This Week in Managed Care: April 16, 2016

The top stories in managed care include a recap of Patient-Centered Diabetes Care, the case for the Oncology Medical Home, UnitedHealth leaves Affordable Care Act exchanges in 2 states, and CMS expands alternative payment model for primary care.

Hello, I’m Justin Gallagher, associate publisher of The American Journal of Managed Care. Welcome to This Week in Managed Care, from the Managed Markets News Network.

Patient-Centered Diabetes Care

Updates in technology and clinical care, and the stigma that keeps patients from getting obesity treatment were on the agenda when AJMC and Joslin Diabetes Center presented the fourth annual conference, Patient-Centered Diabetes Care.

The meeting covered how reimbursement barriers—not patient demand—have held back the broader use of technology in diabetes care, for both prevention and treatment. But that could change as technology companies get ready to offer the National Diabetes Prevention Program, which will soon be covered by Medicare.

Big Data is also changing the nature of care itself, as Lonny Reisman, MD, of HealthReveal covered in his keynote address and later with AJMC. Watch his video interview.

For full conference coverage, see the conference page.

Oncology Medical Home

How can oncologists address skyrocketing costs of care and still guarantee high quality? In the current issue of Evidence-Based Oncology, authors from the Commission on Cancer and the Community Oncology Alliance make the case for the Oncology Medical Home, a new accreditation model being put in place by the American College of Surgeons.

The model is centered on 5 core areas:

  • Patient engagement
  • Expanded access
  • Evidence-based medicine
  • Team-based care
  • Quality improvement

For more information, read the full commentary.

And follow our coverage of the Community Oncology Alliance annual conference.

UnitedHealth Leaves 2 ACA State Exchanges

UnitedHealth Group is leaving the exchanges for the Affordable Care Act in 2 states—Arkansas and Georgia. This week’s announcement came after speculation that the insurer might quit the ACA business altogether. UnitedHealth may still leave other states in 2017 after posting losses on ACA policies last year, as did Aetna.

The states UnitedHealth is leaving have among the highest rates of obesity and diabetes, and higher-than- average rates of prostate and lung cancer. Arkansas was the first state to expand Medicaid through a customized waiver, while Georgia has not expanded Medicaid.

A CMS spokesman said these shifts are to be expected. Said Aaron Albright: “As with any new market, we expected changes and adjustments in the early years, with issuers both entering and existing states.”

Alternative Payment Model for PCPs

Family doctors will get more time with patients and be rewarded for coordinating care under an alternative payment model that CMS will be expanding to 20,000 physicians over the next 5 years. The model, called Comprehensive Primary Care Plus, is based on a demonstration project that’s reached 2100 doctors since 2012.

The project has found that paying more attention to primary care—and to what happens with patients between doctor visits—is key to managing chronic disease and controlling costs. The announcement is part of CMS’ goal of tying 50% of Medicare payments to value-based models by 2018.

ACO Coalition

If you want to learn more about new payment models, join us in Scottsdale, Arizona, for the spring meeting of the ACO and Emerging Healthcare Delivery Coalition, which meets April 28-29.

For the agenda and to register, visit the meeting page.

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