Center on Health Equity & Access

Clinical

Health Care Cost

Health Care Delivery

Insurance

Policy

Technology

Value-Based Care

News

All News

Press Releases

Product Approvals and Launches

Video

All Video Types

AJMC TV

Guidelines

Insights

OnLocation

Payer Perspectives

Peer Exchange

Post Conference Perspectives

Stakeholder Summit

Podcasts

Journals

All Journals

The American Journal of Managed Care

Population Health, Equity & Outcomes

Evidence-Based Oncology

About Supplements and Featured Publications

Supplements and Featured Publications Issues

Submit a Manuscript

Conferences

Conference Coverage

Conference Listing

Events

Institute for Value-Based Medicine

Patient-Centered Oncology Care

Resources

Interactive Tools

Formulary Central

Clinical Spotlight

Microsites

About AJMC

AJMC Staff

Anniversary

Seema Sonnad Award

Strategic Alliance Partners

Subscribe

. Her work focuses on disparities and systemic inequities in care and access to the health system, as well as the impacts of health policy on various racial, gendered, and socioeconomic communities. She seeks perspectives from experts in internal medicine, health equity, community outreach, clinical research, mental health, and legislative policy.

, she delved into rare disease coverage at HCPLive

, a sister publication, where she fostered connections that extended beyond the research community into that of health advocacy, paving the way to her current role. Her work has been featured in 

NewsBreak, CHEST Today, Contemporary Pediatrics, Contemporary OB/GYN, Dermatology Times, Drug Topics, Managed Healthcare Executive, RamaOnHealthcare, and CGTLive.

Articles

Quality improvement programs markedly increase sleep apnea testing in stroke patients, showing effective ways to improve guideline-based care.

Quality Improvement Program Dramatically Boosts Sleep Apnea Testing After Stroke in VA Hospitals

Julia is an associate editor for The American Journal of Managed Care® (AJMC®) and joined AJMC® in 2022. She produces written and video content covering multiple disease states, and assists in the screening process for manuscripts submitted to AJMC®.

She has a BA in English language and literature from Rutgers University. You can connect with Julia on 

Videos

Although a cure is likely still a ways off, continuing to pursue long-acting injectable treatments and PrEP is key to reducing cases of HIV.

Innovation in Long-Acting Prevention Is the Future of HIV: Antonio Urbina, MD

Public health dental hygienists expand dental care access and oral health education in underserved communities, improving overall health outcomes.

5 Things Driving Better Dental Health Access in Underserved Communities

Mary Caffrey is the Executive Editor for The American Journal of Managed Care® (

®). She joined AJMC® in 2013 and is the primary staff editor for 

the multistakeholder publication that reaches 22,000+ oncology providers, policy makers and formulary decision makers. She is also part of the team that oversees speaker recruitment and panel preparations for 

®'s premier annual oncology meeting, Patient-Centered Oncology Care®. For more than a decade, Mary has covered ASCO, ASH, ACC and other leading scientific meetings for 

Mary has a BA in communications and philosophy from Loyola University New Orleans. You can connect with Mary on 

ASH 2025 Offers Data That Could Make Novel Therapies More Accessible

The American Journal of Managed Care provides insights into the latest news and research in managed care across multimedia platforms.

About

Contact

Editorial Boards

Advertise

Do Not Sell My Information

Terms & Conditions

Privacy Policy

AJMC - Managed Care News, Research, and Expert Insights

Facebook

LinkedIn

Instagram

Specialty Area

Biosimilars

Cardiorenalmetabolic

Dermatology

Gastroenterology

Hematology

Hepatology

Immunology

Infectious Disease

Mental Health

Neurology

Obesity

Oncology

Ophthalmology

Pulmonology

Rare Disease

Respiratory

Rheumatology

Women's Health

Spotlight

Free In-Person Regional Events Focused on Oncology and Population Health

Topics

Digital Health

Formulary

Gene Therapy

Health Care Administration

Population Health

All Coverage

Event Coverage

Interviews

AJMC Journals

Author Forms

Authors

Nominate a Rising Leader

1rem

Topic

On this episode of Managed Care Cast, we dive into 

, or RTM, a topic of great interest in the physical rehabilitation industry. We are joined by Donovan Campbell, CEO of Medbridge, a leading provider of physical therapy education, currently serving approximately 360,000 clinicians and supporting 15 million patients annually.

 as part of the Calendar Year 2026 Physician Fee Schedule (CMS-1832-P), recognizing that RTM is critical for supporting physical therapy, patient health, and patient engagement. At its core, RTM is the fusion of in-person care with convenient, digitally provided care—a core component of what is known as hybrid care.

