Managed Care Cast

Chronic kidney disease (CKD) affects an estimated 37 million Americans, yet most cases go undiagnosed until the disease has significantly progressed. A urine albumin-to-creatinine ratio (uACR) test can detect kidney damage years before a decline in the estimated glomerular filtration rate (eGFR), but it remains underutilized. In the first episode of Beyond the Silo: Integrated Care Across the CRM Continuum, a podcast series from The American Journal of Managed Care®, Marc P. Bonaca, MD, MPH, moderates a discussion with Josephine Harrington, MD, on why uACR has not yet become a standard of care, how CKD fits into the broader cardio-renal-metabolic (CRM) disease continuum, and what changes are needed across specialties, systems, and workflows. Bonaca is a cardiologist and vascular medicine specialist at the University of Colorado Anschutz and the executive director of CPC Clinical Research. Harrington is also a cardiologist, specializing in advanced heart failure and transplant cardiology at UCHealth’s Heart and Vascular Center at the University of Colorado Hospital. Throughout the conversation, they emphasize that CKD is an early integral part of the CRM continuum, as it is both a driver and consequence of cardiovascular risk, with uACR elevation often appearing before eGFR decline and signaling increased risk even at mild levels. Despite strong guideline support, uACR screening remains underused due to structural barriers. Therefore, the experts explained that the primary barrier is not the test itself but the lack of streamlined workflows that make screening routine and results actionable without adding clinician burden. They concluded that early detection is critical because it enables the timely use of therapies such as SGLT2 inhibitors, glucagon-like peptide-1 receptor agonists, and finerenone, which improve outcomes. To close the gap, the experts noted that uACR should be treated as a routine vital sign for cardiometabolic risk and embedded into health system quality metrics to ensure consistent, accountable use.

On this episode of Managed Care Cast, The American Journal of Managed Care® (AJMC®) was joined by Tim McDonald, PhD, MPP, and Bryan E. Dowd, PhD, authors of research published in the April 2026 issue. Their study, "Benefit Design and Consumer Information: Results From a Randomized Trial," found that reducing information barriers for consumers selecting primary care clinics in a tiered network design had only a marginal effect on choice. McDonald and Dowd noted that this suggests informational interventions alone may be insufficient to overcome existing inertia. They added that consumers may already be adequately informed through the tiered benefit design. In AJMC’s conversation with the authors, we discussed how provider- and consumer-oriented payment reforms influence health care efficiency and the role of consumer inertia. We also explored the key findings from their research and the broader implications for patient decision-making.

A clinical pharmacy leader outlines 8 interdependent domains institutions must master to build financially sustainable, patient-accessible CGT programs.

In this episode of Managed Care Cast, Ella Hohmann speaks with Douglas Marks, MD, breast medical oncologist and associate professor at NYU Grossman Long Island School of Medicine, about the role of lifestyle interventions in reducing breast cancer risk. Marks reviews the evidence behind dietary modification, physical activity, and alcohol reduction, and discusses why some of these strategies remain underutilized despite their strong risk-benefit profiles. The conversation also addresses critical gaps in the research, including the underrepresentation of minority populations in clinical and epidemiologic studies, and the socioeconomic barriers that limit real-world uptake of preventive interventions. Looking ahead, Marks shares his perspective on emerging opportunities from GLP-1 receptor agonists to wearable technology and AI-driven monitoring that could transform how clinicians support and track lifestyle change in their patients.

Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO, chief medical officer with the International Myeloma Foundation and professor in the Applied Cancer Research and Drug Discovery Division of the Translational Genomics Research Institute, has spent more than 25 years advancing the treatment of multiple myeloma. In this episode, he breaks down how improved survival, evolving frailty assessments, and the rise of therapies like CAR T and bispecific antibodies are reshaping care for an aging population, and he highlights the growing emphasis on quality of life, caregiver support, and expanding clinical trial access.

On this episode of Managed Care Cast, The American Journal of Managed Care® (AJMC®) was joined by Yubin Park, PhD, and Michael Ellenbogen, MD, authors of research published in the March 2026 issue. Because financial incentives may influence clinical decision-making, their study examined the relationship between industry payments and Medicare beneficiary spending. As reflected in its title, “Industry Payments to Cardiologists Are Associated With Higher Medicare Spending,” their cross-sectional analysis of more than 26,000 cardiologists found that industry payments were associated with increased Medicare costs. Specifically, every $10,000 in payments was linked to an additional $14.10 in beneficiary spending. In AJMC’s conversation with the authors, they discuss what inspired their research, the key findings, and how these results may inform policies and strategies to both better manage physician-industry relationships and control health care spending.

On this episode of Managed Care Cast, I spoke with Dr. Michael Bernstein, an assistant professor in the department of diagnostic imaging at the Warren Alpert Medical School, and Brian Sheppard, a professor of law at Seton Hall Law who focuses on malpractice litigation, to discuss the broader implications of AI becoming more prevalent in health care; understanding its potential impact on legal outcomes and physician liability is essential for providers, risk managers, and policymakers alike.

