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src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1fb0458d4007f177c86e1a37a8c9d4ba60b1f084-303x160.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/health-equity-access-weekly-roundup-november-2-2024">Health Equity & Access Weekly Roundup: November 2, 2024</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><a href="/view/health-equity-access-weekly-roundup-november-2-2024"><span class="text-sm text-gray-500 pl-4">November 2nd 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">This week’s Center on Health Equity & Access highlights emphasize the role of social determinants of health in policy-making and underscore the importance of addressing rising costs and challenges employers face. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/health-equity-access-weekly-roundup-november-2-2024"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full 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href="/view/contributor-vulnerable-seniors-are-at-risk-with-looming-medicare-advantage-cuts-income-based-programs-can-minimize-the-damage">Contributor: Vulnerable Seniors Are at Risk With Looming Medicare Advantage Cuts—Income-Based Programs Can Minimize the Damage </a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/andrey-ostrovsky-md">Andrey Ostrovsky, MD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/anna-de-paula-hanika">Anna de Paula Hanika</a></div><a href="/view/contributor-vulnerable-seniors-are-at-risk-with-looming-medicare-advantage-cuts-income-based-programs-can-minimize-the-damage"><span class="text-sm text-gray-500 pl-4">October 31st 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">In the wake of the Inflation Reduction Act and other regulatory changes, Medicare Advantage plans have braced for significant cuts that are forcing them to take a hard look at their product offering. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/contributor-vulnerable-seniors-are-at-risk-with-looming-medicare-advantage-cuts-income-based-programs-can-minimize-the-damage"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="flex md:hidden justify-center items-center"></div><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " 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flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Program yields largest savings in its history of more than $2.1 billion in 2023. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/medicare-shared-savings-program-continues-to-deliver-savings-quality-care"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " 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href="/view/improve-american-health-care-by-moving-away-from-employer-sponsored-insurance">Improve American Health Care by Moving Away From Employer-Sponsored Insurance</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/david-b-muhlestein-phd-jd">David B. Muhlestein, PhD, JD</a></div><a href="/view/improve-american-health-care-by-moving-away-from-employer-sponsored-insurance"><span class="text-sm text-gray-500 pl-4">October 30th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The US should consider reducing or eliminating employer-sponsored insurance. Here are some ways to do it efficiently.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/improve-american-health-care-by-moving-away-from-employer-sponsored-insurance"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" 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href="/view/hssp-pharmacists-demonstrate-substantial-cost-avoidance-in-specialty-medication-use">HSSP Pharmacists Demonstrate Substantial Cost Avoidance in Specialty Medication Use</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><a href="/view/hssp-pharmacists-demonstrate-substantial-cost-avoidance-in-specialty-medication-use"><span class="text-sm text-gray-500 pl-4">October 28th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Cost avoidance varied by clinical setting, with the largest savings occurring in hematology clinics ($73,773), followed by rheumatology ($45,330) and pediatric gastrointestinal/irritable bowel syndrome ($16,519).</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/hssp-pharmacists-demonstrate-substantial-cost-avoidance-in-specialty-medication-use"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/medicaid-budget-survey-highlights-postpandemic-challenges-and-priorities"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:66.66666666666666%"></span><img alt="Medicaid Budget | Image Credit: zimmytws - stock.adobe.com" title="Medicaid Budget | Image Credit: zimmytws - stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Medicaid Budget | Image Credit: zimmytws - stock.adobe.com" title="Medicaid Budget | Image Credit: zimmytws - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/medicaid-budget-survey-highlights-postpandemic-challenges-and-priorities">Medicaid Budget Survey Highlights Postpandemic Challenges and Priorities</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/cameron-santoro">Cameron Santoro</a></div><a href="/view/medicaid-budget-survey-highlights-postpandemic-challenges-and-priorities"><span class="text-sm text-gray-500 pl-4">October 24th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The Medicaid budget survey for fiscal years 2024 and 2025 revealed state predictions are expecting a decline in Medicaid enrollment and an increase in spending next year due to the end of pandemic-era policies and federal funding.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/medicaid-budget-survey-highlights-postpandemic-challenges-and-priorities"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/breast-cancer-outcomes-improved-in-states-with-medicaid-expansion"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:66.66666666666666%"></span><img alt="Medicare Expansion | Image Credit: wladimir1804- stock.adobe.com" title="Medicare Expansion | Image Credit: wladimir1804- stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Medicare Expansion | Image Credit: wladimir1804- stock.adobe.com" title="Medicare Expansion | Image Credit: wladimir1804- stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F48f2cf9bb4aa09a495d57461328e4b728e975001-6000x4000.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F48f2cf9bb4aa09a495d57461328e4b728e975001-6000x4000.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F48f2cf9bb4aa09a495d57461328e4b728e975001-6000x4000.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F48f2cf9bb4aa09a495d57461328e4b728e975001-6000x4000.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F48f2cf9bb4aa09a495d57461328e4b728e975001-6000x4000.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F48f2cf9bb4aa09a495d57461328e4b728e975001-6000x4000.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F48f2cf9bb4aa09a495d57461328e4b728e975001-6000x4000.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F48f2cf9bb4aa09a495d57461328e4b728e975001-6000x4000.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F48f2cf9bb4aa09a495d57461328e4b728e975001-6000x4000.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/breast-cancer-outcomes-improved-in-states-with-medicaid-expansion">Breast Cancer Outcomes Improved in States With Medicaid Expansion</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/cameron-santoro">Cameron Santoro</a></div><a href="/view/breast-cancer-outcomes-improved-in-states-with-medicaid-expansion"><span class="text-sm text-gray-500 pl-4">October 24th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Medicaid expansion is associated with improved care and increased survival rates for patients with certain breast cancers, but future studies should focus on whether Medicaid expansion mitigates the disparities between Black and non-White patients.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/breast-cancer-outcomes-improved-in-states-with-medicaid-expansion"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="flex md:hidden justify-center items-center"></div><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/social-determinants-of-health-linked-to-higher-health-care-costs-payer-expenditures"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:66.66666666666666%"></span><img alt="SDOH community population health - TarikVision - stock.adobe.com" title="SDOH community population health - TarikVision - stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="SDOH community population health - TarikVision - stock.adobe.com" title="SDOH community population health - TarikVision - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F9d6a1455ac7e8c89648ed50c404dc39c9f9bcf9c-1200x800.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F9d6a1455ac7e8c89648ed50c404dc39c9f9bcf9c-1200x800.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F9d6a1455ac7e8c89648ed50c404dc39c9f9bcf9c-1200x800.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F9d6a1455ac7e8c89648ed50c404dc39c9f9bcf9c-1200x800.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F9d6a1455ac7e8c89648ed50c404dc39c9f9bcf9c-1200x800.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/social-determinants-of-health-linked-to-higher-health-care-costs-payer-expenditures">Social Determinants of Health Linked to Higher Health Care Costs, Payer Expenditures</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><a href="/view/social-determinants-of-health-linked-to-higher-health-care-costs-payer-expenditures"><span class="text-sm text-gray-500 pl-4">October 23rd 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Medicaid, Medicare, and private insurance programs all showed significant variability in expenditures based on social and nonclinical factors.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/social-determinants-of-health-linked-to-higher-health-care-costs-payer-expenditures"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/racial-ethnic-disparities-in-cost-related-barriers-to-care-among-near-poor-beneficiaries-in-medicare-advantage-vs-traditional-medicare"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:49.10025706940874%"></span><img alt="AJMC" title="AJMC" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="AJMC" title="AJMC" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, 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src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/racial-ethnic-disparities-in-cost-related-barriers-to-care-among-near-poor-beneficiaries-in-medicare-advantage-vs-traditional-medicare">Racial/Ethnic Disparities in Cost-Related Barriers to Care Among Near-Poor Beneficiaries in Medicare Advantage vs Traditional Medicare</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/alexandra-g-hames-phd">Alexandra G. Hames, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/renuka-tipirneni-md-msc">Renuka Tipirneni, MD, MSc</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/galen-e-switzer-phd">Galen E. Switzer, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/john-z-ayanian-md-mpp">John Z. Ayanian, MD, MPP</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/jeffrey-t-kullgren-md-ms-mph">Jeffrey T. Kullgren, MD, MS, MPH</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/erica-solway-phd-mph-msw">Erica Solway, PhD, MPH, MSW</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/eric-t-roberts-phd">Eric T. Roberts, PhD</a></div><a href="/view/racial-ethnic-disparities-in-cost-related-barriers-to-care-among-near-poor-beneficiaries-in-medicare-advantage-vs-traditional-medicare"><span class="text-sm text-gray-500 pl-4">October 23rd 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Among near-poor Black and Hispanic individuals, Medicare Advantage was associated with increased vision care and some, although not uniform, reductions in access disparities vs traditional Medicare.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/racial-ethnic-disparities-in-cost-related-barriers-to-care-among-near-poor-beneficiaries-in-medicare-advantage-vs-traditional-medicare"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/biden-harris-administration-proposes-new-rule-to-expand-affordable-contraception-coverage"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span 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srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F011b254b1d2eb8a746b314336e9030b5074270a4-5184x3456.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F011b254b1d2eb8a746b314336e9030b5074270a4-5184x3456.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F011b254b1d2eb8a746b314336e9030b5074270a4-5184x3456.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F011b254b1d2eb8a746b314336e9030b5074270a4-5184x3456.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F011b254b1d2eb8a746b314336e9030b5074270a4-5184x3456.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/biden-harris-administration-proposes-new-rule-to-expand-affordable-contraception-coverage">Biden-Harris Administration Proposes New Rule to Expand Affordable Contraception Coverage</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><a href="/view/biden-harris-administration-proposes-new-rule-to-expand-affordable-contraception-coverage"><span class="text-sm text-gray-500 pl-4">October 23rd 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Groundbreaking proposal to expand contraception coverage under the ACA marks the most significant update in over 10 years. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/biden-harris-administration-proposes-new-rule-to-expand-affordable-contraception-coverage"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " 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href="/view/women-s-awareness-of-aca-preventive-services-remains-low-amid-ongoing-legal-challenges"> Women’s Awareness of ACA Preventive Services Remains Low Amid Ongoing Legal Challenges</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/brooke-mccormick">Brooke McCormick</a></div><a href="/view/women-s-awareness-of-aca-preventive-services-remains-low-amid-ongoing-legal-challenges"><span class="text-sm text-gray-500 pl-4">October 21st 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Many women remain unaware that the Affordable Care Act (ACA) mandates cost-free preventive services; however, ongoing legal challenges threaten the future of this coverage.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/women-s-awareness-of-aca-preventive-services-remains-low-amid-ongoing-legal-challenges"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/cost-savings-from-an-mhealth-tool-for-improving-medication-adherence"><div class=""><span 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mHealth Tool for Improving Medication Adherence" title="Cost Savings From an mHealth Tool for Improving Medication Adherence" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/cost-savings-from-an-mhealth-tool-for-improving-medication-adherence">Cost Savings From an mHealth Tool for Improving Medication Adherence</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/chad-stecher-phd">Chad Stecher, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/sebastian-linnemayr-phd">Sebastian Linnemayr, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/peter-reaven-md">Peter Reaven, MD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/sara-cloonan-ms">Sara Cloonan, MS</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/peter-huckfeldt-phd">Peter Huckfeldt, PhD</a></div><a href="/view/cost-savings-from-an-mhealth-tool-for-improving-medication-adherence"><span class="text-sm text-gray-500 pl-4">October 21st 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The Wellth smartphone app significantly increased medication adherence and lowered unnecessary health care utilization and costs over 9 months among Medicaid beneficiaries who were self-managing chronic conditions.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/cost-savings-from-an-mhealth-tool-for-improving-medication-adherence"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/breaking-down-co-pay-accumulators-maximizers-and-the-impact-on-patients"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:56.32812499999999%"></span><img alt="Screenshot of an interview with Kimberly Westrich, MA" title="Screenshot of an interview with Kimberly Westrich, MA" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Screenshot of an interview with Kimberly Westrich, MA" title="Screenshot of an interview with Kimberly Westrich, MA" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F6026a484297a1a1a31739aca5bf174000a014bbe-1280x721.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F6026a484297a1a1a31739aca5bf174000a014bbe-1280x721.png%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F6026a484297a1a1a31739aca5bf174000a014bbe-1280x721.png%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F6026a484297a1a1a31739aca5bf174000a014bbe-1280x721.png%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F6026a484297a1a1a31739aca5bf174000a014bbe-1280x721.png%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F6026a484297a1a1a31739aca5bf174000a014bbe-1280x721.png%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F6026a484297a1a1a31739aca5bf174000a014bbe-1280x721.png%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F6026a484297a1a1a31739aca5bf174000a014bbe-1280x721.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F6026a484297a1a1a31739aca5bf174000a014bbe-1280x721.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/breaking-down-co-pay-accumulators-maximizers-and-the-impact-on-patients">Breaking Down Co-Pay Accumulators, Maximizers and the Impact on Patients</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/laura-joszt">Laura Joszt, MA</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/logan-lutton">Logan Lutton</a></div><a href="/view/breaking-down-co-pay-accumulators-maximizers-and-the-impact-on-patients"><span class="text-sm text-gray-500 pl-4">October 18th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Co-pay accumulators and maximizers are 2 programs that insurers have started implementing to help them redirect financial assistance from the patient, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/breaking-down-co-pay-accumulators-maximizers-and-the-impact-on-patients"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/racial-and-ethnic-disparities-in-prior-authorizations-for-patients-with-cancer"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:49.10025706940874%"></span><img alt="AJMC" title="AJMC" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="AJMC" title="AJMC" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/racial-and-ethnic-disparities-in-prior-authorizations-for-patients-with-cancer">Racial and Ethnic Disparities in Prior Authorizations for Patients With Cancer</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/benjamin-ukert-phd">Benjamin Ukert, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/stephanie-schauder-phd">Stephanie Schauder, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/daniel-cullen-phd">Daniel Cullen, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/david-debono-md">David Debono, MD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/michael-eleff-md">Michael Eleff, MD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/michael-j-fisch-md-mph">Michael J. Fisch, MD, MPH</a></div><a href="/view/racial-and-ethnic-disparities-in-prior-authorizations-for-patients-with-cancer"><span class="text-sm text-gray-500 pl-4">October 11th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The prior authorization process for patients with cancer demonstrates fewer days until submission and lower denial rates for Asian patients relative to White patients.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/racial-and-ethnic-disparities-in-prior-authorizations-for-patients-with-cancer"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/steady-premium-hikes-continue-employer-health-costs-rise-another-7-in-2024"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:52.5%"></span><img alt="health insurance-Annap-stock.adobe.com" title="health insurance-Annap-stock.adobe.com" 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/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8407028b1adf3b02243f5daea116e949e122261d-1200x630.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8407028b1adf3b02243f5daea116e949e122261d-1200x630.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8407028b1adf3b02243f5daea116e949e122261d-1200x630.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8407028b1adf3b02243f5daea116e949e122261d-1200x630.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8407028b1adf3b02243f5daea116e949e122261d-1200x630.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8407028b1adf3b02243f5daea116e949e122261d-1200x630.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8407028b1adf3b02243f5daea116e949e122261d-1200x630.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/steady-premium-hikes-continue-employer-health-costs-rise-another-7-in-2024">Steady Premium Hikes Continue: Employer Health Costs Rise Another 7% in 2024</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><a href="/view/steady-premium-hikes-continue-employer-health-costs-rise-another-7-in-2024"><span class="text-sm text-gray-500 pl-4">October 9th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">According to KFF’s annual Employer Health Benefits Survey, the average premium for family coverage now stands at $25,572, with workers contributing an average of $6296 annually. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/steady-premium-hikes-continue-employer-health-costs-rise-another-7-in-2024"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="flex md:hidden justify-center items-center"></div><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/patient-assignment-and-quality-performance-a-misaligned-system"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:49.10025706940874%"></span><img alt="Patient Assignment and Quality Performance: A Misaligned System" title="Patient Assignment and Quality Performance: A Misaligned System" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Patient Assignment and Quality Performance: A Misaligned System" title="Patient Assignment and Quality Performance: A Misaligned System" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/patient-assignment-and-quality-performance-a-misaligned-system">Patient Assignment and Quality Performance: A Misaligned System</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/kailey-love-mba-ms">Kailey Love, MBA, MS</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/stefanie-turner-mhi">Stefanie Turner, MHI</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/george-runger-phd">George Runger, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/cameron-adams-mpp">Cameron Adams, MPP</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/william-riley-phd">William Riley, PhD</a></div><a href="/view/patient-assignment-and-quality-performance-a-misaligned-system"><span class="text-sm text-gray-500 pl-4">October 9th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">This article explores the congruence between payer patient assignment and quality performance and the implications for incentive payments in alternative payment models.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/patient-assignment-and-quality-performance-a-misaligned-system"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/managing-germline-mutations-in-hereditary-breast-cancer-risk"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:60%"></span><img alt="Breastcancergeneticrisk | Image Credit: © Rasi-stock.adobe.com" title="Breastcancergeneticrisk | Image Credit: © Rasi-stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Breastcancergeneticrisk | Image Credit: © Rasi-stock.adobe.com" title="Breastcancergeneticrisk | Image Credit: © Rasi-stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F32ec24199c9fc74174402cb493dd846dcef6cfc8-6000x3600.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F32ec24199c9fc74174402cb493dd846dcef6cfc8-6000x3600.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F32ec24199c9fc74174402cb493dd846dcef6cfc8-6000x3600.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F32ec24199c9fc74174402cb493dd846dcef6cfc8-6000x3600.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F32ec24199c9fc74174402cb493dd846dcef6cfc8-6000x3600.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/managing-germline-mutations-in-hereditary-breast-cancer-risk">Managing Germline Mutations in Hereditary Breast Cancer Risk</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><a href="/view/managing-germline-mutations-in-hereditary-breast-cancer-risk"><span class="text-sm text-gray-500 pl-4">October 7th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Hereditary breast cancers are caused by germline mutations, which are genetic mutations inherited at conception and so called because they originate in germ cells, those that develop into reproductive cells and become eggs in female individuals and sperm in male individuals.