Interviews

Throughout 2015, as The American Journal of Managed Care celebrated 20 years, the publication invited key healthcare industry leaders to write special guest commentary, which appeared each month in the journal.

The new opioid measures from the Pharmacy Quality Alliance (PQA) are supposed to compare opioid dosages across organization to attempt to get a handle on the issue of opioid addiction, said Woody Eisenberg, MD, senior vice president of performance measurement and strategic alliances for the PQA.

There needs to be more transparency in the healthcare industry because even though there is currently information available on health plans and hospitals, it's often not information that is useful to consumers or purchasers, explained Leah Binder, MA, MGA, president and chief executive officer of The Leapfrog Group.

Historically cancer survivorship programs have not emphasized cardiac follow-up and there is not a lot of long-term data on cardiac toxicity in patients who received certain drugs, but that is changing as patients live longer and fuller lives after treatment, explained Crystal S. Denlinger, MD, from the Fox Chase Cancer Center in Philadelphia.

The Better Medicare Alliance works to articulate the value of Medicare Advantage and the way it has improved access to care and the right kind of care for millions of beneficiaries, said Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance.

When accountable care organizations first started forming, the country thought it would be easier than it has been, but finding the right partner is crucial, said Pam Halvorson, regional vice president of clinic operations with Trinity Pioneer ACO.

As patients with cancer live longer and the disease becomes a chronic disease for many, it becomes important for providers to understand how the needs of the patient change from being newly diagnosed to active therapy to long-term therapy, explained Linda House, president of the Cancer Support Community.

The US horizon scanning system is more comprehensive than the one used in Europe, but the US has the disadvantage of having a more fragmented healthcare system, explained Elise Berliner, PhD, director of the Technology Assessment Program in the Center for Outcomes and Evidence at the Agency for Healthcare Research and Quality.

Julia Adler-Milstein, PhD, was named the first winner of the Seema S. Sonnad Emerging Leader in Managed Care Research Award at the 20th anniversary event for The American Journal of Managed Care, held October 28 in Orlando, Florida. Ashish K. Jha, MD, professor of health policy at the Harvard T.C. Chan School of Public Health, nominated her for the award and explains why he believes she is an Emerging Leader and the importance of this award.

Patients, especially those with complex chronic conditions, factor in a lot of different things when making care decisions, and increasingly cost is a huge issue, said Marc Boutin, JD, chief executive officer of the National Health Council.

As the healthcare industry moves toward population health and improving quality and value, The American Journal of Managed Care (AJMC) is in a good position to help lead the change, according to Rose Maljanian, RN, MBA, chairman and chief executive officer of HealthCAWS and a member of the AJMC editorial board.

Getting health information technology (IT) to work in one provider system can be difficult enough, but in ACOs, they have multiple systems on different platforms, explained Joseph Gifford, MD, chief executive officer of the Providence-Swedish Health Alliance.

Measuring quality of life in oncology care is difficult for a number of reasons, but Laura Long, MD, MPH, president at TheLongView, PC, expects that to change in the future.

The shift to a pay-for-performance environment healthcare gets the provider more involved with the patient, which has a greater impact on quality measures like adherence, said Mitzi Wasik, PharmD, BCPS, director of Pharmacy Medicare Programs at Aetna, Inc.

There has been tremendous momentum in the value-based insurance design movement in the US healthcare industry, but there are 3 specific ones that are noteworthy, according to A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

There are a number of financial hardships patients with cancer can face, even if they are insured, such as loss of employment, depletion of retirement accounts, and bankruptcy, said Veena Shankaran, MD, MS.

There have been many studies proving that depression interferes with medication adherence, but it isn't enough to just treat depression to get better outcomes, providers have to hand hold patients and help them improve their motivation to start taking medications again, explained Paul Ciechanowski, MD, MPH, associate professor at the University of Washington.

One way to make all patients with cancer, regardless of socioeconomic status, feel like they're on the same level when receiving treatment is to ensure they know they're being taken care of, said Mary Lou Smith, MBA, co-founder of the Research Advocacy Network.

The Patient-Centered Oncology Care meeting provides a great opportunity for stakeholders from across healthcare to get together, and when that happens very good things can come from it, according to Peter Bach, MD, MAPP, director of Memorial Sloan Kettering Cancer Center's Center for Health Policy and Outcomes.

There is no such thing as intervention for mental health that is too early-one of the most interesting early interventions Robin Henderson, PsyD, director of behavioral health services and interim director of health integration at St. Charles Health System, has been involved with is in the neonatal intensive care unit.

Although there are innovative ideas from drug manufacturers and pharmacy benefit managers (PBMs) about improving medication adherence, no one wants to get into legal trouble to implement them, said Lauren Harner, JD, senior manager of policy at PhRMA.

Pathways are still a young enterprise so barriers to their adoption are being more readily recognized than the number of problems being solved are, according to Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.

Managed care will become rapidly refined and driven toward more patient-reported outcomes in the future, said Christine K. Cassel, MD, president and chief executive officer of National Quality Forum.

With new treatments helping patients with cancer to live longer, healthcare providers now have new issues of long-term survivorship to consider, said Joseph Alvarnas, MD, the editor-in-chief of Evidence-Based Oncology.

The digitization of health will help to identify patients when they're most vulnerable and present new opportunities to change the trajectory of their disease before they suffer avoidable consequences associated with chronic disease, said Lonny Reisman, MD.

One of the great aspects of the Medicare Shared Savings Program is that it provides an important opportunity directly to physicians, said Louis Morgenier, chief executive officer of Physicians ACO, LLC.

The American Journal of Managed Care (AJMC) is the first and greatest source of managed care information and research, said Julie Slezak, MS, chief analytics officer at CareCore National and an editorial board member for AJMC.

The use of genetic testing has led to a radical change within certain specialties and hospital departments. And although doctors are being asked to do more, they do it gladly because the work leads to better treatment decisions for patients, said Mark G. Kris, MD, William and Joy Ruane chair in thoracic oncology at Memorial Sloan Kettering Cancer Center.

With the goal of accountable care organizations and population health being patient centric, it is important that stakeholders involved in the care of the patient develop partnerships to deliver high-quality care in a cost-effective manner, explained René Lere, MD, president of Florida Blue and GuideWell.

There are 3 main risks to the sustainability of accountable care organizations and the move to accountable care, said Farzad Mostashari, MD, former National Coordinator of Health Information Technology and co-founder and chief executive officer of Aledade.