Interviews

Dawn Repola recalls her journey to diagnosis of chronic fibrosing interstitial lung disease with progressive phenotype and relays frustrations along the way.

To mark the 25th anniversary of The American Journal of Managed Care®, we spoke with Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID). Fauci has been at NIAID for 36 years, and he gave a keynote address at the 6th International AIDS Conference in San Francisco in 1990. Here he speaks on progress that has been made in the fight against HIV and AIDS, from AZT to Truvada to undetectable viral loads; why there is no cure just yet; and how the first tumultuous years of the AIDS crisis shaped research for decades to come.

Using electronic health records of patients with cancer can provide a better understanding of which interventions and treatments are possible and can give patients the best outcomes, explained Blythe Adamson, PhD, MPH, principal quantitative scientist at Flatiron Health, in an interview for ASCO20 Virtual, this year’s annual meeting of the American Society of Clinical Oncology.

Even before the coronavirus disease 2019 (COVID-19) pandemic, the struggle to curb the opioid epidemic in the United States has produced disappointing outcomes. Now that COVID-19 and the resulting social distancing requirements have allowed the opioid epidemic to flourish, authors in the July issue of The American Journal of Managed Care® suggest an alternative approach that emphasizes building resiliency and investing in social support. Marcelina Jasmine Silva, DO, joined us to discuss the current approaches to opioid use and potential lessons to be learned from COVID-19.

The addition of Kynmobi, a discreet, under the tongue treatment of OFF periods in patients with Parkinson disease, adds to the growing market of innovations in care, said Stewart Factor, DO, professor of Neurology and director of the Movement Disorders Program at the Emory University School of Medicine.

Benchmarking, accountability, bilateralism, and scalability are the 4 parameters critical to successful alternative payment models in oncology, said Aaron Lyss, MBA, director of strategy and business development at Tennessee Oncology.

There are a growing number of innovations within treatment of OFF periods in Parkinson disease that seek to address this unmet need in patient care, said Stewart Factor, DO, professor of Neurology and director of the Movement Disorders Program at the Emory University School of Medicine.

In each performance period of the Oncology Care Model for which we've received data, we've seen different aspects of care that we can improve upon in the following 6 months, said Aaron Lyss, MBA, director of strategy and business development at Tennessee Oncology.

Unlike in fee-for-service, we have an amazing opportunity to begin to understand and build in factors that will keep patients healthy and give them the best outcomes possible, said Lili Brillstein, CEO of Brillstein Collaborative Consulting, and former Director for Episodes of Care at Horizon Blue Cross Blue Shield of New Jersey.

The Oncology Care Model (OCM) has helped practices develop their capacity to use data for continuous quality improvement, said Aaron Lyss, MBA, director of strategy and business development at Tennessee Oncology.

There will never be all mandatory payment models or all value-based models, but we can craft a value-based model around just about anything as long as everybody agrees on what the criteria is, said Lili Brillstein, CEO of Brillstein Collaborative Consulting, and former Director for Episodes of Care at Horizon Blue Cross Blue Shield of New Jersey.

Forming an action plan to manage treatment of patients with epilepsy, as well as factors such as stress and anxiety that may be intensified amid the COVID-19 pandemic, can assist in lessening the uptick of seizures and emergency department use, said James Wheless, MD, director of the Le Bonheur Comprehensive Epilepsy Program and chief of the Department of Pediatric Neurology at the University of Tennessee Health Science Center.

From a state-level perspective, Sharecare's Flatten the Curve survey highlights the negative impact of COVID-19 on respondents in states with typically high mental, financial well-being, as well as the lack of change in those within states already known for these negative tendencies, said Elizabeth Colyer, senior vice president of Community Well-Being Index at Sharecare.

Based on the respondent pool, Sharecare observed 3 core takeaways from the Flatten the Curve survey–mental well-being, the connection between health and wealth, and access to health care, said Elizabeth Colyer, senior vice president of Community Well-Being Index at Sharecare.

