This Week in Managed Care: April 17, 2020

This week, the top managed care news included a report that accountable care organizations may drop out of the Medicare Shared Savings Program; states and healthcare plans address unemployment brought on by COVID-19; a sneak peek of the virtual 2020 Community Oncology Conference.

Accountable care organizations may drop out of the Medicare Shared Savings Program, states and healthcare plans are taking on unemployment issues brought on by COVID-19, and we offer a sneak peek into next week’s virtual conference from the Community Oncology Alliance.

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

ACOs May Drop Out of MSSP

A survey by the National Association of Accountable Care Organizations finds that 56% of risk-based ACOs currently enrolled in the Medicare Shared Savings Program are likely to drop out of the program. Respondents say they fear they will lose money in the program due to the COVID-19 pandemic.

Clif Gaus, president and chief executive officer of the National Association of Accountable Care Organizations, explained: “When ACOs made a commitment to assume risk, they didn’t expect they’d be handling the risk of a global pandemic.”

Gaus notes that CMS has not fully addressed the costs and disruptions caused by the pandemic, which may cause millions of Medicare beneficiaries to lose access to care coordination and quality improvement efforts if ACOs leave the program in droves.

“Medicare’s decade-long effort to change how we pay for healthcare to better reward quality and outcomes may be lost unless Washington acts quickly to throw these providers a lifeline,” Gaus said.

For more, visit

States, Health Plans Prepare for Medicaid Influx

With 22 million Americans having filed for unemployment benefits in the last 4 weeks, Medicaid plans are preparing for a massive influx of beneficiaries, which will require information technology readiness, social service coordination, and, of course, financial resources.

AJMC® spoke with 2 experts on financial and technology strain that state Medicaid programs may face and how to navigate them—former Kentucky Medicaid commissioner Russ Fendley and Patrick Sturdivant, president of the Amerigroup Texas Medicaid plan—about the solutions.

Said Sturdivant, “We’re expecting that there will be an influx and we’re prepared to enroll new members and make sure they have access to the care that is required. There’s an increased need in our state, so we’re actively monitoring the situation; we have plans to expand as needed; we’ll continue to work on behalf of our members.”

For the full interview, visit

Community Oncology Conference Goes Virtual

Next week, the Community Oncology Alliance will present their 2020 Community Oncology Conference in a virtual format.

In a series of previews for the virtual meeting, we spoke with Dr Lee Schwartzberg, the chief medical director of West Cancer Center and the chief medical officer of OneOncology, who is moderating a stakeholder panel discussion on genomic profiling in cancer, and Dr Debra Patt, executive vice president of policy and strategy at Texas Oncology, who is presenting on applied informatics in oncology. will bring you full coverage of the virtual meeting, which will take place from April 23 to 24.

For the interviews with Dr Schwartzberg and Dr Patt, visit

For full conference coverage, visit

Webinar to Feature Insights on Telemedicine in Oncology

Next Monday, April 20, at 5:15 pm Eastern time, AJMC® will be hosting a webinar titled “Bringing Telemedicine to Oncology Practice in COVID-19,” with experts from Florida Cancer Specialists.

The webinar will share insights on how healthcare providers can rapidly implement telemedicine in the oncology practice during the COVID-19 pandemic.

For access to this complimentary webinar, register here.

Paper of the Week

Now we bring you Paper of the Week, which looks back at research and commentary of the past 25 years in The American Journal of Managed Care® and why it matters today.

With the discussion over how and when to prescribe the cocktail of antimalarial drugs and antibiotics int he time of COVID-19, we look back at our most-read paper of 2016, which described antibiotic prescribing patterns in the United States. In “Variation in US Outpatient Antibiotic Prescribing Quality Measures According to Health Plan and Geography,” authors from the CDC found disparities by region in antibiotic use for common complaints, such as sore throats in children and respiratory infection. Despite protocols to prevent overuse of antibiotics, and thus avoid vulnerability to superbugs, health plans in South Central states were far more likely to prescribe antibiotics when they were not warranted.

For the full paper, visit

For all of us at AJMC®, I’m Matthew Gavidia. Thanks for joining us.