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

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

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

Managed Care Cast

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