Interviews

The American Journal of Managed Care recently sat with Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS), as she discussed CMS's role in the new, evolving healthcare landscape. This special AJMCtv interview highlights just some of the initiatives CMS has implemented, as well as some of the challenges that remain for the organization.

Margaret K. Pasquale, PhD, principal researcher, Comprehensive Health Insights at Humana, says Humana's predictive model of opioid abuse suggests that there are a few factors that might lend people to be at high risk for opioid abuse

Patricia Coyle, MD, director, MS Comprehensive Care Center, Stony Brook Neurosciences Institute, professor and vice chair of clinical affairs, Department of Neurology, SUNY at Stony Brook, says that prognostically, the earlier you treat multiple sclerosis the better.

Katherine Baicker, PhD, professor of health economics, Department of Health Policy and Management, Harvard School of Public Health, says that Medicare Advantage Plans still hold promise to deliver high-value, better-tailored care to beneficiaries.

Edmund J. Pezalla, MD, MPH, national medical director, Aetna Pharmacy Management, suggest that the healthcare industry will continue to move in the direction of providing patients incentives to make use of health risk assessment tools and screenings.

Joseph Antos, the Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute, says the federal Medicare program not only has a spending problem, but a delivery system problem that the fee-for-service model has not solved.

Dan Crippen, executive director of the National Governors Association, says the single biggest issue with state Medicaid programs is its significant impact on state budgets.

Bruce Feinberg, DO, vice president and chief medical officer, Cardinal Health Specialty Solutions, says that the populations of Medicaid and commercial patients have historically been different.

Matt Salo, executive director, National Association of Medicaid Directors, says there are many concerns associated with Medicaid expansion.

Melanie Bella, director, Medicare-Medicaid Coordination Office, Centers for Medicare & Medicaid Services, says the sole focus of the Medicare-Medicaid Coordination Office is to increase coordination and access to services from many fronts.

Jan Berger, MD, MJ, president & CEO, Health Intelligence Partners, and editor-in-chief of The American Journal of Pharmacy Benefits, says that historically medication adherence, when it pertained to PBMs, was really just about selling pills-it was an isolated, siloed issue.

Patrick Courneya, MD, CHIE, health plan medical director, HealthPartners, Inc, says that his organization sees a wide variety of models in Minnesota.

Patrick Gleason, PharmD, director of Health Outcomes, Prime Therapeutics, says there are many current and forthcoming trends in specialty pharmacy management.

Paul Ginsburg, PhD, president at Center for Studying Health System Change, says hospital mergers are increasingly building larger health systems.

Susan Dentzer, senior policy adviser, Robert Wood Johnson Foundation, says there are many trends that are transforming today's health insurance marketplace.

Tom Lee, MD, Founder and CEO, One Medical Group, says there are a wide variety of technologies that can enhance patient-centered care.

Bruce Feinberg, DO, Vice President and Chief Medical Officer, Cardinal Health Specialty Solutions, says cancer treatment is more than clinical guidelines, protocols, or individual drugs.

Jan Berger, MD, MJ, President & CEO, Health Intelligence Partners, and editor-in-chief of The American Journal of Pharmacy Benefits, says that the availability of pharmacies nationwide presents a unique situation.

David Lansky, PhD, President & CEO, Pacific Business Group on Health, says that Accountable Care Organizations (ACOs) must truly be accountable for the care they provide.

In order to deliver quality and cost-effective cancer care, Michael Kolodziej, MD, Aetna's national medical director for oncology strategies, says that providers need to get better connected with payers.

Robert Williams, MD, director, Deloitte, Consulting LLP, says physician integration is driven predominantly by the department of justice, and FTC regulations that require physicians to meet the definition of clinical integration.

Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology, US Department of Health and Human Services, says that meaningful use sets a foundation for new models to deliver care to an entire population.

Peter Goldbach, MD, Chief Medical Officer, Health Dialog, says providers must engage their patients by communicating information about their health in efficient ways.

Patrick Courneya, MD, CHIE, Health Plan Medical Director, HealthPartners, Inc, says integration is not necessarily a description of a business model, but a description of a care model.

Karen Ignagni, President and Chief Executive Officer, America's Health Insurance Plans (AHIP), says health plans are doing a number of things to reduce cost and improve value, as they know the two go hand in hand.

The presence of inexpensive centers and new data collection tools show promise in cutting costs as providers take a new path in care delivery, says Eric Topol, MD, Director of the Scripps Translational Science Institute, Chief Academic Officer at Scripps Health, Cardiologist, and Professor of Genomics at The Scripps Research Institute.

Jan Berger, MD, MJ, President & CEO, Health Intelligence Partners, and editor-in-chief of The American Journal of Pharmacy Benefits, says the triple aim consists of cost, quality, and access. Additionally, the largest benefit that healthcare consumers can use is their health pharmacy benefit.

Dea Belazi, PharmD, Vice President, Payer & Healthcare Solutions, Source Healthcare Analytics, says a copay assistance program is primarily sponsored or supported by a pharmaceutical manufacturer.

According to Douglas Chaet, Senior Vice President, Independence Blue Cross, incentives for providers in accountable care organizations (ACOs) should stem from wanting to get an edge on the competition.

Surya Singh, MD, Vice President, Medical Benefit Management, CVS Caremark, says the buy-and-bill model is most typically applied to the provider space, and more specifically to physicians' offices.