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Jared is a freelance writer for The American Journal of Managed Care® (AJMC®), and previously worked as a senior editor for HCPLive® at MJH Life Sciences®.

He has an MA from University of Sioux Falls. You can connect with Jared on 

Articles

Investigators believe the SWIFT-seq system holds potential to replace more invasive bone marrow biopsies. 

Novel Blood Test Could Transform Multiple Myeloma Diagnosis, Monitoring

Regardless of CNS Involvement, Patients With B-ALL Benefit From Brexu-Cel

Skylar is an associate editor for The American Journal of Managed Care® (AJMC®) and The Center for Biosimilars®, and joined AJMC® in 2020. She is responsible for covering all aspects of the ever-changing global biosimilar industry and produces content that is accessible and informative for all health care stakeholders.

She has a BA in journalism and media studies from Rutgers University. You can connect with Skylar on 

Real-world evidence on infection risks from multiple sclerosis treatments remains limited, with inconsistent findings compared with clinical trials and significant gaps in data for newer therapies and specific infection types.

Gaps in Observational Data Challenge Understanding of Infection Risk in MS Treatments

Patients with chronic lymphocytic leukemia (CLL) had significantly lower monocyte-to-lymphocyte ratio values compared with healthy controls. 

Monocyte-to-Lymphocyte Ratio Linked With Functional Status in CLL

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 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 

, a social-impact startup that aims to improve community well-being by transforming everyday moments in laundromats into opportunities to build trust, support 

, and connect families with health and social services.

, "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. 

Listen above or on one of these podcast services:

Lindsey Leininger, PhD, and Allister Chang, MPA, highlight the potential of laundromats as accessible, community-based settings to support Medicaid outreach, foster trust, and connect families with essential health and social services.

Laundromats as a New Frontier in Community Health, Medicaid Outreach

speaks with Larragem Raines, MS, director of research at the 

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

Looking ahead, Raines discusses the potential of 

 (AI) to improve diagnosis, treatment, and 

Larragem Raines, MS, of the Center for Innovation & Value Research, discusses the organization's major depressive disorder (MDD) open-source value model, dynamic pricing, and the future role of artificial intelligence in care.

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

Today, we are bringing you a conversation on the use of continuous glucose monitoring (CGM) technology and its transformative potential in diabetes care.

Davida Kruger, NP, a certified nurse practitioner at Henry Ford in the Division of Endocrinology, spoke with:

Jaime Murillo, MD, senior vice president and chief medical officer, medical affairs, United Health Group

Jeremy Wigginton, MD, chief medical officer at a regional Blue plan

Ian Neeland, MD, director of cardiovascular prevention, University Hospitals Harrington Health and Vascular Institute, and associate professor of medicine, Case Western Reserve University School of Medicine

Ken Cohen, MD, executive director of translational research, Optum Health.

The topics of conversation for today’s podcast include how CGM addresses therapeutic inertia, enhances glycemic control, and drives improvements in patient outcomes and health care efficiency, as well as the barriers to adoption, strategies for expanding access, and the cost-effectiveness of CGM implementation.

While CGM use started with patients with type 1 diabetes, it has transitioned to use in type 2 diabetes, Neeland explained. CGM allows for “more real-time, faster therapeutic interventions,” Wigginton added.

“I think we all know that the CGM in the right patient population with the right physician and the right care team managing that data can absolutely improve clinical inertia to earlier intervention [and] better patient outcomes,” he said. “I think that's a well-known fact that that can happen.”

CGM can provide several metrics beyond just actual glucose, and since the technology provides a 10- to 14-day snapshot of data, it provides average glucose, time in range, the Glucose Management Indicator, and glucose variability. These metrics are now also playing a role in Healthcare Effectiveness Data and Information Set measures and quality targets for accountable care organizations, Cohen noted.

However, there are varying coverage policies for CGM that impact patient access and outcomes.

“Health plans need to standardize more their coverage decisions, and that has to be done based on evidence-based medicine,” Murillo said. “There is this perception out there that health plans make unilateral decisions based on their own convenience. The reality is all those coverage decisions should be based on evidence.”

Listen above or through one of these podcast services:

A group of experts discusses the use of continuous glucose monitoring (CGM) technology in diabetes and its transformative potential in managing the disease.

Managed Care Cast Presents: Unlocking the Potential of CGM Technology

On this episode of Managed Care Cast, we speak with George Jones, chief operating officer at UpScript Health, an online pioneer of eprescribing 20 years ago, to learn how telemedicine has progressed from asynchronous conferencing to real-time video consultation, enabling the treatment of complex conditions beyond primary care. Although technology access remains a challenge for some, Jones emphasizes telemedicine’s potential to reduce wait times and improve efficiency, especially for conditions requiring specialist care.

