Managed Care Cast

In part 2 of this 2-part series on health equity in the treatment of psoriasis, Ryan Haumschild, PharmD, and Bryan Buckley, DrPH, discuss how providers can address disparities in psoriasis care, specifically with race, cultural, and ethnic backgrounds in mind.

Recently released vaccine data from both Pfizer and Moderna indicate encouraging steps forward in the global fight against coronavirus disease 2019 (COVID-19). But both vaccines are still a long way from becoming readily available to the wider public, prompting the question, who should be prioritized once doses become available? To provide guidance on this front, The National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) requested The National Academies of Science, Engineering, and Medicine (NASEM) to construct a framework assisting US policymakers and global health communities to plan for an equitable allocation of a COVID-19 vaccine. On this episode of Managed Care Cast, we speak with Jewel Mullen, (MD, MPH) the associate dean for health equity and associate professor of population health and internal medicine at the University of Texas at Austin, Dell Medical School. Mullen is the former principal deputy assistant secretary for health in the U.S. Department of Health and Human Services (HHS) and a member of the National Academies committee which developed the framework for vaccine allocation. Mullen discusses criteria used to prioritize vaccine recipients, barriers to equitable distribution, and the role of misinformation in the push for an effective COVID-19 vaccine. Read more: Pfizer Says Vaccine 90% Effective; Biden Team Announces COVID-19 Transition Panel: https://www.ajmc.com/view/pfizer-says-vaccine-90-effective-biden-team-announces-covid-19-transition-panel Study Backs Decision to Move Forward With Pfizer Vaccine Candidate: https://www.ajmc.com/view/study-backs-decision-to-move-forward-with-pfizer-vaccine-candidate Moderna SARS-CoV-2 Vaccine Elicits Response in Older Adults: https://www.ajmc.com/view/moderna-sars-cov-2-vaccine-elicits-response-in-older-adults Dr Maura Abbott: Talk to Your Patients About Their Vaccine Fears: https://www.ajmc.com/view/dr-maura-abbott-talk-to-your-patients-about-their-vaccine-fears Dr Maura Abbott: COVID-19 Vaccine Development Process Is Safe Despite a Quicker Timeline: https://www.ajmc.com/view/dr-maura-abbott-covid-19-vaccine-development-process-is-safe-despite-a-quicker-timeline Dr Victoria Smith on Experience Taking Part in a COVID-19 Vaccine Trial: https://www.ajmc.com/view/dr-victoria-smith-on-experience-taking-part-in-a-covid-19-vaccine-trial

Every week, The American Journal of Managed Care® recaps the top managed care news of the week. This week, the top managed care news included CMS planning to pay more for at-home dialysis equipment; ACR supports continued use of telemedicine after the COVID-19 pandemic passes; coverage of AIDS 2020, the 23rd International AIDS Conference. Read more about the stories in this podcast: CMS Seeks Incentives for At-Home Dialysis in Wake of COVID-19: https://www.ajmc.com/newsroom/cms-seeks-incentives-for-athome-dialysis-in-wake-of-covid19 ACR Position Statement Supports Use of Telemedicine After COVID-19 Crisis: https://www.ajmc.com/newsroom/acr-position-statement-supports-use-of-telemedicine-after-covid19-crisis Telehealth Growth in April Suggests Continuing Impact of COVID-19: https://www.ajmc.com/contributor/robin-gelburd-jd/2020/07/telehealth-growth-in-april-suggests-continuing-impact-of-covid19 Study Results Show Possible Link Between Medicaid Expansion, Drop in Advanced Breast Cancer: https://www.ajmc.com/newsroom/study-results-show-possible-link-between-medicaid-expansion-drop-in-advanced-breast-cancer- AIDS 2020: Virtual: https://www.ajmc.com/conferences/aids-2020 A Timeline of COVID-19 Developments in 2020: https://www.ajmc.com/focus-of-the-week/a-timeline-of-covid19-developments-in-2020 Physician and Patient Tools to Improve Chronic Kidney Disease Care: https://www.ajmc.com/journals/issue/2018/2018-vol24-n4/physician-and-patient-tools-to-improve-chronic-kidney-disease-care

Medication access barriers and nonadherence significantly impact medication underuse in the United States. This issue is estimated to cost the country’s healthcare system between $100 billion to $290 billion annually, as patients who underuse medication are more likely to have complications, which can result in costly health care utilization. Recently, The Pharmacy Quality Alliance (PQA) and National Pharmaceutical Council (NPC) announced 2 research grants funding studies of patients’ real-world medication access barriers. Leveraging the framework devised by the PQA and NPC released in March 2019, researchers at The Johns Hopkins Hospital and University of Rhode Island will investigate this problem and release their findings in 2021. Oral anticancer therapies have become popular alternatives to more traditional care, such as chemotherapy. However, research shows that adherence to oral anti-cancer therapies can range from 20% to 100%. Several factors contribute to medication non-adherence and access barriers. To learn more, we spoke with Ami Vyas, PhD, an assistant professor of pharmacy practice, specializing in health outcomes research, at The University of Rhode Island.

The last decade has brought great strides in diabetes care. Better insulins and better technology can allow people with diabetes—both type 1 and type 2—to keep their blood sugar from rising and falling in ways that cause long-term damage to their eyesight and vascular systems. New classes of drugs for patients with type 2 diabetes have been shown to cut the risk of heart and renal failure, and more widespread use could help some patients avoid dialysis. But the good news is not felt by everyone. Amid this progress, the rate of amputations rose 50% between 2009 and 2015. African American patients lose limbs at triple the rate of other groups. The mission of the Affordable Care Act—spend more to prevent disease and complications, and save money later—has bypassed many of these patients for one reason: they lack access to care. Fourteen states have not expanded Medicaid, including several Deep South states where diabetes and obesity rates are highest. The result of these state-level policy decisions is becoming clear. Research presented at the recent meeting of the American Diabetes Association found a 17% decrease in the risk of amputation when patients lived in states that expanded Medicaid. What’s more, the number of hospital admissions for diabetic foot ulcers plummeted in states that expanded Medicaid, while rising 21% in states that rejected expansion. None of this is news to Foluso Fakorede, MD, who treats patients at risk of limb loss in the Mississippi Delta. Fakorede spoke with The American Journal of Managed Care® about his work in Mississippi, through his practice, Cardiovascular Solutions of Central Mississippi. Read more: Diabetes Shouldn't Cost Patients Their Legs: https://www.ajmc.com/contributor/bret-weichmann/2020/01/diabetes-shouldnt-cost-patients-their-legs Understanding Diabetes Risks Can Save Your Limbs: https://www.ajmc.com/contributor/gerald-niedzwiecki/2019/12/understanding-diabetes-risks-can-save-your-limbs Heart Failure Coverage Success Seen in Medicaid Expansion States: https://www.ajmc.com/focus-of-the-week/heart-failure-coverage-success-seen-in-medicaid-expansion-states