the 2 guidelines.
2. How Could Genetic Testing Have the Most Impact?
As part of the series The Evolution and Clinical Impact of Diagnostic Testing, David C. Collymore, MD, MBA, considered cardiovascular disease, which is the leading cause of death, and how genetic testing could significantly impact outcomes for individuals who die from sudden heart attacks. Genetic testing could also make an impact in diabetes care by helping providers to identify the most effective medication and in addiction care, where an understanding genetic predisposition to addiction could help tailor pain prescribing.
1. Role of Genetic Versus Genomic Testing in Cancer
In another interview part of the The Evolution and Clinical Impact of Diagnostic Testing series, Edmund Pezalla, MD, MPH, described the use of genetic and genomic testing in cancer care. Genomics may be more important because it identifies the genetic makeup of the tumor, which differs from the patient, and can help guide treatment. Genetic testing, which helps guide screening and preventive services is still in the early stages.