Managed Care Cast

This week's Managed Care Cast episode features a conversation between The American Journal of Managed Care® (AJMC®) and Grace Mackleby, PhD, a research scientist at the USC Schaeffer Center, about her study, "Plan Switching Among Medicare Advantage Enrollees Dually Eligible for Medicaid," published in the September 2026 issue of AJMC.

The study examined how often beneficiaries switched from one Medicare Advantage (MA) plan to another or from MA to traditional Medicare (TM). It compared enrollees dually eligible for Medicaid with those eligible for Medicare only. Mackleby explained that dually eligible beneficiaries account for about one-fifth of the Medicare population and tend to have more chronic conditions, higher costs, and greater needs; they are also subject to different rules on when they can switch plans.

Mackleby and coauthors Angela Liu, PhD, and Erin Trish, PhD, used administrative Medicare enrollment data to track switching from 2016 to 2022. She highlighted 3 main results. First, about 22% of fully dually eligible enrollees switched MA plans in 2022, up from about 12% in 2016. Second, these enrollees were roughly 6 times more likely to switch to another MA plan than TM. Third, dually eligible beneficiaries overall switched MA plans more often than those eligible for Medicare only.

The study did not examine causes, but Mackleby pointed to 2 likely drivers: the growing number of available MA plans and the strong competition among insurers, which have heavily marketed supplemental benefits such as flex cards and dental coverage. For non–dually eligible beneficiaries, she added, it is difficult in most states to obtain Medigap coverage after enrolling in MA, which makes returning to TM financially unappealing.

Switching also varied by race and ethnicity. Black, Hispanic, and American Indian/Alaska Native fully dually eligible enrollees switched MA plans more often than non-Hispanic White enrollees. Mackleby said geography may play a role. However, higher switching could also indicate lower satisfaction with available plans, which warrants further study, she noted.

Looking ahead, Mackleby emphasized the need to understand whether switching helps or harms beneficiaries, including its effects on access to care and cost sharing. She also called for research on how switching shapes market performance.

"I think looking at it from a beneficiary welfare perspective is going to be really important, and then also looking at it from a market perspective is going to be important too," Mackleby concluded.

On this episode, I spoke with Jonathan Kimmelman, PhD, professor of biomedical ethics and associate member of the Department of Experimental Medicine at McGill University, about the ethical concerns surrounding Kalshi as it relates to clinical trial outcomes and FDA approvals.

During Suicide Prevention Month, UPMC experts discuss how lived experience, peer support, and connection strengthen suicide prevention.

September is Blood Cancer Awareness Month, and to mark it, we have a special Director's Cut episode of Managed Care Cast. My name is Maggie Shaw, lead editor at AJMC, and my guest today is Surbhi Sidana, MD, associate professor of medicine at Stanford University, where she leads the Myeloma Disease Focused Group and serves as associate director for clinical research in the BMT and Cell Therapy Division. We talk about her path into myeloma research, the field's shift from a once-fatal diagnosis to real conversations about cure, the barriers patients face accessing CAR T-cell therapy, and her advice for the next generation of hematologists.

Health-system pharmacy is entering a decade of change, and Future-Proofing Pharmacy is built to keep asking what that future should look like. In this debut episode, host Mark Makhinson, PharmD, senior director of outpatient and specialty pharmacy at Mount Sinai Health System, introduces the podcast's mission: exploring how pharmacy leaders can build organizations that are clinically meaningful, scalable, and ready to adapt, rather than simply reacting to financial pressure, workforce shifts, and drug shortages as they arise.

Makhinson lays out the questions the series will return to throughout its run, including what a health system pharmacy enterprise looks like in 2035, where artificial intelligence can meaningfully help, and where human judgment should remain central.

Episode 1 kicks off with Nilesh Desai, PharmD, chief pharmacy officer at University of Miami Health System, who shares the pharmacy enterprise he would build from scratch in 2035 and the lessons that shaped his thinking during a major pharmacy transformation at Baptist Health, including the development of a consolidated pharmacy service center.