Managed Care Cast

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

Scalable Strategies Boost Heart Failure Prescription Fills: Weston Blakeslee, PhD by Managed Care Cast

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.

Frameworks for Advancing Health Equity: Dental Health Care Access by Managed Care Cast

Today we are bringing you a conversation on the evolving landscape for idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) treatment. Ryan Haumschild, PharmD, MS, MBA, vice president of ambulatory pharmacy at Emory Healthcare and Winship Cancer Institute, spoke with Marilyn Glassberg, MD, the John W. Clarke Professor and Chair of medicine at Loyola University Chicago Stritch School of Medicine; Ayodeji Adegunsoye, MD, MSc, PhD, FACP, FCCP, assistant professor at the University of Chicago; and Janet Pope, MD, MPH, professor of medicine and division member of rheumatology at the University of Western Ontario in Canada. IPF and PPF are increasingly prevalent conditions that pose a growing burden on both patients and health care systems. Despite the availability of FDA-approved antifibrotic therapies, the median survival for patients with IPF and PPF remains less than 5 years after diagnosis—underscoring the critical unmet needs that persist in this field. The panelists discussed the impact these conditions have on patients' lives, evaluated emerging agents, and addressed economic considerations that affect treatment decisions and health care resource allocation.

On this episode of Managed Care Cast, Rachel A. Prusynski, DPT, PhD, an assistant professor at the University of Washington's School of Medicine, speaks with The American Journal of Managed Care® about her research published in the November 2025 issue. Her study, "Medicare Advantage Reimbursement Structures Impact Home Health Delivery and Outcomes," explores how home health care delivery and patient outcomes differ between 3 plan types: traditional Medicare, episodic Medicare Advantage, and per-visit Medicare Advantage. Throughout the conversation, Prusynski discusses what motivated the research, the study's key findings, and the broader implications for improving the quality and accessibility of future home health care.

On this episode of Managed Care Cast, AJMC spoke with lead CML researcher, Jorge Cortes, MD, to discuss the evolution of the groundbreaking treatment Imatinib and its effect on survial in patients with chronic myelogenous lukiemia.

Donovan Campbell, CEO, and his organization Medbridge are urging CMS to finalize specific refinements to RTM 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. 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.

On today’s episode, Dr. Tabby Khan, senior director of analytics for Komodo Health, spoke about their newest data analysis measuring age and insurance disparities in antibody-drug conjugate, or ADC, treatment rates in patients with metastatic breast cancer. The analysis was in partnership with the Tigerlily Foundation, a national breast cancer advocacy organization, in celebration of the 40th anniversary of Breast Cancer Awareness Month.

Today we are bringing you a conversation on how topical therapies can effectively manage atopic dermatitis. Brian Keegan, MD, PhD, FAAD, a dermatologist with Princeton Dermatology, spoke with Alexa Hetzel, MS, PA-C, physician assistant with Schweiger Dermatology Group; Vikash D. Oza, MD, director of pediatric dermatology at NYU Langone; and Amy Spizuoco, DO, FAOCD, dermatologist and dermatopathologist at True Dermatology. In addition to discussing the clinical benefits and impact on patient outcomes of using topical therapies for atopic dermatitis, the panelists explored how health economics research informs treatment decisions by demonstrating the cost-effectiveness and accessibility of topical therapies. The panel also analyzed the potential health care cost savings and resource optimization achieved through strategic use of topical treatments and atopic dermatitis management.