This Week in Managed Care: August 3, 2018

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This week, the top managed care stories included a report that found quality issues and fraud in Medicare’s hospice program; the Trump administration expanded short-term health plans; cancer screening rates are falling short of targets.


A report finds quality issues and fraud in Medicare’s hospice program, short-term health plans will expand, despite warnings from payers, and Part D premiums will fall in 2019.

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

Hospice Fraud

Medicare hospice patients went without pain medicine and sometimes received poor quality care, while taxpayers were billed for services that were never provided.

That’s what the HHS Inspector General found in a review of 10 years of research on the hospice program. The findings come as the population is aging and more Americans will need hospice care.

The review found:

  • Medicare spending on hospice care rose from $9.2 billion in 2006 to $16.7 billion in 2016.
  • The number of hospice programs grew 42% during that period, and the number of patients grew 50% to 1.4 million.
  • Some schemes included recruiting hospice patients who should not be enrolled, which could leave these patients without curative treatment.
  • Hospices often write out their own care plans and then don’t follow them.

Said Regional Deputy Inspector General Nancy Harrison, “One of the things that is so troubling is that hospices are writing their own care plans. They do set their own bar, and they don’t meet them.”

Extending Short-Term Health Plans

Young, healthy adults who need insurance may flee the exchanges, now that the Trump Administration has expanded short-term, limited duration plans. CMS this week released a final rule that will allow these plans to be expanded from 90 days to 12 months, with renewals for up to 3 years.

Said HHS Secretary Alex Azar, “Under the Affordable Care Act, Americans have seen insurance premiums rise and choices dwindle. President Trump is bringing more affordable insurance options back to the market, including through allowing the renewal of short-term plans. These plans aren’t for everyone, but they can provide a much more affordable option for millions of the forgotten men and women left out by the current system.”

However, health plans have warned that these plans have less coverage and may catch consumers off guard.

Blue Cross Blue Shield Association’s Justine Handelman said, “Health insurance should be available and affordable for everyone, regardless of their health status. The broader availability and longer duration of slimmed-down policies that do not provide comprehensive coverage has the potential to harm consumers, both by making comprehensive coverage more expensive and by leaving some consumers unaware of the risks of these policies.”

Part D Premiums to Drop

For the second year in a row, the average Medicare Part D premium will fall, according to CMS. The average price will drop from $33.59 to $32.50 per month. CMS said the drop was due to regulatory changes to boost competition and allow some generics to reach formularies more quickly.

Cancer Screenings Fall Short of Targets

Cancer screening rates are falling short of targets, according to the CDC. The agency said data from the National Interview Study shows the US health system is not meeting goals for colorectal screening, mammograms, and Pap smears outlined in Healthy People 2020.

The data show:

  • 83% of women age 21 to 65 received a Pap test, short of the goal of 93%.
  • 72% of women aged 50 to 74 received a mammogram, but the goal is 81%.
  • Only 64% of women and 61% of men ages 50 to 75 are screened for colorectal cancer, much lower than the 80% target.

Authors in the CDC journal, Preventing Chronic Disease, called for special physician outreach efforts to those not being screened, including women aged 50 to 64.

Longer-Lasting CGM Sensors

FDA has approved a new 14-day sensor for the Freestyle Libre continuous glucose monitor (CGM). The device, the first CGM system that doesn’t require finger sticks, was approved last year with a sensor that lasts 10 days.

Longer-lasting sensors will mean lower out of pocket costs for people with diabetes. Abbott Diabetes said the new sensor is also more accurate than the earlier version.

Read more.

VBID Improves Medication Adherence

Finally, AJMC® co-editor-in-chief, A. Mark Fendrick, MD, is a coauthor of a review that finds value-based insurance design (VBID) programs improve medication adherence without added cost.

The review, which appeared in Health Affairs, included studies that compared a traditional prescription plan with a VBID plan, which lowers copays and coinsurance for high-value treatments.

Read a summary of Fendrick’s review from the University of Michigan V-BID Center, where he is the director.

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