This Week in Managed Care: August 22, 2015

Transcript (may be slightly modified):

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.

Our top story this week comes from JAMA, which announced results for patients with type 2 diabetes treated with high-dose liraglutide. The drug is marketed in the United States as Saxenda. Overweight patients taking the 3 mg dose for 56 weeks lost 6% of their weight on average, or 14 pounds, while maintaining good glycemic control. A quarter of the patients lost more than 10% of their weight. The study’s lead author, Dr Melanie Davies, told AJMC that these findings could lead to better coverage for the drug in both the United States and in the United Kingdom, where the study was based. Payers, including CMS, have been slow to cover obesity therapies even though the American Medical Association declared obesity a disease in June 2013.

Medicaid managed care covers more beneficiaries each year, as states look for ways to hold down costs. Iowa this week awarded contracts to 4 vendors for its $4.2 billion program, which will begin serving 560,000 residents in January. But as managed care has expanded in programs that serve the poor, it is now covering more clients that are hard to serve, including those receiving home care, children with severe disabilities, and those with life-threatening illnesses.

Advocates for disabled children in California this week raised questions about a plan to move a special children’s healthcare program into Medi-Cal, the state’s Medicaid program. Earlier this year, the state auditor found that Medi-Cal already had too few providers, and that calls to the ombudsman went unanswered. Medicaid managed care regulations pending before CMS are expected to address how states must serve the most vulnerable patients, but those rules will not be final for months.

Medication adherence differs from group to group, and healthcare delivery must adapt in response to what patients want. That’s what Michael Evans, the director of Geisinger’s ambulatory clinical pharmacy systems, told AJMC.com recently. Watch the video here.

Finally, one of this week’s most popular contributor pieces comes from Dr. Katy Kozhimannil, who writes about the rising popularity of doula services, and the increased evidenced that they help new mothers and infants avoid complications. According to the article on ajmc.com, doula services are especially sought-after by parents who work for health plans. Their influence may help get the services covered for everyone. You can read the article about doula services here.

For the Managed Markets News Network, I’m Justin Gallagher. Thank you for joining us.