John A. Johnson, MD, MBA: On the managed care side, again, the part we play is to make the medications available. As I stated earlier, there are 12 different classes of oral antidiabetic medications. Insulin [is available] as an injectable medication, [and] the GLP-1s (glucagon-like peptide-1s) are also available.
You’ve got a lot of different medications available, so access to the medications is the part that we would play [a role in] as a health plan. Then, [as a health plan, we provide] wraparound support to augment the medical cocktail—meaning the disease management, the nutrition counseling, and the personal health coach, as well as the nurses that help with meal planning.
That’s how we play our role. If you look at both standards, whether it’s the ADA (American Diabetes Association) or the AACE (American Association of Clinical Endocrinologists), both start with lifestyle modifications. Both start with single-drug therapy. From there, it requires surveillance every 3 months to ensure that you’re checking the patient’s—our member’s—HbA1C (glycated hemoglobin). Again, getting that HbA1C to goal, which would be below 7 for the ADA and below 6.5 for the AACE, and monitoring for hypoglycemia, of course, [is important].
Our hope is that the provider community will use the guidelines that we make available on WellCare.com. [In addition], other managed care companies do the same thing. They have clinical practice guidelines that they make available, and those guidelines are used because they’re evidence-based—they’re connected to recommendations from the medical societies, from the CDC (Centers for Disease Control and Prevention), the NIH (National Institutes of Health), and all of the other approved entities in the United States. Just using those tools that are available [can] enhance the management of your diabetics.
AI in Health Care: Closing the Revenue Cycle Gap
April 1st 2025This commentary explores the current state, challenges, and potential of artificial intelligence (AI) in health care revenue cycle management, emphasizing collaboration, data standardization, and targeted implementation to enhance adoption.
Read More
Managed Care Reflections: A Q&A With Hoangmai H. Pham, MD, MPH
April 1st 2025To mark the 30th anniversary of The American Journal of Managed Care® (AJMC®), each issue in 2025 will include a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The April issue features a conversation with Hoangmai H. Pham, MD, MPH, a member of AJMC’s editorial board and the president and CEO of the Institute for Exceptional Care (IEC).
Read More
Bridging Care Gaps With a Systemwide Value-Based Care Strategy
March 29th 2025Mapping care management needs by defining patient populations and then stratifying them according to risk and their needs can help to spur the transformation of a siloed health care system into an integrated system that is able to better provide holistic, value-based care despite the many transitions that continue among hospital, primary, specialty, and community care environments.
Read More