• Center on Health Equity and Access
  • Clinical
  • Health Care Cost
  • Health Care Delivery
  • Insurance
  • Policy
  • Technology
  • Value-Based Care

This Week in Managed Care: December 1, 2017


This week, the top managed care news included a new proposal from CMS that insurers warn will cause confusion; a new review examines the prevalence and cost of chronic conditions in Medicaid; and a study finds 42% of all new US cancer cases in 2014 were due to potentially modifiable exposures.

Insurers warn that a CMS proposal will cause confusion, a new study highlights the costs of chronic conditions in Medicaid, nd a leading diabetes group calls for FDA to approve drugs and devices on factors Beyond A1C.

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

CMS Rule Causes Confusion

Letting states define essential health benefits sounds good, but it will confuse consumers and weaken health insurance markets. That’s what leading insurers told CMS in comments on a plan the agency has proposed for 2019.

Anthem, Centene, Molina, Kaiser Permanente, and the Blue Cross Blue Shield Association, all predicted problems with the CMS proposal, which would let states build their own benchmark plans as an alternative to the 10 essential health benefits under the Affordable Care Act. States can:

  • Adopt another state’s 2017 benchmark plan
  • Pick and choose elements of another state’s benchmark plan
  • Build a new benchmark plan based on a “typical employer plan”

Kaiser Permanente said that employer plans are often tailored to specific populations. Aetna, which generally supports the CMS plan, said allowing states to change benchmark plans every year would create unpredictability and instability.

For more, visit ajmc.com.

Common Chronic Diseases in Medicaid

As the Medicaid population grows, tracking the program’s spending starts with understanding how chronic conditions drive up costs. A new review in the American Journal of Preventive Medicine looked at studies published between 2000 and 2016 to examine the prevalence and costs of chronic conditions in Medicaid.

The review found that 55.7% to 62.1% of Medicaid recipients between ages 18 and 64 had at least 1 chronic condition, and that up to one-fourth of those studied had hypertension and hyperlipidemia.

Other common conditions were depression, asthma, diabetes and heart disease, and 9.5% of those in Medicaid had cancer.

The authors wrote: “As the Medicaid population continues to change, it is increasingly important to understand the major health burdens this population faces and the associated medical costs, which is important for informing future program design and developing health promotion programs to contain or reduce the public health burden and healthcare costs.”

Beyond A1C

When FDA approves drugs and devices for people with diabetes, it looks at changes in the average A1C level, a measure that represents a 3-month average of blood glucose.

While useful, people living with diabetes say it fails to capture important challenges of living with the disease—especially how often a person experiences hypoglycemia.

Now, a 2-year effort by leading diabetes groups has led to a consensus statement published in Diabetes Care, which calls on FDA to consider measures Beyond A1C when evaluating new drugs and devices for people with type 1 diabetes. The article called on regulators to pay special attention to the following:

  • hypoglycemia, including how often a person’s blood sugar falls below both 70 milligrams per deciliter, and below the more dangerous level of 54 milligrams per deciliter.
  • time in range, which refers to how many hours per day a person stays out of hypo- and hyperglycemia.
  • diabetic ketoacidosis, a dangerous condition in which the body produces excess blood acids, or ketones.

The effort, led by JDRF, could ultimately lead to information about hypoglycemia or time in range being added to drug or devices labels.

Novo Nordisk, one of the world’s leading insulin manufacturers, has highlighted fewer hypoglycemia events in recent studies. Todd Hobbs, MD, vice president and chief medical officer at Novo Nordisk, told AJMC that while a change in FDA standards is still a long way off, the consensus report is promising.

Modifiable Cancer Risk Factors

Some cancers are due to genetic factors, but many occur due to risk factors that people can change, according to a new study in the journal CA, which is published by the American Cancer Society. About 42% of all new US cancer cases in 2014 were due to potentially modifiable exposures, such as alcohol use or being overweight.

The study was based on 3 leading cancer reports, including 1 from the American Institute for Cancer Research, which looked at 26 different cancer types in adults age 30 and older. Leading risk factors included: smoking, ultraviolet radiation, low fiber intake, eating red or processed meat, lack of physical activity, human papillomavirus, and alcohol intake.

Read the full article.

Health Reform's Impact on Young Adults

Finally, a study in the current issue of The American Journal of Managed Care finds that prescription drug spending among young adults rose in the early years of the Affordable Care Act.

However, most of the benefit went to 19-to-25-year-olds in middle class households, where drug spending went up more than 11 percent from 2011 to 2013.

Drug spending actually declined in this age group in households earning below 200 percent of the federal poverty level.

The provision of the ACA that allows young adults to stay on family health plans until age 26 is highly popular, and it is one of the few elements that is expected to remain no matter what happens to the rest of the law.

Read the full study.

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

Related Videos
Chase D. Hendrickson, MD, MPH
Steven Coca, MD, MS, Icahn School of Medicine, Mount Sinai
Matthew Crowley, MD, MHS, associate professor of medicine, Duke University School of Medicine.
Susan Spratt, MD, senior medical director, Duke Population Health Management Office, associate professor of medicine, division of Endocrinology, Metabolism, and Nutrition,
Stephen Nicholls, MD, Monash University and Victorian Heart Hospital
Amal Agarwal, DO, MBA
Dr Robert Groves
Dr Robert Groves
Jeremy Wigginton, MD
Related Content
© 2023 MJH Life Sciences
All rights reserved.