New technologies and quick drug approvals contribute to the challenges of incorporating value-based care in oncology, said Lili Brillstein, CEO of Brillstein Collaborative Consulting, and former Director for Episodes of Care at Horizon Blue Cross Blue Shield of New Jersey.

Some independent practices utilize clinical pathways to mange complex regimens, but lack of education and cost concerns may limit practices' use of clinical pathways, said Ray Page, DO, PhD, president and director of research at The Center for Cancer and Blood Disorders.

The shift from fee-for-service to value-based care requires collaboration, communication, and coordination across the care continuum, said Lili Brillstein, CEO of Brillstein Collaborative Consulting, and former Director for Episodes of Care at Horizon Blue Cross Blue Shield of New Jersey.

As the COVID-19 pandemic continues to affect the mental health of US workers, Lyra Health has advised partnered employers to increase access to high quality, evidence-based mental healthcare, said Renee Schneider, PhD, vice president of Clinical Quality at Lyra Health.

Raising awareness on the involvement of primary care providers can assist cancer survivors in transitioning from oncology care, said Kelly Filchner, MSN, director at Fox Chase Cancer Center Partners.

Transformational changes in cancer care can bring forth important innovations, but all those come at a cost, said Ray Page, DO, PhD, president and director of research at The Center for Cancer and Blood Disorders.

Delays in reporting Oncology Care Model results from performance periods creates tremendous uncertainty, said Ray Page, DO, PhD, president and director of research at The Center for Cancer and Blood Disorders.

The Michael J. Fox Foundation has implemented a variety of resources for people with and without Parkinson disease to address emerging issues precipitated by the COVID-19 pandemic, said Rachel Dolhun, MD, vice president of Medical Communications at The Michael J. Fox Foundation for Parkinson Research.

Innovations to promote communication between primary care providers, oncologists are vital to delineate distinct roles in oncology patient management, said Kelly Filchner, MSN, director at Fox Chase Cancer Center Partners.

Anti-anxiety and anti-insomnia prescriptions surged after mid-March after the coronavirus disease 2019 (COVID) pandemic was declared, said Glen Stettin, senior vice president and chief innovation officer at Express Scripts, who discussed the use of mental health and behavioral health prescriptions during the current public health emergency.

Oncology practices in 2-sided risk arrangements have reported mixed results, pointing to the need for more time to make the transition, said Michael Diaz, MD, president of Community Oncology Alliance.

Many patients when they start their cancer therapy get so ingrained in the cancer world that their oncologist just becomes their main point of contact, but we have to do a better job at letting the patients know that the PCP still is an integral part of their care, said Kelly Filchner, MSN, director at Fox Chase Cancer Center Partners.

The clinicians and nurses at Pontchartrain Cancer Center address the education behind the clinical trials, which helps patients understand that they can have access to cutting edge therapy that they would not otherwise have access to, said Kathy W. Oubre, MS, chief operating officer at Pontchartrain Cancer Center. Kathy Oubre is additionally scheduled to speak at the Community Oncology Alliance Virtual Meeting, which runs from April 23-24, 2020.

The American Journal of Managed Care® spoke with Lindsay Bealor Greenleaf, JD, MBA, Vice President of Policy, ADVI Health, about CMS’ recent enactment of the 2021 Medicare Advantage rate announcement, and the effects of COVID-19 on Medicare Advantage. This transcript has been edited slightly for clarity.

We're sending patients eye charts via email, doing zoom visits or telehealth visits by video or audio– it's been interesting to see that ophthalmologists can adapt to to this. I think that's going to be something that will stay on in some way, shape, or form after this pandemic subsides, said Sonal Tuli, MD, Clinical Spokesperson for the American Academy of Ophthalmology (AAO).

The expansion of Medicare Advantage benefits patients, but presents challenges in oncology care, said Jeffrey Lowenkron, MD, chief medical officer of The Villages Health.