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This Week in Managed Care: April 14, 2017


This week, the top managed care stories include an update for prostate cancer screening guidelines; the consequences of conflicting breast cancer guidelines; and Florida seeks work requirements for Medicaid.

Controversial guidelines for prostate cancer screening get an update, conflicts in breast cancer guidelines lead to differences in care, and Florida weighs work rules for Medicaid.

Welcome to This Week in Managed Care, I’m Laura Joszt.

Prostate Cancer Screening

The US Preventive Services Task Force caused an uproar 5 years ago when it changed guidelines for prostate cancer screening, causing a sharp decline in routine PSA tests that catch this deadly cancer when it is still treatable.

This week, the task force gave a new recommendation that calls for individual decision making for men ages 55 to 69, in consultation with their doctor. Said task force member Alex Krist, MD: “Prostate cancer is one of the most common cancers to affect men, and the decision about whether to begin screening using PSA-based testing is complex.”

Treatment for prostate cancer can cause incontinence and erectile dysfunction, and in cases of slow-growing cancer, a “watch-and-wait” strategy may be recommended, aided by diagnostic testing.

Krist said men who are considering screening deserve to be aware of what the science says.

Mammogram Confusion

There’s also controversy over when women should have mammograms, based on conflicting guidelines—and a new study shows that has caused different levels of care.

A new study from JAMA Internal Medicine finds that three sets of guidelines—from USPSTF, the American Cancer Society, and the American College of Obstetricians and Gynecologists—cause women to have their first mammogram as young as age 40 or as old as age 50.

An editorial found that the fee-for-service system can encourage too much screening, which can be harmful. The authors wrote:

“Ultimately, alternative payment systems that value evidence-based, patient-centered outcomes would improve patient care, choice, and satisfaction while decreasing wasteful spending.”

Work Requirements for Medicaid

Florida may require Medicaid recipients to go to work or show why they aren’t.

Members of Florida’s House of Representatives this week weighed a proposal that would require able-bodied people in Medicaid to show proof they have a job, are looking for one, or are enrolled in school or job training.

The proposal also calls for recipients to pay monthly premiums of 10 to 15 dollars, based on income, and would end benefits for 12 months for those who skip premiums or don’t meet work requirements.

Florida’s action comes after CMS sent a letter to the nation’s governors stating it would be open to Medicaid waivers that include work requirements.

For more, read the article.

Obesity and High Blood Pressure Among Hispanics

Rising rates of obesity among teens are a problem across all ethnic groups, but a new study shows how the link between obesity and high blood pressure is especially strong among Hispanic teens.

A study in the journal Pediatrics, based on 15 years’ worth of data gathered at school clinics in the Houston area, found that obese teens who were Hispanic were six times as likely to have high blood pressure, a rate much higher than obese teens who were white, Asian, or black.

By contrast, Hispanic teens who were normal weight were least likely to have high blood pressure of the four major ethnic groups studied.

The study illuminates risk factors in the Hispanic population, which is more likely to develop diabetes, heart disease, and kidney failure as adults than the overall population. CDC reports that 50% of Hispanic adults will develop type 2 diabetes in their lifetime, and Hispanics are 66 percent more likely to develop chronic kidney disease than whites.

Click here for the full story.

Prepare for Impact With ACO Coalition

There’s still time to register for the spring meeting of the ACO and Emerging Healthcare Delivery Coalition, which meets May 4-5 in Scottsdale, Arizona.


Featured speaker Avik Roy, keynote speaker Darius Lakdawalla, and an ACO favorite, the Healthcare 2020 series, will offer insights into where payment reform is headed under the new administration.

For information and to register, visit our conference page: http://www.ajmc.com/acocoalition/spring17

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

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