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/managing-germline-mutations-in-hereditary-breast-cancer-risk"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/cvs-to-lay-off-nearly-3000-employees-as-part-of-cost-saving-initiative"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:66.49590163934425%"></span><img alt="CVS storefront | Image credit: Bill - stock.adobe.com" title="CVS storefront | Image credit: Bill - stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="CVS storefront | Image credit: Bill - stock.adobe.com" title="CVS storefront | Image credit: Bill - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Fd8cc2f16b1993dfb28f714e933b437032fa6f696-5856x3894.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, 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ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/cvs-to-lay-off-nearly-3000-employees-as-part-of-cost-saving-initiative">CVS to Lay Off Nearly 3000 Employees as Part of Cost-Saving Initiative</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><a href="/view/cvs-to-lay-off-nearly-3000-employees-as-part-of-cost-saving-initiative"><span class="text-sm text-gray-500 pl-4">October 1st 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The company announced layoffs due to business challenges and regulatory pressures.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/cvs-to-lay-off-nearly-3000-employees-as-part-of-cost-saving-initiative"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/lower-drug-costs-on-the-horizon-for-medicare-beneficiaries"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:61.5%"></span><img alt="Price drop questioned | Image Credit: © Fokussiert-stock.adobe.com" title="Price drop questioned | Image Credit: © Fokussiert-stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Price drop questioned | Image Credit: © Fokussiert-stock.adobe.com" title="Price drop questioned | Image Credit: © Fokussiert-stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5370b14b5acf569e7c7133dde64bc218c2d3299b-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5370b14b5acf569e7c7133dde64bc218c2d3299b-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5370b14b5acf569e7c7133dde64bc218c2d3299b-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5370b14b5acf569e7c7133dde64bc218c2d3299b-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5370b14b5acf569e7c7133dde64bc218c2d3299b-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5370b14b5acf569e7c7133dde64bc218c2d3299b-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5370b14b5acf569e7c7133dde64bc218c2d3299b-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5370b14b5acf569e7c7133dde64bc218c2d3299b-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5370b14b5acf569e7c7133dde64bc218c2d3299b-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/lower-drug-costs-on-the-horizon-for-medicare-beneficiaries">Lower Drug Costs on the Horizon for Medicare Beneficiaries</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><a href="/view/lower-drug-costs-on-the-horizon-for-medicare-beneficiaries"><span class="text-sm text-gray-500 pl-4">September 30th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Average Medicare drug premiums for older Americans will drop next year for those enrolled in traditional Medicare plans or who have coverage through Medicare Advantage, with opinions divided along party lines on the economic implications. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/lower-drug-costs-on-the-horizon-for-medicare-beneficiaries"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/at-home-cholesterol-screening-accessible-through-new-program"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:60%"></span><img alt="National Cholesterol Education month | Image Credit: © Waseem Ali Khan-stock.adobe.com" title="National Cholesterol Education month | Image Credit: © Waseem Ali Khan-stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="National Cholesterol Education month | Image Credit: © Waseem Ali Khan-stock.adobe.com" title="National Cholesterol Education month | Image Credit: © Waseem Ali Khan-stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Fc923f91672c1ed58f3b415da1928363c48243a49-1200x720.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, 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flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/at-home-cholesterol-screening-accessible-through-new-program">At-Home Cholesterol Screening Accessible Through New Program </a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><a href="/view/at-home-cholesterol-screening-accessible-through-new-program"><span class="text-sm text-gray-500 pl-4">September 30th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The innovative program from the Family Heart Foundation includes being able to order a free test kit for an at-home blood lipid panel and track your results online, as well as the ability to discuss the findings with care navigators and health care providers. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/at-home-cholesterol-screening-accessible-through-new-program"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/state-policy-opportunities-to-control-health-care-prices-a-cpr-report"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:57.42804857760772%"></span><img alt="health policy - JOURNEY STUDIO7 - stock.adobe.com" title="health policy - JOURNEY STUDIO7 - 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Policy Opportunities to Control Health Care Prices: A CPR Report</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><a href="/view/state-policy-opportunities-to-control-health-care-prices-a-cpr-report"><span class="text-sm text-gray-500 pl-4">September 25th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Catalyst for Payment Reform (CPR) explores stakeholder perspectives in Florida, Michigan, and Nevada, revealing both the challenges and opportunities states face in reforming health care pricing structures.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/state-policy-opportunities-to-control-health-care-prices-a-cpr-report"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/house-unanimously-passes-seniors-access-to-critical-medications-act"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:66.67312911981388%"></span><img alt="Prescription drugs in pharmacy vials | Image Credit: kenwnj - stock.adobe.com" title="Prescription drugs in pharmacy vials | Image Credit: kenwnj - stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Prescription drugs in pharmacy vials | Image Credit: kenwnj - stock.adobe.com" title="Prescription drugs in pharmacy vials | Image Credit: kenwnj - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F537540d61060c567692485e01f744efe9cbe2c5a-5158x3439.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F537540d61060c567692485e01f744efe9cbe2c5a-5158x3439.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F537540d61060c567692485e01f744efe9cbe2c5a-5158x3439.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F537540d61060c567692485e01f744efe9cbe2c5a-5158x3439.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F537540d61060c567692485e01f744efe9cbe2c5a-5158x3439.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F537540d61060c567692485e01f744efe9cbe2c5a-5158x3439.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F537540d61060c567692485e01f744efe9cbe2c5a-5158x3439.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F537540d61060c567692485e01f744efe9cbe2c5a-5158x3439.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F537540d61060c567692485e01f744efe9cbe2c5a-5158x3439.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/house-unanimously-passes-seniors-access-to-critical-medications-act">House Unanimously Passes Seniors’ Access to Critical Medications Act</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/brooke-mccormick">Brooke McCormick</a></div><a href="/view/house-unanimously-passes-seniors-access-to-critical-medications-act"><span class="text-sm text-gray-500 pl-4">September 25th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The House of Representatives unanimously passed the bipartisan Seniors’ Access to Critical Medications Act (HR 5526), which would reverse CMS restrictions on mail delivery of cancer medications to Medicare beneficiaries.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/house-unanimously-passes-seniors-access-to-critical-medications-act"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/efforts-at-lowering-blood-pressure-affected-by-medicaid-coverage"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:66.66666666666666%"></span><img alt="Blood pressure | Image credit: Photo Sesaon - stock.adobe.com" title="Blood pressure | Image credit: Photo Sesaon - stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Blood pressure | Image credit: Photo Sesaon - stock.adobe.com" title="Blood pressure | Image credit: Photo Sesaon - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8b4db3e79e3df044ed3c5245b2e03ef8e9de8ce6-4896x3264.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8b4db3e79e3df044ed3c5245b2e03ef8e9de8ce6-4896x3264.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, 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Lowering Blood Pressure Affected by Medicaid Coverage</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><a href="/view/efforts-at-lowering-blood-pressure-affected-by-medicaid-coverage"><span class="text-sm text-gray-500 pl-4">September 23rd 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Medicaid coverage was able to help some people lower their blood pressure according to a new study.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/efforts-at-lowering-blood-pressure-affected-by-medicaid-coverage"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="flex md:hidden justify-center items-center"></div><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/medicare-high-value-drug-list-model-could-lower-out-of-pocket-costs-for-4-in-10-beneficiaries"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:66.66666666666666%"></span><img alt="American money | Image Credit: Stillfx - stock.adobe.com" title="American money | Image Credit: Stillfx - stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="American money | Image Credit: Stillfx - stock.adobe.com" title="American money | Image Credit: Stillfx - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F2e0af76cb127f84677bbab0c5b761e5dce00d414-5184x3456.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, 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ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/medicare-high-value-drug-list-model-could-lower-out-of-pocket-costs-for-4-in-10-beneficiaries">Medicare High-Value Drug List Model Could Lower Out-of-Pocket Costs for 4 in 10 Beneficiaries </a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/brooke-mccormick">Brooke McCormick</a></div><a href="/view/medicare-high-value-drug-list-model-could-lower-out-of-pocket-costs-for-4-in-10-beneficiaries"><span class="text-sm text-gray-500 pl-4">September 23rd 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The proposed Medicare High-Value Drug List Model, also known as the Medicare $2 Drug List, could have modestly reduced out-of-pocket costs for 38% of beneficiaries if implemented in 2021. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/medicare-high-value-drug-list-model-could-lower-out-of-pocket-costs-for-4-in-10-beneficiaries"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/cmmi-s-payment-models-address-health-care-disparities-but-challenges-remain"><div class=""><span 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/cmmi-s-payment-models-address-health-care-disparities-but-challenges-remain">CMMI's Latest Payment Models Address Health Disparities, but Challenges Remain</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><a href="/view/cmmi-s-payment-models-address-health-care-disparities-but-challenges-remain"><span class="text-sm text-gray-500 pl-4">September 22nd 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">"As CMMI continues to test new equity adjustments, it is important that changes be grounded in scientific principles with extensive testing and validation to ensure the tightest linkage to social needs and health outcomes for underserved communities across the entire US," authors wrote.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/cmmi-s-payment-models-address-health-care-disparities-but-challenges-remain"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start 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src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/systemic-treatments-for-advanced-prostate-cancer-relationship-between-health-insurance-plan-and-treatment-costs">Systemic Treatments for Advanced Prostate Cancer: Relationship Between Health Insurance Plan and Treatment Costs</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/deborah-r-kaye-md-ms">Deborah R. Kaye, MD, MS</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/hui-jie-lee-phd">Hui-Jie Lee, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/alexander-gordee-ma">Alexander Gordee, MA</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/daniel-j-george-md">Daniel J. George, MD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/charles-d-scales-jr-md-mshs">Charles D. Scales Jr, MD, MSHS</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/peter-a-ubel-md">Peter A. Ubel, MD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/m-kate-bundorf-phd-mba-mph">M. Kate Bundorf, PhD, MBA, MPH</a></div><a href="/view/systemic-treatments-for-advanced-prostate-cancer-relationship-between-health-insurance-plan-and-treatment-costs"><span class="text-sm text-gray-500 pl-4">September 20th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The authors examine how insurer and patient out-of-pocket payments for advanced prostate cancer differ by drug and health plan type and describe the relationship between these payments and utilization.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/systemic-treatments-for-advanced-prostate-cancer-relationship-between-health-insurance-plan-and-treatment-costs"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/at-risk-patient-populations-face-higher-rates-of-claim-denials-for-preventive-care"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:61.875%"></span><img alt="Health insurance blocks_REDPIXEL - 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stock.adobe.com" title="Doctors talking | Image Credit: © Flamingo Images - stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Doctors talking | Image Credit: © Flamingo Images - stock.adobe.com" title="Doctors talking | Image Credit: © Flamingo Images - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8bc045c3dab93f8880383eca2404a178c3e280c8-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8bc045c3dab93f8880383eca2404a178c3e280c8-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8bc045c3dab93f8880383eca2404a178c3e280c8-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8bc045c3dab93f8880383eca2404a178c3e280c8-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8bc045c3dab93f8880383eca2404a178c3e280c8-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8bc045c3dab93f8880383eca2404a178c3e280c8-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8bc045c3dab93f8880383eca2404a178c3e280c8-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8bc045c3dab93f8880383eca2404a178c3e280c8-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8bc045c3dab93f8880383eca2404a178c3e280c8-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/what-value-do-teaching-hospitals-provide-commercial-beneficiaries-when-in-an-aco-">What Value Do Teaching Hospitals Provide Commercial Beneficiaries When in an ACO?</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/matthew-c-baker-phd">Matthew C. Baker, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/theresa-r-f-dreyer-mph">Theresa R. F. Dreyer, MPH</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/erin-naomi-hahn-mph">Erin Naomi Hahn, MPH</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/keith-a-horvath-md">Keith A. Horvath, MD</a></div><a href="/view/what-value-do-teaching-hospitals-provide-commercial-beneficiaries-when-in-an-aco-"><span class="text-sm text-gray-500 pl-4">September 16th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Accountable care organizations (ACOs) with a major teaching hospital were associated with lower mortality, lower inpatient spending, lower emergency department utilization, and higher overall outpatient spending.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/what-value-do-teaching-hospitals-provide-commercial-beneficiaries-when-in-an-aco-"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/uninsured-rate-in-us-stable-from-2022-to-2023-us-census-bureau-report"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:61.9710836981032%"></span><img alt="While the overall percentage of Americans without insurance did not statistically significantly change, rates of uninsurance varied across age and poverty levels. | Image credit: Kiattisak - stock.adobe.com" title="While the overall percentage of Americans without insurance did not statistically significantly change, rates of uninsurance varied across age and poverty levels. | Image credit: Kiattisak - stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="While the overall percentage of Americans without insurance did not statistically significantly change, rates of uninsurance varied across age and poverty levels. | Image credit: Kiattisak - stock.adobe.com" title="While the overall percentage of Americans without insurance did not statistically significantly change, rates of uninsurance varied across age and poverty levels. | Image credit: Kiattisak - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Fde14b33646d9f1d4d3549f282fc7978088944b26-7539x4672.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Fde14b33646d9f1d4d3549f282fc7978088944b26-7539x4672.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Fde14b33646d9f1d4d3549f282fc7978088944b26-7539x4672.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Fde14b33646d9f1d4d3549f282fc7978088944b26-7539x4672.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Fde14b33646d9f1d4d3549f282fc7978088944b26-7539x4672.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Fde14b33646d9f1d4d3549f282fc7978088944b26-7539x4672.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Fde14b33646d9f1d4d3549f282fc7978088944b26-7539x4672.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Fde14b33646d9f1d4d3549f282fc7978088944b26-7539x4672.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Fde14b33646d9f1d4d3549f282fc7978088944b26-7539x4672.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/uninsured-rate-in-us-stable-from-2022-to-2023-us-census-bureau-report">Uninsured Rate in US Stable From 2022 to 2023: US Census Bureau Report</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/rose-mcnulty">Rose McNulty</a></div><a href="/view/uninsured-rate-in-us-stable-from-2022-to-2023-us-census-bureau-report"><span class="text-sm text-gray-500 pl-4">September 12th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The rate of uninsurance in 2023 was 8.0%, a statistically insignificant change from the 7.9% uninsured rate in 2022. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/uninsured-rate-in-us-stable-from-2022-to-2023-us-census-bureau-report"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div></div><div class="w-full text-center flex justify-center pb-24"><a class="px-4 py-2 border-y border-r bg-primary text-white" href="/topic/insurance?page=1">1</a><a class="px-4 py-2 border-y border-r " href="/topic/insurance?page=2">2</a><a class="px-4 py-2 border-y border-r " href="/topic/insurance?page=3">3</a><a class="px-4 py-2 border-y border-r " href="/topic/insurance?page=4">4</a><a class="px-4 py-2 border-y border-r " href="/topic/insurance?page=5">5</a><a class="px-4 py-2 border-y border-r " href="/topic/insurance?page=6">6</a><a class="px-4 py-2 border-y border-r " href="/topic/insurance?page=7">7</a><a class="px-4 py-2 border-y border-r " href="/topic/insurance?page=8">8</a><div class="px-4 py-2 border-y border-r">...</div><a class="px-4 py-2 border-y border-r" href="/topic/insurance?page=90">90</a><a class="px-4 py-2 border-y border-r" href="/topic/insurance?page=2">></a></div></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-NK5KQXS" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><div 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Salgo, MD: ","_key":"eEd9WrCT"},{"_type":"span","text":"I’m going to go around the panel. We’ve come to the point now where I’m going to get the seers of wound care, that would be you guys, not “ea” but “eers” of wound care. Take a look in the future. Take 30 seconds, 45 seconds. Tell me what you see going on forward from here. Michael, you want to start on this?","_key":"dMxtPxcL"}],"_type":"block","style":"normal","_key":"xN7pUjmJ","markDefs":[]},{"_type":"block","style":"normal","_key":"8JYKPmeI","markDefs":[],"children":[]},{"_type":"block","style":"normal","_key":"pnBoOOqj","markDefs":[],"children":[{"marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"9eCWaID3","_type":"span"},{"_type":"span","text":"Sure. The future is that first of all, we know full well and what’s one of the sobering aspects is that Medicare itself has determined through its economic model that a chronic wound of a certain severity is 1 of the top 5 most expensive conditions that can beset a Medicare beneficiary. They adjust for it accordingly. That’s a huge opportunity for product manufacturers, for managed care plans, for provider groups to get together and develop programs bearing risk, if you will, or within a managed care environment, in coordination with CMS to be able to implement appropriate protocols, standardization of care, and economic models that can heal these wounds. They’re one of the top 5 most expensive conditions that can beset.","_key":"f2iPoXaS"}]},{"_key":"XqfK98PV","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"4kJbp6nV","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"IGophSqJ"},{"text":"Robert, you’re next up.","_key":"X4iQWRgM","_type":"span"}],"_type":"block"},{"style":"normal","_key":"jxwYFNcy","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS:","_key":"s18bDgt4"},{"text":" I agree first and foremost, you need the economic models to prove the point. I think once you have them, it will become crystal clear to people like us sitting on this panel that they’re truly going to find that if you intervene sooner and you’re doing the right things, and you’re educated to these conditions appropriately, and you understand the evidence, then these patients more often than not will do better than if they didn’t have that care. I also think that as we move to a value-based system from a fee-for-service model, I think things like point of care diagnostic tests are going to be extraordinarily important, so that we don’t have to wait a week to determine whether a patient may need a particular type of topical or systemic therapy.","_key":"tjbTqEXn","_type":"span"}],"_type":"block","style":"normal","_key":"X6rrSF7f"},{"_type":"block","style":"normal","_key":"O1bd4sY3","markDefs":[],"children":[]},{"_key":"Z8V4D8Bc","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"vYsqDoRj"},{"_type":"span","text":"One of the bad points about being right all the time is you have to go last. They’ve used all the good stuff. What do you see the future of this problem being?","_key":"M9hwl5T9"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"BO8CqKVf"},{"style":"normal","_key":"RxXwKNQL","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"MNhoDbhw"},{"_type":"span","text":"I think I’m going to use his, it depends. There are 2 futures that I can foresee. The more dismal future is we continue as is, that the cost from an economic standpoint as well as in just a general wellness standpoint of wounds, remains under appreciated and under recognized by the medical profession. Or, we help educate the medical profession on how serious a problem and how costly a problem this is. We get our primary providers who are our gatekeepers to appreciate the impact of a wound on an individual’s well-being and to intervene sooner than later.","_key":"xMdNcV18"}],"_type":"block"},{"style":"normal","_key":"b2CWmAEe","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"pIiNV0lr"},{"_type":"span","text":"I want to thank all of you for being here. It’s been a tremendous discussion and for me, an eye-opener. It’s rare I sit on a panel and get surprised all the time. I want to thank all of you for sharing this information. To your point, one of the ways that we inform providers is to do just what we did. I hope you had a tremendous time watching this discussion. I want to thank you for joining us. I hope you found this ","_key":"bzq2nJGB"},{"_type":"span","marks":["em"],"text":"Peer Exchange","_key":"iOusMtn3"},{"_type":"span","text":" to be useful and