Today we’re highlighting a discussion with a panel of experts in interstitial lung disease moderated by Ryan Haumschild, PharmD, director of Pharmacy Services at Emory Healthcare and Winship Cancer Institute.

The topics of conversation for today’s podcast include treatment goals in patients with ILD and a review of treatment paradigms and standard of care therapies.

Managed Care Cast Presents: ILD Peer Exchange—Treatment Goals in ILD, Part 1

On this episode of Managed Care Cast, we speak with Reverend Paul Abernathy, chief executive officer of the Neighborhood Resilience Project and board member of UPMC for You, who discusses his experiences in promoting health and resiliency in trauma-affected communities, as well as challenges related to access and accessibility of care and medical mistrust.

Promoting Health Equity and Resiliency in Trauma-Affected Communities

Mental health issues and substance use disorder are one of the contributing factors to America’s high maternal mortality rates, in addition to poverty, racism, and lack of access to adequate health care. Last year, the CDC reported that suicide accounts for 9% of the maternal mortality rate 1 year postpartum. Anxiety, perinatal and postpartum depression, and birth-related PTSD are the most common complications of pregnancy and childbirth, affecting 1 in 5 individuals, and for those affect, 75% do not get treatment. Women of color are both more likely to experience these conditions and also also less likely to seek help.

On this episode of Managed Care Cast, we speak with Heather Waters, LCSW who leads the maternal health and children’s health services team at Inland Empire Health Plan, a managed care plan serving more than 1.4 million residents on Medi-Cal in California.

She tells us about a new maternal mental health program at IEHP aimed at supporting new mothers, both before they give birth and afterwards.

Addressing Maternal Mortality in Medicaid by Focusing on Mental Health

On this episode of Managed Care Cast, we're talking with Dr Paige Nong, the author of a study published in the Health IT bonus issue. 

Her study, "Equity and AI Governance at Academic Medical Centers," found that academic medical centers show minimal consideration for equity when developing governance for AI technologies; this highlights the need for health systems and policymakers to prioritize equity literacy and oversight policies.

Unveiling the AI Equity Gap: A Wake-Up Call for Health Care Systems

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 American Oncology Network.

The topics of conversation for today’s podcast include the pathophysiology of PNH, complement inhibitors, treatment strategies, and the challenges of managing this rare, life-threatening disorder.

Managed Care Cast Presents: Challenges of Diagnosing and Managing PNH

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 Rare Diseases: Duchenne Muscular Dystrophy," estimates the insurance value of novel Duchenne muscular dystrophy (DMD) treatment from a survey of individuals planning to have children.

Insurance Insights: Dr Jason Shafrin Estimates DMD Insurance Value

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.

Frameworks for Advancing Health Equity: Health Equity by Design

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 care engagement, the role of trust in patient-provider relationships, and how community-based approaches and partnerships are improving care access nationwide.

Building Trust, Breaking Barriers: Health Care Leaders Tackle Primary Care Challenges

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. Looking ahead, we also discussed strategies to improve ratings for 2025, especially for smaller plans.

Effective Strategies to Enhance Medicare Advantage Star Ratings

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 insufficient insurance coverage for obesity management.

Obesity Uncovered: Dr Eden Miller on US Obesity Epidemic, Insurance Shortcomings

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

Breaking the Cycle: The Importance of Early Intervention in Hidradenitis Suppurativa

On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Larragem Raines, MS, director of research at the Center for Innovation & Value Research, about her organization's open-source value model for major depressive disorder (MDD). 

She also defines dynamic pricing and explains how it is incorporated into the MDD value model, topics she expands upon in a recent contributor article.

Looking ahead, Raines discusses the potential of artificial intelligence (AI) to improve diagnosis, treatment, and access in the MDD space.

Inside the Center's MDD Value Model and Its Use of Dynamic Pricing

On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Lindsey Leininger, PhD, health policy professor and faculty director of the Center for Health Care at the Tuck School of Business at Dartmouth College, and Allister Chang, MPA, co-founder of Fabric Health, a social-impact startup that aims to improve community well-being by transforming everyday moments in laundromats into opportunities to build trust, support Medicaid recertification, and connect families with health and social services.

Their study, "Unmet Health Care and Health-Related Social Needs of Laundromat Users," published in this month's issue, identifies laundromats as a promising community-based setting for Medicaid outreach, with Medicaid enrollees comprising the majority of users and facing disproportionately high levels of unmet needs. 

