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This Week in Managed Care: August 18, 2017


This week, the top managed care articles included a report from the Congressional Budget Office on the impact of eliminating the cost-sharing reduction payments; a decision from CMS to eliminate 2 mandatory bundled payment programs; and a new value-based alliance that called for ending use of a test for diagnosing heart attacks.

CBO puts a price on getting rid of healthcare subsidies, CMS moves away from mandatory bundled payments, and a value-based alliance calls for ending a popular test for heart attacks.

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

For months, President Donald Trump has toyed with the idea of ending cost-sharing reduction payments, which let insurers hold down out-of-pocket costs for low-income individuals who buy Silver plans on the exchanges.

CBO Report on CSR Payments

This week, the Congressional Budget Office found that ending these payments would cause a drop in the number of uninsured starting in 2020, while raising premiums by 20 percent starting next year. For most people with Silver plans, rising premiums would be offset with tax credits. The greater effect might be on the federal deficit, which the report said would increase by $194 billion through 2026.

CMS, meanwhile, extended the deadline until September 5 for health plans to file rates for HealthCare.gov, so that states can let them plan for a possible end to the CSR payments.

Writing on the Health Affairs blog, healthcare expert Timothy Jost, JD, said, “In other words, HHS may stop reimbursing insurers for reducing cost sharing for low-income consumers at some undetermined point in the future—it has not yet decided … This despite the fact that the ACA requires the payments.”

Cutting Back on Mandatory Payment Programs

Also this week, CMS said it plans to cancel 2 mandatory bundled payment programs that were scheduled to take effect January 1. And it wants to scale back an existing bundled payment model for hip-and-knee replacements that has been in effect for more than a year.

The cardiac care bundle and the expansion of the comprehension joint replacement bundle were proposed at the end of the Obama administration, but current HHS Secretary Tom Price, MD, has made it clear he prefers voluntary payment models to mandatory ones.

In a statement, CMS said it would reduce the number of areas using the current joint replacement model from 67 to 34. The program will be voluntary for the other areas, and for certain low-volume providers in the remaining areas.

While some experts who spoke with The American Journal of Managed Care® said voluntary programs were better for providers, one expert said it’s important to remember why value-based care is a priority. Said Michael Abrams of Numerof and Associates: "We need to keep in mind, bundled pricing is not the end goal here. We need to drive down the cost of care.”

For more, read the full article.

Experimenting With Payment Models

Abrams said that commercial payers are experimenting with many types of value-based models, and United Healthcare’s Lee Newcomer, MD, recently spoke with AJMC® about 2 models the payer has tried in cancer care. Watch the video.

Saving Money on Low-Value Tests

An alliance at Johns Hopkins School of Medicine created to promote high-value care has offered its first report, and called for an end to a popular test for diagnosing heart attacks.

Writing in JAMA Internal Medicine, the High-Value Practice Academic Alliance said this week that the creatine kinase-myocardial band, known as CK-MB, has since been surpassed by a more sensitive test and can no longer be considered the best biomarker for diagnosing a heart attack.

The authors outlined a 4-step process for educating emergency room and other healthcare staff to move away from the test, which they said would save $416 million a year. Lead author Jeffrey Trost, MD, said the effort is just the beginning.

“This article is the first in a series of collaborative multi-institutional publications designed to bridge knowledge of high-value practice.”

New Issue of EBO®

Finally, the current issue of Evidence-Based Oncology® looks at issues in precision medicine, including the role of genetic counselors, the challenges of bringing the promise of targeted therapies to life in the community setting, and the importance of engaging patients in what to expect.

Check out the full issue.

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

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