Despite coronavirus disease 2019 (COVID-19) being the top health-related story of 2020, the most-popular episodes of Managed Care Cast this year revolved around patient care management.
The top 5 most listened-to podcasts spanned a range of health topics, including key 2020 election concerns among stakeholders, the use of applied machine learning to predict health care utilization, and real-world evidence on biomarker testing in colon cancer.
5. Predicting Healthcare Utilization With Applied Machine Learning
In January 2020, we spoke with John Showalter, MD, chief product officer at Jvion and an internal medicine physician, and Soy Chen, MS, director of data science at Jvion and part of their data science team. Showalter and Chen explained the development of an algorithm that predicted which social determinants of health lead to hospitalizations and emergency department visits, which their team wrote about in the January 2020 Health Information Technology issue of The American Journal of Managed Care® (AJMC®). Overall, the social determinant of health most associated with risk was air quality, but neighborhood in-migration, transportation, and purchasing channel preferences were more telling than ethnicity or gender in determining patients’ use of resources.
4. Concerns of Healthcare Stakeholders in the Runup to 2020 Election
According to a 2019 survey published by Wolters Kluwer Health, nearly 75% of Americans would have considered health care a main factor when they voted in the 2020 presidential election. In January 2020, we spoke with Peter Bonis, MD, chief medical officer at Wolters Kluwer Health, about the survey entitled “Mending HealthCare in America 2020: Consumers & Cost.” Results showed alignment and deep divisions among patients and providers, with issues around transparency, cost, and care variability causing concern.
3. Biomarker Testing in Advanced Colon Cancer: Why It’s Still Lagging
Biomarker testing rates remain poor in populations with metastatic colorectal cancer (mCRC), despite genomic testing being recognized in national oncology guidelines as a key to determining the right therapy for patients. In January 2020, we spoke with Stuart Goldberg, MD, a hematologist oncologist at the John Theurer Cancer Center at Hackensack University Medical Center, about real-world testing of biomarkers in mCRC uncovered through mining electronic health records. Goldberg was a coauthor of a study on this topic published in JCO Precision Oncology.
2. How Do Medicaid Beneficiaries Benefit From Complex Care Management?
Complex care management programs aim to improve health outcomes of high-cost, high-need patients through coordinating medical and social services, while in general Medicaid patients have high rates of chronic conditions and often utilize preventable acute care, leading to avoidable spending. In March 2020, we spoke with Farhad Modarai, DO, about a paper he cowrote in the February issue of AJMC® entitled “Impact of Complex Care Management on Spending and Utilization for High-Need, High Cost Medicaid Patients.” Modarai and colleagues conducted a study at CareMore Health in Memphis, Tennessee, to determine the impact that complex care management programs can have on Medicaid beneficiaries.
1.Accelerating the Prior Authorization Process: How a 2-Day Rule Can Optimize Efficient Care
The most popular episode of Managed Care Cast in 2020 included an interview with April Todd, senior vice president of CORE and Explorations for CAQH. CAQH CORE is a multistakeholder collaboration aimed at creating health care operating rules for electronic administrative transactions and establishing a common foundation for the operational components of value-based payment. Todd discussed CAQH CORE’s recent approval of a 2-day rule for health plans in requesting additional supporting information from providers and making final determinations on prior authorization requests.