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This Week in Managed Care: August 13, 2016


This week, the top stories in managed care include news on how Medicaid expansion improved health outcomes of low-income individuals, a report on how physical activity lowers risk of 5 common chronic conditions, and findings on how insurance type impacts health outcomes in cancer.

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.

Expanded Coverage

Medicaid expansion has dramatically improved healthcare access for the working poor, according to a new study published in JAMA Internal Medicine. Researchers interviewed 9000 people who earned less than 138% of the federal poverty level, a group that can now receive Medicaid if they live a state that has expanded the program.

Residents from Arkansas and Kentucky, 2 early expansion states, reported better health than those from Texas, the largest state that has not grown the program. Low-income consumers in Arkansas and Kentucky were more likely to use primary care, less likely to visit the emergency room, and less likely to stop using medication because of cost. Both states saw uninsured rates drop around 30% in the target group of low-income working adults.

The researchers found little difference between the beneficiaries in Kentucky, which used conventional Medicaid managed care, and those in Arkansas, who purchased private coverage with federal dollars. Benjamin Sommers, MD, PhD, the lead author, said the results show states can have flexibility in Medicaid expansion and still produce good results. “What this means is that it doesn’t matter so much how states expand coverage. … What matters is whether they expand at all.”

For more about the study, visit our article.

Physical Activity

Being active lowers the risk of common chronic diseases, according to an analysis of studies conducted over a 25-year period. Researchers reporting in The BMJ said 174 studies published since 1980 show that physical activity cuts the risk of breast and colon cancer, diabetes, heart disease and stroke.

However, the benefits of exercise are greatest among those who had not been active at all, and gains diminish as activity increases. Based on earlier studies, the World Health Organization recommends 150 minutes of walking or 75 minutes of running each week for good overall health.

Insurance Coverage and Cancer Outcomes

How well a patient does fighting cancer can depend on whether the person has insurance—and what type. The journal CANCER reported 2 studies that revealed disparities in health outcomes for those with testicular germ cell tumors or glioblastoma.

Those with no insurance or with Medicaid were more likely to be diagnosed when the disease was already advanced, and care was less than optimal compared with those with insurance.

Said Christopher Sweeney, MBBS, of the Dana-Farber Cancer Institute, author of one of the studies: “Our findings support the belief that early diagnosis and management is key, and removal of barriers to access to healthcare should be implemented."

Stakeholder Collaboration

Finding solutions in healthcare increasingly requires cooperation among many stakeholders, including hospitals, health plans, and physicians. Linda Schwimmer, who is President and CEO of the New Jersey Healthcare Quality Institute, told AJMC about how bringing stakeholders together can yield progress for all. Watch the video.

AJMC has 2opportunities this fall for stakeholders from across healthcare to share ideas:

On October 20-21, our fall meeting of the ACO & Emerging Healthcare Delivery Coalition comes to Philadelphia, and on November 17-18, we will present the fifth annual meeting of Patient-Centered Oncology Care in Baltimore.

New AJMC Cover

This month, The American Journal of Managed Care unveils a new look, one that highlights peer-reviewed research in both the print journal and online at AJMC.com. After a week that saw both top pharmacy benefit managers increase the number of drug exclusions, this month’s issue features a review of how formulary drug exclusions affect patients and the bottom line.

Now in its 21st year, AJMC remains the leading forum for peer-reviewed research on healthcare outcomes.

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

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