During the conversation, Leininger and Chang highlight how engaging with enrollees at laundromats can help foster trust, address unmet social needs, and strengthen Medicaid engagement.

Laundromats as a New Frontier in Community Health, Medicaid Outreach

A quick roundup episode of major health policy developments, from shifting COVID-19 vaccine guidance and scientific publishing controversies to rising cancer care costs and the impact of oncology biosimilars.

Managed Care Cast News Roundup: June 3, 2025

On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Julia Lucaci, PharmD, MS, the senior director of global health economics and outcomes research at Becton, Dickinson and Company (BD), an international medical technology company.

Her commentary, "Should Payers Incentivize Pharmacies to Blister-Package Chronic Medications?" argues that payers should consider offering higher reimbursement rates and/or preferred network status to pharmacies that dispense chronic medications in blister packs to enhance medication adherence and patient outcomes.

During the conversation, Lucaci explores the widespread impact of medication nonadherence, the benefits and underutilization of blister packaging in the US, and strategies that could support broader adoption to improve chronic disease management and lower overall health care costs.

Blister Packs May Help Solve Medication Adherence Challenges and Lower Health Care Costs

A quick roundup episode of major news and health policy developments from The American Journal of Managed Care. 

Managed Care Cast News Roundup: June 17, 2025

Delays, denials, and endless paperwork—prior authorization isn’t just a headache for providers; it’s a barrier for patients who need timely care. From shocking patient delays to the surprising role of fax machines in 2025, in this episode, we explore why prior auths are driving burnout, potentially harming outcomes, and what’s being done to streamline the process.

Stuck in Prior Auth Purgatory: The Hidden Costs of Health Care Delays

Gastropsychiatrist Eva Szigethy, MD, PhD, and Benjamin Cohen, MD, Cleveland Clinic, discuss quality of life improvement in terms of behavioral health and inflammatory bowel disease (IBD).

Addressing the Physical, Psychological Complexity of IBD Through Coordinated Care

Explore how the Collaborative Care Model enhances mental health access in this episode featuring Anna Bob, executive director of the Path Forward coalition.

Why Collaborative Care Is the Path Forward for Mental Health Care: Anna Bob

Managed Care Cast News Roundup: July 8, 2025

Precision medicine has long guided cancer treatment by matching therapies to tumor mutations, but the emerging field of predictive genomics aims to take this further by factoring in a patient’s genetics, health history, and environment to better predict drug response.

Navigating Risk, Treatment, and Reimbursement in Precision Oncology: Sadie Dobrozsi, MD

On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Jonathan Gabison, MD, DABOM, and Stephen Lott, PharmD, MS. At the University of Michigan, Gabison is an obesity medicine specialist and family physician, while Lott serves as director of the postgraduate year one managed care residency program and manager of the university's prescription drug plan.

Their qualitative study, "Understanding Insurance Coverage Policies for Incretin Mimetics for Weight Management," determined that the high costs associated with these therapies limit insurance coverage and contribute to variation in utilization management strategies aimed at controlling short-term spending.

During the conversation, the investigators discuss how high costs, misconceptions about obesity, and inconsistent coverage policies continue to hinder equitable, patient-centered care.

High Costs, Coverage Variability Limit Access to Incretin Mimetics for Weight Management

Heart failure remains one of the most urgent challenges in health care, affecting millions of individuals and imposing a significant burden on families and the broader health system. Although guideline-directed medical therapy (GDMT) has been shown to improve clinical outcomes and reduce hospitalizations, adoption of these therapies remains suboptimal nationwide. Addressing this treatment gap is essential not only for enhancing survival and quality of life but also for mitigating the rising economic impact of heart failure as its prevalence continues to increase. Gluckman also led the session “Addressing Underuse of Guideline-Directed Medical Therapy in Heart Failure” at the July 9 Institute for Value-Based Medicine® (IVBM) event in Garden Grove, CA, where he addressed the need for integrated approaches to drive sustainable, system-level change in cardiovascular care.

On this episode of Managed Care Cast, Ty Gluckman, MD, MHA, FACC, FAHA, FASPC—a practicing cardiologist at Providence Heart Institute in Portland, Oregon, and medical director of Providence's Center for Cardiovascular Analytics, Research, and Data Science—discusses strategies to improve GDMT implementation. The conversation explores opportunities for payers and providers, the potential of remote patient monitoring and digital health tools, and the role of value-based care models in supporting optimal therapy. Emphasis is placed on the importance of aligning clinical guidelines with managed care policies to drive meaningful improvements in patient outcomes.

