Interviews

Neil Goldfarb, president and CEO of Greater Philadelphia Business Coalition on Health (GPBCH), discussed his initial motivations for launching a business coalition 10 years ago in the Greater Philadelphia region and what accomplishments GPBCH has had so far in driving health care value.

Athena Gierbolini, president of Hope for HS, a nonprofit advocacy group for those affected with hidradenitis suppurativa (HS), spoke on common stigmas regarding HS and how clinicians can improve consultation through a culturally sensitive approach.

Pharmacists must take time to understand why patients are not adherent to HIV pre-exposure prophylaxis (PrEP) and what barriers exist, said Kevin N. Astle, PharmD, BCPS, BCACP, AAHIVP, CDES, assistant professor at the University of South Florida Taneja College of Pharmacy.

Several elements of the Inflation Reduction Act (IRA) align with CMS’ goals of promoting equity through health policy, explained A. Mark Fendrick, MD, co–editor in chief of The American Journal of Managed Care® and director of the V-BID Center at the University of Michigan.

A medical student at the University of Kansas discusses a research project she started in her first year of school—2020—looking at whether a racial bias in pulse oximetry was present in patients with acute hypoxemic respiratory failure.

Patients may be able to forgo radiation following use of cemiplimab to treat their resectable cutaneous squamous cell carcinoma (cSCC), as it is likely to demonstrate significant improvement in quality of life (QOL) for patients and enable less invasive surgeries, noted Neil D. Gross, MD, FACS, head and neck surgeon and director of clinical research in the Department of Head and Neck Surgery at The University of Texas MD Anderson Cancer Center.

The Inflation Reduction Act (IRA) temporarily extended Affordable Care Act premium subsidies and instituted an insulin co-pay cap for Medicare beneficiaries, but bipartisan agreement is needed to make these changes permanent and more broadly applicable, explained A. Mark Fendrick, MD.

It's hard to predict whether the Medicare drug price negotiation provision in the Inflation Reduction Act (IRA) could lead to higher or lower prices in the commercial market, said A. Mark Fendrick, MD, co–editor in chief of The American Journal of Managed Care® and director of the V-BID Center at the University of Michigan.

Kelly Price, US Head of Rare Disease at HRA Pharma, talks about the shifting preference for nonpharmacologic treatments.

Arianne Baldomero, MD, MS, a pulmonologist in the Veterans Health Administration, discusses findings of a study looking at chronic obstructive pulmonary disease (COPD) disease management for veterans in rural areas.

Urban areas face a concentration of various pollutants that will be exacerbated by the increasing temperatures caused by climate change, and low-income residents likely have fewer resources to withstand negative health impacts, according to Emily Brigham, MD, MHS, of the University of British Columbia.

There is potential impact on the heart, coronary arteries, and heart function following radiation to the left side of the body, explained Amresh Raina, MD, director of the Advanced Heart Failure and Pulmonary Hypertension Program at Allegheny General Hospital and the Allegheny Health Network in Pittsburgh, Pennsylvania.

According to Tom Robinson, vice president of global access at JDRF, the creation of the Type 1 Diabetes (T1D) Index was prompted by a lack of basic data on the condition, such as how many people are living with and affected by T1D.

Patients with uveitis and their physicians may be very familiar with intravitreal injections, but triamcinolone acetonide injectable suspension (Xipere) has a novel delivery method, said Steven Yeh, MD, professor and the Stanley Truhlsen Jr. Chair in Ophthalmology at the Truhlsen Eye Institute, University of Nebraska Medical Center.

Most implementations of value-based insurance design (VBID) in commercial markets involve prescription drugs, but some plans are beginning to incorporate cost-sharing offsets, said A. Mark Fendrick, MD, co–editor in chief of The American Journal of Managed Care® and director of the Center for Value-Based Insurance Design at the University of Michigan.

There are several closely watched randomized trials examining catheter-directed therapies for acute pulmonary embolism, according to Parth Rali, MD, an associate professor of thoracic medicine and surgery at the Lewis Katz School of Medicine and director of the Temple University Health System Pulmonary Embolism Response Team.

While more research is needed, obesity does play a role in the response to viral infections as well as immunizations, said Kara Dupuy-McCauley, MD, a pulmonologist at the Mayo Clinic in Rochester, Minnesota.

Biosimilars have had such an impact on driving down costs, that in some instances the reference product might be the lowest cost option, explained Paul Forsberg, PharmD, director of pharmacy, Minnesota Oncology.

Melissa O'Connor, PhD, MBA, RN, FGSA, FAAN, endowed professor in community and home health nursing, M. Louise Fitzpatrick School of Nursing, Villanova University, and director, Gerontology Interest Group, addressed the impact of food/housing insecurity and other social determinants of health (SDOH) on care outcomes in home health.

Patients have to always come first, and technology can enhance their care experience, stated Anne Marie F. Rainey, MSN, RN, CHC, director of quality and value-based care at Clearview Cancer Institute.

On day 1 of this year’s Association of Community Cancer Centers’ (ACCC) National Oncology Conference, The American Journal of Managed Care® sat down for a conversation with David Penberthy, MD, MBA, ACCC’s president for the 2022-2023 term, and his brother Scott Penberthy, PhD, MS, director, Applied AI, Office of the CTO, at Google.

There have been many silver linings of the pandemic, including improvements in financial, operational, and clinical advancement efficiencies, as well as addressing the total cost of care in population health management, said Mike Koroscik, MBA, MHA, vice president of oncology, Allina Health and the Allina Health Cancer Institute.

The Inflation Reduction Act (IRA) contains provisions allowing Medicare to negotiate net prices for prescription drugs, but it remains to be seen whether this will translate into savings for beneficiaries, explained A. Mark Fendrick, MD, co–editor in chief of The American Journal of Managed Care® and director of the V-BID Center at the University of Michigan.

It’s important that patients are the healthiest they can be when going into treatment for cancer, emphasized Debra Delaney, MSN, FNP-BC, primary care nurse practitioner at ChristianaCare’s Helen F. Graham Cancer Center & Research Institute.

Much of artificial intelligence (AI) is now being used in the more mundane areas of health care, figuring out where to be most helpful, so doctors can do what they do best, which is diagnostic care, noted Scott Penberthy, PhD, MS, director, Applied AI, Office of the CTO, at Google.

On this episode of Managed Care Cast, we speak with Matthew D. Eisenberg, PhD, lead author of a study published in the October issue of The American Journal of Managed Care® that investigated the use of high-deductible health plans and their impact on substance use disorder care and spending.

Athena Gierbolini, president of Hope for HS, a nonprofit advocacy group for those affected with hidradenitis suppurativa (HS), discusses current knowledge on the impact of diet and other holistic care strategies in the management of HS.

Even though there is a 1-year gap between the Oncology Care Model and the Enhancing Oncology Model, there remain value-based oncology payment programs with private payers, said Glenn Balasky, executive director of Rocky Mountain Cancer Centers.