5 Things We Got Right (or Wrong) in 2016

Covering any field involves informed thinking about what’s to come—and healthcare is no exception. In a year like 2016, however, trying to predict what was ahead wasn’t easy. Here are 5 key issues The American Journal of Managed Care^® (AJMC^®) covered throughout the year, including some we called correctly and others where we’d like to return our crystal ball.

1. CMS scraps plan to overhaul Medicare Part B proposal.

A March proposal called for experimenting in with new payment models in certain geographic areas, but it was met with resistance from the start, especially from oncologists, ophthalmologists, and rheumatologists. Our coverage, including opinion pieces from patient advocate Debra Madden, discussed how lowering the add-on payments to high-cost cancer agents from 6% to 2.5%, plus a flat fee of $16.80, would be catastrophic for oncology practices. After groups like the Community Oncology Alliance and the American Society of Clinical Oncology weighed in against it, we were not surprised when CMS pulled the plug on the project earlier this month.

MOSTLY RIGHT

2. Insulin will be the next EpiPen.

Frustration this summer over huge, unexplained cost increases for the epinephrine injection devices, made by Mylan, raised the obvious question: what will be the next drug that sparks public outrage? Led by a September editorial from Robert A. Gabbay, MD, PhD, the chief medical officer at Joslin Diabetes Center who also serves as editor-in-chief for Evidence-Based Diabetes Management^TM, our coverage and an informal poll revealed the growing, widespread anger in the diabetes community over recent price hikes in insulin. We weren’t surprised when the American Diabetes Association called for Congress to investigate price hikes and Senator Bernie Sanders, I-Vermont, and Representative Elijah Cummings, D-Maryland, requested an investigation into insulin prices for possible collusion. In addition, recent job cuts at major insulin manufacturers suggest the industry is bracing for ongoing pushback over prices.

MOSTLY RIGHT

3. Drug costs will be the big political issue of 2016.

Polling shows voters support steps to lower drug prices, and in any other year this issue might have taken center stage. Costs certainly were a hot topic, but while Republican Donald Trump and Democrat Hillary Clinton were split on many topics, they agreed on the need to give Medicare the right to negotiate prices. This issue didn’t dominate the way we thought it might back in 2015, but we correctly predicted that Americans would remain fed up with prescription costs to the end of the campaign. If President-elect Trump fails to follow through on promises to rein in prices, this could re-emerge as a top consumer issue.

PARTLY RIGHT

4. Aetna withdraws from exchanges in all but 4 states.

While an earlier move by UnitedHealth to cut back its presence on the marketplace exchanges was not a surprise, this move in August came as a big blow, since Aetna had said as recently as May it had no plans to contract its footprint—and might even expand. Aetna did lay the groundwork for the move by withdrawing as a member of America’s Health Insurance Plans (AHIP). Published reports tied Aetna’s move to the Justice Department’s resistance to its proposed merger with Humana, and showed that Aetna laid out the possibility in court filings.

MOSTLY WRONG

5. Donald Trump is elected president, vows to undo the Affordable Care Act (ACA).

We’re not alone on this one. Right up to Election Day, experts at an AHIP meeting and elsewhere discussed 2017 assuming that Clinton would be president. On the plus side, AJMC^® wrote extensively about Trump’s healthcare proposals and did one of the first in-depth articles on what his call to “sell insurance across state lines” might mean. Like everyone else, we’ll be watching to see how President-elect Trump follows through on his call to “repeal and replace” the ACA.

MOSTLY WRONG