What It Takes to Improve Guideline-Based Heart Failure Care With Ty J. Gluckman, MD

On this episode, Mary Caffrey, Executive Editor of AJMC and Evidence-Based Oncology (EBO), is joined by Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO Chief Medical Officer of the International Myeloma Foundation (IMF), was the primary interviewee and source for a recent EBO article. His insights in that piece highlight how the IMF’s M-Power initiative builds trust and awareness through its 3-pillar approach: community engagement, primary care education, and improving care for patients. During the discussion, Mikael talks about how IMF's M-Power initiative is expanding with the organization's medical student scholars program, using patient narratives to encourage trial participation among Black patients, and navigating today’s political climate around diversity, equity, and inclusion—all while pushing toward a future where lifesaving treatments and cures reach every patient who needs them. Stay tuned for this enlightening discussion on bridging the clinical trial gap.

Hope on the Horizon for Underserved Patients With Multiple Myeloma: Joseph Mikael, MD

Breast cancer is the second most common cancer among women and the second leading cause of cancer-related deaths among women in the US. In light of Breast Cancer Research Awareness Day, the American Journal of Managed Care® breaks down the most recent advancements in breast cancer prevention, screening, and therapies.

The Breakdown: Breast Cancer Research Awareness Day

On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Richard A. Brook, MS, MBA, president of Better Health Worldwide, Inc., and author of a study published in the August 2025 issue.

His retrospective analysis, "The Impact of Health Benefit Design on Patients With Infertility," examined how benefit design influences infertility treatment use and pregnancy outcomes. The study found that coverage for infertility treatment was associated with significantly higher use of assisted reproductive technology (ART) medications, more ART procedures performed, and improved pregnancy outcomes.

In this conversation, Brook explores the current state of infertility care in the US, the inspiration behind his study, its key findings, and next steps to expand access to ART.

Infertility Coverage Boosts ART Use and Pregnancy Success: Richard A. Brook, MS, MBA

Committed to building safe, reliable, and value-driven AI solutions that enhance health care delivery and the member experience, UPMC Health Plan's approach to AI is grounded in strong governance, balancing innovation with critical ethical concerns. In this conversation, we dive into how UPMC Health Plan builds trust with providers and members, discuss challenges of scaling AI effectively, and hear about concrete examples of AI's positive impact. 

AI in Health Care: Balancing Governance, Innovation, and Trust

We discuss the May 16 FDA approval of the first blood test to diagnose Alzheimer disease. This landmark approval marks a significant shift in how Alzheimer disease is identified, moving away from more traditional methods or invasive methods. Our guests, Howard Fillit, the Alzheimer’s Drug Discovery Foundation, and Anthony “Nino” Sireci, MD, MSc, Eli Lilly and Company, help us understand this “huge accomplishment" and how it may be able to transform the diagnostic landscape from one of nihilism to one of hope and early intervention. 


Navigating the Alzheimer Disease Blood Test Revolution

For National Recovery Month, we are joined by Matthew O. Hurford, MD, vice president, Behavioral Health, UPMC Insurance Services Division, and Michael Lynch, MD, an attending emergency physician and medical toxicologist at UPMC. Among the topics we hit on are the 4 crucial dimensions of recovery; understanding that addiction is a brain disease, not a moral failing; and the challenges and opportunities they encounter in providing behavioral health services to millions of Pennsylvanians.

Transforming Addiction Care: From Stigma to Support

As Andy Slavitt, MBA, acting administrator of CMS, comes to the end of his tenure, he spoke with Mandi Bishop, MA, CEO of Aloha Health, about the task of making health policy translatable and the legacy of payment reform he leaves behind.

During his tenure, Slavitt, who has held the position since March 2015, oversaw the rollout of a number of new payment models to move healthcare to a value-based care system, including the implementation of the Medicare Access and CHIP Reauthorization Act. In addition, he has made a point to work on providing Americans with tools to help them find the best hospitals.

In the interview with Bishop, he offered insights for the incoming administration in the continued move toward value-based care.

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Making Health Policy Translatable: Mandi Bishop Interviews Andy Slavitt

Creators of President Donald Trump’s blueprint to control drug prices, American Patients First, say it represents real reform. Critics see a pulled punch to the pharmaceutical industry.

Mary Caffrey, the managing editor of The American Journal of Managed Care’s Evidence-Based series, spoke with Harvard healthcare economist Michael E. Chernew, PhD, who is the co-editor in chief of AJMC, to discuss elements of the Trump administration proposal to control drug prices. Chernew is also a former vice chair of the Medicare Payment Advisory Commission.

