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In this episode, Peter Wehrwein, managing editor of Managed Healthcare Executive, speaks with Dr. Rodrigo Cerda. Dr. Cerda has been recently promoted to the position of senior vice president of health services and chief medical officer of Independence Blue Cross in Philadelphia. He is also a member of Managed Healthcare Executive’s editorial advisory board. Peter and Dr. Cerda discuss his new role at the Independence Blue Cross, what it means to be a chief medical officer at an insurer these days, valued-based care, social determinants of health, and, of course, the pandemic.

A 2022 report by the Department of Labor cites specific examples of health plans and health insurance issuers failing to ensure parity. For instance, a health insurance issuer covered nutritional counseling for medical conditions like diabetes, but not for mental health conditions such as anorexia nervosa, bulimia nervosa and binge-eating disorder.

A look inside six trends that will shape and influence care, planning and performance over the next year for health plans.

The introduction of an electronic tracking system decreased the time from hepatocellular carcinoma (HCC) diagnosis to treatment by more than a month.

The true key to achieving high savings, more patient volume, and better health outcomes is to effectively use clinical and cost data with physicians to create interventions that improve performance.

Authors of an article in Health Affairs about a program for smaller and rural ACOs say their finding show those kinds of ACOs can generate major savings for Medicare, but apprehension about downside risk prompted an exodus from the program.

The global cancer immunotherapy market is set to grow at a compound annual growth rate, or CAGR, of 12.6% to $277.1 billion by 2030.

Price transparency is a primary focus for health plans in 2022 to support rising consumer demand for improved healthcare experiences and align to federal price transparency mandates.

The new Medi-Cal Rx program that debuted Jan. 1 has alarmed health clinics that say the state's Medicaid will lose money and have to cut services.

Real-time notifications accelerate accurate care management. To deliver better and more timely care management to patients, payers should work with providers to adopt a technology-agnostic communication strategy .

Our survey results reflect the reality that American healthcare is inching not galloping to value-based care.

A longitudinal study of 10 million people in the U.S. military shows the link. The researchers say genetic predisposition, other factors are likely needed for the viral infection to cause multiple sclerosis.

The company joins the wide array of online pharmacy services, such as Amazon Pharmacy, that have popped up in recent years. Cuban has also launched a namesake PBM.

Many have claimed that technology will be the great equalizer in healthcare. While technology is objective and purely data-driven and without prejudice, there can still be inherent biases that hamper the ultimate goal of health equity.

Many of the darkest fears about COVID-19 affect on people with HIV have not come to pass. According to a recent review, some evidence suggests that people with HIV may be more likely to develop a severe case of COVID-19, although it isn’t certain. Antiretroviral therapy, especially Truvada, may provide some protection against infection and severity.

The Janssen drug is the only DOAC available in an oral suspension, which facilitates pediatric weight-based dosing.

CMS and state officials are using payment incentives, data collection and program requirements to start edging the lofty ideals of health equity toward reality.

Almost two-third of the respondents to our survey were in favor of the trend of more state-level regulation of the pharmacy benefit management industry.

Cerdá, a member of the Managed Healthcare Executive® editorial advisory board, is part of a new wave of leadership at the Philadelphia-based insurer led by CEO George Deavens.

United States healthcare spending rose 9.7% in 2020, while medication spending is increasing by more than 18%.

Healthcare professionals need to make patients the primary decision-makers in their own care and actively support their efforts to achieve their care goals.

Most (54%) respondents indicated that they believe the FDA made a mistake when it approved the controversial Alzheimer’s drug in June 2021.

The limit is four tests per household.

Telehealth, efforts to address social determinants of health and a focus on health disparities are likely to be among the top priorities in population health this year.

The FDA okayed two Janus kinase 1 (JAK1) JAK inhibitors January 14 the for atopic dermatitis: Cibinqo and Rinvoq.

Forty percent of the respondents to our annual State of the Industry survey expect vertical integration of providers to increase this year.

Walmart seems to be pulling back and opioid litigation looms.

The use of digital devices has surged significantly as people spend more time at home, with Americans logging an average of 13 hours per day watching screens. That compares to between seven and 10 hours per day before the COVID-19 pandemic started, with the increase in screen time likely contributing to more exposure to blue light.