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This Week in Managed Care: April 6, 2018


This week, the top managed care news included final numbers for 2018 enrollment in Affordable Care Act plans; an increase in Medicare Advantage payments; National Public Health Week highlighted the importance of community relationships in improving health.

Enrollment in Obamacare plans dips slightly, CMS raises Medicare Advantage payments, and the Surgeon General says local health decisions matter.

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

2018 ACA Enrollment Figures

The numbers are in, and 2018 enrollment in Affordable Care Act (ACA) plans is 11.8 million, down about 400,000 from 2017, according to CMS.

Enrollment in states with their own marketplaces was flat, while enrollment in the 39 states that use HealthCare.gov was down. First-time consumers accounted for 27% of enrollees, down from 31%. The average unsubsidized premium rose, and most Americans who bought insurance on the exchange were older Americans seeking a silver plan. However, sales of bronze plans increased.

Some were worried enrollment would be worse after CMS suspended most advertising in the final weeks of open enrollment. There are concerns that enrollment will further decline now that CMS is allowing association health plans in some markets.

Josh Peck, of the pro-ACA group Get America Covered, said: "While enrollment remained steady because of high consumer satisfaction and more affordable premiums for those who qualify for tax credits, enrollment would have outpaced previous years' if the administration had focused on signing people up instead of derailing open-enrollment efforts."

Meanwhile, a Kaiser Family Foundation poll found 9 in 10 people without group coverage will continue to buy insurance despite the end of the individual mandate. But when they don’t buy insurance, the chief reason is the cost.

Read more.

CMS Reveils Finalized Rules, Payments

CMS Administrator Seema Verma announced that payments for Medicare Advantage will rise an average of 3.4% in 2019. Some payments will rise by 6.5% when updated risk scores are factored in.

Verma said the agency is changing how it uses data collected during visits with patients, and adding new mental health, substance abuse, and kidney conditions to its models.

CMS will take several steps to lower drug costs, including lowering the out-of-pocket maximum that low-income beneficiaries can pay for biosimilars.

Learn more.

Community Relationships Key for Public Health

Health doesn’t happen without strong community relationships, according to US Surgeon General Jerome Adams, MD, MPH, who kicked off National Public Health Week with a keynote address on the theme, “Healthiest Nation 2030: Changing our Future Together.”

Adams addressed how Americans are falling short of their health goals, as life expectancy is declining for the first time in 50 years. While the federal government has a role in healthcare, Adams said, the most important decisions happen at the community level.

He said, “Just as they say all politics is local, all health is local. We can meaningfully and sustainably change health when local partners come together.”

He offered 3 tips for public health leaders to engage others:

  • Invite people to your table and go to theirs
  • Show people you care
  • Identify your target audience and adjust your message accordingly

For more, read the full article.

Off-the-Shelf CAR T Treatment

Personalizing CAR T-cell therapies for each patient is one reason they cost so much. But what if an “off the shelf” therapy were available? That’s what Allogene Therapeutics will try to do.

Two former executives of Kite Pharma, which sold the first FDA-approved CAR T therapy for adults to Gilead, have purchased Pfizer’s cell therapy portfolio. Arie Belldegrun, MD, the former Kite CEO, will be Allogene’s executive chairman, and David Chang, MD, the former Kite chief medical officer, will be Allogene’s CEO.

Their new concept would harvest cells from healthy donors and modify them before treating eligible patients with cancer. If it worked, the new method could shave weeks off treatment time for patients.

New EBDMTM Available

Finally, the new issue of Evidence-Based Diabetes ManagementTM is available online.

With a theme of access and adherence, the issue features original research, as well as a commentary from the former Medicaid director of Mississippi.

In addition, editor in chief Robert Gabbay, MD, offers a timely commentary on the recent split between diabetes professional groups and the American College of Physicians (ACP), who called for easing up on guidelines for management of blood glucose levels for patients with type 2 diabetes.

Gabbay said ACP’s position does not make sense given the availability of new diabetes therapies such as SGLT2 inhibitors and GLP-1 receptor agonists.

He wrote: “To me, the greatest surprise in the ACP recommendations is the lack of concern for our younger patients with [type 2 diabetes]. Data from CDC show [type 2 diabetes] incidence is occurring at younger ages, but with today’s treatments, these patients should have decades of life ahead of them.”

Check out the full issue.

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

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