informative. I’m Dr Peter Salgo, and I’ll see you next time.","_key":"pFXY0gDn"}],"_type":"block","style":"normal","_key":"6EHv2paO"},{"_type":"hrtag","_key":"lkw1Cs4IuF"}],"_id":"episode_8813ef224a097aac885dd8ff6d0400fa","link":"/view/practical-advice-and-the-future-of-wound-care","summary":null,"internalTag":["Peer Exchange","wound","clinical","treatment","providers","managed care","claims","patient","healthcare","financial","medicare"],"_createdAt":"2021-05-14T18:01:43Z","url":{"current":"practical-advice-and-the-future-of-wound-care","_type":"slug"},"_updatedAt":"2021-05-20T01:20:07Z","seoTag":["Peer Exchange","wound","clinical","treatment","providers","managed 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Care: Medicare 30-Day Tried and Failed Policy","body":[{"_type":"youtube","_key":"fgXtgRZ4c","url":"https://www.youtube.com/embed/TwW3NUS8LzA?rel=0\u0026fs=0"},{"children":[],"_type":"block","style":"normal","_key":"p0lPYS70","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"GU7dFMEo"},{"_key":"YtlzQu69","markDefs":[],"children":[{"_type":"span","text":"The panel discusses the Medicare 30-day tried and failed policy.","_key":"PRirgcOU"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"0FpPfVmK"},{"style":"normal","_key":"UC4JYGBh","markDefs":[],"children":[{"_type":"span","marks":["underline"],"text":"Transcript","_key":"uWkYN7V6"}],"_type":"block"},{"_key":"C8VBgsT3","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"82N0NSQN"},{"text":"Since we’ve been talking about Medicare, and I’m not beating up on Medicare because when I heard what they were doing for readmission rates, there is a logic to it, which is don’t ignore this or we’re going to penalize you for it. What is the policy here? There’s something called the 30-day tried and failed policy. What is that?","_key":"fbpvfdHm","_type":"span"}],"_type":"block","style":"normal"},{"style":"normal","_key":"E3Wwcvq8","markDefs":[],"children":[],"_type":"block"},{"_type":"block","style":"normal","_key":"fzJfHJ8P","markDefs":[],"children":[{"marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"CmbSrIUx","_type":"span"},{"_type":"span","text":"I alluded to it earlier. What they try to do is they take a global definition of a chronic wound and they apply that toward an economic model of being able to approve subsequent treatment or appropriate treatment following a certain period. What they’re saying is that we have to establish that this is indeed a chronic wound. That takes 30 days to be able to do that.","_key":"tQORs8Pn"}]},{"_key":"Ds7TyD34","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"vldDXgyx","markDefs":[],"children":[{"text":"Peter L. Salgo, MD: ","_key":"UKpu2hsz","_type":"span","marks":["strong"]},{"_type":"span","text":"During which time….","_key":"igUCVUpZ"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"EKuP99QQ"},{"_key":"6jGjdZ0O","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"NbytlCvQ"},{"_type":"span","text":"They’re paying to establish, as I mentioned earlier, the chronicity of the wound. Once that wound is now defined as being chronic, in a statistically significant number of patients, it could have been a stage II that is now a stage III. OK? Meaning sometimes chronicity has to be established or documented at the time of encounter and not very many times historically.","_key":"4tM1HUvJ"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"KEiWamSM"},{"style":"normal","_key":"lBMJRYsl","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"h8D12tox"},{"_type":"span","text":"Are you implying that to get paid, you’ve got to see this thing get worse, and it might have not gotten got worse had you paid earlier?","_key":"4OLLoMxB"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"QOqzJgPz"},{"_key":"s7i2gRXZ","markDefs":[],"children":[{"marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"yFsFVjAo","_type":"span"},{"_key":"UL1mkb2C","_type":"span","text":"I wouldn’t put it that way."}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"iy3j8itN","markDefs":[],"children":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"t0vGw9qg"},{"_type":"span","text":"The wound is not getting better.","_key":"rLTCB66a"}],"_type":"block","style":"normal","_key":"E1ZRwl8Z","markDefs":[]},{"_key":"d9IShUkS","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"LCh1hMau"},{"_type":"span","text":"Not getting better over a period of time. That would be a more accurate description.","_key":"MuKP0PvP"}],"_type":"block","style":"normal","_key":"KZ9d7NBO"},{"children":[],"_type":"block","style":"normal","_key":"ne0Hg2vF","markDefs":[]},{"style":"normal","_key":"7MTIr7il","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"x0BYjIln"},{"_type":"span","text":"So it’s established,","_key":"EwUG4Ztf"},{"marks":["strong"],"text":" i","_key":"kWeVuLcZ","_type":"span"},{"_type":"span","text":"f I’m reading you right, an incentive to watch this wound not get better, click past that 30-day point, and then intervene?","_key":"CRyDrr2i"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"lPtHaAyO"},{"_type":"block","style":"normal","_key":"6uIYI6lG","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"emgMzob0"},{"text":"There’s a second stage to this. A lot of these advanced products have been studied after the wound has been open for 4 weeks. Very often, CMS will look at the data and look at the randomized controlled trial and say, well, these patients didn’t get the benefit of this therapy for 30 days, therefore that’s the protocol that we’re going to use.","_key":"vdmGfcHc","_type":"span"}]},{"_type":"block","style":"normal","_key":"O3hchGyP","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"D7Q9vfEG"},{"_type":"span","text":"Let me turn this on its head. Wouldn’t it be better if CMS so constructed their protocol that we dive in early with full guns blazing, get this thing under control, we’re not going to wait for 30 days, we’ll spend a little money up front to prevent the chronicity occurring at the 30-day point.","_key":"f5vKJ4I5"}],"_type":"block","style":"normal","_key":"8Y2901W7"},{"_key":"YisOPjQZ","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"jEO89HCD","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"qgfyv7rt"},{"_type":"span","text":"I would say not in Medicare classic fee-for-service because it’s a la carte, and that opens up a whole subset of other possibilities as to when the appropriate time is. However, it can be managed well in a managed care environment, establish a risk-bearing entity where the providers have the latitude to be able to implement these protocols and procedures whenever they want at their cost. Their primary responsibility to the payer group and to the patient is a healed patient at the end of a period of time.","_key":"i3iDvOG7"}],"_type":"block"},{"_type":"block","style":"normal","_key":"p92tDMhl","markDefs":[],"children":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"a8Z94EDq"},{"_type":"span","text":"If I’m a patient, here’s what I don’t want to hear. I don’t want to hear, “We’ve got some great therapies that really do show promise, but I can’t use them until you get sicker or you’re not getting better.” I don’t want that.","_key":"2wKYLHCx"}],"_type":"block","style":"normal","_key":"TKUEGLwp","markDefs":[]},{"style":"normal","_key":"TS8qmddt","markDefs":[],"children":[],"_type":"block"},{"_type":"block","style":"normal","_key":"EzhFTLX1","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"7tqiaxDl"},{"text":"There is another side to the coin though. There are patients who will respond to standard care. We did a study a couple of years ago looking at diabetic patients. We found that patients for which the area reduction of their wound didn’t get 50% smaller in the first 4 weeks were very unlikely to heal by week 12. However, if we looked at 2 weeks, we could make a decision at 2 weeks as to whether they would reach that threshold. There are validated markers that will guide the clinician to say, well, it’s been 2 weeks, the patient is getting worse, we need to intervene and do something.","_key":"DwKXTPj3","_type":"span"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"LsrKVvQv"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"ROrq4QXd"},{"text":"You would agree there’s a statistically significant number of patients where we can determine how well or how effective the treatment is going to be within the first 2 weeks.","_key":"DZAbv3fI","_type":"span"}],"_type":"block","style":"normal","_key":"CbU8Ds45"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"a2cwLv0E"},{"children":[{"marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"a7DJ1LvY","_type":"span"},{"_type":"span","text":"We can.","_key":"QTiiWo1J"}],"_type":"block","style":"normal","_key":"1b6D3K54","markDefs":[]},{"_type":"block","style":"normal","_key":"TmO7m1bq","markDefs":[],"children":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"MtCoiKdz"},{"_type":"span","text":"The Medicare 30-day policy, maybe we make it shorter?","_key":"GpbOILuo"}],"_type":"block","style":"normal","_key":"dSdrOZUa","markDefs":[]},{"_type":"block","style":"normal","_key":"eOfsH4bn","markDefs":[],"children":[]},{"_type":"block","style":"normal","_key":"5zyvw2tV","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"U1lBqRW6"},{"_type":"span","text":"Maybe we don’t have it at all and we leave it to the clinician to make that decision.","_key":"hoWZDhxI"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"gOxpPqIn"},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"qsJaKwx3"},{"_type":"span","text":"Now, there’s a concept for you. You like that?","_key":"slMYhVHb"}],"_type":"block","style":"normal","_key":"upCiV0uP","markDefs":[]},{"children":[],"_type":"block","style":"normal","_key":"VLOwlEZ3","markDefs":[]},{"_type":"block","style":"normal","_key":"YpQZsmE0","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"fm0x6qr8"},{"_type":"span","text":"I like it.","_key":"YeFBn6Ci"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"VNaMDwoH"},{"_type":"block","style":"normal","_key":"MckyGrA3","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"v3qalxPv"},{"_type":"span","text":"You like that?","_key":"K5XKb6fm"}]},{"_type":"block","style":"normal","_key":"IgUnrfg7","markDefs":[],"children":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"tBrjE8l8"},{"_type":"span","text":"Maybe we don’t focus on the fact that this is a chronic wound, right? Maybe we focus on the condition that underlies the wound, like a diabetic-related wound, or a pressure-induced injury, or a vascular disease-related wound, rather than determining whether it’s an acute diabetic-related wound or a chronic diabetic-related wound.","_key":"rw9APkDM"}],"_type":"block","style":"normal","_key":"u5RW1RtR","markDefs":[]},{"children":[],"_type":"block","style":"normal","_key":"ExAnmy1p","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"eYj8Nhnf"},{"_type":"span","text":"Got it.","_key":"6vGYYixJ"}],"_type":"block","style":"normal","_key":"XStadeIF"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"Qr5w1CDL"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. 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noncompliance.","_key":"yncKNfIH","_type":"span"}],"_type":"block","style":"normal","_key":"Re2A23vF"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"dLfF2cdV"},{"style":"normal","_key":"DDLIYHdx","markDefs":[],"children":[{"_type":"span","marks":["underline"],"text":"Transcript","_key":"DKrPL3OZ"}],"_type":"block"},{"markDefs":[],"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"Hqu7Gu9D","_type":"span"},{"_type":"span","text":"This brings us to wound recurrences, which is you have treated the wound, someone’s gone home. Maybe he’s still got a hole but he’s not septic, he’s not infected. Then this person comes back. What’s the rate of readmission for recurrent wounds, wound infections, and wound problems? Do you know the number?","_key":"16SJpvTS"}],"_type":"block","style":"normal","_key":"rkFSus85"},{"style":"normal","_key":"cXKTfv2k","markDefs":[],"children":[],"_type":"block"},{"_key":"0OHn8enB","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"XxAKj7Py"},{"_type":"span","text":"There are not a lot of data.","_key":"lsO5VsW0"}],"_type":"block","style":"normal"},{"_key":"QZAr6o56","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"EDLgGlWd","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"1hQ0dZZI"},{"_key":"pEgn1sxT","_type":"span","text":"How did I know you were going to say that?"}]},{"_type":"block","style":"normal","_key":"cJeyexLn","markDefs":[],"children":[]},{"style":"normal","_key":"MRNDt9RS","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"R42VACg8"},{"_key":"zdy4eNxd","_type":"span","text":"Well, there are not a lot of data in general relating to wound care, unfortunately. The rate of recidivism can be as high as 100% in some patients."}],"_type":"block"},{"_key":"ybM2V8F8","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"BIY0FD9F"},{"_type":"span","text":"What’s the impact, because of readmission, because of improper treatment, then wound reopening and reinfection? Do we know that?","_key":"wAhTbjI5"}],"_type":"block","style":"normal","_key":"cms9vkg1"},{"style":"normal","_key":"ZngUvMia","markDefs":[],"children":[],"_type":"block"},{"children":[{"_key":"JVSRCy89","_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: "},{"_key":"Azc0H0sU","_type":"span","text":"We don’t."}],"_type":"block","style":"normal","_key":"qSkiAfqd","markDefs":[]},{"style":"normal","_key":"67LA61LR","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. 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So maybe we will alter that statement.","_key":"A0HFgeHT"}],"_type":"block","style":"normal","_key":"QBi183ux","markDefs":[]},{"style":"normal","_key":"03bO45Ws","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"_key":"C2OOLQLj","_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: "},{"_type":"span","text":"Absolutely.","_key":"RW8pgZWT"}],"_type":"block","style":"normal","_key":"lJFqC1hF"},{"children":[],"_type":"block","style":"normal","_key":"WcSsZFwt","markDefs":[]},{"markDefs":[],"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"iombZEPY","_type":"span"},{"_type":"span","text":"This is a very scary panel. This is a huge problem, seriously. It’s a huge problem without a lot of data because we haven’t been looking at it perhaps long enough and perhaps not properly, it seems to me just listening to you guys.","_key":"1YM4GAdE"}],"_type":"block","style":"normal","_key":"6815VTFn"},{"_type":"block","style":"normal","_key":"YYa6Qk4c","markDefs":[],"children":[]},{"style":"normal","_key":"hPTMa1HC","markDefs":[],"children":[{"_key":"wHgV0QCD","_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: "},{"_type":"span","text":"Was it a readmit to a hospital because of the same diagnosis?","_key":"cj7uKikV"}],"_type":"block"},{"style":"normal","_key":"gc78uhvF","markDefs":[],"children":[],"_type":"block"},{"_key":"dAa0PfLR","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. 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Salgo, MD:","_key":"PveegbJT","_type":"span"},{"text":" Maybe they’re not going to admit to it, is that what you’re implying?","_key":"oRWl13f6","_type":"span"}],"_type":"block","style":"normal","_key":"598fUy8w","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"cQEdxjqx"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"9YPVt66k"},{"_type":"span","text":"How reliable are the data?","_key":"j3jRhq9Y"}],"_type":"block","style":"normal","_key":"HdIM9Ajd"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"mW5NN45G"},{"_key":"7wGH6vgb","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"l1tIjcaW","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"text":"That’s all he’s going to say about it. Let’s then turn the table. Supposing you’re a clinician. Here’s somebody with an ulcer, and you tell that patient as clearly as you can, do A, do B, do C, then they’re not, what was the word you used?","_key":"EHVWaSLz","_type":"span"}],"_type":"block","style":"normal","_key":"o8bR34zc"},{"_key":"bGVyAcGi","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"Dm7AZj6s","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"KQ2Voiwj"},{"_key":"wfay7Hc7","_type":"span","text":"Concordant."}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"5prXJmI1"},{"markDefs":[],"children":[{"text":"Peter L. Salgo, MD: ","_key":"ymdTDUdl","_type":"span","marks":["strong"]},{"_type":"span","text":"They’re not concordant with what you’ve told them. What is the impact on their health? Do we have any numbers of either days lost of work, days sick, days spent readmitted to the hospital? Do we know any of this? I guess what I’m asking is does it make a difference if they do what you tell them to do?","_key":"l88C9fwR"}],"_type":"block","style":"normal","_key":"y8PAAqT5"},{"style":"normal","_key":"C3PticC1","markDefs":[],"children":[],"_type":"block"},{"style":"normal","_key":"nu2ynUoO","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"6Wd1w49r"},{"text":"My answer again will be it depends on the individual. Some people are meticulous, others are not. Sometimes it’s just a matter of wearing appropriate diabetic shoe gear and appropriate insert and making sure that you’re wearing them appropriately, that you’re seeing your primary care doctor on a regular basis, that you are seeing your podiatrist and your ophthalmologist or optometrist on a regular basis. All these things obviously play into the situation.","_key":"FtGeK95B","_type":"span"}],"_type":"block"},{"_key":"nB0VxdTG","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"Kf4Packp","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"0gr1huu4"},{"_key":"wRoSAoor","_type":"span","text":"Any suggestions in the art of medicine to help get patients to do more of what you’d like them to do?"}],"_type":"block"},{"children":[],"_type":"block","style":"normal","_key":"3vxkiBRs","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"NNCMfci8"},{"_type":"span","text":"Education to me has always been the key, but it’s also been a challenge because patients have to listen to what it is you’re saying. To my point before, you have to not only educate your patient, but you have to educate the caregiver if in fact there is one. Their support system must be educated as well because very often they’re the drivers to prevent rates of recidivism.","_key":"ZOvROMIv"}],"_type":"block","style":"normal","_key":"6wW1QAvX","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"Myv1rtTk"},{"_key":"fEA53p1g","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"tcDcHGnC"},{"_type":"span","text":"I took what you said quite seriously, which is because there is a punitive aspect to patients being readmitted within 30, 60, 90 days with the same issue, they’re often not coded that way, so that they can get reimbursed for care and not be punished for it. Is there a way out of that? What is the impact, if you don’t have the data, you don’t know the impact on spending for readmission, do you?","_key":"apM8Ng22"}],"_type":"block","style":"normal"},{"_key":"jL3h6GPA","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"kodDWzDr"},{"_type":"span","text":"No.","_key":"OW8yc9Lr"}],"_type":"block","style":"normal","_key":"FBmDrLhC"},{"_type":"block","style":"normal","_key":"oYNs0iRQ","markDefs":[],"children":[]},{"_key":"HMqxwTXa","markDefs":[],"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"oFhOPMiH","_type":"span"},{"_type":"span","text":"So that’s the answer to the second question. What about the first question?","_key":"A4agkc5I"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"3aZq2Xvl","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"FnuHlbk9"},{"_key":"1CYglveG","_type":"span","text":"That is one of the biggest challenges right now. Do we have appropriate mechanisms in place that will incentivize accurate coding?"}],"_type":"block","style":"normal","_key":"PFdYV98U"},{"_type":"block","style":"normal","_key":"HipCewTv","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"eqye9o9F"},{"_type":"span","text":"I think patients are released too soon. I think the care is not appropriately coordinated. That continuum of care very often is not in place and these patients fall through a crack or a hole, a big black hole, and they’re not seen for weeks at a time. They’re not getting care. They’re not able to get access to a home health nurse to come into their home. Their blood sugars aren’t being checked on a regular basis. They can’t afford to buy their insulin. There are a whole host of reasons why these patients will be readmitted.","_key":"mzGR4nlt"}],"_type":"block","style":"normal","_key":"E8v2w6oB"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"b88BUJmu"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"MSX3ci3t"},{"_type":"span","text":"On the pressure ulcer subset of these wounds, we have a double-edge sword. If the pressure ulcer isn’t recognized at the point of admission to an inpatient setting, the facility will actually not be reimbursed but will be penalized because it’s considered a hospital-acquired condition.","_key":"bhjl9DVb"}],"_type":"block","style":"normal","_key":"bPGEocTp"},{"_key":"ov3w7OwF","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"8T2Ohv8a"},{"_type":"span","text":"No good deed goes unpunished.","_key":"1dSJN0Ek"}],"_type":"block","style":"normal","_key":"kHdEl678"},{"_key":"BCrPkMlh","markDefs":[],"children":[],"_type":"block","style":"normal"},{"children":[{"marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"tzghD6YR","_type":"span"},{"_type":"span","text":"Right. So what do you do? Do you code it or don’t you, right?","_key":"mnuKeulH"}],"_type":"block","style":"normal","_key":"Kvgexx3n","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"ISc3LxTH"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"h88meq3s"},{"_type":"span","text":"I know what’s going on in many hospitals because I talk to folks. On admission, that patient is examined microscopically. This red spot, this ulcer was present on admission, so that we can now bill for it, not our institution. We have at least 1 crack at this. But in order to improve compliance with all kinds of wound care protocols, CMS is not going to pay if you come back with the same condition 60 days later, 90 days later. To some degree, although well intentioned, I’m getting a sense from you that that’s shooting the hospital in the foot, if you will. That’s a terrible analogy. Take it and run.","_key":"m5Ijq8oH"}],"_type":"block","style":"normal","_key":"g5nFXz1s"},{"_type":"block","style":"normal","_key":"OsINq6t5","markDefs":[],"children":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"x2jkkDr2"},{"_type":"span","text":"Particularly if you have podiatrists in the room.","_key":"Z8rnlBCf"}],"_type":"block","style":"normal","_key":"aSMdg8CR","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"dFDUgxkc"},{"_type":"block","style":"normal","_key":"I7zELPLA","markDefs":[],"children":[{"text":"Peter L. 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Salgo, MD: ","_key":"A3s6v5Bw"},{"_type":"span","text":"What are the challenges as an insurer of wound management in terms of paying for all of this? Give me a list of the challenges as you see them?","_key":"HXrvnMkY"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"IuVlE9pc"},{"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"cl5Sry3d"},{"_type":"span","text":"What are the challenges they’re paying for?","_key":"CqKMfAE8"}],"_type":"block","style":"normal","_key":"YqwouYwb","markDefs":[]},{"style":"normal","_key":"UwPtDapl","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"_key":"ZA2QKQgc","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"_type":"span","text":"They’re paying for all of that. What are your challenges as an insurer? How do you get the right money to the right people, to the right treatment, to the right patient?","_key":"LxHG63tN"}],"_type":"block","style":"normal","_key":"xhl5tXaw"},{"style":"normal","_key":"vBs9pQVq","markDefs":[],"children":[],"_type":"block"},{"_key":"XpR2giJj","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"46miCB9S"},{"_type":"span","text":"You have to identify the costs, which is very difficult, and find out the size of the problem and then look at what is business as usual regarding this cost center and then start looking at what’s the most appropriate mechanism to be able to deal with chronic wounds. Do we treat them where we are now, or do we set up areas where we incentivize individuals and doctors to band together to form centers of excellence that can carve the entity out as a true chronic condition in and of itself?","_key":"UUiSF1mJ"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"BQCyOhig"},{"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"tkV82sBE"},{"text":"Would you agree that there presently are not enough economic data out there to really make some of those decisions, or do you think the data are there?","_key":"HiywfYgW","_type":"span"}],"_type":"block","style":"normal","_key":"DIndbGts","markDefs":[]},{"_type":"block","style":"normal","_key":"xHCcv6u2","markDefs":[],"children":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"OqKTarJn"},{"_key":"dd1vsorV","_type":"span","text":"The data are there, they are just very difficult to mine. As I mentioned earlier, there are different reporting mechanisms, there are different incentivization programs in place in different geographies around the country. I’ll give you an example. It’s very easy to go to a managed care company that holds global risk and determine what their costs are in wound management, because they have all the codes. They know exactly what they’re doing when they disburse their risk management dollars, and their delegation of financial risk isn’t parsed out. It’s in 1 area. Those are easier to be able to quantify. Then you move to a different geographic location where the risk is delegated to different entities, you have to go looking for data that are there."