Current policies being employed to limit spending can have serious consequences for patients. In the April issue of The American Journal of Managed Care, A. Mark Fendrick, MD, co-authored a paper that examined the relationship between consumer cost sharing for branded antidepressants and the initiation of branded therapy among patients who were filling a prescription for a generic medication to treat major depressive disorder.

Read the paper:
Cost Sharing and Branded Antidepressant Initiation Among Patients Treated With Generics: www.ajmc.com/journals/issue/2018/2018-vol24-n4/cost-sharing-and-branded-antidepressant-initiation-among-patients-treated-with-generics

Providing an open channel of communication between pharmacists and patients, medication therapy management (MTM) allows pharmacists to optimize medications for their patients and patients to take an active role in their healthcare. As MTM services help pharmacists better understand how different medications interact with each other, MTM has been recommended as a way to identify and prevent opioid misuse.

In an effort to provide greater incentive for Part D sponsors to use MTM programs, the Center for Medicare and Medicaid Innovation launched in January 2017 the 5-year Part D Enhanced Medication Therapy Management (eMTM) Model. The model is assessing whether incentives, such as payment and regulatory flexibilities, will result in enhancements in the MTM program, ultimately leading to improved patient outcomes and reduced costs.

In this podcast, we speak with Brian Litten, JD, chief strategic officer, Tabula Rasa HealthCare; and Calvin Knowlton, BScPharm, MDiv, PhD, chief executive officer and founder of Tabula Rasa HealthCare, to get more insight into MTM and the eMTM model.

Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included the FDA commissioner discussing boosting drug competition; BMS offering details on its acquisition of Celgene; and cancer mortality rates declining for the 25th consecutive year.

Read more about the stories in this podcast:
FDA's Scott Gottlieb, MD, Highlights Biosimilars Initiatives in J.P. Morgan Keynote Address: https://www.centerforbiosimilars.com/conferences/jp-morgan-2019/fdas-scott-gottlieb-md-highlights-biosimilars-initiatives-in-jp-morgan-keynote-address
BMS, Celgene Discuss $74 Billion Acquisition During JP Morgan Healthcare Conference: https://www.ajmc.com/newsroom/bms-celgene-discuss-74-billion-acquisition-during-jp-morgan-healthcare-conference
Cancer Mortality Rate Drops for the 25th Consecutive Year, but Socioeconomic Gap Widens: https://www.ajmc.com/focus-of-the-week/cancer-mortality-rate-drops-for-the-25th-consecutive-year-but-socioeconomic-gap-widens
Rise of Marijuana Cries Out for Research, Regulation, Physicians Say: https://www.ajmc.com/focus-of-the-week/rise-of-marijuana-cries-out-for-research-regulation-physicians-say
CVS Health CEO Outlines How Aetna Deal Will Benefit Customers: https://www.ajmc.com/newsroom/cvs-health-ceo-outlines-how-aetna-deal-will-benefit-customers

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

The widespread nature of the opioid epidemic will require coordination from a variety of stakeholders and all levels of government. In this podcast, experts discuss how the crisis got so out of hand, various tactics being undertaken to reverse the opioid, and the current impact of stigma on getting treatment.

This week, the top stories in managed care included new hypertension guidelines lowering the threshold for high blood pressure, Trump nominating a new HHS secretary, and many consumers now have access to less expensive Affordable Care Act plans.

High Blood Pressure Starts at 130/80, New Guidelines Say: www.ajmc.com/conferences/aha-2017/80-new-guidelines-say

Trump Nominates Alex Azar, Former Lilly Executive, to Lead HHS: www.ajmc.com/newsroom/trump-nominates-alex-azar-former-lilly-executive-to-lead-hhs

Kaiser Analysis: For Many, Health Coverage Costs Less Than Individual Mandate Penalty: www.ajmc.com/focus-of-the-week/kaiser-analysis-for-many-health-coverage-costs-less-than-individual-mandate-penalty

