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This Week in Managed Care: April 23, 2021


This week, the top managed care news included COVID-19 vaccine eligibility opens to all adults nationwide; a spotlight on payment models and value-based care; barriers to mental health care for children and teenagers.

COVID-19 vaccine eligibility opens to all adults nationwide, a NAACOS Spring 2021 session spotlights CMMI’s pause of payment models and commitment to value-based care, and Managed Care Cast explores barriers to mental health care for children and teenagers.

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

All Adults Nationwide Eligible for COVID-19 Vaccines

This week, all 50 states and US territories met President Joe Biden’s April 19 deadline in expanding eligibility for COVID-19 vaccines to all adults.

With half of all US adults having received at least 1 COVID-19 dose and 33% now fully vaccinated, the current US vaccination rate stands at 61.6 doses per 100 people. Notably, states with the highest vaccination rates have a history of voting Democratic and supporting President Biden in the 2020 election, compared with Republican states such as Alabama and Tennessee, which have the lowest rates across the country.

Meanwhile, the pause of the Johnson & Johnson COVID-19 vaccine could soon end in Europe in light of a nonbinding recommendation from the European Medicines Agency, which included adding a warning on possibly associated rare blood clots. The rare adverse events have been a setback to vaccine confidence over the past few weeks.

In the United States, the nation’s top infectious disease expert and chief medical adviser to President Biden, Anthony Fauci, MD, said that he believes a decision on whether to end the pause of the J&J vaccine will come by Friday, when the CDC's Advisory Committee on Immunization Practices meets.

Stressing that these clotting events were significantly rare, Fauci and other federal officials still recommend those who have received the J&J shot to be alert for symptoms such as severe headaches, movement difficulty, chest discomfort, and difficulty breathing.

Worldwide, cases of COVID-19 topped 3 million this week, with average US cases continuing to increase as well. Compared with the 7-day average of 53,000 new cases per day 4 weeks ago, the current 7-day average is estimated to be 67,443, an increase of 1% from last week.

CMMI Remains Dedicated to Value-Based Care Despite Pause to Some Models, Fowler Says

During the opening session at the NAACOS Spring 2021 conference, Liz Fowler, PhD, JD, deputy administrator and director of the Center for Medicare and Medicaid Innovation, or CMMI, highlighted how the center is taking time to reassess its portfolio of payment models to align with a goal of the Affordable Care Act in moving away from fee-for-service to value-based care.

The past year the COVID-19 pandemic has spotlighted limitations in the US health care system,, such as vast racial and ethnic disparities and the shortcomings of fee-for-service when volume drops, she said.

Acknowledging the pause of some CMMI models, which include Primary Care First’s Seriously Ill Population component and the Geographic Direct Contracting Model, Fowler said CMMI wants to make sure that its models lower costs, improve quality of care, and better align payment systems to promote patient-centered care.

“I understand that collectively these announcements may have led to questions about where the center is headed next. I want to make clear that our commitment to value-based care has never been stronger,” said Fowler.

According to Fowler, health care providers need to collect, report, and use data on race and ethnicity, and this will be a part of models being developed going forward. In addition, CMMI needs to develop, test, and scale models that reduce disparities, and she called on the attendees to let the center know if they have seen models that work.

For more, visit AJMC.com.

Removing Barriers to Mental Health Care for Children and Teenagers

In assessing mental health, children and teenagers have unique needs that have not benefitted from the many changes that have taken place to integrate mental health care into primary care for adults.

Even before the pandemic, children's mental health in the United States had been declining. Depressive symptoms and feeling of sadness and hopelessness were rising, and more of their caregivers were experiencing rising rates of substance abuse. With the pandemic, adolescents have reported higher rates of depression, and with the economic fallout from COVID-19, the child poverty rate is forecast to rise by 53%.

In this week’s episode of Managed Care Cast, we speak with Benjamin F. Miller, PsyD, chief strategy officer for Well Being Trust, and an author of a recent report by his organization in collaboration with the California Children's Trust and Mental Health America that examined how well health insurers and state Medicaid programs are covering mental health care for children and compliance with federal law.

Miller discusses the unique challenges that youth face, the health disparities, racism, and community trauma that has been experienced in the past year, and some creative ways for organizations and communities to consider in increasing access of mental health supports.

For more, visit AJMC.com.

First Immunotherapy for Initial Treatment of Gastric Cancer Approved

Last week, the FDA approved nivolumab, sold as Opdivo, in combination with certain types of chemotherapy for the initial treatment of patients with advanced or metastatic gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma.

Marking the first immunotherapy agent to receive approval in the United States for patients with gastric cancer, the PD-1 inhibitor combined with several types of chemotherapy was shown in the phase 3 CheckMate-649 trial to significantly improve overall survival from 11.1 months to 14.4 months, reduce risk of death by 29%, and reduce risk of disease progression or death by 32%, when compared with chemotherapy alone.

With about 28,000 new cases of gastric cancer diagnosed annually, the rate of cure with resection is very low and the survival rate for all stages is 32%. Moreover, the 5-year survival rate for advanced or metastatic gastric cancer is 5%.

“Today’s approval is the first treatment in more than a decade to show a survival benefit for patients with advanced or metastatic gastric cancer who are being treated for the first time,” said Richard Pazdur, MD, director of the FDA’s Oncology Center of Excellence and acting director of the Office of Oncologic Diseases in the FDA’s Center for Drug Evaluation and Research, in a statement.

For more, visit AJMC.com.

NAACOS Spring, AAD, and NAMCP Virtual Conferences

Along with coverage of the NAACOS Spring 2021 virtual conference, The American Journal of Managed Care® is covering 2 other conferences this week, including the 2021 American Academy of Dermatology Virtual Meeting Experience and the National Association of Managed Care Physicians’ 2021 Live Virtual Spring Managed Care Forum.

AJMC.com has full coverage of each virtual meeting, including late-breaking sessions, interviews with panelists, and developments in each care field.

For full conference coverage, visit AJMC.com.

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

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