With CMS proposing new codes that materially 

—including the potential shift to allowing billing after just 2 days of data transmission—RTM has the opportunity to move from a niche category to a mainstream model of care delivery.

We will explore how this shift provides a crucial financial incentive for organizations, but more importantly, how the successful adoption of RTM enhances the clinical value proposition by improving population health, lowering overall costs, and tackling the problem of access barriers to conservative care.

Listen above or on one of these podcast services:

Medbridge is working to refine remote therapeutic monitoring, or RTM, to transform physical therapy and enhance patient care.

From Niche to Mainstream: Transforming Physical Therapy by Refining Remote Therapeutic Monitoring

Studies focused on applying deep-learning artificial intelligence (AI) models to mammography screenings have shown promising results in improving radiologist reading times and reducing false negatives 

 spoke with Robert Nishikawa, PhD, a professor in the Department of Radiology at the University of Pittsburgh, in light of Breast Cancer Awareness Month. Nishikawa’s career and research focus on breast imaging technology, development, implementation, and assessment.

Nishikawa discussed the practical implications and evolution of AI models used in mammography screenings to aid radiologists’ readings and advance 

 screenings for patients.

Recent developments in deep-learning AI models applied to mammography screening improved double-radiologist readings in the Netherlands while detecting a significant number of malignancies. However, when forced to match the high specificity of double-radiologist readings, its sensitivity was far less.



Contrary to European practices of double-radiologist readings, the US only requires a single reader with the assistance of computer-aided detection.

Whereas European studies supplement the second radiologist’s readings with deep-learning AI models, practical application is not as feasible for studies in the US, Nishikawa said. However, when used, it allowed radiologists to read screenings faster at a higher sensitivity and specificity, he said.

To further develop the accuracy of deep-learning AI models, Nishikawa suggested using them in clinical settings to gauge their effectiveness in the US. As the AI models cannot replace single-radiologist readings, Nishikawa emphasized it’s up to the radiologist to decide whether they want to use it or not. Within that, he explained that radiologists must maintain a certain level of trust when interacting with AI, as current algorithms are “very accurate.”

Clinical applications of AI models may also optimize survivorship care, as screenings are one of the primary points in follow-up care. In cases where there is a low likelihood of malignancy, AI can be used to expedite such cases, thus relieving radiologists’ workload so they can focus on more complex cases.

1. McCrear S. AI-assisted mammogram readings reduce radiologist workload and maintain performance. 

. August 20, 2025. Accessed October 22, 2025. 

https://www.ajmc.com/view/ai-assisted-mammogram-readings-reduce-radiologist-workload-maintain-performance

2. Taylor-Phillips S, Stinton C. Double reading in breast cancer screening: considerations for policy-making. 

. 2020;93(1106):20190610. doi:10.1259/bjr.20190610

3. McCrear S, Adriana Olivo N. The future of survivorship care: precision tools for women after breast cancer. 

. September 10, 2025. Accessed October 22, 2025. 

https://www.ajmc.com/view/the-future-of-survivorship-care-precision-tools-for-women-after-breast-cancer

4. Screening for breast cancer. CDC. September 16, 2024. Accessed October 22, 2025. 

https://www.cdc.gov/breast-cancer/screening/index.html

AI-powered mammography is enhancing breast cancer screening and early detection through cutting-edge radiology insights.

The Evolution of AI Models in Mammography With Robert Nishikawa, PhD

 speaks with Reuben Daniel, associate vice president of artificial intelligence at 

. Committed to building safe, reliable, and value-driven artificial intelligence (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 our conversation, we'll dive into how UPMC Health Plan builds trust with providers and members, discuss challenges of 

, and hear about concrete examples of AI's positive impact. We'll also look ahead to promising developments Reuben anticipates in health care AI over the next 5 years.

UPMC

In this conversation with Reuben Daniel, associate vice president of artificial intelligence at UPMC Health Plan, 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

 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. 

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

Polarized dermatoscopes produced higher-quality teledermatology images but at greater cost, raising questions about feasibility and equitable access.

Polarized Dermatoscopes Improve Teledermoscopy Image Quality but Raise Cost Barriers

New research reveals that total social media use does not significantly impact adolescents' body image concerns, challenging previous assumptions.

Technology

Latest News