Health Management

Navigate to: Preventive Health & Lifestyle Medicine | Behavioral Health | Chronic Illness: Autoimmune, Cardiovascular, Diabetes, Infectious Disease, Musculoskeletal/Rheumatology, Neurological, Ophthalmology, Pulmonary, Urology, Additional Topics

Preventive Health & Lifestyle Medicine

New Horizons in Acute Pain Relief: A Close Look at the Role of New and Emerging Non-Opioid Therapies

Every year in the United States, over 80 million people are prescribed medication for acute pain. Without adequate understanding of pain assessments, pain conditions, or their treatments, these patients may continue to experience diminished quality of life or chronic pain. Of these patients, about 40 million are prescribed an opioid. Nearly 10% of acute pain patients treated initially with an opioid will go on to have prolonged opioid use, and about 85,000 patients will develop opioid use disorder annually. Poorly controlled acute pain can lead to reduced quality of life, development of chronic pain, and increased clinical and economic burden on the health care system and society. Fortunately for patients that will deal with acute pain, new and emerging therapies, including non-opioid, highly selective pain signal inhibitors, have recently been approved, giving managed care professionals and clinicians more options for treating acute pain for the first time in decades. With new therapies entering the treatment paradigm with different mechanisms of action, knowledge gaps have been created, making it imperative that managed care physician medical directors, primary care physicians, emergency physicians, pharmacists, payers, nurses and other healthcare professionals who manage EC patient populations have a solid understanding of these options to optimize both costs and patient outcomes in their therapeutic application, for optimized clinical and economic outcomes.
Physician, Nursing and CMCN credits valid to August 1, 2026

Behavioral Health

New Horizons in the Treatment and Management of Schizophrenia: Managed Care Considerations on the Impact of New and Emerging Therapies

Schizophrenia is a complex and chronic psychiatric disorder distinguished by disturbances in thought, cognition, and behavior. It may result in a mix of hallucinations, delusions, and disorganized thinking and behavior. Hallucinations involve seeing things or hearing voices that aren’t observed by others. Delusions involve firm beliefs about things that are not true. People with schizophrenia can seem to lose touch with reality, which can make daily living very hard. Disparities persist, and low response rates to the current treatments are poor, with research showing only half of patients being able to live a normal life. It is estimated to impact approximately 2.8 million people in the United States. Symptoms typically first appear in early adulthood and present differently in each person, making symptoms difficult to diagnose and manage.
Fortunately for patients with schizophrenia, new classes of therapy have recently become available for the first time in decades, giving managed care professionals and clinicians new options and approaches for treating this patient population. These new therapies, including muscarinic agonists, offer novel ways to improve patient adherence, functioning and management, and reduce the economic impact associated with nonadherence and relapse. With new therapies entering the treatment paradigm, knowledge gaps have been created, making it imperative that managed care physician medical directors, mental health professionals, pharmacists, payers, nurses and other healthcare professionals who manage schizophrenia patient populations have a solid understanding of these options to optimize both costs and patient outcomes in their therapeutic application, for optimized clinical and economic outcomes.
Physician, Nursing and CMCN credits valid to August 1, 2026

Chronic Illnesses

AutoImmune

Tailoring Patient Care Using Novel Agents in Ulcerative Colitis: Multidisciplinary Approaches for Enhancing Patient Outcomes