A major theme in the telemedicine space is access to 

 treatments, particularly glucagon-like peptide-1 (GLP-1) medications like semaglutide, which was recently included on the second 

 under the Inflation Reduction Act. We also discuss how Medicare’s limited obesity coverage may reduce the impact of these negotiations, advocating for policies and step therapy models that can help to lower patient costs, and the regulatory concerns associated with compounded GLP-1s as an alternative, knowing that these medications are prepared outside FDA oversight.

George Jones of UpScript Health discusses telemedicine's evolution from basic e-prescribing to real-time video consultations, expanding treatment beyond primary care.

Telemedicine’s Evolution and Expanding Access to Obesity, Specialty Care

Welcome to the latest episode of Managed Care Cast and our conversation with Jeff Giullian, MD, MBA, chief medical officer with DaVita Kidney Care. In this interview, we dive into 4 important aspects of kidney care: prevention, social support, integrated care, and patient support.

Throughout this conversation, highlights include how to best manage 

 among high-risk populations, community education initiatives from DaVita that focus on kidney health resources, and comorbidity management. Dr Giullian underscores the value of integrated care teams in managing comorbidities and improving patient outcomes, emphasizes the role of technology in enhancing care without replacing the essential human touch, and addresses the need to reduce health disparities.

In our conversation with Jeff Giullian, MD, MBA, chief medical officer with DaVita Kidney Care, we dive into 4 important aspects of kidney care: prevention, social support, integrated care, and patient support.

Engage, Educate, Empower: Transforming Kidney Care

On this episode of Managed Care Cast, we're talking with Jason Spangler, MD, MPH, CEO of the Center for Innovation and Value Research, formerly known as the Innovation and Value Initiative (IVI). 


We discuss the strengths and limitations of health technology assessment (HTA),  one major limitation being its lack of equity. We also touch on IVI's recent rebrand to the Center for Innovation and Value Research on July 16 and how people can get involved.

On this episode of Managed Care Cast, we're talking with Jason Spangler, MD, MPH, CEO of the Center for Innovation and Value Research on equity challenges within health technology assessment.

Dr Jason Spangler on Enhancing Equity in Health Technology Assessment

On this episode of Managed Care Cast, Emily Goldberg, MS, CGC, genetic counselor at 

 works and why it is so important to increase awareness and education around these screening tools available to patients who may be at risk for cancer.

JScreen's CancerGEN test is a 4-step at-home saliva test for adults to screen for genetic changes that may increase one's risk for cancer and includes genetic counseling for individuals. 

On this episode of Managed Care Cast, Emily Goldberg, MS, CGC, a genetic counselor at JScreen, breaks down how genetic screening for breast cancer works and why it is so important to increase awareness and education around these screening tools available to patients who may be at risk for cancer.

Emily Goldberg Shares Insights as a Genetic Counselor for Breast Cancer Risk Screening

’s 12th annual health IT issue, on this episode of Managed Care Cast, we speak with Christopher M. Whaley, PhD, health care economist at the RAND Corporation, who focuses on health economics issues, including the influence of the COVID-19 pandemic on health care delivery. In particular, he examines how existing technology has pivoted to become a backbone for 

 while its ongoing evolvement has highlighted inequities in care delivery, making access and lack thereof divisive issues.

In their article in the health IT issue, “

Differences in Telehealth During COVID-19 Between Commercial and Medicaid Enrollees

,” Dr Whaley and his co-authors compare rates of telehealth and in-person evaluation and management visits between individuals with commercial insurance through the California Public Employees’ Retirement System, or CalPERS, and those with publicly funded coverage through the California Medicaid program, with implications for equitable access to telehealth and development of policies to guide its ongoing and future use.

To mark the publication of The American Journal of Managed Care®’s 12th annual health IT issue, on this episode of Managed Care Cast, we speak with Christopher M. Whaley, PhD, health care economist at the RAND Corporation, who focuses on health economics issues, including the influence of the COVID-19 pandemic on health care delivery. 

Examining Telehealth Uptake to Increase Equitable Care Access

An unprecedented level of detail and robustness around interoperability standards is on its way, and on this episode of Managed Care Cast, we speak with Donald Rucker, MD, the former National Coordinator for Health Information Technology in HHS, about what the opportunities and responsibilities for payers are.



The change is precipitated by 2020 rulemaking regarding the 21st Century Cures Act requirement regarding application programming interfaces. The new requirement will enable access to patient-level data across a patient population, allowing for more analysis that can inform clinical decisions, track those decisions to costs, and even influence future policy.

Rucker, who received his medical degree from the University of Pennsylvania and also has an MBA in business and an MS in medical computer science and informatics from Stanford University, is currently chief strategy officer at 1upHealth.

An unprecedented level of detail and robustness around interoperability standards is on its way, and on this episode of Managed Care Cast, we speak with Donald Rucker, MD, the former National Coordinator for Health Information Technology in HHS, about what the opportunities and responsibilities for payers are.