Patient-Centered Oncology Care: www.ajmc.com/conferences/pcoc-2017/

Today we’re speaking with Dr. Steven Goldberg, the vice president of medical affairs, population health, and chief health officer at Quest Diagnostics. He is also a co-author of a recent peer-reviewed case study that analyzed a benefits and wellness program designed by a self-insured employer. The employer, Quest Diagnostics, covers nearly 60,000 lives. The analysis of the program showed that it was able to reduce costs while maintaining program quality and promoting population health. According to the study findings, through proactive changes, physician executive leadership, health plan collaboration, disease-specific population health initiatives, and plan design, Quest Diagnostic's annual healthcare cost trend steadily improved from a year-over-year trend of 5.7% from 2014 to 2015, to 4.6% from 2015 to 2016, to -1.0% for 2016 to 2017, and most recently, 0.3% in the 2017 to 2018 year.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included a new direction for the Center for Medicare and Medicaid Innovation; a bipartisan group of governors spoke out against the latest effort to repeal the Affordable Care Act; and the World Health Organization warned that antibiotics currently being developed were not enough to fight antibiotic-resistant infections.

Health literacy in the United States is low to begin with, and health financial literacy is even lower. The changing health insurance system is partly to blame. A few decades ago, health insurance covered everything. Now, patients have a lot more financial responsibility, and they don’t always understand it. In cancer, health financial literacy is particularly important since treatment can be so costly.

This episode of Managed Care Cast includes conversations with a few experts in the field: Yousuf Zafar, MD, MHS, of the Duke Cancer Institute; Clara Lambert, BBA, OPN-CG, chair of the Association of Community Cancer Centers Financial Advocacy Network Advisory Committee; Todd Yezefski, MD, senior fellow in the Clinical Research Division at the Fred Hutchinson Cancer Research Center and Division of Medical Oncology at the University of Washington; and Michele McCourt, senior director of the CancerCare Co-Payment Assistance Foundation.

Read more:
A Descriptive Study of Patients Receiving Foundational Financial Assistance Through Local Specialty Pharmacies: www.ajmc.com/journals/supplement/2018/the-patient-assistance-safety-net-how-many-need-help-how-many-are-helped/a-descriptive-study-of-patients-receiving-foundational-financial-assistance-through-local-specialty-pharmacies
Impact of Trained Oncology Financial Navigators on Patient Out-of-Pocket Spending: www.ajmc.com/journals/supplement/2018/the-patient-assistance-safety-net-how-many-need-help-how-many-are-helped/impact-of-trained-oncology-financial-navigators-on-patient-outofpocket-spending
Policy Improvement Areas to Reduce Financial Hardship: www.ajmc.com/conferences/pan-2018/policy-improvement-areas-to-reduce-financial-hardship
Addressing Financial Concerns at the Outset to Improve Patient Outcomes: www.ajmc.com/conferences/pan-2018/addressing-financial-concerns-at-the-outset-to-improve-patient-outcomes

Every week, The American Journal of Managed Care® (AJMC®) recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

​​​​​​​This week, the top managed care news included the Institute for Clinical and Economic Review investigating rising drug prices; CMS expanding value-based insurance design; and researchers using a blood test to detect preclinical Alzheimer disease.

Read more about the stories in this podcast:
What's Driving US Healthcare Costs? Stakeholders Weigh In: https://www.ajmc.com/focus-of-the-week/whats-driving-us-healthcare-costs-stakeholders-weigh-in
ICER Will Review If Drug Price Hikes Are Supported by New Evidence: https://www.ajmc.com/newsroom/icer-will-review-if-drug-price-hikes-are-supported-by-new-evidence
Report: Increasing Drug Prices, Shortages Causing Hospitals to Cut Staff, Putting Patient Safety at Risk: https://www.ajmc.com/focus-of-the-week/report-increasing-drug-prices-shortages-causing-hospitals-to-cut-staff-putting-patient-safety-at-risk
What We're Reading: Insulin Costs Double; PhRMA's Record Spending; Causes of Liver Transplants: https://www.ajmc.com/newsroom/what-were-reading-insulin-costs-double-phrmas-record-spending-causes-of-liver-transplants
CMS Expands VBID in Medicare Advantage, Increases Risk Sharing in Part D: https://www.ajmc.com/newsroom/cms-expands-vbid-in-medicare-advantage-increases-risk-sharing-in-part-d
Researchers Use Blood Test to Detect Preclinical Alzheimer Disease Signs: https://www.ajmc.com/newsroom/researchers-use-blood-test-to-detect-preclinical-alzheimer-disease-signs
Improving Care for Patients With Metastatic Breast Cancer: https://www.ajmc.com/peer-exchange/advances-metastatic-breast-cancer/improving-care-for-patients-with-metastatic-breast-cancer

