On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Brady Post, PhD, assistant professor at Northeastern University and lead author of a study published in this month's issue.His study, "Impact of Hospital-Physician Integration on Medicare Patient Mix," found no evidence that hospital-employed physicians treated …

Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes. Overall, their findings show a significant uptick in tirzepatide d…

Today we are bringing you a conversation the use of continuous glucose monitoring technology and its transformative potential in diabetes care. Davida Kruger, a certified nurse practitioner at Henry Ford in the division of endocrinology, spoke with Jaime Murillo, MD, senior vice president and chief medical officer, medical affairs, United Health Gr…

On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.By Managed Care Cast

On this episode of Managed Care Cast, we are speaking with Jai N. Patel, PharmD, the associate director of shared resources management at Atrium Health Wake Forest Baptist Comprehensive Cancer Center.His study, "Medical Policy Determinations for Pharmacogenetic Tests Among US Health Plans," uncovered significant differences in coverage decisions fo…

On this episode of Managed Care Cast, we speak with George Jones, chief operating officer at UpScript Health, an online pioneer of eprescribing 20 years ago, to learn how telemedicine has progressed from asynchronous conferencing to real-time video consultation, enabling the treatment of complex conditions beyond primary care.…

On this episode of Managed Care Cast, we speak with Perry N. Halkitis, PhD, MS, MPH, dean of the Rutgers School of Public Health. Our conversation centers on the potential withdrawal of the United States from the World Health Organization, the new directive for the CDC to stop communications with the WHO, and their public health implications. We al…

Today, we're diving deep into a crucial aspect of preventive healthcare: the Annual Wellness Visit. Our guest is Dr. Christopher Wheelock, a clinical transformation physician executive at Highmark Health, responsible for developing payer and provider collaborations to move toward value-based care. In the past, he was heavily involved with developin…

On this episode of Managed Care Cast, we're talking with Allison Ju-Chen Hu, PhD, a postdoctoral associate in the Department of Population Health Sciences at Weill Cornell Medicine.Her study, "Medicaid Managed Care Network Adequacy Standards and Mental Health Care Access," examined the association between quantitative network adequacy standards (NA…

Joining us for this episode of Managed Care Cast is Robert H. Hopkins, Jr, MD, mnedical director at the National Foundation for Infectious Diseases and NFID liaison to the Advisory Committee on Immunization Practices, who will help separate fact from fiction about avian influenza and discuss what needs to be done to prevent a future escalation.…

Today, we do a deep dive into psychedelic-assisted therapy with Jessica Tracy, head of Growth and Partnerships at Enthea. She shares how employers and unions can support mental health and address access barriers to evidence-based ketamine treatments.By Managed Care Cast

March 11, 2025, will mark 5 years since the World Health Organization (WHO) declared COVID-19 a pandemic. Between January 22, 2020, and March 10, 2023, Johns Hopkins University recorded over 676 million confirmed COVID-19 cases worldwide and more than 6.8 million related deaths. In the US alone, it reported over 103 million cases and more than 1 mi…

The editors in chief of The American Journal of Managed Care® discuss the key managed care research and news from 2024 and look forward to the journal’s upcoming 30th anniversary.By Managed Care Cast

Today we are bringing you a conversation on treatment with Bruton tyrosine kinase inhibitors for patients with treatment-naïve chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL).Ryan Haumschild, PharmD, MS, MBA, CPEL, vice president of ambulatory pharmacy at Emory Healthcare and Winship Cancer Institute, spoke with 3 experts: Tara Gr…

Rachael Drake, pharmacy technician coordinator, University of Kansas Health System, explains how her team collaborates with insurance companies and providers to support patients with non-Hodgkin lymphoma access treatment.By Managed Care Cast

Among the latest data being presented at the American Society of Hematology Annual Meeting and Exposition, held December 7-10, 2024, in San Diego, California, were 3 abstracts that focused on patient preferences and treatment choices.Sikander Ailawadhi, MD, professor of medicine in the Division of Hematology/Oncology at the Mayo Clinic Florida was …

Today we are bringing you insights from 3 separate interviews with experts about the treatment, management, and burdens of idiopathic pulmonary fibrosis (IPF).In this podcast, you’ll hear insight from the following individuals: Toby Maher, MD, PhD, professor of clinical medicine, Keck School of Medicine, USC; Martin Kolb, MD, PhD, professor of medi…

