Managed Care Cast

Chronic kidney disease (CKD) affects an estimated 37 million Americans, yet most cases go undiagnosed until the disease has significantly progressed. A urine albumin-to-creatinine ratio (uACR) test can detect kidney damage years before a decline in the estimated glomerular filtration rate (eGFR), but it remains underutilized.

In the first episode of Beyond the Silo: Integrated Care Across the CRM Continuum, a podcast series from The American Journal of Managed Care®, Marc P. Bonaca, MD, MPH, moderates a discussion with Josephine Harrington, MD, on why uACR has not yet become a standard of care, how CKD fits into the broader cardio-renal-metabolic (CRM) disease continuum, and what changes are needed across specialties, systems, and workflows.

Bonaca is a cardiologist and vascular medicine specialist at the University of Colorado Anschutz and the executive director of CPC Clinical Research. Harrington is also a cardiologist, specializing in advanced heart failure and transplant cardiology at UCHealth’s Heart and Vascular Center at the University of Colorado Hospital.

Throughout the conversation, they emphasize that CKD is an early integral part of the CRM continuum, as it is both a driver and consequence of cardiovascular risk, with uACR elevation often appearing before eGFR decline and signaling increased risk even at mild levels. Despite strong guideline support, uACR screening remains underused due to structural barriers. Therefore, the experts explained that the primary barrier is not the test itself but the lack of streamlined workflows that make screening routine and results actionable without adding clinician burden.

They concluded that early detection is critical because it enables the timely use of therapies such as SGLT2 inhibitors, glucagon-like peptide-1 receptor agonists, and finerenone, which improve outcomes. To close the gap, the experts noted that uACR should be treated as a routine vital sign for cardiometabolic risk and embedded into health system quality metrics to ensure consistent, accountable use.

On this episode of Managed Care Cast, The American Journal of Managed Care® (AJMC®) was joined by Tim McDonald, PhD, MPP, and Bryan E. Dowd, PhD, authors of research published in the April 2026 issue.

Their study, "Benefit Design and Consumer Information: Results From a Randomized Trial," found that reducing information barriers for consumers selecting primary care clinics in a tiered network design had only a marginal effect on choice.

McDonald and Dowd noted that this suggests informational interventions alone may be insufficient to overcome existing inertia. They added that consumers may already be adequately informed through the tiered benefit design.

In AJMC’s conversation with the authors, we discussed how provider- and consumer-oriented payment reforms influence health care efficiency and the role of consumer inertia. We also explored the key findings from their research and the broader implications for patient decision-making.

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

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

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