}],"_type":"block","style":"normal","_key":"U3ex00qV","markDefs":[]},{"_type":"block","style":"normal","_key":"l0Y5WwvT","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_key":"zO3rVHxf","_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: "},{"_type":"span","text":"If you ever tried to navigate the CDC website, it is very difficult. If you have the time.","_key":"irTzvtSm"}],"_type":"block","style":"normal","_key":"XTyyOP5W"},{"_type":"block","style":"normal","_key":"Bb9sjIEF","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"qdhKCbqq"},{"_key":"KPYE5VuF","_type":"span","text":"Do they have a GPS [Global Positioning System] for that?"}],"_type":"block","style":"normal","_key":"eod75tud"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"qT6TaiV9"},{"style":"normal","_key":"9TNmCi5D","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"Rc4b0OvZ"},{"_type":"span","text":"I tried it once, and I went howling into the night.","_key":"C2YtSFO5"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"I8CY1ebG"},{"_key":"LVjVO6CP","markDefs":[],"children":[{"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"SQC28mGo","_type":"span","marks":["strong"]},{"text":"If you have the time, initially when you look at it, it appears that actually the number of amputations are going down, the number of infections in diabetic patients are going down. What they’re not taking into account is the denominator is enlarging, so you’re getting more diabetics, you’re getting diabetics who are not living to 60, they’re living to 80, so they’re going to develop a lot of these complications that we perhaps wouldn’t see 10 or 15 years ago. I think that’s going to ultimately translate to the dollars that we’re going to have to spend.","_key":"A8bbFs1I","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"GFgYigko"},{"_key":"7PaAPD6V","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"mcJURsmT"},{"_type":"span","text":"Let me throw this out as a suggestion. Medicare tends to drive what managed care does in terms of assessment of quality, right, and how patient populations are managed. And for example, in diabetics, it’s hemoglobin A1C. That’s the marker that has to be reported for quality purposes on Medicare databases. Perhaps, and I’m just throwing this out there as a thought, what about a skin assessment of some form as a quality metric for good physician practice and trying to get at the front end of this wound problem, instead of where we’re looking at it, focusing on the back, terminal end?","_key":"fRLOB4tU"}],"_type":"block","style":"normal"},{"style":"normal","_key":"H62AAFc5","markDefs":[],"children":[],"_type":"block"},{"children":[{"marks":["strong"],"text":"Peter L. 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Kazamias, MS, DPM: ","_key":"aHXEDxGg"},{"_type":"span","text":"It’s actually been established in private practice, a lot of physicians now, for those quality measures they have to, and in podiatry specifically, there are quality measures that qualify under podiatry that are used for reporting to incentivize reimbursement to those clinicians. There are attempts in order to be able to incorporate those skin markers or those diabetic assessments.","_key":"5V65bY75"}],"_type":"block","style":"normal","_key":"dtdKUUAg"},{"_type":"block","style":"normal","_key":"URsS3VBX","markDefs":[],"children":[]},{"style":"normal","_key":"NDRh1Vvy","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"N6LfPsgX"},{"_type":"span","text":"They’re only enforced for podiatrists, not for primary care physicians.","_key":"Up5b8azH"}],"_type":"block"},{"_key":"2idtiVsV","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"6WKaB8Nl"},{"_key":"tWqUp8c8","_type":"span","text":"Good point."}],"_type":"block","style":"normal","_key":"srcYpGcg"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"89eEYqTP"},{"_type":"block","style":"normal","_key":"Mv95kMTp","markDefs":[],"children":[{"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"DourT8zs","_type":"span","marks":["strong"]},{"_type":"span","text":"That’s my point.","_key":"Q4Z35Naq"}]},{"children":[],"_type":"block","style":"normal","_key":"9Hdh77hj","markDefs":[]},{"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"aB33Edmq","_type":"span"},{"_type":"span","text":"People tend to agree with you a lot. Have you noticed that?","_key":"SYYpihG6"}],"_type":"block","style":"normal","_key":"gWArM8gc","markDefs":[]},{"_key":"uU7boC7N","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"YbcQEWjp","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"HL7Piyl7"},{"_type":"span","text":"It currently is not a quality measure.","_key":"JNXPdBBa"}],"_type":"block"},{"style":"normal","_key":"VHMm9Plv","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"UmEZzZma"},{"_type":"span","text":"But it should be, yes?","_key":"jxey37C3"}],"_type":"block","style":"normal","_key":"MgyQcNt7"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"AVaCg3bA"},{"_type":"block","style":"normal","_key":"9oJDTxfX","markDefs":[],"children":[{"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"EeB8dcIn","_type":"span","marks":["strong"]},{"_key":"BsskwojD","_type":"span","text":"Certainly, there are many things that should be quality measures, unfortunately they’re limited at this point."}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"SRH0O1bC"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"vqknz4GA"},{"_type":"span","text":"Well, if I may say to sum that up, looking at the patient should not be optional, and taking off the shoes and socks should not be optional, and reporting that in should be easy enough to do. 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share insight on the standardization of wound care, highlighting challenges in accessing evidence-based guidance.","_key":"Twj5OatK"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"py2Cuyzb","markDefs":[],"children":[]},{"_type":"block","style":"normal","_key":"ikl3t8Gb","markDefs":[],"children":[{"_type":"span","marks":["underline"],"text":"Transcript","_key":"G3Fp9zdi"}]},{"_type":"block","style":"normal","_key":"xAg9y9Nu","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"xckYRa74"},{"_type":"span","text":"What’s surprising to me is that there isn’t a central, focused standard of care. Someplace you can look and say, “Look, I’ve got this kind of an ulcer, here’s what everybody in this field as a consensus panel recommends.” Should there be? Should there be standardization for wound care? What guidelines are out there, and what do you like?","_key":"8rUSRy6k"}]},{"_key":"6OLhZnIG","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_key":"7RmTuatR","markDefs":[],"children":[{"text":"Michael T. Kazamias, MS, DPM: ","_key":"LUV7R4P7","_type":"span","marks":["strong"]},{"text":"There should be standardization.","_key":"HGNAzcsJ","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"HitwGkhj","markDefs":[],"children":[]},{"style":"normal","_key":"y0XIJaSG","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"AObL9etY"},{"_type":"span","text":"There should be.","_key":"sS9nnRA2"}],"_type":"block"},{"_type":"block","style":"normal","_key":"oo3EEFXi","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"h8c5z6nP"},{"_type":"span","text":"There should be.","_key":"I6bGVSth"}],"_type":"block","style":"normal","_key":"LgxTJwGi"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"jLpq7WWn"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"HM6Bntkg"},{"_key":"BOVC9DPu","_type":"span","text":"There absolutely should be. And here’s the good news: they’re there. They’re out there."}],"_type":"block","style":"normal","_key":"txYh32Dw"},{"_key":"MOOqvjfB","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"FmZvxMj8","markDefs":[],"children":[{"_key":"fCiw40Mv","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"text":"Where? Where?","_key":"szQYaxvl","_type":"span"}]},{"_key":"jZEi4eVR","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"flmo8RD5","markDefs":[],"children":[{"_key":"bdjuyk3e","_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: "},{"_type":"span","text":"The centers of excellence, the wound care centers, the home care agencies, the risk groups that manage these particular patients effectively. The challenge is, there isn’t—let me back up and see if I can clarify it a little more.","_key":"qALjVOgA"}]},{"_key":"foRySN8O","markDefs":[],"children":[],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"6PgNlb92"},{"_type":"span","text":"Sure. If you say they’re there, and I go look for them and I can’t find them, they’re effectively not there.","_key":"PLkzROcK"}],"_type":"block","style":"normal","_key":"NGJFgXQj","markDefs":[]},{"_key":"WqVm1wcH","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"D3r7TR6x","_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: "},{"text":"It’s there because when you’re treating chronic conditions, the mechanisms for doing that in our healthcare delivery system are well established. The only thing that hasn’t been plugged into that as a skin, is wound care. Chronic wound care has not been treated that way. If we were able to carve it out as an entity, the centers of excellence and the protocols that are established by doctors like Dr Robert Snyder in his center and care centers all over the country, once those are aggregated and plugged into a delivery system that is accessible to the provider and the caregiver with the staffing of the health plan and the payer groups that are integrated into that care continuum, it exists. It’s all out there.","_key":"4mIOJb6a","_type":"span"}],"_type":"block","style":"normal","_key":"07lLWi0E"},{"style":"normal","_key":"Sr70YHG2","markDefs":[],"children":[],"_type":"block"},{"style":"normal","_key":"5lO7jDoz","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"YACWlkxE"},{"_type":"span","text":"It was a very quick answer to see if they’re there, but then you went on to say why it’s probably not easy to find it and why it’s not there. And so?","_key":"ngQT2Z1F"}],"_type":"block"},{"style":"normal","_key":"MfMrLRSj","markDefs":[],"children":[],"_type":"block"},{"children":[{"_key":"s0Fc5Dxw","_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: "},{"_key":"u4cYltPm","_type":"span","text":"There’s no quarterback."}],"_type":"block","style":"normal","_key":"C7GSuU2q","markDefs":[]},{"_type":"block","style":"normal","_key":"J1Tz4z3M","markDefs":[],"children":[]},{"style":"normal","_key":"7cTkP5c4","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"0qcKU3dE"},{"_type":"span","text":"If a plan exists in a forest but nobody can access it, does it exist?","_key":"aOVGF7Ra"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"co3M5oHI"},{"_type":"block","style":"normal","_key":"LA3TX7Vh","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"Uw9e1k13"},{"_type":"span","text":"It is accessible. It is something that is available to everyone, particularly with the Internet, etc. One of the main reasons—besides the economic drivers\u0026mdash;that hospitals coordinate with companies that will manage their centers is that 1 of those components is they will supply appropriate algorithms that are evidence based. So they can train those physicians working and clinicians of all kinds working in those centers to try to stay within those guidelines. Guidelines are nothing more than guides. Every patient is different. Additionally, many different clinicians are transitioning to wound management from other fields. They have been treating wounds in a particular way for 20 years. It’s very difficult to retrain those individuals to the appropriate protocols.","_key":"NDC6hHxS"}]},{"children":[],"_type":"block","style":"normal","_key":"chHBqWNn","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"3MaqZ7rP"},{"_type":"span","text":"You get back to, “Damn it, Jim. I’m a doctor, and I know what I’m doing, Jim!”","_key":"QsucaWCD"}],"_type":"block","style":"normal","_key":"3eqii1aH"},{"_type":"block","style":"normal","_key":"JVHHwwgx","markDefs":[],"children":[]},{"_key":"UWPsQZ2e","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"aTCJf7K0"},{"_type":"span","text":"I’ve done it this way for 20 years, and I understand what you’re saying. But this is the way I treat it.","_key":"FDqZPoJJ"}],"_type":"block","style":"normal"},{"style":"normal","_key":"r2H7HNm8","markDefs":[],"children":[],"_type":"block"},{"_type":"block","style":"normal","_key":"uY3xyQj6","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"mSrGivLB"},{"_type":"span","text":"Walk me through this for a second, because I really want to parse this out. I know what you said. I know that you said that if you look for it and if you think about it, there is a way to approach these things.","_key":"oOKJxVON"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"GYytLgpC"},{"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"8b8Xmzng"},{"text":"Well, from a practical perspective, if Dr Snyder has vast experience in treating wounds, he’s treated tens of thousands of diabetic wound care patients. When 1 walks into his facility, he has a very good idea after doing his appropriate evaluation on how that patient is going to respond to the treatment he recommends, his protocols. The challenge is the primary care physician who is going to see that patient in 2 weeks doesn’t.","_key":"YVFxFWGu","_type":"span"}],"_type":"block","style":"normal","_key":"Ihtp2CBL","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"iY1Uuxdq"},{"markDefs":[],"children":[{"text":"Peter L. Salgo, MD: ","_key":"oaGyc9hM","_type":"span","marks":["strong"]},{"_type":"span","text":"That’s my point.","_key":"VMrGZ6cC"}],"_type":"block","style":"normal","_key":"qctTS6Le"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"E9b5kyMZ"},{"_type":"block","style":"normal","_key":"Ue0FH5dW","markDefs":[],"children":[{"_key":"kyh2o2oT","_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: "},{"text":"However, if there were a risk-bearing entity that carved wound care out as a chronic condition, that could access those protocols with technological—and this is sort of a future look, but it can be done because it was done.","_key":"CMxL1hVR","_type":"span"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"SX8woZHs"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"uTPcVFdU"},{"_type":"span","text":"Again, future looks, subjunctive text. Right now, I’m Joe Doc or Jane Doc. Someone comes into my office, and I really want to do this right. There is a wound, I want to pay attention to it, I had the patient take his shoes and socks off, and I see this wound. I’m looking for the path, and I want a codified easy-to-find protocol. Can I find it?","_key":"qCGYSGEg"}],"_type":"block","style":"normal","_key":"YzFmMPO2"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"lPSq8QkJ"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"nnSz4iVE"},{"_type":"span","text":"You can find it, but my opinion is, that if a doctor who does not have an expertise in wound management, particularly in the diabetic population, then that patient should be referred. This is my own opinion.","_key":"LBLylK59"}],"_type":"block","style":"normal","_key":"LowK60Lm"},{"style":"normal","_key":"N0bbvFwG","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"kqnaGNBY"},{"text":"Not everybody is going to be referable to a wound center.","_key":"FWFSATYl","_type":"span"}],"_type":"block","style":"normal","_key":"fNYK3DfU"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"jlBXrhsi"},{"style":"normal","_key":"l6EEMHdC","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"qjBTIXXx"},{"_type":"span","text":"Not necessarily a wound center, but perhaps someone in your community [who] has more of an expertise in that area than you do.","_key":"xUc7sdw6"}],"_type":"block"},{"style":"normal","_key":"JUJzY2Hq","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"grMMLv2f"},{"_type":"span","text":"Correct me if I’m wrong, but you’re suggesting that at these centers of excellence, they have established themselves a protocol.","_key":"mbAmGDCU"}],"_type":"block","style":"normal","_key":"uOAGcy2F"},{"children":[],"_type":"block","style":"normal","_key":"tRnYunmQ","markDefs":[]},{"style":"normal","_key":"FPGb5Uwl","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"rpDWcM7p"},{"_type":"span","text":"Correct.","_key":"FXJqRbAG"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"4d1OsvUe"},{"_type":"block","style":"normal","_key":"8XFyQabH","markDefs":[],"children":[{"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"hTz0W2Qc","_type":"span","marks":["strong"]},{"_type":"span","text":"That works for them.","_key":"6ip77hpg"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"Zt9KJ05N"},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"7hULYOXA"},{"_type":"span","text":"Correct.","_key":"45PSZPaO"}],"_type":"block","style":"normal","_key":"jxyyBUNI","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"ndBLrqfe"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"D6yK1Box"},{"_type":"span","text":"I think what you’re getting at is that protocol is not supported by a society and placed out there for acceptance for all practicing physicians in different fields.","_key":"JUkhxFpw"}],"_type":"block","style":"normal","_key":"ea7ViYxD"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"aLEI5aCS"},{"_type":"block","style":"normal","_key":"noqtRE0Y","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"HqabQPCK"},{"_type":"span","text":"I feel so much better.","_key":"QbmGtQ2H"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"KBxOWNCf"},{"children":[{"_key":"eSxk3H4A","_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: "},{"_type":"span","text":"Right?","_key":"gTVIw20V"}],"_type":"block","style":"normal","_key":"h5BoftMp","markDefs":[]},{"_type":"block","style":"normal","_key":"adxazQah","markDefs":[],"children":[]},{"style":"normal","_key":"R0S6mWHE","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"3fiR2mMm"},{"_key":"LA1UshUH","_type":"span","text":"Yes. I know you guys know what you’re doing."}],"_type":"block"},{"children":[],"_type":"block","style":"normal","_key":"PzLcpplm","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"kXAxybI8"},{"_key":"uK7NgKUv","_type":"span","text":"There’s not an American academy of wound care."}],"_type":"block","style":"normal","_key":"1ZoJGAU3"},{"_type":"block","style":"normal","_key":"9jHhsaZj","markDefs":[],"children":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Michael T. 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If they went to the center of excellence, the discharge orders would follow that patient because we would coordinate the care, we would forward those protocols to the home care agency so everyone was on the same page with those appropriate care protocols.","_key":"vcB09aBy"}],"_type":"block","style":"normal","_key":"HcYMbivh","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"eZyMSOay"},{"style":"normal","_key":"WqXLcm57","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"CHjHUyMH"},{"_type":"span","text":"I don’t want you to have the wrong impression. There are societies—wound related, dermatologic related, podiatric related\u0026mdash;that have established validated protocols that are available. Very often they’re very complex.","_key":"DnSTYi54"}],"_type":"block"},{"children":[],"_type":"block","style":"normal","_key":"CeYNbL02","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"NsTD9luM"},{"_type":"span","text":"That’s my question. I mean, lots of protocols to me equates to no protocols. Complicated protocols to me equates to no protocols.","_key":"6vVn53VD"}],"_type":"block","style":"normal","_key":"bejUmmxK"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"be7aBF6L"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"xJoBxqeg"},{"_type":"span","text":"If we only had 1.","_key":"FmW58GAW"}],"_type":"block","style":"normal","_key":"VqGNIJE4"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"4CcIk1rI"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. 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If you don’t know how to put on a total-contact cast, find someone who does know and learn the technique. Those tools are out there. It’s just a matter of those individuals who wanted to have access to them.","_key":"AwdtlK5U"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"ZyGvJmgc"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"Wm84EHBZ"},{"_type":"span","text":"Is that too simple? I caught a little no from you when he was talking.","_key":"ygD5TYSq"}],"_type":"block","style":"normal","_key":"7EynQNqB"},{"style":"normal","_key":"rYtKAgJm","markDefs":[],"children":[],"_type":"block"},{"_type":"block","style":"normal","_key":"1oGbfzlm","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. 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Salgo, MD: ","_key":"HkEFaFbC"},{"_type":"span","text":"Does a payer prefer a patient to be seen at a wound care center, or an ER [emergency department], or a DPO [designated provider organization], or some sort of outpatient setting? Where is the sweet spot today for a payer?","_key":"2iMuruBF"}],"_type":"block","style":"normal","_key":"OcjcfZvn","markDefs":[]},{"children":[],"_type":"block","style":"normal","_key":"TaClbRJJ","markDefs":[]},{"_type":"block","style":"normal","_key":"aVyCJPFg","markDefs":[],"children":[{"_key":"4DsV7yqI","_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: "},{"text":"I would say there isn’t any. Do you know of a sweet spot?","_key":"ikAPriz9","_type":"span"}]},{"style":"normal","_key":"QM8gpwC7","markDefs":[],"children":[],"_type":"block"},{"_type":"block","style":"normal","_key":"3j8KfDMX","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"TqdXbCnY"},{"_key":"se0BaCGj","_type":"span","text":"No. Again, my “depends” answer is again coming up."}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"KW7hL4Oo"},{"_key":"f24FpnaA","markDefs":[],"children":[{"text":"Peter L. Salgo, MD: ","_key":"08sdNjD2","_type":"span","marks":["strong"]},{"_key":"2AAooL7b","_type":"span","text":"You’ve got to rubber-stamp that."}],"_type":"block","style":"normal"},{"_key":"y12kpmAp","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_key":"0Pz4iKVp","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"tjjvgWC6"},{"_type":"span","text":"It really depends on the payer. It depends on the gatekeeper. If the gatekeeper is capitated and understands the dynamics and the importance of this, and knows that if the patient is seen by the right clinician at a wound care center, then the cost will actually be less than it would be if the patient didn’t go to that center. That patient will likely be referred there. Others may not be as well versed in this topic. They’ll flatly refuse things like hyperbaric oxygen, as an example, because they “don’t believe in it,” as if it’s a religion.","_key":"zTuzGgMs"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"R5oC4j37","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_key":"abD51KyH","_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: "},{"_type":"span","text":"Here’s an area in which the product manufacturers can bring some very interesting technologies to bear in order to leverage the capabilities of what we would call the centers of excellence—like an outpatient wound care center\u0026mdash;into the community, where the home health agency can have technologically enhanced capabilities in order to access a center of excellence’s protocols for wound management. And the attendant costs go down.","_key":"YQ68ycD9"}],"_type":"block","style":"normal","_key":"rjoqxr0K"},{"children":[],"_type":"block","style":"normal","_key":"R1vyt1Yu","markDefs":[]},{"style":"normal","_key":"sjayyyIy","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"1TBLiB60"},{"_type":"span","text":"One other thing to add, and that’s the continuum of care. I think what tends to happen is, particularly if a patient is hospitalized with a serious problem—let’s say an infection or even sepsis and then is discharged\u0026mdash;very often they fall into a black hole somewhere. They’re not really seen by a specialist.","_key":"fpQcaA6M"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"276ZYh9h"},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"5wLqKsNe"},{"_type":"span","text":"I fixed their sepsis—come on!","_key":"LV2MIMsD"}],"_type":"block","style":"normal","_key":"7mvPr9xY","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"waxlqngQ"},{"_type":"block","style":"normal","_key":"zCOj5gBp","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"fKXb1Fk2"},{"_type":"span","text":"That’s a big problem.","_key":"F4EDj0rj"}]},{"children":[],"_type":"block","style":"normal","_key":"JNXjXaE4","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"Gjlups8W"},{"_type":"span","text":"Well, it’s a good point. A lot of times, many stage IV patients who are the costliest comparatively and from an acute perspective, by definition can’t get to an outpatient wound care center with enough reliability to be able to establish an appropriate treatment protocol.","_key":"hdQBl3Zr"}],"_type":"block","style":"normal","_key":"I7N101rc"},{"style":"normal","_key":"YgZrSNJ3","markDefs":[],"children":[],"_type":"block"},{"_type":"block","style":"normal","_key":"7qClJX7t","markDefs":[],"children":[{"text":"Peter L. Salgo, MD: ","_key":"Qqs2mXMZ","_type":"span","marks":["strong"]},{"_key":"JdwFxXQd","_type":"span","text":"Their pseudomonas went away."