On this episode of Managed Care Cast, we're talking with Joanne Armstrong, MD, MPH, the vice president and chief medical officer for women's health and genomics at CVS Health.We explored the progress and persistent challenges in women's health, highlighting topics like care access, the role of technology, maternal health outcomes, and efforts to br…

In this special episode of Managed Care Cast, the executive editor of The American Journal of Managed Care, Mary Caffrey, speaks with Tyler Sandahl, PharmD, of Cleveland Clinic, and Michael Byrne, DO, of Tennessee Oncology, about the use of bispecific antibodies to treat patients with multiple myeloma, the importance of caregivers for this regimen,…

On this episode of Managed Care Cast, we're talking with Josie Cooper, BA, executive director of the Alliance for Patient Access.Her study, "Utilization Management and Physician Burnout," involved a survey that assessed physician experiences with utilization management and burnout, investigating the potential link between the 2.…

Dr Elizabeth Warner, chief medical officer at CDPHP, discusses how Wellness Way's focus on patient experience, community partnerships, and integration of physical and mental health care services sets it apart from traditional hospital-based care.By Managed Care Cast

Prompt care supports mental well-being, as hidradenitis suppurativa is often associated with depression and anxiety due to its physical and social challenges.By Managed Care Cast

On this episode of Managed Care Cast, we're talking with Benjamin Ukert, PhD, of Elevance Health's Public Policy Institute. His study, "Racial and Ethnic Disparities in Prior Authorizations for Patients With Cancer," evaluated prior authorization decisions in cancer care by race and ethnicity for commercially insured patients.…

In our conversation with Jeff Giullian, MD, MBA, chief medical officer with DaVita Kidney Care, we dive into 4 important aspects of kidney care: prevention, social support, integrated care, and patient supportBy Managed Care Cast

On this episode of Managed Care Cast, we're talking with Rick Chapman, PhD, chief science officer of the Center for Innovation & Value Research, formerly known as the Innovation and Value Initiative (IVI).We discussed the Center's Rare Disease project, including the primary goals, key discoveries from Phase 1, and what to expect moving forward.…

To help celebrate and recognize National Recovery Month, we have brought you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In this final episode, we speak with Lyndra Bills, MD, senior medical director, and Shari Hutchison, MS, director of program evaluation and outcomes, both with Communit…

Delia Orosco, MS, director of Community Wellness Centers at Inland Empire Health Plan (IEHP), shares insight into innovative initiatives like the mobile mammogram clinics.By Managed Care Cast

To recognize National Recovery Month, we are bringing you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In episode 4, Amy Herschell, PhD, associate vice president, Program Implementation and Evaluation, Community Care Behavioral Health Organization, and Jessica Meyers, MSEd, senior advisor …

On this episode of Managed Care Cast, we're talking with Simon F. Haeder, PhD, MPA, associate professor of public health at Texas A&M University.His study, "When is a Network Adequate? Consumer Perspectives on Network Adequacy Definitions," explored the factors that consumers consider essential for an adequate provider network, including travel tim…

Chris Barton, senior director of Integrated Systems of Care & Network Innovation at Horizon Blue Cross Blue Shield of New Jersey, discusses how the Youth Behavioral Health Strategy program focuses on addressing the specific needs of youth with mental health and substance use issues through a comprehensive approach…

To recognize National Recovery Month, we are bringing you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In episode 3, we speak with Kim MacDonald-Wilson, ScD, CPRP, senior director, Recovery and Wellness Transformation, and Tracy Carney, CPS, CPRP, senior recovery specialist, both at Commun…

To recognize National Recovery Month, we are bringing you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In episode 2, we speak with Rebekah Sedlock, DSW, LCSW, Community Care Behavioral Health Organization, part of the UPMC Insurance Services Division, and Mandy Fauble, PhD, LCSW, UPMC West…

To recognize National Recovery Month, we are bringing you another limited-edition month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In episode 1, we speak with Michael Lynch, MD, associate professor of emergency medicine at the University of Pittsburgh and an attending emergency physician and medical toxicologist at t…

On this episode of Managed Care Cast, we're talking with Eden Miller, DO, founder of the Diabetes and Obesity Care clinic in Bend, Oregon, which provides high-level obesity intervention and diabetes treatment and prevention.Her study, "Inadequate Insurance Coverage for Overweight/Obesity Management," reviews the US obesity epidemic and discusses in…

