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This Week in Managed Care: August 27, 2016


This week in managed care, the top stories included new reports on a 10-year experiment in payment reform, more results from the early years of the Affordable Care Act, and findings on employee wellness programs.

Hello, I’m Sara Belanger with The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

Aligning Forces for Quality

This week, AJMC published a series of reports on a 10-year experiment in payment reform funded by the Robert Wood Johnson Foundation. Called Aligning Forces for Quality, or AF4Q,

the effort brought stakeholders within distinct regional markets together to collaborate on care delivery and engage consumers in their care.

The supplement features results of an independent evaluation led by Dennis Scanlon, PhD, of Penn State University and associate editor of AJMC. Researchers found that getting stakeholders in healthcare to collaborate over an extended period is not easy, and engaging consumers is even more challenging.

The supplement’s editor, Donald Berwick, MD, MPP, told AJMC in an exclusive interview that while the Affordable Care Act is landmark legislation, it’s still very hard for ordinary citizens to understand their role in the healthcare system. Watch the video.

Payment Reform and Emergency Care

Results from the early years of the Affordable Care Act continue to appear in AJMC, including a new commentary on the challenges of applying new payment models to the emergency room environment.

By their nature, emergency departments cannot always control which patients they treat, and authors from the Brookings Institution and Duke University examined how careful transitions from pure fee-for-service to newer models are needed to ensure financial stability of emergency departments, given their fixed costs.

Read the full article.

Employee Wellness

Employee wellness programs have been touted as a way to lower health insurance costs. However, a new survey finds that while employees like having these programs, they aren’t always useful.

Results from Welltok and the National Business Group on Health found that 81 percent of those surveyed thought the programs had a positive impact, and 60 percent thought including family members would boost participation.

Thirty-seven percent of those who took part in the programs didn’t find them relevant, and 20 percent—a full one-fifth of the employees surveyed—did not know the programs were available.

Brian Marcotte, CEO and President of the National Business Group on Health, had this advice: “Personalization is the key. … There are emerging engagement platforms and point solutions that show great promise in driving and sustaining engagement by leveraging data, predictive analytics and technology to reach people with personalized, timely, relevant, and actionable information.”

FDA Deals Setback to Sanofi

Sanofi revealed a setback this week, when it announced that approval for its insulin combination therapy will be delayed until November.

The FDA required Sanofi to submit more information on the pen delivery system for its therapy, which combines basal insulin and lixisenatide for the treatment of type 2 diabetes. Sanofi had redeemed a $245 million priority review voucher to move its approval time ahead of Novo Nordisk’s Xultophy, which combines its Tresiba insulin with liraglutide. A decision on Xultophy is expected in September.

Both insulin and GLP-1 combination treatments received plenty of attention at the June meeting of the American Diabetes Association.

EBO Special Issue

There are more cancer therapies than ever, but what happens if the cost puts them out of reach? A special issue of Evidence-Based Oncology explores the clinical, ethical, and practical questions surrounding the cost of cancer care, including the burden on family members and young adults with the disease.

As Editor-in-Chief Joseph Alvarnas, MD, wrote: “The issue of cost sharing in oncology care sits squarely at the intersection of our aspirations to deliver precision-medicine solutions while attempting to foster an economically sustainable cancer care system.”

Read the full issue of Evidence-Based Oncology.

Patient-Centered Oncology Care

To learn more about the effect of cost on cancer care, join us for the fifth annual meeting of Patient-Centered Oncology Care, which will convene in Baltimore on November 17 and 18. For information and to register, click here.

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

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