}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"WMxHSQtb"},{"markDefs":[],"children":[{"marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"IGLYx5qe","_type":"span"},{"_type":"span","text":"Exactly.","_key":"jMqPPugY"}],"_type":"block","style":"normal","_key":"PfpA4J8d"},{"children":[],"_type":"block","style":"normal","_key":"ZHEwu2Ii","markDefs":[]},{"style":"normal","_key":"bAHy90rC","markDefs":[],"children":[{"text":"Peter L. Salgo, MD: ","_key":"7NP5Amzt","_type":"span","marks":["strong"]},{"_type":"span","text":"It’s gone. We fixed it.","_key":"aZ9fszPz"}],"_type":"block"},{"_key":"DeWECZQn","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"YevD7sBq"},{"_type":"span","text":"But the hole didn’t.","_key":"kl5CeU3Q"}],"_type":"block","style":"normal","_key":"Mwg1WByK"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"zKvB18pN"},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"Zn7FhHJi"},{"_type":"span","text":"But the hole through which it entered remains.","_key":"qj6nGQkk"}],"_type":"block","style":"normal","_key":"KBOL8osG","markDefs":[]},{"style":"normal","_key":"TdxXG1a3","markDefs":[],"children":[],"_type":"block"},{"_key":"GwV4LkW9","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"UBZ4K7ci"},{"_type":"span","text":"Correct.","_key":"sgVbnEda"}],"_type":"block","style":"normal"},{"_key":"OKvYVnl0","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"fybKvUqc","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"ggedB8TU"},{"_type":"span","text":"Right. We don’t treat just the hole; we treat the whole patient.","_key":"kynl4SdN"}],"_type":"block"},{"children":[],"_type":"block","style":"normal","_key":"1777nJkP","markDefs":[]},{"markDefs":[],"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"k7OAZknr","_type":"span"},{"_type":"span","text":"If there is a managed care approach to this in which a managed care organization standardized care, first of all, I can’t believe I’m speaking well of this, because most doctors beat managed care organizations over the head. Does that make sense to you that this managed care organization is going to mandate that a patient, who had a hole and had a sepsis, gets the hole fixed or tended to as well? Does that make sense?","_key":"UzAeTc3c"}],"_type":"block","style":"normal","_key":"AaHnVvHz"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"fpFJg2SL"},{"_type":"block","style":"normal","_key":"IMyhzyYs","markDefs":[],"children":[{"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"hFhVzcku","_type":"span","marks":["strong"]},{"_type":"span","text":"It certainly makes sense. Whether or not it would happen, from what I know about how most managed care organizations think and function, I’m not sure. However, It certainly makes sense.","_key":"fyMJEbkg"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"P55AkZUB"},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"ifkiALuO"},{"_key":"69GWIUaG","_type":"span","text":"By the way, I’d like to point out. You did say the managed care organizations do think."}],"_type":"block","style":"normal","_key":"7ET66OSk","markDefs":[]},{"_type":"block","style":"normal","_key":"EJnKFbO2","markDefs":[],"children":[]},{"markDefs":[],"children":[{"marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"bcX0rXJx","_type":"span"},{"_type":"span","text":"To that point, maybe they haven’t looked at it correctly because of the conditions that can beset Medicare beneficiaries. We talked earlier about how a chronic wound is up in the top 5 for cost-ratio reimbursement. In other words, they get a higher bump in their risk adjustment. It’s 1 of the only conditions that can be healed in a reasonable period of time. In other words, let’s say an HCC [hierarchical coexisting condition] is in the area of ventilator dependency, which is really close to where a chronic wound is. Think about that: ventilator dependency, according to Medicare, costs about as much as a chronic wound.","_key":"1PVT96qb"}],"_type":"block","style":"normal","_key":"KMA95BpR"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"saJIPdJZ"},{"markDefs":[],"children":[{"_key":"jPhcoZKD","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"_type":"span","text":"That’s huge.","_key":"HRP5lDnF"}],"_type":"block","style":"normal","_key":"rZOEzA9e"},{"_key":"7oIbTNqO","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"uTxTHffE","markDefs":[],"children":[{"marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"VCEouhJY","_type":"span"},{"_type":"span","text":"Can you heal or can you otherwise—what is the percentage of patients who can be healed on ventilator dependency versus those who can be healed appropriately through standardization of treatment protocol and all the other advantages we can consolidate? All the tools are there. And if they’re consolidated, and you heal a wound in a 90-day period of time, there’s an incentive for that managed care company to be able to cut that cost. It’s 1 of the few areas that can quantifiably be cut.","_key":"ZNvJuc6n"}],"_type":"block"},{"children":[],"_type":"block","style":"normal","_key":"rkdd7Gfo","markDefs":[]},{"_key":"KGln8PPo","markDefs":[],"children":[{"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"JEFW2Sbj","_type":"span","marks":["strong"]},{"_type":"span","text":"The second part of that equation is to prevent the rate of recidivism as well. Once those wounds heal, if the patient is not compliant—or concordant, as we like to call it now\u0026mdash;or their disease…","_key":"GypiT1IZ"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"N7jpUBvE"},{"_type":"block","style":"normal","_key":"p15BYtEb","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"aP5w6If0"},{"_type":"span","text":"Is that really the PC [politically correct] phrase for ","_key":"aeEpyBkh"},{"_type":"span","marks":["em"],"text":"compliant","_key":"A7CLkpcZ"},{"_type":"span","text":"? ","_key":"VnQHVawx"},{"marks":["em"],"text":"Concordant","_key":"hW9qMLN4","_type":"span"},{"_key":"paY1qybU","_type":"span","text":"?"}]},{"children":[],"_type":"block","style":"normal","_key":"kRFuHVAJ","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"2radf9b1"},{"_type":"span","text":"Yes.","_key":"WtXwg3jx"}],"_type":"block","style":"normal","_key":"pw7K8sIp"},{"_key":"TT6YZFHG","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"gxMbtUgt","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"kMRT5s7j"},{"_type":"span","text":"OK, I just wanted to ask.","_key":"MmsgI2HI"}],"_type":"block"},{"children":[],"_type":"block","style":"normal","_key":"UmESRXD6","markDefs":[]},{"_key":"vtLY4IEJ","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"x1a7ZAH9"},{"_key":"Dr7OQtxO","_type":"span","text":"It’s an interesting point, because I base my entire career on this. One of the sobering things that I heard from a medical director was—we always try to close the wound, close the wound, close the wound. So I was on the phone with 1 of the managed care medical directors, and I said, “You know, doc, I wasn’t able to completely bring this wound to closure.” And he said, “Mike, since you’ve been treating this patient according to the model that I had set up, this patient has not been readmitted to the hospital in an entire year. I don’t care if you ever heal that patient.” That patient has been stabilized, they haven’t had an infection, their quality of life has improved, and they haven’t been serially readmitted to the hospital. That is a positive outcome. That patient may never heal."}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"MEaHN07A"},{"style":"normal","_key":"Q12hVVR0","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"HU7JOCES"},{"_key":"Q3J2Int1","_type":"span","text":"For them."}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"tjfn0zE2"},{"_type":"span","text":"The patient may never heal. We’ve seen those for whom they closed it 90%. However, if we as physicians can keep them in a stabilized state—and that wound does not present itself with other life-threatening comorbidities\u0026mdash;I would think from a quality-of-life perspective, if the patient is doing better, the entire system does better.","_key":"uQvoajI1"}],"_type":"block","style":"normal","_key":"YB7AlIso"},{"_key":"o5AGAyCv","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"bL03okJ1"},{"_type":"span","text":"Having a realistic expectation of whether that will occur, those individuals who really understand wound management as a profession can kind of gauge whether this wound has the likelihood of healing and whether we can stabilize.","_key":"hpnSwBKn"}],"_type":"block","style":"normal"},{"style":"normal","_key":"hJXtu1qx","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"plodIiJe"},{"text":"There is a subtext to your story, which is you to say paid attention to the wound. That is it say, regardless of whether that wound closed, that patient got seen on a regular basis and got attended to, and the wound got cleaned and infected material got removed, coordinated care.","_key":"MQH031tP","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"U7HFp253"},{"_type":"block","style":"normal","_key":"9OClzdCK","markDefs":[],"children":[{"text":"Michael T. Kazamias, MS, DPM: ","_key":"snTEh4er","_type":"span","marks":["strong"]},{"_type":"span","text":"It was treated like a chronic condition. There were case managers at the health plans who were looking at what we were doing. We gave them access to electronic medical records, so everyone on the treatment team could see what’s happening with that patient. If an order came in for a low-air-loss mattress or some other modality, there wouldn’t be a delay, an artificial delay in treating that patient.","_key":"VMvEY73M"}]},{"children":[],"_type":"block","style":"normal","_key":"KMDVLT5i","markDefs":[]},{"_key":"Dm2rr7Q5","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"stBaFkTq"},{"_type":"span","text":"So that continuum of care versus what we commonly refer to as siloed care, where individuals are coming in, doing what they do, no communication, they’re leaving and so be it, and call me when you need me again. Which normally will be the case.","_key":"Sm6F0Wya"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"ueJvqBYc"},{"_key":"U7rK1Rs0","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"jaCmDqLi"},{"_type":"span","text":"Thank you for the opportunity to assist in the care.","_key":"eNjdmGx7"}],"_type":"block","style":"normal"},{"_key":"UsaWhazC","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_key":"1Zuwua9e","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"oZ9E1bWd"},{"_type":"span","text":"That’s correct. The continuum of care is extraordinarily important.","_key":"v1Ittnjy"}],"_type":"block","style":"normal"},{"children":[],"_type":"block","style":"normal","_key":"CFK4F2Ya","markDefs":[]},{"markDefs":[],"children":[{"_key":"DYwg459n","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"_type":"span","text":"Avoid hypoxia and hypotension is usually in that note too, right?","_key":"8HTirlDQ"}],"_type":"block","style":"normal","_key":"ovLnqVsN"},{"style":"normal","_key":"QSijr9PR","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"8Hv3sKYV","_type":"span","marks":["strong"]},{"_type":"span","text":"That’s correct.","_key":"hu5bfyD1"}],"_type":"block","style":"normal","_key":"LfGwD1Qu"},{"style":"normal","_key":"JaJgjSIP","markDefs":[],"children":[],"_type":"block"},{"style":"normal","_key":"T1E9AouT","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"kWkIhgDc"},{"text":"The major hang-up in this coordination of care is the transmission of the right trigger, which are the claims data. Unfortunately, managed care has the same issue that Medicare does in recognizing what’s driving the healthcare cost. If the claim doesn’t come through primarily as a wound or a wound-related issue, that coordination of care may never be triggered at the health plan level.","_key":"RrywWpWC","_type":"span"}],"_type":"block"},{"_type":"block","style":"normal","_key":"hrHfpwO4","markDefs":[],"children":[]},{"_key":"2erlIbjq","markDefs":[],"children":[{"_key":"dEoypiGf","_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: "},{"text":"It might not be triggered. That’s a very good point that you bring up. What we did was we were assisting the health plans in their data mining by looking at inferences, similarly in the way they capture MRA [magnetic resonance angiogram]. We’re looking at inferences as to what would the most probable inciting diagnosis be for this admission. Then they start getting better granularity on the costs. Some of the health plans we worked with found out that their PMPM [cost per member per month] for wound management, when the totality was taken into account—from home health, to podiatry networks, to surgical networks, to outpatient wound care centers\u0026mdash;when that was added up, the PMPM approached cardiology.","_key":"QTc1JFzB","_type":"span"}],"_type":"block","style":"normal"},{"_type":"hrtag","_key":"FQZivS81kM"}],"url":{"current":"wounds-managed-care-organizations-and-coordinated-care","_type":"slug"},"_updatedAt":"2021-05-20T01:19:50Z","documentGroup":{"_type":"reference","_ref":"media_series_article_peer-exchange_deeper-understanding-of-wound-care"},"title":"Wounds: Managed Care Organizations and Coordinated Care","_type":"article","documentGroupMapping":[{"_type":"reference","_key":"KiNYAizMB","_ref":"media_series_article_peer-exchange_deeper-understanding-of-wound-care"}],"link":"/view/wounds-managed-care-organizations-and-coordinated-care"},{"published":"2019-12-16T19:00:10Z","taxonomyMapping":[{"parent":{"_ref":"15012229-f713-4f0a-8f82-7667530bb382","_type":"reference"},"_type":"taxonomy","identifier":"clinical","_createdAt":"2020-05-04T23:46:13Z","_rev":"HexDiduX8d6Nqnq1ECriVF","name":"Clinical","_id":"topic_clinical","_updatedAt":"2022-02-18T12:13:55Z","summary":[{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The ","_key":"e80c79954e08"},{"text":"AJMC","_key":"a8e0f75c5d05","_type":"span","marks":["em"]},{"_type":"span","marks":["superscript"],"text":"®","_key":"f7d4dddf7edd"},{"marks":[],"text":" clinical page includes all the published content across AJMC.com, ","_key":"0f03d46e3b3a","_type":"span"},{"_key":"cc409f2da7da","_type":"span","marks":["em"],"text":"The American Journal of Managed Care"},{"marks":["superscript"],"text":"®","_key":"2babb3e59bb3","_type":"span"},{"_type":"span","marks":[],"text":" and ","_key":"d86a5bb12052"},{"text":"Evidence-Based Oncology","_key":"40b2eaba6c17","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":"™ on a variety of specialties, including dermatology, cardiology, oncology, and rheumatology.","_key":"b59bef533cdf"}],"_type":"block","style":"normal","_key":"dd8ad578cd0b"}]},{"_createdAt":"2020-05-04T23:46:13Z","_rev":"GQ2iWOdzjKwgYpKUFVt5oL","_type":"taxonomy","name":"Insurance","_id":"topic_insurance","_updatedAt":"2020-07-30T14:47:46Z","identifier":"insurance","parent":{"_ref":"15012229-f713-4f0a-8f82-7667530bb382","_type":"reference"}}],"documentGroup":{"_ref":"media_series_article_peer-exchange_deeper-understanding-of-wound-care","_type":"reference"},"_createdAt":"2021-05-14T18:01:24Z","seoTag":["Peer Exchange","wound","clinical","treatment","providers","managed care","claims","patient","healthcare","financial","medicare"],"title":"Evaluating the Cost of Wound Care Driven by Comorbidities","url":{"current":"evaluating-the-cost-of-wound-care-driven-by-comorbidities","_type":"slug"},"_rev":"t0UqCH1GSwzWjCsM0qU5MJ","_type":"article","body":[{"_type":"youtube","_key":"xFfSMu4xi","url":"https://www.youtube.com/embed/Pr7OOTAR8Do?rel=0\u0026fs=0"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"rCOOMYWi"},{"_type":"block","style":"normal","_key":"nblNXPtO","markDefs":[],"children":[]},{"children":[{"text":"Specifics on the cost of wound care driven by comorbidities such as diabetes, peripheral vascular disease, and neuropathies.","_key":"WA88Kglo","_type":"span"}],"_type":"block","style":"normal","_key":"KvsfTZqd","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"tRRwHlc2"},{"children":[{"_type":"span","marks":["underline"],"text":"Transcript","_key":"UedXXEoz"}],"_type":"block","style":"normal","_key":"5unZXh8L","markDefs":[]},{"markDefs":[],"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"WoCL0QJh","_type":"span"},{"text":"Let’s put some numbers on this then. Financial impact, if you will. Diabetic, foot ulcers, the impact of this problem to the nation. How big is it? How much does it cost?","_key":"ezHq26fx","_type":"span"}],"_type":"block","style":"normal","_key":"jnU7wWHQ"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"8xfrz7jn"},{"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"fOn1doE8"},{"_type":"span","text":"It is the major complication associated with diabetes generally. Diabetes can be well managed. There are many diabetic patients who never get a wound. If you want to ascribe a cost to diabetes, the wound is the primary driver.","_key":"2oiE45k6"}],"_type":"block","style":"normal","_key":"XRcmS1BJ","markDefs":[]},{"_key":"KtIhTwFd","markDefs":[],"children":[],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"p2g8aF7j"},{"_type":"span","text":"It’s the driver.","_key":"URgnw777"}],"_type":"block","style":"normal","_key":"xokNvsQW","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"3QOC2Jt6"},{"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"os2Dyoei"},{"text":"Absolutely. That’s what turns manageable diabetes into a very high cost center.","_key":"zyEgIcSk","_type":"span"}],"_type":"block","style":"normal","_key":"JWGtcbW3","markDefs":[]},{"children":[],"_type":"block","style":"normal","_key":"b5SfS7nf","markDefs":[]},{"children":[{"_key":"Ms555lCN","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"_type":"span","text":"That’s an important statistic to know. What about peripheral vascular disease [PVD] as divorced from diabetes. People have PVD without diabetes. How does the cost of that compare, for example, to diabetes?","_key":"WPwLfWS8"}],"_type":"block","style":"normal","_key":"nsKSsJZF","markDefs":[]},{"children":[],"_type":"block","style":"normal","_key":"KiASHhJz","markDefs":[]},{"style":"normal","_key":"JduXbr8I","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"SZU3ZA4S"},{"_key":"YmmZbT8h","_type":"span","text":"If it’s not appropriately diagnosed or appropriately managed, if there isn’t the ability to work with or see a vascular surgeon, it depends on the level of specialty care and what environment the patient is trying to navigate in, based on their particular circumstance, whether it’s a payer environment or not."}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"0v23ISzB"},{"_type":"block","style":"normal","_key":"S48HgcuZ","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"kXwgQt8v"},{"_type":"span","text":"I’m going to make a comment that may shock you.","_key":"NSx6MLX2"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"UsbBkeVM"},{"style":"normal","_key":"oOtzhyMF","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"ts9YVv1Q"},{"_key":"10qK7OJt","_type":"span","text":"I’m easily shocked apparently. I’ve been shocked a lot so far."}],"_type":"block"},{"_type":"block","style":"normal","_key":"BIoM3Fc1","markDefs":[],"children":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"pXz9HjAZ"},{"_type":"span","text":"Fifty percent of all diabetic patients who have non-traumatic amputations never have a vascular evaluation of any kind.","_key":"5jKnZxlu"}],"_type":"block","style":"normal","_key":"1hWQalrV","markDefs":[]},{"style":"normal","_key":"OazKhQsU","markDefs":[],"children":[],"_type":"block"},{"_type":"block","style":"normal","_key":"TMjgsDIQ","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"3vdcdIY4"},{"_key":"BdDe93nM","_type":"span","text":"I’m shocked. That’s insane."}]},{"style":"normal","_key":"P7Alqaj8","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"_key":"X6V5PAHS","_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: "},{"_key":"oPGQUfkY","_type":"span","text":"It shows you the range of how these patients can potentially be treated."}],"_type":"block","style":"normal","_key":"N0iJkQ1X"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"hP0NEdis"},{"markDefs":[],"children":[{"text":"Peter L. Salgo, MD: ","_key":"YEm62qbp","_type":"span","marks":["strong"]},{"text":"If I understand what you’re telling me, and I’m not trying to be facetious here. We have a disease. One of the major complications of this disease is vascular disease with poor perfusion to the distal extremities, and it’s a known offender in this regard. I’m speechless. It’s doesn’t happen very often, but I’m speechless.","_key":"ykamllZy","_type":"span"}],"_type":"block","style":"normal","_key":"vZn7ZFwj"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"PaXzn3De"},{"_type":"block","style":"normal","_key":"WIOJf62o","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"DyN95CUy"},{"text":"Something else to keep in mind, with the new endovascular techniques being so advanced and often so successful, it’s still shocking to me that so many people never have the ability to get to that specialist.","_key":"V3PtjBuG","_type":"span"}]},{"_key":"igrxsfG8","markDefs":[],"children":[],"_type":"block","style":"normal"},{"children":[{"_key":"YNdkHo7Z","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"_type":"span","text":"Nobody looks at their peripheral pulses?","_key":"28vuHP0J"}],"_type":"block","style":"normal","_key":"UErgQjoZ","markDefs":[]},{"_type":"block","style":"normal","_key":"YQgrYKr5","markDefs":[],"children":[]},{"_key":"ffGNdwHL","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"foywRXBz"},{"_type":"span","text":"I’m not saying nobody, but I’m saying 50%.","_key":"O0iMibjX"}],"_type":"block","style":"normal"},{"children":[],"_type":"block","style":"normal","_key":"ySLsRO6C","markDefs":[]},{"children":[{"text":"Peter L. Salgo, MD: ","_key":"M3uWJAm3","_type":"span","marks":["strong"]},{"_type":"span","text":"It’s rare, 50%.","_key":"AbkDwXXm"}],"_type":"block","style":"normal","_key":"qehC4NEt","markDefs":[]},{"children":[],"_type":"block","style":"normal","_key":"hAjPCocs","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"JUUoC7jJ"},{"_type":"span","text":"Fifty percent have never had a vascular evaluation of any kind, including an ankle-brachial index, nothing.","_key":"0nRibWSx"}],"_type":"block","style":"normal","_key":"dPA3lYaL"},{"_type":"block","style":"normal","_key":"zBdOSagb","markDefs":[],"children":[]},{"_key":"7ExNMRZR","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"rYhid9IB"},{"_type":"span","text":"Look at peripheral pulses, look at the skin color, look at capillary refill. They don’t do that?","_key":"Z2lFQroI"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"1evxFsUm"},{"_key":"BelXIIDH","markDefs":[],"children":[{"marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"fEzLypc1","_type":"span"},{"_type":"span","text":"Fifty percent of those patients don’t ever have a vascular examination.","_key":"eVHnULGL"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"WrdpX1pG","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"pzinM2s4"},{"_type":"span","text":"It makes me sad.","_key":"VUdV8rNX"}],"_type":"block","style":"normal","_key":"Sz2oydU4"},{"children":[],"_type":"block","style":"normal","_key":"SWDvBJVf","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"cUGzJWZG"},{"_type":"span","text":"This speaks to the segmentation issue in medicine. You go to this specialist for this treatment, and that specialist thinks within the specialty box and maybe doesn’t make the appropriate referral or think outside what other issues underlie this condition that I’m treating. We need to break this down, break the silos.","_key":"BvDUT4cj"}],"_type":"block","style":"normal","_key":"Zrwsiaaw","markDefs":[]},{"style":"normal","_key":"44NPGCtQ","markDefs":[],"children":[],"_type":"block"},{"style":"normal","_key":"JoefV9Ao","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"jxvuDEtU"},{"_type":"span","text":"We mentioned earlier specialists. Expanding on the point brought across by Dr Snyder, that specialist from a managed care perspective or from a payer perspective can be an organization. We talked earlier about carving out wound care as a chronic entity. If you establish an organization comprised of a multidisciplinary group of specialists in a risk-bearing entity where it is carved out, then you start bringing the advantages that managed care has brought to other chronic conditions where it’s better quarterbacked or better managed.","_key":"F78KVYq9"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"uVkB2MpE"},{"_key":"LDlVKsQ6","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"MDA45kTD"},{"_type":"span","text":"I had one other comment, you had mentioned….","_key":"2mkWq4uL"}],"_type":"block","style":"normal"},{"children":[],"_type":"block","style":"normal","_key":"OCmjS3fy","markDefs":[]},{"_key":"xlpAH5oG","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"25yV7hld"},{"_key":"qQ9Kra7U","_type":"span","text":"He keeps shocking me. Please bring it on."