At the fall live meeting of The American Journal of Managed Care's ACO & Emerging Healthcare Delivery Coalition, speakers discussed how to care for complex patients, and the latest in reimbursement. The week before the Coalition met, CMS released the final rule for the Medicare Access and CHIP Reauthorization Act, which was a huge topic of conversation. Among the speakers was CMS' Kate Goodrich, MD, who joined a panel discuss the particulars of the rule and how providers will be impacted.

Here we present key takeaways from the sessions and panels presented at the Coalition meeting in Philadelphia in the words of the presenters themselves.

Healthcare is increasingly trying to use big data and clinical pharmacists are no exception. On today's episode of Managed Care Cast, we talk with an assistant professor at Geisinger’s Center for Pharmacy Innovation and Outcomes about his work with big data.

In 2018, the Ochsner Accountable Care Network was able to reduce expected costs of care by more than $12.78 million for its Medicare beneficiaries, and it increased its savings 12% over 2017. This comes amidst research and claims that accountable care organizations may not be successful at reducing costs while improving outcomes.

David Carmouche, MD, president of the Ochsner Health Network and executive director of the Ochsner Accountable Care Network, explains how the Ochsner accountable care organization (ACO) was able to find success and how other ACOs can get over the learning curve to achieve savings.

Learn more about Ochsner
https://www.ajmc.com/partners/ochsner

Surviving cancer doesn't mean the challenges are all in the past. After cancer is treated and cured, many survivors still face financial debt and lingering toxcities that impact their lives. Samantha Eisenstein Watson, MBA, CEO and founder of The Samfund, explains the challenges that young adult cancer survivors, in particular, go through and how her organization tries to help alleviate some of the financial burden. Plus, a look at what the effects of cancer treatment mean for fertility and what challenges this represents for young adults.

As the prevalence of burnout among healthcare providers has increased over the last few years, it has raised attention to the issue. Burnout includes overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and a lack of accomplishment. Among physicians, common drivers include excessive workloads, clerical burdens, organizational structures, and leadership culture.

Greater attention to the issue, and the impact it can have on patient outcomes, has led to more organizations to implement interventions to address and alleviate burnout in healthcare. Bernadette Melnyk, PhD, RN, APRN-CNP, FAANP, FNAP, FAAN, vice president for health promotion, chief wellness officer and professor and dean of the college of nursing at The Ohio State University, highlighted the need for a chief wellness officer, same as healthcare has chief technology and quality officers, and some interventions being implemented.

Learn more about burnout:
Making The Case For The Chief Wellness Officer In America’s Health Systems: A Call To Action: https://www.healthaffairs.org/do/10.1377/hblog20181025.308059/full/
Physicians Are Pessimistic About Future of Healthcare, Highlight Extent of Social Determinants: https://www.ajmc.com/focus-of-the-week/physicians-are-pessimistic-about-future-of-healthcare-highlight-extent-of-social-determinants
Physician Burnout Associated With Poorer Patient Outcomes: https://www.ajmc.com/focus-of-the-week/physician-burnout-associated-with-poorer-patient-outcomes
Dr W. Clay Jackson Discusses Identifying, Addressing Clinician Burnout: https://www.ajmc.com/conferences/psychcongress2018/dr-w-clay-jackson-discusses-identifying-addressing-clinician-burnout
Will HHS' Strategy to Address Health IT–Related Physician Burden Provide Relief for Providers? https://www.ajmc.com/focus-of-the-week/will-hhs-strategy-to-address-health-itndashrelated-physician-burden-provide-relief-for-providers
After Increasing for Several Years, Physician Burnout Shows Modest Decline: https://www.ajmc.com/newsroom/after-increasing-for-several-years-physician-burnout-shows-modest-decline

This week included the much-anticipated report from the Congressional Budget Office releasing rating of the GOP's health plan; the Senate voted to confirm Seema Verma for CMS administrator; and President Donald Trump nominated Scott Gottlieb, MD, to lead the FDA.