During this segment, the panelists explore issues faced by managed care during treatment coverage decisions in castration-resistant prostate cancer (CRPC).
Michael Kolodziej, MD, discusses the high costs of newly developed agents, their role in drug-sequencing plans, and the Affordable Care Act’s impact on treatment coverage in CRPC.
Jeffrey D. Dunn, PharmD, MBA, explains the need for improvements in the research that can help provide better data about a drug’s effectiveness, and can help professionals determine a product’s cost and availability for health coverage.
David Quinn, MD, agrees with Dr Dunn and suggests that a patient’s improvements in health and overall outcomes must be additive to the cost of therapy. Dr Quinn further explains that by studying the value of agents used to treat CRPC, a paradigm shift may provide results about the benefits of options given to treat patients over a sequence of time.
New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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Contributor: For Complex Cases, Continuity in Acute Care Is Necessary
April 23rd 2025For patients with complex needs and social challenges like unstable housing, the hospital has become their de facto medical home—yet each visit is a fragmented restart, without continuity, context, or a clear path forward.
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