}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"Mz3SrFjA","markDefs":[],"children":[]},{"_type":"block","style":"normal","_key":"xel5Qc2O","markDefs":[],"children":[{"_key":"sLujLmAp","_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: "},{"_type":"span","text":"You had mentioned peripheral arterial disease. I’m doing some work with the Critical Limb Ischemia Association, and we’re looking at creating a checklist for the generalist to make sure that an appropriate referral is made. As you know, checklists have to be very specific and very short so that they’re easily used and comprehended.","_key":"5q4y0NSZ"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"5myrZlj9"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"qbHlTkT5"},{"_key":"A23oi48j","_type":"span","text":"Or they’re driven by the EMR [electronic medical record] and they’re annoying. So go ahead."}],"_type":"block","style":"normal","_key":"1VcmggcF"},{"_key":"rqkyHr1q","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_key":"3cSo036y","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"YJHLmUYT"},{"_type":"span","text":"In this case, we’re trying to keep it medically oriented. The point that I’m going to tell you is, the first question is, did you take the patients’ shoes and socks off? It gets that rudimentary.","_key":"Ugrc08D5"}],"_type":"block","style":"normal"},{"style":"normal","_key":"1QCEYLYU","markDefs":[],"children":[],"_type":"block"},{"children":[{"text":"Peter L. Salgo, MD: ","_key":"15KcY080","_type":"span","marks":["strong"]},{"_key":"jgpAWgX3","_type":"span","text":"Really?"}],"_type":"block","style":"normal","_key":"3hxuHO9o","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"CzJ2z6Yf"},{"style":"normal","_key":"hrmXDiU5","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"sG4jm4Ot"},{"_type":"span","text":"In many clinicians’ offices who are practicing general medicine, either they’re not even addressing the patient, or if they do, they tell them to strip to their shoes and socks. They don’t even evaluate their lower extremities.","_key":"uOpXx1CT"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"lx4ZipMF"},{"_key":"yZxnr2PJ","markDefs":[],"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"dNRHOxaq","_type":"span"},{"_type":"span","text":"The pun is so obvious. They’re not just addressing the patient, they’re failing to undress the patient.","_key":"vd8FeBCd"}],"_type":"block","style":"normal"},{"children":[],"_type":"block","style":"normal","_key":"RiXNdnt0","markDefs":[]},{"_key":"QDaQOeKi","markDefs":[],"children":[{"_key":"ul8Ptr9m","_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: "},{"_type":"span","text":" It shows you how simplistic we really have to get.","_key":"q2U5ocnA"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"WA7JctBw"},{"style":"normal","_key":"7PBxbERw","markDefs":[],"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"40CKVkIm","_type":"span"},{"_type":"span","text":"It’s rudimentary, isn’t it? I know we’ve discussed this. Why doesn’t somebody lay out the hidden costs of wounds caused by these comorbidities, other than treating the injury itself. Where are the hidden costs centers to America?","_key":"6YHETZ6v"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"UJ8bO7kP"},{"_type":"block","style":"normal","_key":"Ik5FY8yC","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"seaFbPo0"},{"_key":"3zyEyI8J","_type":"span","text":"Well, we talked earlier about the bureaucratic cost."}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"C0ZoQB5O"},{"style":"normal","_key":"0XcKoG07","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"lbyiY2us"},{"_type":"span","text":"I really love that comment.","_key":"uwZo8oWb"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"PHDNGLJ5"},{"style":"normal","_key":"LH1yFmcm","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"uTzTmWIA"},{"_type":"span","text":"The cost of treating the wound. There’s the physiological time, which incidentally is very hard to pin down. If you were to look up what is the length of time that it takes to heal a stage 4 pressure ulcer, the literature is varied. There’s a consensus that it takes over 120 days. Now, is that 120 days a physiological reason for why the wound can’t heal? We accept it, wow, these take a long time. But what happens is, and I think we’ll get to this in subsequent questions, is the industry as a whole or medical care as a whole is firmly established in establishing a chronicity over a 30-day period of time for that wound. Then we start looking at other “high-cost modalities” to bring them in as magic bullets.","_key":"dEvGS516"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"IiIptrjn"},{"_key":"lAkvTKCH","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"KzxnscYt"},{"_type":"span","text":"In other words, they have to meet that threshold to get the money.","_key":"FnB9LLFQ"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"8RQ8FlBF"},{"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"zW3mgtny"},{"text":"The cost versus time matter in determining what it takes to heal a wound. If a home care agency identifies a wound, a pressure ulcer that requires a low-air-loss mattress, it can take 2 weeks to be able to get that order or that indication to the gatekeeper’s desk, to the provider for actionable information. In our work, we found out that we could heal the vast majority of wounds in under a 90-day period, and it had nothing to do with using magic bullets. What it had to do with was proper coordination of care and cutting out the red tape. Now, what’s that cost?","_key":"Wuh8cwFE","_type":"span"}],"_type":"block","style":"normal","_key":"VyGRjYTf","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"gEvTzfpO"},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"LW4nxu3K"},{"_type":"span","text":"It’s not to anyone’s advantage.","_key":"Hvd6Pjvv"}],"_type":"block","style":"normal","_key":"HGSflyPC","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"hRkN2gyY"},{"_type":"block","style":"normal","_key":"I1qY35Y2","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"5TVJmdhp"},{"_type":"span","text":"Something else to keep in mind, there is some good evidence that shows that the earlier you institute any kind of advanced therapy, the better the patient will do.","_key":"LwxwtyYJ"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"KsSDV1zC"},{"children":[{"_key":"YLziu8jR","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"text":"Doesn’t that fall under the duh category?","_key":"gG7IqOku","_type":"span"}],"_type":"block","style":"normal","_key":"vGlSLLAM","markDefs":[]},{"children":[],"_type":"block","style":"normal","_key":"xt1f6Wqr","markDefs":[]},{"markDefs":[],"children":[{"text":"Michael T. Kazamias, MS, DPM: ","_key":"nANTFJSa","_type":"span","marks":["strong"]},{"_type":"span","text":"That’s where risk comes in.","_key":"KW4n4dl0"}],"_type":"block","style":"normal","_key":"kTCh558b"},{"_key":"tpK6whz0","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"4IPPJqr2"},{"_type":"span","text":"That’s where the risk comes in.","_key":"OzleggUX"}],"_type":"block","style":"normal","_key":"mGc8VdTT"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"8gg3MZj5"},{"_type":"block","style":"normal","_key":"3R3AqHDB","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. 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on the optimal work-up for wounds and the setting where wounds would best be managed.","_key":"AFul5zqg"}],"_type":"block","style":"normal"},{"_key":"zNnYPUzx","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_key":"MpRgSgoT","markDefs":[],"children":[{"marks":["underline"],"text":"Transcript","_key":"PeKPelSy","_type":"span"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"rhMY4RoF"},{"_type":"span","text":"More advanced wounds; I want to talk about how to treat them, and are there differences in procedures from center to center, practitioner to practitioner, and wound to wound? How do you begin to sort all this out? Anyone want to jump in on this one? How do you sort out a wound? I’m looking at this wound, how do I treat this?","_key":"04yUMVWi"}],"_type":"block","style":"normal","_key":"ASWsDKH6","markDefs":[]},{"_type":"block","style":"normal","_key":"N3K0MDWD","markDefs":[],"children":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"sig83AMl"},{"_type":"span","text":"First and foremost, you have to do a complete history and a physical examination.","_key":"yX0V7B7X"}],"_type":"block","style":"normal","_key":"cwEy9YQA","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"UVq5N6YH"},{"_type":"block","style":"normal","_key":"uBGqaqKe","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"kZGsFP3i"},{"_type":"span","text":"OK.","_key":"CIrpe76u"}]},{"_key":"JPZTEFIX","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"FvBfym2J"},{"_type":"span","text":"Head-to-toe. You have to make certain that you’re looking at every aspect of their medical care, what their underlying comorbidities are, etcetera. Often we can use a checklist for that to at least guide us in the right direction so we don’t miss anything. We’re making certain that their vascularity is appropriate; whether they have problems orthopedically, neurologically, neuropathy, etcetera. Then once we make a diagnosis, we can go down a pathway utilizing appropriate evidence-based guidelines as they are known today, and sometimes they vary. By using that evidence-based approach, we can hopefully get a positive result.","_key":"6TeqQstK"}],"_type":"block","style":"normal","_key":"VXD1bCFm"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"nrGujxTf"},{"_key":"M6EmvbAi","markDefs":[],"children":[{"text":"Peter L. Salgo, MD: ","_key":"3pKizaV8","_type":"span","marks":["strong"]},{"_type":"span","text":"Are there acceptable different pathways for the same wound? It looks the same, you","_key":"zIw15VWh"}],"_type":"block","style":"normal"},{"children":[{"_key":"KrOHn8A4","_type":"span","text":"get the history, maybe it’s subtly different in history. Are there different ways to get to the same end? Are they acceptable going in 2 different directions?"}],"_type":"block","style":"normal","_key":"3skkx0ob","markDefs":[]},{"style":"normal","_key":"LZm0tiP7","markDefs":[],"children":[],"_type":"block"},{"_type":"block","style":"normal","_key":"wCYmBa5W","markDefs":[],"children":[{"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"W5OBa8Ln","_type":"span","marks":["strong"]},{"_type":"span","text":"The answer is, again, it depends.","_key":"Ot9iyBFi"}]},{"_key":"etutziQp","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"eEwmluni","markDefs":[],"children":[{"_key":"dWh2AbTq","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"_type":"span","text":"I knew that was the answer, I knew that.","_key":"Eh7h6Yiv"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"rl6uAmI0"},{"children":[{"_key":"ryptMpie","_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: "},{"_type":"span","text":" As an example, you may have a patient who you think has a diabetic foot ulcer who’s not getting better with appropriate therapy, offloading and debridement, and moist wound healing. You realize when you take a biopsy that they have this squamous cell cancer, or maybe they have a vasculitis.","_key":"xqSQi00q"}],"_type":"block","style":"normal","_key":"HM5v82fK","markDefs":[]},{"style":"normal","_key":"8R9Tk7l0","markDefs":[],"children":[],"_type":"block"},{"_type":"block","style":"normal","_key":"IIiFs9R9","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"M6zlBXgD"},{"_type":"span","text":"Well there’s a difference.","_key":"YNF1rihh"}]},{"style":"normal","_key":"kOPhsdCH","markDefs":[],"children":[],"_type":"block"},{"children":[{"_key":"JTtqU43d","_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: "},{"_type":"span","text":"You have to be able to have that knowledge base and have that flexibility, and understand what the evidence is telling you to be able to make those decisions.","_key":"X8wVxsBY"}],"_type":"block","style":"normal","_key":"GvR2zY2D","markDefs":[]},{"style":"normal","_key":"CkQS8ckL","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"text":"Peter L. Salgo, MD:","_key":"IwCxTBos","_type":"span","marks":["strong"]},{"_type":"span","text":" That’s another kernel that’s come out here, which never occurred to me, but should have, which is, if you’re doing everything right and it’s not getting better, look for what’s wrong, maybe it’s not what you thought. There’s something, a different pathology. ","_key":"r1HQEpVu"}],"_type":"block","style":"normal","_key":"JBaubNq3"},{"_key":"IKKiHgFY","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"JFEky3mA","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"ihCV2gub"},{"_type":"span","text":"I had a mentor, Robert Warner, who unfortunately passed away, really an iconic figure in our field. His mantra, “If the wound is not getting better within 4 weeks, start over because you’ve missed something.”","_key":"pkiW6c4u"}],"_type":"block"},{"children":[],"_type":"block","style":"normal","_key":"s3iMlXKZ","markDefs":[]},{"style":"normal","_key":"iIMq7M9l","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"LsU1tDtc"},{"_type":"span","text":"That’s amazing. I have a partner in the ICU [intensive care unit] who says, “If a patient isn’t diagnosed in 2 weeks, you’re in trouble.” It’s similar—you’ve got a real problem. If a patient goes to an emergency department for wound care, as opposed to a wound care center for wound care, and I’m assuming there are more emergency departments, in fact I know this, than there are wound care centers, is there a difference in the kind of treatment this patient is going to get? What do you think?","_key":"QJ7PMgAE"}],"_type":"block"},{"style":"normal","_key":"gFcARDb4","markDefs":[],"children":[],"_type":"block"},{"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"FWQzIFDl"},{"_type":"span","text":" First of all, I would say that in the emergency department [ED] level, and you all can speak to this more than I can, I am not a podiatrist, I’m an orthopedic surgeon.","_key":"AwE3f4w5"}],"_type":"block","style":"normal","_key":"Rs5fp1em","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"yt5BjXLa"},{"style":"normal","_key":"ydx2P0eO","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"wAtbnrZ1"},{"_type":"span","text":"We like them too.","_key":"iuwUy1z7"}],"_type":"block"},{"_key":"Hd2opIqn","markDefs":[],"children":[],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"jp1SCw1r"},{"_type":"span","text":" We tend to defer these to our podiatry colleagues as well. But oftentimes, as you know as a physician, the ED, it’s kind of like a sorting point, you know?","_key":"BLey9Ux3"}],"_type":"block","style":"normal","_key":"F2sIzszj","markDefs":[]},{"children":[],"_type":"block","style":"normal","_key":"YqueyQuo","markDefs":[]},{"_key":"KlMbw0s4","markDefs":[],"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"wsSe7YoM","_type":"span"},{"text":"Sure.","_key":"bRlM07mD","_type":"span"}],"_type":"block","style":"normal"},{"_key":"GAVSoBjm","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"ZSKl4xGI","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"FPVAsoZc"},{"_type":"span","text":" Your ED physician tries to figure out what’s going on with the individual and then does a consultation. Do you even get definitive treatment, or are you even placed on the right track to definitive treatment at the emergency department level? You all can answer this better than I can. I would suspect, possibly not.","_key":"SL2NhS8h"}]},{"_type":"block","style":"normal","_key":"7CpyuOqZ","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_key":"uES91cAf","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"text":"With all due respect to emergency department physicians, they’ve got an impossible job. They’ve got someone with a wound over here; someone with crushing chest pain over there; somebody in DKA [diabetic ketoacidosis] and septic shock over there; and they’ve got to have 8 arms, they’ve got to be an octopus. ","_key":"IZUoAciK","_type":"span"}],"_type":"block","style":"normal","_key":"eC9aVtei"},{"_key":"Docmw79G","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"b9TdHqxV","_type":"span","marks":["strong"]},{"_type":"span","text":" Remember, too, the ED physician is not going to develop a relationship with this patient. It’s a one-and-done scenario. Secondly, they’re not looking at the patient holistically. They’re focusing in on that problem at the time. Often they wind up leaving with an antibiotic that they may not even need and referred to an appropriate specialist, hopefully.","_key":"0KhZoVHU"}],"_type":"block","style":"normal","_key":"r1Joe441"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"Gk1SfOyP"},{"style":"normal","_key":"FuTbIFgn","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"dEMoJ3cW"},{"_key":"iv0QLG39","_type":"span","text":"Or maybe the hospital-based outpatient wound care center that happens to be down the hall."}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"gCetTkza"},{"_key":"ubcoyuxe","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"WrA6nMzp"},{"_type":"span","text":"Nudge, nudge, wink, wink.","_key":"53vSkwKl"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"WjrQrQOp","markDefs":[],"children":[]},{"style":"normal","_key":"vlGaITeg","markDefs":[],"children":[{"_key":"EMbMsANM","_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: "},{"_key":"w6xAGRw6","_type":"span","text":"We also have the confounding factor that if you do have an individual who is seeking the definitive treatment over and over in the emergency department, that individual’s probably not doing what they need to be doing to properly heal their wounds."}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"SwWg1MaF"},{"_key":"bnO5E1Hz","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"DMdRu8AV"},{"text":"Let me ask you the softball question. I’ll give this one to you. It’s 2 out, the bottom of the 9th—this is really softball\u0026mdash;and you have a choice\u0026mdash;an analogy, grant me this one\u0026mdash;of going to a wound clinic or an ED for the treatment of your wound, what do you choose?","_key":"A462KVWM","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"zXrI1M49"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"loeEBG7o"},{"text":"Knowing what I know, I’m going to a wound clinic.","_key":"oHljZTOO","_type":"span"}],"_type":"block","style":"normal","_key":"3Bq3oHAh"},{"_key":"VWIDyq2B","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"SkDu10lN","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"i6SSQk9R"},{"_type":"span","text":"He swings, and the ball is heading over the wall. 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The vast number of people who have wounds that require treatment don’t end up in wound care centers. They end up in primary care doctors’ offices, they wind up in a whole plethora of other specialty offices and not necessarily wound care centers.","_key":"X8kx4ANF"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"a8NvWfXF"},{"_key":"lzxnixMC","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD:","_key":"VFgE6kWb"},{"_type":"span","text":" Is that a consequence of there not being any wound care centers, or because they’re going to the wrong place, or because there are a lot of places you can get good wound care?","_key":"2551sAON"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"QKnwsV89"},{"_type":"block","style":"normal","_key":"k1iDif1l","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. 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To be paid under CMS [Centers for Medicare \u0026 Medicaid Services], you have to be affiliated with a hospital.","_key":"MOr95rdn"}]},{"_key":"FDHcr2i6","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_key":"ytdOXcVh","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"kYy23njI"},{"_type":"span","text":"I’m shocked. I would think you could have a free-standing wound care center.","_key":"3WtbnQgG"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"LNcSATOZ"},{"_key":"5KY3ToS6","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"t5f5BiKv"},{"_type":"span","text":"Managed care allows you some latitude with this.","_key":"seAZHlu7"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"IO2qg2Fj"},{"children":[{"text":"Peter L. Salgo, MD: ","_key":"XSpcmuos","_type":"span","marks":["strong"]},{"_type":"span","text":"Does it? How so?","_key":"A7FFoiLg"}],"_type":"block","style":"normal","_key":"ClP1k0bX","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"Q0EwWJTH"},{"_type":"block","style":"normal","_key":"Y5i939MO","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"dxxtgmq1"},{"_type":"span","text":"One of the companies that I have founded was a company that brought all of the advantages of a wound care center to the outpatient environment. The company was technologically enhanced. We used some nice, gee whiz bang type of technology to be able to render that care. To your point doctor, on a classic Medicare fee-for-service, freestanding outpatient wound care centers are rare. Managed care has the latitude to be able to create them.","_key":"cNgSFlP0"}]},{"_type":"block","style":"normal","_key":"EcybtSnm","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"0PN0u0GW"},{"text":"OK, but you can carve them out inside a hospital setting.","_key":"YQj82aEM","_type":"span"}],"_type":"block","style":"normal","_key":"6M9cI8W4"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"mtXsKqz4"},{"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"t5AUp99U"},{"_type":"span","text":"You can carve them out inside a hospital setting. Sometimes they’re managed by ancillary groups, management groups that will actually manage the clinics for them, the hyperbaric systems. Hire the nursing staff, the physicians, etcetera. It actually is a place theoretically where you have a group of experts practicing under 1 roof. You have nurses who are extraordinarily familiar with wound management protocols and therapies. People, as with any other specialty, will go to the specialty clinics for specialized care. Now is that always the case? Unfortunately, it is not.","_key":"OjI0b982"}],"_type":"block","style":"normal","_key":"UO1IPCmT","markDefs":[]},{"_key":"B7MCfgUI","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"MS0Xy3bJ","markDefs":[],"children":[{"_key":"ftCbLphV","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"_type":"span","text":"If I were to ask you to, in a nutshell, define the role of the wound care specialist, because when I was in medical school nobody said to me, “Gee, when I grow up I want to be a wound care specialist.” You laugh, but I’m sure that’s happening now. Some people do want to do this. 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Salgo, MD: ","_key":"eX9NhQCN","_type":"span"},{"_type":"span","text":"Before we leave all of this, I know there’s a difference in the way people are covered, the way things are paid—inpatient versus outpatient; formulary in-house versus pharmacy costs outside. What does this mean to the total healthcare bill? What does this mean to patients? Do they pay more if they’re outpatients, or pay less?","_key":"6s2hj99E"}],"_type":"block","style":"normal","_key":"pjJ0hHsT","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"VxYtJzMN"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Samuel D. Young, MD, MBA, CPE, CHCQM: ","_key":"2OHm9Wjy"},{"_key":"nc1yHRJC","_type":"span","text":"It depends on the funding source. If you’re a Medicare beneficiary, you pay more typically on outpatient coding, just because of the way that traditional Medicare is structured. Under a Medicare Advantage plan, that’s not necessarily the case. It could be a difference to you in terms of where you are in your deductible and so forth, whether it’s an outpatient versus an inpatient."