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This Week in Managed Care: August 24, 2018

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.

Read coverage of the meeting.

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 can be screened by a Pap test every 3 years, or
  • Women can be screened by a Pap test and high-risk HPV together every 5 years, in a process called co-testing.
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:
  • In 2011, physicians worked an average of 52.2 hours per week and one-fourth were self-employed.
  • In 2015, physicians were working 51.9 hours a week and self-employment was down to 20.3%.
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.

Read more.

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.

See the full issue.

For all of us at the Managed Markets News Network, I’m Laura Joszt. Thanks for joining us.

 
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