This Week in Managed Care: April 10, 2020

This week, the top managed care news includes a report on how CDC lacks data to tell the full story on disparities in the COVID-19 pandemic, Medicare Advantage gets a pay bump amid COVID-19 rule changes, and the nation’s top infectious disease expert speaks with the editor-in-chief of JAMA.

CDC lacks data to tell the full story on disparities in the COVID-19 pandemic, Medicare Advantage gets a pay bump amid COVID-19 rule changes, and the nation’s top infectious disease expert speaks with the editor-in-chief of JAMA.

Welcome to This Week in Managed Care, I’m Matthew Gavidia.

As the United States prepares for what some warn could be the worst week yet of the COVID-19 pandemic, increased attention on epicenters in New York and New Jersey has overshadowed the impact on economically vulnerable populations.

In particular, minorities have historically high rates of chronic conditions—such as diabetes, obesity, and COPD—which means these groups are at greater risk of during the pandemic.

With the CDC yet to provide data on race and COVID-19 mortality, ProPublica showed that African Americans in Milwaukee are contracting and dying from COVID-19 at an "alarming" rate.

As of April 2, “19 people had died of illness related to COVID-19 in Milwaukee County. All but 4 were black… Records show that at least 11 of the deceased had diabetes, 8 had hypertension, and 15 had a mixture of chronic health conditions that included heart and lung disease,” according to ProPublica.

For more, visit

This week, CMS announced a 1.66% average rate increase for Medicare Advantage plans in 2021, which comes as the agency is easing up on quality reporting requirements to give health systems breathing room amid the pandemic.

The average increase was higher than the proposed rate of 0.93%, but less than the increase Medicare Advantage plans received in 2020. Officials said this did not reflect adjustments for “underlying coding trend,” which would mean that if Medicare beneficiaries have multiple diagnoses, average payments could rise as much as 3.56%.

CMS is also seeking input on new measures for care in renal failure and dialysis, prior authorizations, physical functioning activities of daily living, and initial opioid prescribing in Part D.

For more on the announcement, visit

In an interview with the editor-in-chief of JAMA, Dr Howard Bauchner, the nation’s top infectious disease expert, Dr Anthony Fauci, said that he thinks the country will soon start to see a plateauing and decline of illness and death from COVID-19.

Fauci additionally held out hope that serological testing could show which individuals have antibodies to the virus.

Such tests might allow people to get back to “critical infrastructure jobs,” Fauci said. The shutdowns triggered by physical distancing has put millions of people out of work.

However, he said life will not go back to the way it was before.

“Don’t anybody ever shake hands again,” said Fauci.

During a White House coronavirus press briefing this week, Fauci also spoke on racial disparities of COVID-19 cases.

“It really does have, ultimately, shined a very bright light on some of the real weaknesses and foibles in our society,” Fauci said.

Fauci compared the disparities to the stigmas prevalent for the gay community during the HIV/AIDS epidemic.

"I see a similarity here because health disparities have always existed for the African American community,” said Fauci, “but here again, with the crisis, how it’s shining a bright light on how unacceptable that is.”

For more, visit

According to an abstract originally slated to be presented at ENDO 2020 but that will now be published in a special supplement to the Journal of the Endocrine Society, researchers reported the creation of a machine-learning—based model to help predict which patients will develop diabetes.

“Currently, we do not have sufficient methods for predicting which generally healthy individuals will develop diabetes,” said lead study author Dr Akihiro Nomura.

The artificial intelligence examined data from physical exams, blood and urine tests, and questionnaires.

During the study period, the artificial intelligence identified 97.2% of patients with new-onset diabetes.

The researchers plan to perform clinical trials “to assess the effectiveness of using statins to treat groups of patients identified by the machine learning model as being at high risk of developing diabetes.”

To learn more, visit

This week, Dr Kimberly Lovett Rockwell and Alexis S. Gilroy, two lawyers who wrote a commentary in the April issue of The American Journal of Managed Care® (AJMC®), discussed in an interview with AJMC® how telemedicine can help alleviate the burden on health systems brought by the COVID-19 pandemic.

Additionally, they indicated how regulations are shifting to enable use of the technology during the pandemic and beyond.

To view the full interview and commentary piece, visit

And, now our Paper of the Week, which looks back at some of the most important papers over the past 25 years of The American Journal of Managed Care® and why they matter today.

Disparities in chronic conditions—and the levels of care that result—have intrigued AJMC journal authors for years.

A frequently cited paper from 2017 took advantage of the emerging data from HEDIS measures to explore the relationship between chronic health conditions and mental illness.

“Disparities in Diabetes and Hypertension Care for Individuals With Serious Mental Illness,” found that those with serious conditions like schizophrenia were less likely to receive good care for diabetes, hypertension, or related conditions compared with others in Medicare or Medicaid, in part due to poor care coordination and the side effects of many psychiatric medications.

The paper called for a stronger role in health plans in ensuring better care for those with serious mental illness.

For the paper, visit

For all of us at AJMC, I’m Matthew Gavidia, thanks for joining us!

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