}],"_type":"block","style":"normal","_key":"Gt0FxCpu"},{"_key":"xMyh5m2x","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_key":"sMThf6e2","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"rJ1fpQPj"},{"_type":"span","text":"Right. I guess what I’m asking is, I’m Joe Ulcer, or Jane Ulcer. I can go and get outpatient therapy and go to my pharmacy and get a prescription, get that filled, with some sort of deductible. Or I can get admitted and have the bill covered by my insurance in a different way. What turns out to cost more for the insuree, do we know? Does anybody know?","_key":"vfxp1oNt"}],"_type":"block","style":"normal"},{"style":"normal","_key":"rWO3BSnx","markDefs":[],"children":[],"_type":"block"},{"style":"normal","_key":"YXhJfcoL","markDefs":[],"children":[{"marks":["strong"],"text":"Michael T. Kazamias, MS, DPM: ","_key":"S0rPkN5b","_type":"span"},{"_type":"span","text":"The lack of coordination of care at the outpatient level [costs more]. In many instances a lot of care and wound care is redundant. They’ll get redundant orders for supplies. They’ll get redundant care. They’ll see specialists who had a focus on radical debridement of a wound, and then later on they’ll see another specialist who focuses on exudate management for a wound.","_key":"7oFSTGea"}],"_type":"block"},{"style":"normal","_key":"GaRdsttN","markDefs":[],"children":[],"_type":"block"},{"_type":"block","style":"normal","_key":"kTMgUhB3","markDefs":[],"children":[{"_type":"span","text":"There are attendant supply costs for both of them; the surgical intervention has an entirely different set of supplies and management from an exudate perspective. Then when we look at how does home health do that? Well, that’s predicated entirely on the expertise of the ordering physician. Is that ordering physician a wound care specialist? More often than not they aren’t. They’re a gatekeeper in a risk environment, who is not a specialist in wounds, who is focusing on the comorbidity and not so much on the actual treatment of the wound. These are cost drivers.","_key":"KOexafs9"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"n1Ab8fRt"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"HKPYK6Kp"},{"_type":"span","text":"I don’t want to leave this topic without explicitly mentioning something that you brought up, and I didn’t really focus our viewers on at the time, but I haven’t forgotten it. At the end of the day, whether it’s sepsis, or a nonhealing wound or, purulence, or everything else, a lot of these patients are looking down the barrel of an amputation, because that’s the end of the line for a diabetic patient.","_key":"0w6d19zE"}],"_type":"block","style":"normal","_key":"x3YFq9TL"},{"children":[],"_type":"block","style":"normal","_key":"J1hCmQCM","markDefs":[]},{"_key":"jxYsEVfL","markDefs":[],"children":[{"_type":"span","text":"Do the patients understand that? Do the primary care physicians understand that? Do the people in the emergency departments understand that, that if you do this wrong, of course sometimes if you do it right, that’s where we’re headed?","_key":"clcUnDxR"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"gbORxDoE","markDefs":[],"children":[]},{"_type":"block","style":"normal","_key":"WlN0ZUFN","markDefs":[],"children":[{"marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"FOekn0LM","_type":"span"},{"_type":"span","text":"The answer is, it depends.","_key":"J2h0W0Gm"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"xM36JKJd"},{"style":"normal","_key":"6DwF3tN5","markDefs":[],"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"1bVXOK1I","_type":"span"},{"_type":"span","text":"Thanks a lot.","_key":"T5vfniN2"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"wy9vczlu"},{"style":"normal","_key":"SM11aOid","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: ","_key":"zAMk872g"},{"_type":"span","text":"It depends on several factors. First and foremost, the protoplasm of the patient, the underlying comorbidity of that patient. As far as educating them to the risk of amputation, that’s something that we have to do really on the front end. Unfortunately, even someone who comes in with a relatively new wound problem who’s diabetic, who has a hemoglobin A1C of 9, as an example, or has peripheral arterial disease, I think that wound can escalate very rapidly to something extraordinarily devastating for that individual.","_key":"Oo2uTJmL"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"mOHaqDxV"},{"style":"normal","_key":"B4DOhRpc","markDefs":[],"children":[{"_key":"vRuvy2eW","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"_type":"span","text":"I’ve seen patients come in who know they have diabetes, and they’ve come in very early with a very small lesion, and they go, “Boy, this scares me because I’m worried what’s going to happen.” And I’ve seen people come in, in extremis, “I’m not worried at all. Give me some antibiotics, it’s all going to go away.” To some degree is that because we’re training them wrong? 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"}],"_type":"block","style":"normal","_key":"ecb86290f61f"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"4cb2bbafa108"}],"_type":"block","style":"normal","_key":"846e833641f7"},{"children":[{"_type":"span","marks":[],"text":"Looking ahead, Regueiro emphasizes the need for increased staffing in specialty practices to better support data mining and outreach efforts, similar to the resources available to primary care teams.","_key":"b73a30800f35"}],"_type":"block","style":"normal","_key":"b45434716c29","markDefs":[]},{"children":[{"text":"","_key":"cf422ececbc0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"ff65d505eb70","markDefs":[]},{"_key":"96b90d4d4fda","markDefs":[],"children":[{"_type":"span","marks":["em"],"text":"This transcript has been lightly edited for clarity.","_key":"bc93be997613"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"8ff12f82e8b3","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"4e8ebf849af1"},{"children":[{"_type":"span","marks":["strong","underline"],"text":"Transcript","_key":"956d862871ea"}],"_type":"block","style":"normal","_key":"0db048054f52","markDefs":[]},{"children":[{"_type":"span","marks":["strong","underline"],"text":"","_key":"050457de72ac"}],"_type":"block","style":"normal","_key":"958f9d7182fa","markDefs":[]},{"markDefs":[],"children":[{"_key":"155fb2ca6d170","_type":"span","marks":["strong"],"text":"Overall, what has this model helped PPWPA accomplish? Moving forward, are there specific areas for improvement PPWPA is focusing on?"}],"_type":"block","style":"normal","_key":"a6fcaa423725"},{"_key":"7ebb22d3eb05","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"","_key":"70f181d61c02"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"3e08a9926f0b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"I think it's really helped us leverage the specialty practices' insights into areas of opportunity, and it's really helped us reach a different group of patients that might really not come into primary care much in our MSSP [Medicare Shared Savings Program] group, just using specialty care and getting them connected better. ","_key":"88b5d8f87a250"}]},{"markDefs":[],"children":[{"text":"","_key":"693941c453a9","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"30b21a93fb58"},{"children":[{"_type":"span","marks":[],"text":"I think it's also been really helpful to facilitate and accelerate a cultural shift in specialty care to understand population health perspectives. Primary care is understood—whether any of us have liked it or not, being a primary care physician—that you're responsible for patients, even those who aren't necessarily doing what's prescribed, even those who may not be in your office, and that takes a different mindset. I think that's been useful to bring that forward to the specialists. 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","_key":"d40e24def526"}],"_type":"block","style":"normal","_key":"b7ac2d518ba0"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"22e12b779a06","_type":"span"}],"_type":"block","style":"normal","_key":"5e3d2fbfbb11"},{"style":"normal","_key":"19e5d5723a0a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"She noted that the program’s focus on smooth care transitions and outreach has significantly decreased readmission rates and health care costs. Regueiro added that these efforts have also enabled AHN to generate shared savings, reinvesting funds to further support cardiology and improve patient outcomes.","_key":"6c2a0ff30a7b"}],"_type":"block"},{"_key":"dd07321c323c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b8dffffd519f"}],"_type":"block","style":"normal"},{"_key":"26d7f890510f","markDefs":[],"children":[{"text":"This transcript has been lightly edited for clarity.","_key":"7fd6386145c1","_type":"span","marks":["em"]}],"_type":"block","style":"normal"},{"children":[{"_key":"3b517752635c","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"35594313bf55","markDefs":[]},{"markDefs":[],"children":[{"_key":"9bd5f3a78a48","_type":"span","marks":["strong","underline"],"text":"Transcript"}],"_type":"block","style":"normal","_key":"77d8907d40df"},{"markDefs":[],"children":[{"_type":"span","marks":["strong","underline"],"text":"","_key":"23f9a1974d8e"}],"_type":"block","style":"normal","_key":"c7ba83bcddba"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Could you tell us about the congestive heart failure (CHF) bundle in particular and what impacts it's had within the cardiology space?","_key":"5fe3371257ac0"}],"_type":"block","style":"normal","_key":"d22c4f048acd"},{"_key":"7b701827488b","markDefs":[],"children":[{"_key":"a0321b975024","_type":"span","marks":["strong"],"text":""}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":[],"text":"I think our shadow bundles really helped us extend our interaction with our cardiologists and really improve the integration between cardiology and primary care even more than before, really extending it to proactive support of primary care where the cardiologist will help educate patients as to why it's important to have a primary care physician and how it can help them avoid going to the ED and get care more quickly, more effectively, less expensively for the patient. So those kinds of things have been good. ","_key":"8f8b7f8d9f4d0","_type":"span"}],"_type":"block","style":"normal","_key":"09620950845f"},{"_key":"33efc693a34f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"17e7c50b15fb"}],"_type":"block","style":"normal"},{"style":"normal","_key":"877d5504e272","markDefs":[],"children":[{"_key":"6ef6bb11a35e","_type":"span","marks":[],"text":"I think it's really helped us decrease our readmission rates. They really do pay a lot of attention to all the various pieces, both at the transition of care when the patients leave and getting them seen in the outpatient space. We take pride in having fairly low readmission rates at this point, especially compared to national averages. "}],"_type":"block"},{"_key":"4ebdeeaba16c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5f9ba9489f64"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"In the last year that we earned shared savings with MSSP [Medicare Shared Savings Program], they were able to earn a large amount of money for the cardiology group, which was important to help plow back into these resources to support their care so the physicians feel supported and they can focus on the physician work. 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We have decreased the cost of care for our patients in this bundle. We have a comparator group, so we can really see that we have groups of patients not in this bundle within our MSSP, and compared to that group, the ones in our CHF bundle with the cardiology group that we're working with on this have really been far less expensive. ","_key":"678e0d6983720"}],"_type":"block","style":"normal","_key":"20da749b74da","markDefs":[]},{"_type":"block","style":"normal","_key":"ca8907e65306","markDefs":[],"children":[{"text":"","_key":"1dd55ca34fe5","_type":"span","marks":[]}]},{"children":[{"text":"In the years that we have achieved shared savings in the overall MSSP program, we've been able to give cardiology back over $400,000 in savings because they've been able to help us achieve that. There's been other things that we're hoping, as we move forward, will help in achieving more savings; it'll be interesting to see. 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Regueiro MD, MSc, director of complex care transformation at ","_key":"8352eacc6144"},{"text":"Allegheny Health Network (AHN)","_key":"3a465da5e36e","_type":"span","marks":["671da2daec16"]},{"marks":[],"text":", discussed the Physician Partners of Western PA (PPWPA) practice support model, a clinically integrated network designed to enhance care quality and efficiency through team-based support in primary and specialty care. ","_key":"868bb182aa23","_type":"span"}]},{"markDefs":[],"children":[{"_key":"0610c190da63","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"68ea8de122b7"},{"children":[{"_type":"span","marks":[],"text":"She also highlighted the shadow bundle distribution model, a non-contractual, year-long cost-management approach within the network. Unlike traditional, time-limited CMS bundles, it holds physicians accountable for total patient care costs. ","_key":"ad3df2283005"}],"_type":"block","style":"normal","_key":"644e96da2885","markDefs":[]},{"_key":"ac7b6d59112c","markDefs":[],"children":[{"_key":"003e8d7602e3","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"style":"normal","_key":"81a2a6822a5f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Additionally, this approach fosters collaboration between primary and specialty care teams, as seen with the role of PPWPA's congestive heart failure (CHF) group in managing emergency department (ED) utilization, enhancing patient education, and improving care integration.","_key":"253bc390b1da"}],"_type":"block"},{"style":"normal","_key":"7e8d452ef177","markDefs":[],"children":[{"text":"","_key":"ccd694d445d2","_type":"span","marks":[]}],"_type":"block"},{"_type":"block","style":"normal","_key":"b8e44cfbb301","markDefs":[],"children":[{"_type":"span","marks":["em"],"text":"This transcript has been lightly edited for clarity.","_key":"992d98c2baad0"}]},{"_type":"block","style":"normal","_key":"7800c9b7f8b6","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"813f922e20e1"}]},{"children":[{"_type":"span","marks":["strong","underline"],"text":"Transcript","_key":"e7d4ac126446"}],"_type":"block","style":"normal","_key":"f9423915ec48","markDefs":[]},{"children":[{"_type":"span","marks":["strong","underline"],"text":"","_key":"0e9a1e163060"}],"_type":"block","style":"normal","_key":"c52227ff6a22","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Could you begin by discussing the Physician Partners of Western PA (PPWPA) practice support model and its key components?","_key":"1f05cf066450"}],"_type":"block","style":"normal","_key":"9df629489c4c"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"","_key":"903fa5961937"}],"_type":"block","style":"normal","_key":"cef9e0c72454"},{"children":[{"_type":"span","marks":[],"text":"PPWPA is our clinically integrated network (CIN), and it's a regional collaboration of physicians who are committed to doing efficiency and quality work together. ","_key":"2d93051445200"}],"_type":"block","style":"normal","_key":"a6a797129c54","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a4723005630e"}],"_type":"block","style":"normal","_key":"445abab0985a"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Our support model really evolved with primary care physicians, initially, with an effort to build in team-based care that they could access for their patients, including dieticians, behavioral health, social workers, etc. That model, we found, has been very helpful, and that's been a key to our thinking about leveraging support for patients in these specialty bundles.","_key":"d5a506cecc7a"}],"_type":"block","style":"normal","_key":"a0c0323c4009"},{"_key":"29add50d60ae","markDefs":[],"children":[{"text":"","_key":"7d86dd79ca4f","_type":"span","marks":["strong"]}],"_type":"block","style":"normal"},{"_key":"9913d1cdc58d","markDefs":[],"children":[{"marks":["strong"],"text":"What is the shadow bundle distribution model? How does it function in practice?","_key":"4b4efbc145510","_type":"span"}],"_type":"block","style":"normal"},{"children":[{"text":"","_key":"75d738441c96","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"a9f085e0e1ed","markDefs":[]},{"style":"normal","_key":"64aa3659d81d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The shadow bundle has really grown out of our Medicare Shared Savings Program (MSSP). The shadow bundles, we call them shadows because they're not contractual with CMS, they're within our own CIN. How we've structured them is, at the beginning of the program, we identify which physicians are part of the group that's in the bundle. ","_key":"fc3b666c4a8a0"}],"_type":"block"},{"style":"normal","_key":"97aad9ce86bf","markDefs":[],"children":[{"marks":[],"text":"","_key":"c4b7a02cb41f","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"c495be9ac240","_type":"span","marks":[],"text":"For our cardiology group, we identified those practices and the associated patients at the beginning of the year. Then, we can accrue patients if we get patients who see those physicians up to June 30, so halfway through the calendar year. "}],"_type":"block","style":"normal","_key":"7d9955c8ada4"},{"style":"normal","_key":"60965c62f36c","markDefs":[],"children":[{"marks":[],"text":"","_key":"c1d2991f866c","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"f0af7545fb34","_type":"span","marks":[],"text":"Those physicians are responsible for the total cost of care of those patients. I think it's notable that in contrast to CMS's other types of bundles, like BPCI [Bundled Payments for Care Improvement], etc, it's not a 90-day thing. It's a whole year, and it's not disease-specific. It really entails everything, which is a big shift in how specialists think about that. "}],"_type":"block","style":"normal","_key":"6f46662487f8"},{"children":[{"_type":"span","marks":[],"text":"","_key":"c534bfc11f7a"}],"_type":"block","style":"normal","_key":"3e568715fb7d","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"If we succeed in MSSP generally and have gained shares in MSSP, then we look at the money we've earned. There's a 20% holdback for the organization for infrastructure, etc, and then that money gets allocated back to cardiology, the remainder, based on the proportion of patients they're seeing, so the number of attributed members.","_key":"c932170448ab"}],"_type":"block","style":"normal","_key":"b4577107687e","markDefs":[]},{"style":"normal","_key":"88688fd2fc20","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"","_key":"ae64cd0cbf69"}],"_type":"block"},{"_key":"ad4c047e3897","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"How does the shadow bundle distribution model align with the PPWPA practice support model?","_key":"2d7b00e8944c0"}],"_type":"block","style":"normal"},{"style":"normal","_key":"b71d4bba5908","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"","_key":"fa67087497b8"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I think the distribution model aligns in a lot of ways because it helps reinforce and support some of our team-based care work. I also think that because it has both primary and specialty care physicians involved, it has really leveraged interaction between the 2 groups, probably more than the traditional referral letter. ","_key":"50c380ae22ab0"}],"_type":"block","style":"normal","_key":"b0332515d0c8"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"35cd13e05ae2"}],"_type":"block","style":"normal","_key":"b1389922eed7"},{"_type":"block","style":"normal","_key":"bd04b74efca8","markDefs":[],"children":[{"_key":"1259c6e46e28","_type":"span","marks":[],"text":"I think, first of all, we were lucky to have a very proactive and collaborative CHF physician group that had a really robust pathway, but they were willing, as we moved along, to consider how the pathway could integrate more with our primary care practices. Examples would be when we've asked them to be responsible for ED use, even if it's not CHF. 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Why are payers doing this and what are some potentially negative consequences of this strategy?","_key":"9fcac0d767560"}],"_type":"block","style":"normal","_key":"92c5b87bd0ea","markDefs":[]},{"style":"normal","_key":"2bcb8dd34c4e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d74be2958b9b"}],"_type":"block"},{"_type":"block","style":"normal","_key":"4b86a8c6fa13","markDefs":[],"children":[{"text":"We had a paper published last year that looked within our database of specialty drug coverage decisions, and on occasion, the same health plan had both a medical policy and a pharmacy policy for the same drug. Confusing. Even more confusing was, 15% of the time, the coverage requirements differed—so","_key":"5d87c3f4dc5a0","_type":"span","marks":[]},{"_key":"e8b097939157","_type":"span","marks":["strong"],"text":" "},{"_key":"0dd780554e46","_type":"span","marks":[],"text":"the step therapy requirements are inconsistent between the medical benefit and the pharmacy benefit. What we were trying to show with this paper is simply that this is very confusing and oftentimes counterintuitive."}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8aba93e49bbb0"}],"_type":"block","style":"normal","_key":"383ceddf4dae"},{"_type":"block","style":"normal","_key":"593f01fb034c","markDefs":[{"_key":"48d9ed97fcd3","blank":true,"_type":"link","href":"https://www.ajmc.com/view/white-brown-bagging-of-therapies-creates-extra-steps-for-oncology-practices"}],"children":[{"_key":"55a588028dcf0","_type":"span","marks":[],"text":"Why are we seeing the merging of the medical and the pharmacy in different instances? Historically, of course, physician-administered drugs are in the medical benefit, self-administered drugs in the pharmacy benefit. 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Complexities"},"_type":"video"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Ian Neeland, MD, director of cardiovascular prevention and co-director of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease at the University Hospitals Harrington Heart \u0026 Vascular Institute, sees the CMS-negotiated drug prices under the Inflation Reduction Act (IRA) as a positive step to improve access to essential therapies for patients with Medicare. ","_key":"ea88d93336300"}],"_type":"block","style":"normal","_key":"eeb13766173b"},{"_key":"0ef01a9ba6dc","markDefs":[],"children":[{"_key":"4ab2477e30c1","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"markDefs":[{"nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/compendium/diabetes","_key":"14f1c8385db3"},{"nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/compendium/cardiovascular","_key":"e181fbdaa281"}],"children":[{"_type":"span","marks":[],"text":"He also recommended a team-based, comprehensive approach to managing ","_key":"38acfc6c60c8"},{"_type":"span","marks":["14f1c8385db3"],"text":"diabetes","_key":"4dcb82a33ee4"},{"_type":"span","marks":[],"text":" and its related complications. Although Neeland eagerly anticipates new developments in glucagon-like peptide-1 (GLP-1) medications and other cardio-renal-metabolic therapies, he noted that medication adherence concerns in patients with ","_key":"cc9ef034e434"},{"_key":"75ebce2bb3a6","_type":"span","marks":["e181fbdaa281"],"text":"cardiovascular disease"},{"_type":"span","marks":[],"text":" highlight the risks of access barriers.","_key":"6c7872192b43"}],"_type":"block","style":"normal","_key":"bf235eaf630a"},{"_type":"block","style":"normal","_key":"701741c8d82b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2ebb6bc744d6"}]},{"markDefs":[],"children":[{"marks":[],"text":"Neeland is also an associate professor of medicine at the Case Western Reserve University School of Medicine.","_key":"708afc5be26a","_type":"span"}],"_type":"block","style":"normal","_key":"8ba6fb8671fb"},{"markDefs":[],"children":[{"text":"\n","_key":"4821ff4884ab0","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"This transcript has been lightly edited for clarity.","_key":"4821ff4884ab1"}],"_type":"block","style":"normal","_key":"9fa7b4ee4063"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"43eb77b31f3c","_type":"span"}],"_type":"block","style":"normal","_key":"fd3c12279fb2"},{"_key":"00b39d6b02b7","markDefs":[],"children":[{"_key":"564edefefe7f","_type":"span","marks":["strong","underline"],"text":"Transcript"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"9dd2649101fa","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8e3d632ff0fc"}]},{"markDefs":[],"children":[{"_key":"02c5eda4543b0","_type":"span","marks":["strong"],"text":"CMS recently announced the negotiated drug prices for the first 10 drugs under the IRA. What is your reaction to the announced prices?"