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that causes inflammation and the formation of ulcers in the lining of the colon and rectum. UC affects around three million people in the United States and is most seen in people aged 20 to 40 years. The diagnosis of UC is typically seen through a combination of clinical symptoms, endoscopic findings, histological examination, and exclusion of other causes of colitis, such as infections. There are certain tests, such as serological markers and fecal calprotectin, that can help, but they are not as definitive when making an accurate diagnosis. Genetic biomarkers and testing continue to gain momentum when looking at diagnostic tools to help with more precise disease categorization and personalized treatment plans.
Therapeutic advances are transforming outcomes and treatment goals for many people living with UC, but patients continue to experience setbacks in their personalized care. Immediate patient goals are to relieve symptoms to help improve a patient’s quality of life, while long-term goals include maintenance of a corticosteroid-free clinical remission, mucosal healing, and endoscopic remission. Traditional therapy for the drug management of UC has involved the use of 5-aminosalicylic acid (5-ASA) compounds, Sulfasalazine, and corticosteroids. These therapeutic pathways have proven effective, but newer options, including alpha-4-integrin blockade agents, anti-CD3 antibodies, and biologic therapies, offer the prospect of improved dosing and compliance with traditional molecules. A better understanding of treatments will offer managed care professionals’ essential information on giving patients the best treatments available to improve quality of life and outcomes. Studies show that inflammation due to an overreaction of the IL-23 pathway can play a crucial role in how UC develops into a chronic disease. One successful treatment option shows a significant reduction in inflammation using a dual-acting monoclonal antibody that blocks IL-23 while also binding to CD64, a receptor on cells that produce IL-23. As these new treatments continue to impress and others begin to come out, it is essential to determine which treatments are preferred based on safety and efficacy data that prove clinical significance to help improve patient outcomes.
Physician, Nursing and CMCN credits valid to August 1, 2026

Improving Outcomes and Integrating Evidence-Based Treatment Approaches for Psoriasis

Psoriasis is a complex, chronic, immune-mediated inflammatory disease that affects approximately 7 million of the population in the United States. Psoriasis is a periodic flare-up of sharply defined red patches, covered by a silvery, flaky surface. The main disease activity leading to psoriasis occurs in the epidermis, the top five layers of the skin. The disease most commonly appears on the skin of the scalp, elbow, knees, and lumbosacral areas of the body. Many of the patients are not receiving the appropriate treatment discussed in the current guidelines and standards of care. Psoriasis is a complex disease to manage, but the goal should be a patient-centered treatment that reduces disease burden, improves quality-of-life, and addresses the risks of systemic complications and comorbid conditions. The under diagnosis and treatment of psoriasis continues to be a serious concern. It is for these reasons that there needs to be continuing education that addresses the treatment gaps and challenges in the diagnosis, treatment, and management of psoriasis.
Physician, Nursing and CMCN credits valid to March 1, 2026

Best Practices in the Diagnosis and Management of Hereditary Angioedema (HAE): Managed Care Considerations for Optimized Clinical and Economic Outcomes

Hereditary angioedema (HAE) is a rare autosomal dominant condition characterized by recurrent attacks of edema at different locations of the body. This potentially life-threatening disease affects approximately 1 in 67,000 individuals, with no identified differences in sex or ethnicity. HAE is characterized by recurrent edema attacks and cutaneous attacks can be disabling. The skin, gastrointestinal tract, and upper airways are most commonly affected and with a persistent risk to the patient of acute events of laryngeal swelling that may prove fatal if not treated in a timely manner. Angioedema in general can be confused with cellulitis, Graves disease, blepharochalasis, eosinophilic fasciitis, or amyloidosis which can lead to delays in diagnosis, and inappropriate treatment poses the risk of adverse events, unnecessary surgical interventions, a higher burden of misery, and a potentially higher rate of morbidity and mortality. Fortunately for patients with HAE, novel therapies have recently become available in the past few years that have shown improved efficacy and safety with improved administration methods, including oral therapy. With these new options comes a knowledge gap among physician medical directors, pharmacists, immunologists, and nurse case managers as the treatment paradigm is growing.
Physician, Nursing and CMCN credits valid to March 1, 2026

Cardiovascular

Assessing the Expanding Roles of Optimal Therapies and Technology in PAH Management