Read more:
Trump Offers Blueprint to Drive Down Prescription Drug Prices; Targets Rebates, "Middlemen": www.ajmc.com/newsroom/-trump-offers-blueprint-to-drive-down-prescription-drug-prices-targets-rebates-middlemen
Azar Stumps for Plan to Hold Down Prescription Drug Costs: www.ajmc.com/focus-of-the-week/azar-stumps-for-plan-to-hold-down-prescription-drug-costs
Trump Targets Drug Prices, Right-to-Try in State of the Union: www.ajmc.com/newsroom/trump-targets-drug-prices-righttotry-in-state-of-the-union
​​​​​​​Will Trump Take Steps to Rein in Drug Prices?: www.ajmc.com/focus-of-the-week/will-trump-take-steps-to-rein-in-drug-prices

What Is and Is Not in Trump’s Drug Pricing Plan: An Interview With Dr Michael Chernew

Health disparities stemming from social, economic, and environmental factors have become a growing target in healthcare with payers, providers, and policy makers turning their attention on how to address those nonmedical factors that impact an individual’s overall health and health outcomes outside of the medical setting.

While the importance of addressing social determinants of health is becoming more clear, there are still challenges for this new field—delving into the arena can be daunting for health systems and there is not much evidence yet on best practices for screening patients and getting them to the right resouces.

In this podcast, we talk to Clifford Goodman, PhD, of The Lewin Group; Shantanu Agrawal, MD, MPhil, of National Quality Forum; and Rachel Gold, PhD, MPH, of the Kaiser Permanente Center for Health Research.

Read more about the stories in this podcast:
Doctors Talk About How Social Determinants Affect Their Work With Patients: https://www.ajmc.com/focus-of-the-week/doctors-talk-about-how-social-determinants-affect-their-work-with-patients
Physicians Call for Action on Social Determinants of Health: https://www.ajmc.com/newsroom/physicians-call-for-action-on-social-determinants-of-health
Humana's "Bold Goal" Update Finds More Healthy Days for Medicare Members in 4 Cities: https://www.ajmc.com/focus-of-the-week/humanas-bold-goal-update-finds-more-healthy-days-for-medicare-members-in-4-cities
A Health Plan's Investigation of Healthy Days and Chronic Conditions: https://www.ajmc.com/journals/issue/2017/2017-vol23-n10/a-health-plans-investigation-of-healthy-days-and-chronic-conditions
Dr Shantanu Agrawal: Bringing Together the Community to Tackle Social Determinants of Health: https://www.ajmc.com/conferences/aco-fall2017/dr-shantanu-agrawal-bringing-together-the-community-to-tackle-social-determinants-of-health
Dr Shantanu Agrawal Highlights Progress Being Made to Address Health Inequities: https://www.ajmc.com/conferences/aco-fall2017/dr-shantanu-agrawal-highlights-progress-being-made-to-address-health-inequities
Data Necessary to Appropriately Address Social Determinants of Health: https://www.ajmc.com/conferences/acdc-spring-2018/data-necessary-to-appropriately-address-social-determinants-of-health

The Importance of Addressing Social Determinants of Health, and the Challenges Remaining

There are concerns that cancer care costs may increase as the site of provider-administers cancer drugs shifts from physician officers to hospital outpatient departments. Researchers in the July issue of The American Journal of Managed Care examined chemotherapy-related spending in Medicare Part B after controlling for patient characteristics, such as cancer type, and explored differences in chemotherapy utilization patterns between the 2 settings.

In this interview, lead author Yamini Kalidindi, a research assistant at Pennsylvania State University and a graduate student in the department of health policy and administration, explains why the findings of her study differ from previous research and highlights the importance of considering patient characteristics such as cancer type.

Read the paper in the July issue:
Differences in Spending on Provider-Administered Chemotherapy by Site of Care in Medicare: https://www.ajmc.com/journals/issue/2018/2018-vol24-n7/differences-in-spending-on-provideradministered-chemotherapy-by-site-of-care-in-medicare

Site of Chemotherapy Administration Impacts Spending: An Interview With Yamini Kalidindi

Optimizing Number and Timing of Doctor's Appointment Reminders: An Interview With Dr John F. Steiner

This week, the top managed care news included Entresto winning the first FDA nod in a hard-to-treat type of heart failure; President Joe Biden nominates a new CMS administrator; experts discuss the potential for Biden health reforms.

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