This week, the top managed care news included a panel mostly endorsed the use of patient-reported outcomes for coverage of chimeric antigen receptor T-cell therapy; the US Preventive Services Task Force released new recommendations for cervical cancer screening; research found accountable care organization penetration may be changing how physicians work.
A panel examines how CMS should pay for chimeric antigen receptor (CAR) T-cell therapy, women receive new recommendations for cervical cancer screening, and a study shows accountable care organizations (ACOs) may be changing how doctors work.
Welcome to This Week in Managed Care, I’m Laura Joszt.
Use of PROs for CAR T
A CMS panel held a daylong hearing to discuss a national coverage determination for CAR T cell therapy, the game-changing cancer treatment approved by FDA for two indications and being studied for more.
CMS’ Medicare Evidence Development and Coverage Advisory Committee, known as MEDCAC, looked at evidence on patient-reported outcomes as it relates to CAR T.
UnitedHealthcare, a large manager of Medicare Advantage plans, asked CMS to start the process because of concerns over the cost of these individualized gene therapies, which can cost more than $400,000 and are difficult to administer.
Peter Bach, MD, of Memorial Sloan Kettering Cancer Center noted in the New England Journal of Medicine ahead of the meeting that despite the promise of CAR T cell therapy, these treatments are not without risk.
Screening for Cervical Cancer
How often women should be screened for cervical cancer depends on their age and other factors, according to new recommendations from the US Preventive Services Task Force.
Changes published this week give women ages 30 to 65 new options:
Women ages 21 to 30 should receive a Pap test every 3 years.
While testing has led to a decline in deaths from cervical cancer, 4170 women will die from the disease this year, according to the American Cancer Society.
Impact of ACOs on Physician Hours
Growth of accountable care organizations, or ACOs, may be changing physician working patterns, and this may be helping doctors to work fewer hours.
A new study in JAMA Network Open suggests that as the number of ACOs increased, physicians were less likely to be self-employed, but they also worked fewer hours.
The data show:
The authors concluded: “Given the wave of concern over physician burnout, it will be important to assess job satisfaction among physicians in ACOs to understand whether ACOs might help to alleviate some of the concerns currently besetting physicians.”
Saving Money in Medicare
Lower-cost generic drugs could save Medicare more than $900 million a year, according to researchers from Harvard Medical School and Brigham and Women’s hospital.
The study in JAMA calculated the difference between what Medicare spent on brand-name combinations and what would have been spent if those drugs were swapped for their generic components.
Role of Diabetes Educators
Robert Gabbay, MD, PhD, FACP, chief medical officer at Joslin Diabetes Center, told members of the American Association of Diabetes Educators last week that they can play a critical role in the transition to value-based care.
“We’ve long been in the fee-for-service world, where the incentive is to do things. We’re moving to one where value is key," he said.
Gabbay said educators help people with diabetes avoid complications and hospital stays, and this will be rewarded with new incentive structures.
Read more coverage of the AADE annual meeting.
Cancer Survivorship
As cancer survivors live longer, the medical system must address challenges with late effects, being lost to follow-up, and financial hardship.
The current issue of Evidence-Based Oncology looks at survivorship, led by a cover story from Florida Cancer Specialists’ Lucio Gordan, MD, and Don Champlain.
For all of us at the Managed Markets News Network, I’m Laura Joszt. Thanks for joining us.
Covered Preventive Services at Risk: V-BID Summit Breaks Down the Braidwood v Becerra Case
March 20th 2024For more than a decade, certain high-value preventive care services have been covered at no cost to patients under the Affordable Care Act, but a current legal challenge has the coverage at risk.
Read More
Oncology Onward: A Conversation With Penn Medicine's Dr Justin Bekelman
December 19th 2023Justin Bekelman, MD, director of the Penn Center for Cancer Care Innovation, sat with our hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for our final episode of 2023 to discuss the importance of collaboration between academic medicine and community oncology and testing innovative cancer care delivery in these settings.
Listen
FDA Approves Tislelizumab for Advanced or Metastatic ESCC After Chemotherapy
March 15th 2024The FDA has approved tislelizumab-jsgr (Tevimbra) for single-agent use in adult patients with unresectable or metastatic esophageal squamous cell carcinoma following prior systemic chemotherapy that did not include a PD-1/PD-L1 inhibitor.
Read More
Oncology Onward: A Conversation With Thyme Care CEO and Cofounder Robin Shah
October 2nd 2023Robin Shah, CEO of Thyme Care, which he founded in 2020 with Bobby Green, MD, president and chief medical officer, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, to discuss his evolution as an entrepreneur in oncology care innovation and his goal of positively changing how patients experience the cancer system.
Listen
Evolution of HDHPs With VBID Components Can Improve Care for Chronic Disease
March 14th 2024Over the course of the last 20 years, high-deductible health plans (HDHPs) have undergone an evolution. Today’s plans, with more high-value services covered predeductible, can improve care for people with chronic diseases, said panelists at the 2024 Value-Based Insurance Design (V-BID) Summit.
Read More
Fragmented Payer System, Vulnerable Supply Chain Among Threats to Accessing Essential Medicines
March 13th 2024During a session of the 2024 V-BID Summit, panelists Stacie Dusetzina, PhD, and Inma Hernandez, PharmD, PhD, discussed how access to essential medications is curtailed not just by the longstanding complexities of insurance design but also by emerging threats such as supply chain weaknesses and cyberattacks.
Read More