In January, the CDC announced major revisions to the US childhood immunization schedule, reducing the number of diseases covered by routine vaccines from 17 to 11. The changes followed a December 2025 presidential memorandum directing HHS Secretary Robert F. Kennedy Jr and acting CDC director Jim O’Neill to update the schedule if “superior approaches” were identified abroad. The revisions also come months after Kennedy ended the terms of all 17 Advisory Committee on Immunization Practices members in June 2025 and quickly replaced them with new appointees, some of whom had previously expressed antivaccine views. He said the move was intended to restore public trust in vaccines. To better understand what these developments could mean for vaccine access and coverage, The American Journal of Managed Care® (AJMC®) spoke with Susan Cantrell, the CEO of the Academy of Managed Care Pharmacy, about the managed care pharmacy perspective on the updated recommendations. Throughout her conversation with AJMC, she discussed her reaction to the changes and their implications for pediatric vaccination and public health, as well as the evolving role of managed care pharmacists in supporting vaccine access and addressing vaccine hesitancy.

What Health Inequities Are Really Costing Your Company: Wayne Rawlins, MD by Managed Care Cast

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Grocery Card Use Associated With Increased Care Among Dual-Eligible Beneficiaries: Jennifer L. Kowalski, MS by Managed Care Cast

Managed Care Cast News Roundup: February 10, 2026 by Managed Care Cast

Kristi Martin, a longtime Washington, DC–based policy strategist with deep experience implementing major legislation like the Affordable Care Act and the Inflation Reduction Act, explores how the Orphan Drug Act, passed in 1983 as a bipartisan, patient-driven effort, transformed rare disease treatment by aligning scientific advances, government investment, and market incentives, but that reform may now be necessary—rethinking incentives for blockbuster drugs, refining orphan eligibility, and shifting toward more targeted, evidence-based negotiation.

The American Journal of Managed Care® (AJMC) kicks off its 2026 author podcast series with Nate C. Apathy, PhD, guest editor of AJMC’s 15th Health Information Technology (IT) special issue. He is an assistant professor of health policy and management at the University of Maryland School of Public Health and an affiliated research scientist at the Regenstrief Institute in Indianapolis, Indiana. To set the stage for this milestone issue, Apathy reflects on the most significant health IT advancements of the past 15 years before zeroing in on developments from 2025. He then explores the issue’s central themes, including artificial intelligence (AI) and telehealth. As highlighted in this year’s Health IT issue, Apathy explains that AI has the potential to reduce administrative and clinical burdens and has been rapidly adopted by clinicians. At the same time, AI presents challenges, including maintaining clinical vigilance and managing costs. He also underscores the benefits of telehealth, particularly when tailored to specific clinical contexts. Despite the pace of technological innovation, Apathy emphasizes that success in health IT ultimately depends on building trust and strong relationships, as well as closely aligning solutions with user needs. Looking ahead, he hopes health IT tools will become more intuitive, seamlessly supporting equity, access, and high-quality care while enabling greater personalization.

On this episode of Managed Care Cast, The American Journal of Managed Care® spoke with David Muhlstein, PhD, JD, founder and CEO of Simple Healthcare, about his recent articles highlighting Transparency in Coverage (TIC) files and ghost rates from 119 insurers, including 3 national commercial payers. Aetna, Cigna, and United Healthcare TIC files were more than 90% ghost rates—billing codes for procedures that would never be performed by a specific physician. For example, there were billing codes for heart surgery performed by a psychiatrist, Muhlstein said. These ghost rates increase the size of TIC files, making them difficult to evaluate for consumers, researchers, and analysts. Data files of this size muddle the true aim of the TIC files to provide actual transparency that would allow consumers to compare the prices of health care services and choose more affordable options.

The latest news from The American Journal of Managed Care.

On today’s episode, AJMC® spoke with Dr. Sachin Jain, president and CEO of SCAN Group and Health Plan, about his 10 predictions for the health care industry in 2026. Jain breaks down his predictions and what they could mean in both the short and long term for Americans and how they may shape access, affordability, and accountability across the US health care system.

To wrap up this year's author podcast series, The American Journal of Managed Care® speaks with Angela Liu, PhD, MPH, assistant research professor at the Johns Hopkins Bloomberg School of Public Health, about her December 2025 study, "Mental Health Care Use After Leaving Medicare Advantage for Traditional Medicare." Her research analyzed Medicare beneficiaries with mental health diagnoses who switched from Medicare Advantage (MA) to traditional Medicare (TM), examining their use of mental health services in the year before and after the switch. In this Managed Care Cast episode, Liu discusses what inspired her research, highlights the key findings, and explores ways to improve equitable access to mental health services for Medicare beneficiaries.

On this episode of Managed Care Cast, we’re talking with the co–editors in chief of The American Journal of Managed Care® (AJMC®), Mark Fendrick, MD, and Michael Chernew, PhD. They look back on the research and news that stood out to them from the past year and discuss what they’re looking forward to in 2026. Check out the dedicated page featuring our efforts to celebrate AJMC’s 30th anniversary: https://www.ajmc.com/anniversary

Have the shorter, darker days of fall and winter ever left you feeling sluggish, down, or simply "blah"? Today, we are discussing seasonal affective disorder with Craig Sawchuk, PhD, LP, a clinical psychologist at Mayo Clinic. He details how the seasonal pattern often presents as "hibernation syndrome"; explores the characteristics that increase vulnerability to SAD; and covers the effective and unique evidence-based treatment for SAD: bright light therapy.