On this episode of Managed Care Cast, we're talking with Marge Ciancetta, the product manager of Cotiviti's Star Intelligence solution, which helps health plans and providers improve their Medicare Advantage Star Ratings.We discussed all things Star Ratings, including their importance, how they are calculated, and their impact on plans in 2024. Loo…

On this episode of Managed Care Cast, we're talking with Sreekanth Chaguturu, MD, chief medical officer of CVS Health; Cathy Moffitt, MD, FAAP, CHIE, chief medical officer of Aetna; and Joneigh Khaldun, MD, MPH, FACEP, chief health equity officer of CVS Health.We discuss various topics, including the current challenges in primary and preventive car…

On this episode of Managed Care Cast we speak with Jeffery A. Goad, PharmD, MPH, 2024-2025 president of the National Foundation for Infectious Diseases, on the recent report from the World Health Organization and UNICEF on public immunization rates, with national and global health implications.By Managed Care Cast

On this episode of Managed Care Cast, we're talking with Jason Spangler, MD, MPH, the CEO of the Center for Innovation and Value Research, formerly known as the Innovation and Value Initiative (IVI). We discuss the strengths and limitations of health technology assessment (HTA), one major limitation being its lack of equity. We also touch on IVI's …

Melissa Clarke, MD, CMQ, the chief health equity officer at Elevance Health, explains "Health Equity by Design" and how Elevance Health is committed to ensuring a personalized and intentional approach for all its members, regardless of race or ethnicity, sexual orientation, gender identity, disability, and geographic or financial access.…

On this episode of Managed Care Cast, we're talking with Jason Shafrin, PhD, the senior managing director of FTI Consulting's Center for Healthcare Economics and Policy and an adjunct professor in the University of Southern California's Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences.His study, "Quantifying the Insurance Value for Rar…

Today we are bringing you a conversation between 3 experts on paroxysmal nocturnal hemoglobinuria (PNH). Ryan Haumschild, PharmD, MS, MBA, vice president of Pharmacy at Emory Healthcare and Winship Cancer Institute, spoke with Jamie Koprivnikar, MD, of John Theurer Cancer Center; David Dingli, MD, PhD, of Mayo Clinic; and Brian P. Mulherin, MD, of …

On this episode of Managed Care Cast, we're talking with Sreekanth Chaguturu, MD, the chief medical officer of CVS Health. We discuss the impact of recent pharmaceutical innovations, namely glucagon-like peptide-1 (GLP-1) receptor agonists and biosimilars, on patient health outcomes. Also, we explore the role of trust between patients and providers…

Kim Zynn, vice president of UPMC Health Plan's provider network and development relations team, shares how physicians can become LGBTQIA+ affirming providers, which is designated within the health plan.By Managed Care Cast

Douglas Weber, MD, explains how zuranolone has changed the landscape for postpartum depression treatment, addressing a gap in care within the specialty.By Managed Care Cast

Charlie Borowicz, manager of trans and gender diverse health at Allegheny Health Network, shares how the program offers comprehensive patient-first care to those in the LGBTQ and gender diverse community.By Managed Care Cast

On this episode of Managed Care Cast, we're talking with the University of Southern California's Erin Duffy, PhD, MPH, an author of a study published in the June 2024 issue of The American Journal of Managed Care®.Her study, "Deductible Double Jeopardy: Patients May Pay More Out of Pocket When Pregnancy Crosses 2 Years" discusses how annual high-de…

In this fifth, and final, special bonus episode of our Pride Month series, we speak with Lauren Albrecht, director of advocacy and organizing, and Layla Orlando, director of health equity and wellness, at Garden State Equality, the largest LGBTQ+ advocacy organization in New Jersey.By Managed Care Cast

In our fourth Pride Month podcast episode, we are speaking with Domenico Ruggerio, executive director of We Are Family, in Charleston, South Carolina, the state's oldest nonprofit, which provides life-affirming and life-saving programs for LGBTQ+ youth.By Managed Care Cast

For June, we are bringing you a limited-edition podcast series to celebrate Pride Month. In our third episode, we speak with Patrick McGovern, CEO of Callen-Lorde since August of 2023 and an outspoken advocate for HIV, LGBTQ+, and community health.By Managed Care Cast

In this interview, we discuss immigrant health with Kheir Mugwaneza, the lead project manager of the Immigrant and Refugee Health Program at Allegheny Health Network.By Managed Care Cast