Pulmonary Arterial Hypertension (PAH) is a progressive vascular disorder characterized by vascular remodeling of the pulmonary arteries which carry blood from the heart to the lungs. For those with PAH, the muscles within the arterial walls tighten, which can cause thickening and/or scar tissue to develop, increasingly narrowing their diameter. This leads to a progressive increase in pulmonary vascular resistance that leads to right ventricular failure and significant morbidity and mortality. Over time, the heart muscle can become so weakened that its ability to pump enough blood through the body is lost, leading to heart failure. The estimated prevalence is between 15 and 50 cases per million individuals and about half of people diagnosed with PAH will not live past five years, while those with untreated PAH have an average survival expectancy of approximately three years following diagnosis – and even with aggressive management, PAH has a 15% annual mortality rate.
Physician, Nursing and CMCN credits valid to March 1, 2026

Diabetes

Delaying the Progression of Type 1 Diabetes: Managed Care Considerations on the Role of New and Emerging Therapies

Type 1 diabetes (once called insulin-dependent or juvenile) is a chronic condition in which the pancreas produces very little or no insulin, a hormone produced by the pancreas to regulate the amount of glucose in the blood. Typically appearing in adolescence, type 1 diabetes is much less common than type 2, making up 5–10% of total diabetes cases in the United States. According to the American Diabetes Association, 1.6 million Americans have type 1 diabetes, including 187,000 children and adolescents. T1D impacts approximately 1 in 300 school-aged children in the US and the cognitive deficits have the potential to affect the growth and neuropsychological development of young children if not managed properly. Fortunately for patients with earlier stages of T1D, the treatment paradigm has expanded in the last year, giving managed care professionals and clinicians more options for managing these patients. This activity will feature strategies to overcome challenges in the optimal management of T1D and highlight the role of managed care professionals in making informed decisions on therapies that will improve quality of life, delay the disease progression, and minimize costs and the burden of disease.
Physician, Nursing and CMCN credits valid to August 1, 2026

Infectious Disease

Best Practices in the Prevention and Management of HIV: Optimizing PrEP and ART Managed Care Decision Making for Improved Clinical and Economic Outcomes

The human immunodeficiency virus (HIV) is a lentivirus that causes HIV infection and over time acquired immunodeficiency syndrome (AIDS). AIDS is a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. HIV infects vital cells in the immune system such as helper T cells, macrophages, and dendritic cells. HIV infection leads to low levels of CD4+ T cells through a number of specific mechanisms. When CD4+ T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections. The CDC estimates that 1,218,400 persons in the United States aged 13 years and older are living with HIV infection. Additionally, an estimated 15,815 people died from HIV and AIDS in 2022. Fortunately for patients with HIV, several new therapies have become available over the past year, including long-acting injectable therapies for both treatment and PrEP and options for heavily treatment-experienced (HTE) patients. With so many new options entering the treatment paradigm, it is critical that medical directors, practicing physicians, nurses, and other healthcare professionals are updated on these emerging options and guidelines and strategies for implementing them into the treatment paradigm and individualizing therapy, which will ultimately improve clinical and economic outcomes.
Physician, Nursing and CMCN credits valid to August 1, 2026

Musculoskeletal & Rheumatology

Neurological

The Role of the Managed Care in Optimizing Treatment for ALS: The Impact of Early Intervention, Patient-Centered Care, and Disease-Modifying Therapies in Slowing Progression

Amyotrophic lateral sclerosis (ALS), more commonly known as Lou Gehrig’s disease, is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. An estimated 20,000 people in the United States are living with ALS. It is a progressive disease in which the motor neurons eventually die. Mortality is usually the result of respiratory failure. Although most patients with ALS die within 3 to 5 years after symptoms first appear, about 20% of patients with ALS will live 5 years, 10% will live 10 years, and about 5% will live 20 years or more. Currently, there is no cure for ALS. Fortunately for patients with ALS, the treatment paradigm has expanded in recent years, giving medical directors and clinicians many more options in managing symptoms and delaying progression in the ALS patient population. Additionally, these treatments have now changed administration methods, giving clinicians and managed care professionals more options for ALS patients and members. With new options expanding the treatment armamentarium in ALS, a knowledge gap has been created, making it imperative that managed care physician medical directors, practicing physicians, pharmacists, payers, nurses and other healthcare professionals who manage ALS patient populations have a solid understanding of differing options to optimize both costs and patient outcomes in their therapeutic application.
Physician, Nursing and CMCN credits valid to August 1, 2026