What’s Coming Up Next in Interoperability With Dr Donald Rucker

In recent years, predictive models in medicine have become increasingly popular what with the continued integration of artificial intelligence and data technology into health care. However, these models can carry the risk of bias depending on which individuals make up the data sets.

The close relationship between health care and technology also raises a myriad of questions when it comes to regulation, accountability, and model implementation.

Health Information Technology special issue

, Paige Nong, a PhD candidate in public health at the University of Michigan, and colleagues present 

 on facilitating informed decision-making and communicating equity issues when integrating predictive models into care.

On this episode of Managed Care Cast, Nong outlines how the researchers carried out their study, the ethical challenges of combining computer science with health, and next steps for combatting bias in predictive models.

On this episode of Managed Care Cast, we interview the lead author of a paper in the Health IT issue of The American Journal of Managed Care. 

The Challenges of Identifying and Mitigating Racial Bias in Predictive Models

Remote Clinical Pharmacists Saved Nearly $9M, Helped Practices Meet EOM Targets

In this study, total flares were investigated for their propensity to predict atopic dermatitis disease severity among adult patients.

Yearly Flares in Atopic Dermatitis May Predict Disease Severity

A new TIAA Institute report says solving workforce shortages with smarter hiring, training, and artificial intelligence could ease the rising demand for care from an aging population.

How Workforce Innovation Can Sustain the US Health Care System

Explore how payers and providers collaborate to enhance value-based care, tackle rising costs, and improve patient outcomes in today's health care landscape.

Payers and Providers Seek Common Ground on Costs, Technology, and Value-Based Care 

A novel image-based deep learning approach achieves high accuracy and interpretability, offering potential for clinical decision support.

AI Model Using EHR Data Predicts 5-Year Survival in Colorectal Cancer

Clayton Irvine, PharmD, MBA, MS, discusses strategies to address payer-driven biosimilar and prior authorization challenges through integrated digital solutions, while advocating for flexible, regularly reviewed treatment pathways supported by molecular tumor boards and AI to balance standardization with personalized, biomarker-driven oncology care.

Integrating AI and Pathway Flexibility to Advance Value-Based Cancer Care: Clayton Irvine, PharmD, MBA, MS

 event, Clayton Irvine, PharmD, MBA, MS, highlighted operational and billing challenges in implementing value-based initiatives, including payer-specific 

 mandates that complicate inventory management and create inefficiencies in academic and infusion centers. Manual prior authorization processes can delay care and contribute to financial toxicity for both patients and institutions, underscoring the need for integrated digital solutions, such as artificial intelligence (AI)–enabled platforms and CoverMyMeds to streamline workflows.

Additionally, Irvine, senior manager of oncology cancer care at Mayo Clinic in Rochester, Minnesota, emphasizes the importance of pathway flexibility—such as defined off-label arms with documented exceptions—regular stakeholder review to keep pace with evolving guidelines, and the use of molecular tumor boards and AI-driven clinical decision support to balance standardized pathways with personalized, biomarker-driven care, particularly in rare or late-line cancer settings.

This is the second video in a series with Irvine. Please revisit 

, where Irvine discusses the importance of academic and community oncology collaboration.

This transcript was lightly edited; captions were auto-generated.

What operational or billing challenges have you faced when implementing value-based initiatives, and how have you addressed them?

We see lots of challenges and inconsistencies for biosimilar formularies across pairs, and it's created a huge challenge in academic centers 

 infusion centers, primarily because there's a lot of specific payers that want a certain biosimilar. It creates inventory issues for pharmacies, and pharmacies having to keep all the drugs on formulary, and then at the time when the patient's there for treatment, how do you know which drug is best for the patient? It ties into many institutions have a manual prior authorization process, and so that creates delays and inefficiencies and also sometimes leads to financial toxicity, not just for institutions, but for patients. I think it's a conversation that we don't talk about enough; it's just some of those financial implications then get passed downstream to patients.

I think there is opportunity when we look at the landscape, can we use integrated platforms like CoverMyMeds or other AI-based solutions? There's prior authorization software out there, and I think when we are able to look at those and evaluate how we can integrate them into our workflows, I think that's really where we see the value and benefit. I know that that's a lot easier said than done, and there's a lot of complexities that come with bringing some of those systems in house, but knowing what's out there and knowing the tools that are available is a step in the right direction.

If you aren't able to leverage those technologies, if you aren't able to incorporate those platforms, looking at ways to streamline those properties can really help the downstream bill waste that we see, especially when we're talking about prior authorizations and other decisions that we clinically would like to make without that in place.

Clayton Irvine, PharmD, MBA, MS, discusses strategies to address payer-driven biosimilar and prior authorization challenges through integrated digital solutions, while advocating for flexible, regularly reviewed treatment pathways supported by molecular tumor boards and artificial intelligence to balance standardization with personalized, biomarker-driven oncology care.

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