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This Week in Managed Care: August 20, 2016


This week, the top stories in managed care included Aetna's announcement that it was pulling back its participation on the Affordable Care Act exchanges, the annual meeting of the American Association of Diabetes Educators outlined how existing sites can help roll out the Diabetes Prevention Program nationwide, and hospital leaders gave their opinions on CMS' hospital readmission program.

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.

Aetna Withdraws From Some Exchanges

Aetna announced this week that it is leaving 11 states where it sells coverage on the marketplace exchanges, and that in 2017 it will reduce its footprint from 778 to 242 counties.

Like other insurers, including United Healthcare, Aetna cited $430 million in losses from patients who are newly insured under the Affordable Care Act (ACA). These patients are sicker than expected, and some cancel their policies after running up large healthcare bills. Aetna also cited problems with the ACA’s financial protection tools, such as risk corridors, that were underfunded by Congress.

While several markets face limited competition in 2017, Aetna’s move took many by surprise because it had supported the exchanges. Critics of Aetna are unhappy that it wants to leave the exchanges while keeping its contracts for Medicaid and Medicare.

And news reports suggest that Aetna is acting in response to the Justice Department’s opposition to its merger with Humana.

Read AJMC's coverage.

Diabetes Prevention

The existing system of 3500 sites where patients receive diabetes self-management education could be leveraged to offer the Diabetes Prevention Program to millions with prediabetes. A plan to tap this network was a highlight of the annual meeting of the American Association of Diabetes Educators, held in San Diego.

Joanna Craver DiBenedetto, director of prevention for AADE, said the existing sites offer several advantages:

  • The sites are set up to bill Medicare.
  • 80% of diabetes educators are already working on prevention.
  • Sites that tested the CDC prevention program under an AADE grant had better weight loss results and cost less to operate.
  • If someone who comes for the prevention program already has diabetes, that person will already be connected to an educator.

Read all of our coverage from the AADE annual meeting.

Journal Cancer Cover

A study in the journal CANCER highlights the need for ongoing surveillance after someone is first diagnosed with the disease. Research at UCLA found that 1 in 12 people who survive a common cancer will develop a second, unrelated malignancy, and this second bout is often more deadly.

Among those who developed a second cancer, 13% died of their primary cancer and 55% died of their secondary cancer. Researchers followed two million adults with 10 common cancers. The most common secondary cancer was lung cancer, especially in patients who smoke.

CMS Readmission Program

A CMS program that charges hospitals penalties for higher-than-expected 30-day readmission rates is having major effects on healthcare delivery, according to a survey in the new issue of The American Journal of Managed Care.

Nearly two-thirds of the hospital leaders who answered the survey said the rules have a “significant” or “great” impact on efforts to reduce readmissions. But three-fourths of those who responded said it is unfair that CMS fails to account for socioeconomic differences between hospital populations, and most felt the penalties were too large.

Read the full study.

ACO Coalition

There’s still time to register for the fall meeting of the ACO and Emerging Healthcare Delivery Coalition, which meets two months from today in Philadelphia. Topics on the agenda include:

  • Disease prevention measures.
  • Tracking high healthcare utilization.
  • Implementing MACRA to the Medicare Part B program.
  • And, what healthcare will look like in 2020.

For information and to register, visit the meeting page.

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

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