Recent Advances in the Treatment and Management of Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic progressive disease. It is the most common neurological cause of disability among young adults, with a prevalence of approximately 1 million cases throughout the United States, and every week around 200 people are diagnosed with the disease. Although there is still no cure for MS, many advances in MS treatment have arrived in recent years, allowing patients to manage these symptoms and improve their quality of life. A number of factors must be considered when selecting a treatment regimen for patients with MS, including variations in clinical and MRI evidence of disease. Over the past decade, there have been numerous revisions to MS diagnostic criteria and the development of multiple new and emerging therapies. While the explosion of these therapies have shown the ability to improve outcomes and quality of life in patient’s MS, it makes staying current with best practices a challenge that must be overcome through education. New options showing improved efficacy, safety and deliverability have arrived, and it is for this reason that medical directors, neurologists, practicing physicians, nurse case managers and other healthcare professionals must be updated on the current and emerging treatments and strategies in the management of MS.
Physician, Nursing and CMCN credits valid to August 1, 2026

Recent Advances in the Treatment and Management of Early Alzheimer’s Disease: Managed Care Insights on Role of Novel Therapies

Alzheimer’s disease is the most common form of dementia, affecting an estimated 5 million people in the United States. It is a cognitive disorder that includes behavioral impairment that interferes with social and occupational functioning. Over time, the disease destroys large areas of the brain, resulting in cellular loss and dysfunction, a gradual loss of memory, problems with reasoning or judgment, disorientation, difficulty in learning, loss of language skills, and decline in the ability to perform routine tasks. Although not all memory loss indicates Alzheimer’s disease, one in ten people over 65 years of age, and over half of those over 85, have Alzheimer’s disease. Currently, 26 million people worldwide have this dementia. By the year 2050, over 15 million Americans may be affected with the disease. Alzheimer’s disease care costs $200 billion annually in the United States alone. Fortunately for patients with Alzheimer’s disease, new and emerging therapies, including anti-beta-amyloid (Aß) monoclonal antibodies, have been recently made available, giving medical directors and clinicians options for providing patients with significant reductions in clinical decline. With new options on the horizon, it is imperative that managed care physician medical directors, practicing physicians, pharmacists, payers, nurses, and other healthcare professionals who manage Alzheimer’s disease patient populations have a solid understanding of these options to optimize both costs and patient outcomes in their therapeutic application, and to be prepared if they are made available.
Physician, Nursing and CMCN credits valid to March 1, 2026

Advancing Care in Narcolepsy and Idiopathic Hypersomnia: Optimizing Treatment and Addressing Challenges in Sleep Management

Hypersomnia is characterized by recurrent episodes of excessive daytime sleepiness or prolonged nighttime sleep. It may be caused by another sleep disorder (such as narcolepsy or obstructive sleep apnea), dysfunction of the autonomic nervous system, or drug or alcohol abuse. In some cases, it results from a physical problem, such as a tumor, head trauma, or injury to the central nervous system. Even when factors such as treatment adherence, medications, comorbid illness, and inadequate sleep duration are controlled, up to 33% of all Americans still experience some type of sleep-depravity. For most people, mild sleepiness is apparent only during boring, sedentary situations, however patients with narcolepsy, severe hypersomnia, can lead to involuntary somnolence during regular activities that could put the patient and others in a harmful situation, such as driving, eating, or talking. Idiopathic hypersomnia (IH) is a sleep disorder in which a person feels excessive tiredness, even after a full and uninterrupted night of sleep. People with this condition may sleep longer than normal, sometimes 11 or more hours a night, yet still feel tired during the day. It is important that medical directors, clinicians and healthcare professionals are kept up-to-date on the novel treatment strategies that will help address the challenges that patients are dealing with daily.
Physician, Nursing and CMCN credits valid to March 1, 2026