}],"_type":"block","style":"normal","_key":"64c57a3fec0e"},{"_key":"80f1c80517ad","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"efe94791944a"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"d022031bd37d","markDefs":[],"children":[{"_key":"d85efb9e67e10","_type":"span","marks":[],"text":"I think it's a very positive move. I think that access to evidence-based therapies has been hindered by cost, especially for folks with Medicare who can't afford the donut hole and those issues that go along with it, so I think this is a great step forward. As many people who can access appropriate care as possible is always a positive thing."}]},{"_key":"811cb63be63a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7cb78c4b0fd1"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"What does a team approach look like when treating a patient with diabetes to prevent or address other health issues they have?","_key":"2409f3a2f6470"}],"_type":"block","style":"normal","_key":"6483f9bfe32e"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f98531665d9f"}],"_type":"block","style":"normal","_key":"20fff7f46474"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Because diabetes is a complex disease with issues related to not just blood sugar control but cardiovascular, kidney, other metabolic [diseases], and obesity, you need a comprehensive team and a management plan that can address all of those different issues together in a way that can attack the central problem and, therefore, resolve many of the issues together. ","_key":"cbe7c013bf310"}],"_type":"block","style":"normal","_key":"2018527ee962"},{"_key":"0e4c1ad616d5","markDefs":[],"children":[{"marks":[],"text":"","_key":"a10f88061ef5","_type":"span"}],"_type":"block","style":"normal"},{"children":[{"marks":[],"text":"So, a team-based approach that's patient centered and comprehensive is, in my opinion, the best way forward in treating diabetes and its complications.","_key":"52032fa033aa","_type":"span"}],"_type":"block","style":"normal","_key":"81c3cb5dd199","markDefs":[]},{"_type":"block","style":"normal","_key":"f110c516d2a9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"0dfe6ae5be6c"}]},{"_key":"6e0157609bf2","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Are there patients who we know are likely to benefit the most from the use of GLP-1s?","_key":"9dff51b7458a0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"47493160d15e"}],"_type":"block","style":"normal","_key":"dff298146356"},{"_type":"block","style":"normal","_key":"26de2105f966","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Patients who have multiple comorbidities, for example, diabetes, obesity, and cardiovascular disease, those patients would most likely benefit from GLP-1–related therapies, because they address many of those different comorbidities together in a comprehensive fashion.","_key":"273ca05712160"}]},{"_type":"block","style":"normal","_key":"048ca0dd5491","markDefs":[],"children":[{"text":"","_key":"bd6d912da881","_type":"span","marks":[]}]},{"markDefs":[],"children":[{"_key":"b70c151d27070","_type":"span","marks":["strong"],"text":"What is the prevalence of adherence to medication among patients with cardiovascular disease and how does that impact the risk of developing something else down the line?"}],"_type":"block","style":"normal","_key":"c52d2d0b2495"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2eab64d9f85e"}],"_type":"block","style":"normal","_key":"d338ba827dc9"},{"_key":"0f0515bfd679","markDefs":[],"children":[{"_key":"fa5014b1b9e00","_type":"span","marks":[],"text":"It depends on the type of medication in terms of how adherent one may be. In general, it's about 80% adherence to therapies, with about 20% of individuals who can't tolerate certain therapies and are unable to take them. "}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"3af5a91c1852","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6fffa4ba5842"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"There's also an issue of access. Even if patients want to take the therapies, they may not be able to get the therapy paid for, so that can have deleterious consequences down the line. If patients are not on appropriate therapies, they're at high risk for recurrent cardiovascular events and even death.","_key":"78cc5d3c2b61"}],"_type":"block","style":"normal","_key":"a904d22cbfc6"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"bc1592a2ae85"}],"_type":"block","style":"normal","_key":"0bbff46cfb6d"},{"_type":"block","style":"normal","_key":"cbcd8bc71236","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"What changes in the cardio-renal-metabolic landscape are you keeping an eye on for 2025?","_key":"6fceed0931380"}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"7977c42d8dcd"}],"_type":"block","style":"normal","_key":"53101f790405","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"I think new compounds and new advances in therapies are very exciting. There [are] GLP-1–related therapies, and there [are] more coming down the market in terms of different agonists, dual- [and] triple-agonists, and even antagonists, that are now out there. ","_key":"b69b62dc4c120"}],"_type":"block","style":"normal","_key":"df4b0aa13657","markDefs":[]},{"_key":"6923276eef4b","markDefs":[],"children":[{"_key":"73d026a73495","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I think those are very exciting, because the more we learn about those therapies, the more we see benefits across different cardiovascular-kidney-metabolic areas. 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professor of medicine in the renal-electrolyte division at the University of Pittsburgh Medical Center, is enthusiastic about CMS's announcement of negotiated drug prices under the Inflation Reduction Act (IRA), especially for patients with ","_key":"607754da403f0"},{"_type":"span","marks":["7035190fe818"],"text":"kidney disease","_key":"18cb85c681e5"},{"_key":"387eed1683ae","_type":"span","marks":[],"text":" facing "},{"marks":["5a355b0b9a98"],"text":"affordability and access issues","_key":"f24da7264e44","_type":"span"},{"_key":"fce57ef084e2","_type":"span","marks":[],"text":". "}],"_type":"block","style":"normal","_key":"f738e280123a"},{"_type":"block","style":"normal","_key":"cc16e6f6af72","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1406d24274d4"}]},{"children":[{"_key":"c2c0a7f9c446","_type":"span","marks":[],"text":"However, she noted that kidney disease awareness remains a major barrier as many patients are unaware they have it until it's advanced. Lastly, looking ahead to 2025, Jhamb is focused on holistically integrating cardio-renal-metabolic care and developing comprehensive treatment guidelines for multiple subspecialties."}],"_type":"block","style":"normal","_key":"a74e9940ed89","markDefs":[]},{"markDefs":[],"children":[{"_key":"12289927f990","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"00e74677d5cd"},{"markDefs":[],"children":[{"_key":"a2ebc3463df5","_type":"span","marks":["em"],"text":"This transcript has been lightly edited for clarity."}],"_type":"block","style":"normal","_key":"78d4c5c995ea"},{"_key":"5fbf5e88dade","markDefs":[],"children":[{"_key":"573c8d6f0346","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"style":"normal","_key":"ecbd4005bea5","markDefs":[],"children":[{"text":"Transcript","_key":"4123be977e9e","_type":"span","marks":["strong","underline"]}],"_type":"block"},{"style":"normal","_key":"7b39addb325a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"99ddf5bf6c40"}],"_type":"block"},{"style":"normal","_key":"ee4118858d55","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"CMS recently announced the negotiated drug prices for the first 10 drugs under the IRA. What is your reaction to the announced prices?","_key":"c6f2db16a80c0"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"6ae0bbe70395"}],"_type":"block","style":"normal","_key":"00e92ba00d22","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I'm very excited. This is a big step, especially for our patients with kidney disease, who a lot of times may have affordability and access issues for these medications. These are truly life-changing medicines for these patients, so it's really great to see the movement going forward to make these medications more accessible, especially for our patients who have a lot of social risk factors. 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One in 9 patients with kidney disease don't even know they have it. Even those with stage 4, or pretty advanced kidney disease, half of them don't know they have it. So, that is one of the biggest barriers. Kidney disease is a silent disease, people don't have any symptoms from it until it's too advanced.","_key":"af94401cccad0","_type":"span"}],"_type":"block","style":"normal","_key":"86e8694a568b"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a6f240c12590"}],"_type":"block","style":"normal","_key":"5433307a200d"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"In addition to that, a lot of times we are not talking—their providers, their clinicians are not talking to them enough about kidney disease and what we can do about this. The big challenge for that is for over 20 years, we never had medications. There were a few medications in the past, but now it's exciting to see newer drug classes coming into this field. 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Employers should learn more about how this system works and not let rebate guarantees cause them to make bad choices for their employees. "}],"_type":"block","style":"normal"},{"_key":"76619090f6f1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c85c729126f2"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"6a9f94f127b8","markDefs":[],"children":[{"_type":"span","marks":[],"text":"It also adds to the research relevant to the investigative journalism of veteran reporters like Bob Herman, Reed Abelson, and Rebecca Robbins. Employer benefits consultants aren't well known, but they play an outsized role in the benefits employers offer to patients and how that affects what people pay at the pharmacy counter. They're taking together all of these things to give policymakers more to consider as they propose reform.","_key":"fbc9d325e014"}]},{"style":"normal","_key":"e19739a51913","markDefs":[],"children":[{"_key":"dec1685ea128","_type":"span","marks":[],"text":""}],"_type":"block"},{"_key":"d0114457f6d7","markDefs":[],"children":[{"text":"Could you discuss your study's limitations? How did they potentially impact your findings?","_key":"c35b19b02eaa0","_type":"span","marks":["strong"]}],"_type":"block","style":"normal"},{"_key":"40c8f3205162","markDefs":[],"children":[{"marks":[],"text":"","_key":"6015fd2fd800","_type":"span"}],"_type":"block","style":"normal"},{"children":[{"marks":[],"text":"First of all, this is a survey, so it measures how people respond to a survey, not what they actually do. We didn't hear back from everyone who received the survey, nor do we have visibility into the confidential agreements signed by the employers who did respond. 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Can you speak to the primary barriers contributing to this disparity and any potential efforts to address them?","_key":"1c281ca7555b","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"9bb38897de32"},{"_type":"block","style":"normal","_key":"b06e67bb9ccc","markDefs":[],"children":[{"_type":"span","marks":[],"text":"That is a little bit of a complicated situation. I would love to tell you that there's just one thing that's driving it, but the reality is it's multifaceted. But let me talk about some of the issues that we have.","_key":"9b30d7832cf20"}]},{"children":[{"_type":"span","marks":[],"text":"I think one problem, frankly, is that within the AAPI [Asian American and Native Hawaiians/Pacific Islander] community, not to stereotype, but there can be a little bit of a stigma—as there is in most communities in the United States—against receiving mental health treatment that can make people less willing to admit that they need medical treatment, less willing to seek that treatment. And if you are not really going to share with your loved ones that you're experiencing a certain kind of condition, you're less likely to seek treatment; you're less likely to have positive outcomes. There's all of those kinds of things. But I would put those in the bucket of stigma.","_key":"8b53dd02ce25"}],"_type":"block","style":"normal","_key":"10e2c8793775","markDefs":[]},{"_key":"d0271eec1b6c","markDefs":[],"children":[{"_key":"9a70ceea4269","_type":"span","marks":[],"text":"That's not even talking about if you are open, the ways in which you may face discrimination because your community, your employer, and others may treat you differently. And I'm not speaking to the legality because there are certainly practices that are illegal that happen. I'm just kind of speaking to the fact that all of those things go to making people less likely to actually seek mental health treatment."}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"58b2829253bf","markDefs":[],"children":[{"text":"A second problem is awareness. I mentioned that there are things that happen in a stigma bucket that are illegal, but if people don't even know that they have legal rights, that they're being discriminated against in a way that violates the law, that's not always something that the government—at whatever level—is going to be able to catch, absent a complaint. Sometimes it requires people to flag those things for us. Other times, we might find something where someone doesn't know that they were discriminated against or that there was a problem and we're able to resolve it nonetheless.","_key":"403c0c5193740","_type":"span","marks":[]}]},{"children":[{"_type":"span","marks":[],"text":"But that awareness, which I would say both about your legal rights and those kinds of things, but also awareness of mental health—that the symptoms that you're experiencing are the result of a disease, and not just, you know, “I'm feeling a little different today than I was yesterday,” or “I felt different for a few weeks,”—that those things actually could signify the mental health condition. And then there's an appropriate treatment for that. Lacking that awareness, obviously, you're not going to necessarily seek medical treatment from a professional if you don't even understand that you have a mental health condition.","_key":"8a3db5a11eb9"}],"_type":"block","style":"normal","_key":"c057057f46ee","markDefs":[]},{"_key":"63a279ab29fc","markDefs":[],"children":[{"_type":"span","marks":[],"text":"A third problem is that there is a lack of access to mental health treatment, which I would put in a couple of different kinds of subbuckets since I’m using this bucket analogy. So, one problem is that mental health careers for individuals who are in educational institutions are not necessarily as attractive as they could be. We don't have enough people in the pipeline going into those fields. We don't have enough people in those fields right now; just as in many other areas of the health care profession, there are provider shortages. And I think that is also exacerbated by the issue that's probably most germane, kind of directly germane to our work, which is that when it comes to coverage of health conditions, that parity is often not being realized in letter, let alone in spirit.","_key":"528358d4f14c0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"What I mean by parity is there's a federal law that's been on the books for over 15 years that essentially stands for pretty basic proposition. That proposition is that when you're receiving treatment for a condition—it shouldn't matter whether that's a traditional medical surgical condition or a mental health or substance use condition—that you shouldn't be discriminated against on that basis, the coverage really should be equivalent across the board.","_key":"f20d2c187cad0"}],"_type":"block","style":"normal","_key":"b5b23dac4a07"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"You can think of it as things like if I sprained my ankle, and I get 15 visits, do I also get 15 visits for something that's equivalent, right? Outpatient treatment, meeting with a therapist for mild depression, right? Do you say that it's 15 visits for the sprained ankle with the PT [physical therapist], but it's only 5 with an LCSW [licensed clinical social worker] for your mild depression? That's a very basic example of what it looks like when parity is not being met, just to illustrate the concept.","_key":"7a4944b6f265"}],"_type":"block","style":"normal","_key":"aa1e3baa2132"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"4a60e4502d120"}],"_type":"block","style":"normal","_key":"6da1de652f02"},{"_key":"c8dbed5161dc","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"May is Mental Health Month and Asian American, Native Hawaiian, and Pacific Islander Heritage Month. What’s important about this convergence?","_key":"d98bb9f7b2940"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"When you look at the data, it's not that Asian Americans and Pacific Islanders have no prevalence of mental health in that community. But there is a significantly lower likelihood that they're going to seek mental health treatment. So part of what we're trying to address this month, in particular, but throughout the year, is any kind of sense of stigma that people have around mental health or substance use conditions. I don't think any of us view it as a character flaw. We don't view it as something to be ashamed of. We believe very deeply that just like any other health condition if it's covered by your insurance, you deserve to get the treatment that you are promised. And the mere fact that it is a mental health or substance use condition should not shy you away from exercising your rights.","_key":"ffe125db7c4b0"}],"_type":"block","style":"normal","_key":"9f975a909766"},{"markDefs":[],"children":[{"_key":"d9341290d5880","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"6296ff97aa33"},{"_key":"7c5856b157cf","markDefs":[],"children":[{"marks":["strong"],"text":"References","_key":"673721c98070","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[{"blank":true,"_type":"link","href":"https://minorityhealth.hhs.gov/mental-and-behavioral-health-asian-americans","_key":"6a75133e7070","nofollow":true}],"children":[{"_key":"ddb1a671488d","_type":"span","marks":[],"text":"1. Mental and behavioral health - Asian Americans. HHS Office of Minority Health. Accessed May 25, 2024. 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Employers are funding a system that is really spiraling out of control in many ways: costs continue to go up, inflation is outpacing general inflation in the United States, hospitals are consolidating more than ever into large systems. It's becoming increasingly difficult to get fair prices on health care services, especially hospital services. And there are lots of concerns about declining population health, growing obesity rates, and growing concerns about mental health as a result of the pandemic. ","_key":"8230fc10a1650","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"421de154e064"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"9a410288cd0b","_type":"span"}],"_type":"block","style":"normal","_key":"ce184a4798d0"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"We don't want employers to feel frustrated or have learned helplessness. We think that there are things that can be done by employers and things that are going on in the broader system that are rays of hope. And so what we want to do in this conference is really spotlight some of the challenges, some of the solutions, and particularly the role of employers in driving change.","_key":"8fc7b8db8c46"}],"_type":"block","style":"normal","_key":"0cdd04accd14"},{"_type":"block","style":"normal","_key":"3bf872532f2b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"40735974993b"}]},{"markDefs":[],"children":[{"_key":"37d237b3cde10","_type":"span","marks":["strong"],"text":"What are some highlights from the agenda this year that attendees can look forward to?"}],"_type":"block","style":"normal","_key":"d2fece039cd2"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"We're really excited about the speakers we've lined up for this year's program and the panel sessions, as well. Starting off the conference, we have a keynote speaker, Ashley Bacot, who is with the Rosen organization in Florida. People in the Northeast may be less familiar with Rosen Hotels, but it's a large hotel chain in Florida, and the Rosen organization as an employer has a fantastic story to tell about how they stemmed health care costs for their workforce—things that they did to drive primary care, and to drive workforce health and engagement of the workforce. We think it's a great story. We think it's something that many other employers could and should be doing, and so we're excited to bring Ashley up from Florida to share this experience. ","_key":"d041435c49ee0"}],"_type":"block","style":"normal","_key":"791c2a86db97"},{"children":[{"_type":"span","marks":[],"text":"","_key":"9cee5862c1d2"}],"_type":"block","style":"normal","_key":"e1af80812ef7","markDefs":[]},{"style":"normal","_key":"925759356b32","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Our afternoon keynote is going to be speaking about the challenges being faced by employers in an increasingly litigious world. From a regulatory perspective, we've seen a couple of lawsuits now from employees aimed at employers regarding benefits and equity and particularly fiduciary responsibility that employers have. We think this is a critical issue, so we wanted to talk about what's going on in the regulatory environment, how employers can prepare so that they are at lower risk of being sued by their employees. ","_key":"6e22b632484a"}],"_type":"block"},{"style":"normal","_key":"71eae1a94767","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"87dea9c7311c"}],"_type":"block"},{"_key":"931ed5ae63a7","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We also have several great panel discussions during the day. One of them is on driving care excellence. How can employers identify who are the better providers? When your health plan says, \"We've identified a network of centers of excellence,\" what questions should you be asking to see if those centers are really, truly excellent or if they were selected based on cost and not on quality of care? ","_key":"a7660ae73972"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"932255b580a2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"cd3785ed629d"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"We have a session on how employers can help drive use of primary care. We as a coalition are strong believers that if everybody had access to high-quality primary care and had a good relationship with a primary care doctor, we would see significantly lower utilization and cost associated with [emergency department] visits and hospitalization, and pharmaceuticals and all the other cost drivers. So we'll be talking about primary care. ","_key":"8fa01f0da6c3"}],"_type":"block","style":"normal","_key":"fc685f1379aa"},{"markDefs":[],"children":[{"text":"","_key":"3907bf82b86f","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"7ca987a56a60"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"We also have a session on artificial intelligence [AI]. Everybody wants to know, \"What does AI mean for my population? What does it mean for me as a benefits manager or another healthcare stakeholder?\" So, we've got a great panel discussion about AI. And then we have a few other sessions, including a great speaker on how New Jersey as a state is trying to create greater transparency and control costs. That should be an interesting session because employers should be working with state government agencies to at least know what's going on in the states. 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And also we'll have a room full of exhibitors, who are some of the leading-edge thinkers about what's next in health care and what employers can do to reduce costs and improve access to care and health, and other issues like equity. ","_key":"8b4bf2ea1aeb0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"4a5be642590a"},{"style":"normal","_key":"1b905f117046","markDefs":[],"children":[{"marks":[],"text":"","_key":"38ea9513a1f2","_type":"span"}],"_type":"block"},{"style":"normal","_key":"39460f9834d9","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.eventbrite.com/e/getting-health-benefits-value-in-a-spiraling-world-tickets-866785908987","_key":"7f8ae72e06eb"}],"children":[{"_key":"107361c900de","_type":"span","marks":[],"text":"We've heard in the past, and I think this year will be no different, that the time spent with exhibitors and other attendees was also excellent. 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