Ophthalmology

Keeping Pace with the Rapid Advancements in the Treatment and Management of nAMD and DME: Expert Managed Care Strategies on the Role of Anti-VEGF Therapies

Retinal diseases are those that affect the retina, or the back layer of your eye. A retinal disease can affect any part of the retina, including the macula. Many retinal diseases cause symptoms that affect a patient’s vision. It’s important to find and treat diseases of the retina, as many of them can cause blindness or low vision if they aren’t treated. Retinal diseases including age-related macular degeneration (AMD) and diabetic retinopathy/diabetic macular edema (DR/DME) pose a significant burden to patients and the health care system. Fortunately for patients with AMD and DR/DME, intravitreal anti-vascular endothelial growth factor (VEGF) therapy has revolutionized the treatment of retinal disease and improved patient outcomes, especially in the area of dosing intervals which have improved quality of life for patients with less frequent injections. However, while the clinical benefits of these compounds are well documented their use brings up other issues for ophthalmologists, namely, cost. In addition to time requirements for appointments for intravitreal injections of anti-VEGF inhibitors and post-injection recovery, the cost of anti-VEGF therapies may limit patient access as well. Managed care professionals, including physician medical directors, must ensure that retinal specialists and patients have access to a variety of anti-VEGF therapies so that treatment can be individualized. Managed care medical directors, pharmacists and nurse case managers need education on the differentiating factors of available anti-VEGF therapies for AMD and DR/DME and emerging agents to equip clinicians to ensure appropriate communication occurs with retinal specialists so that patients receive timely, effective, and comprehensive treatment.
Physician, Nursing and CMCN credits valid to August 1, 2026

Pulmonary

Urology

Additional Topics

Elevating Women’s Care with Optimal Treatment Strategies for Menopause and Vasomotor Symptoms

Menopause is a routine, non-pathologic condition involving the permanent cessation of menses for at least 12 months and occurs in all menstruating females due to non-pathologic estrogen deficiency. In the United States, approximately 1.3 million women become menopausal each year. It typically begins between the ages of 51 and 52, although some women experience premature menopause before the age of 40, due to permanent ovarian failure that may be associated with sex chromosome abnormalities. Menopause symptoms vary, but 75% of women experience vasomotor symptoms (VMS). These include hot flashes, night sweats, palpitations, and migraines. Woman can also experience urogenital and psychogenic symptoms, which can include anxiety, depression, sexual dysfunction, and migraines.
Menopause treatment and management revolve around treating and minimizing symptoms, preventing long-term complication, and managing comorbidities. Hormone therapy can treat vasomotor symptoms and prevent vaginal/urogenital atrophy, as well as preserve an advantageous lipoprotein profile and prevent bone loss. It can be given in various forms in different modalities, and is available as systemic estrogen, estrogen-progestin, estrogen-bazedoxifene, progestin alone, or combined oral contraceptives. Selective estrogen receptor modulators (SERMs), such as raloxifene, bazedoxifene, and ospemifene, have the ability to modulate estrogen action without stimulating endometrial growth or increasing risk of cancer. SERMs have the same outcome as hormone therapy in preventing bone loss and promoting beneficial lipoprotein levels. Non-hormonal therapies can include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin, and clonidine. Many treatments can be used for short durations (a few months) for menopause symptoms. With all the different treatments options on the horizon, healthcare professionals need to be educated on the safety and efficacy of each and how they can impact and improve patient outcomes.
Physician, Nursing and CMCN credits valid to August 1, 2026

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For more information contact Jeremy Williams at 804-527-1905 or jwilliams@namcp.org.
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