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This Week in Managed Care: December 14, 2018


This week, the top managed care news included a report that found uninsured rates were on the rise in 2017; an analysis of rising health insurance costs for families; predictions for cardiology trends in 2019.

Uninsured rates were on the rise in 2017, health insurance costs rose for families, and enrollment on the exchanges is off for the coming year.

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

Uninsured Rate Increases

The share of Americans without health coverage rose last year for the first time since 2014, according to a report from the Kaiser Family Foundation.

The number of uninsured people rose by 700,000 in 2017, representing the first increase since the Affordable Care Act took full effect. The large increases came in states that did not expand Medicaid, and occurred among African Americans and those living just above the poverty line.

After trying to repeal the ACA, the Trump administration made several changes:

  • It used the 2017 tax law to repeal the individual mandate
  • It allowed several types of short-term plans that do not require essential health benefits
  • It allowed association health plans for employer groups

Financial Burden of Insurance

The Commonwealth Fund also reported this week that healthcare costs rose sharply in 2017, growing 5.5% for family plans and 4.4% for single coverage.

As premiums have climbed, so have employee contributions. After rising an average of 4.6% each year for 5 years, premium costs for family coverage rose 6.8% in 2017.

Said lead author Sara Collins, “The cost of employer health insurance premiums and deductibles continues to outpace growth in workers’ wages. This is concerning, because it may put both coverage and healthcare out of reach for people who need it most—people with low incomes and those with health problems.”

ACA Enrollment

Meanwhile, enrollment on the exchanges for 2019 appears down as open enrollment comes to a close December 15.

Sign-ups appear down by about 12% heading into the final week of enrollment, and experts listed several reasons, including:

  • The end of the individual mandate
  • New enrollment options off the exchange
  • Virginia’s addition of Medicaid expansion
  • Fewer insurers exited the market, so more consumers will be auto-enrolled. These sign-ups won’t be reported until after enrollment ends.

Cardiology Predictions for 2019

The American College of Cardiology has published its annual forecast of predictions for 2019. Featured in Cardiology Today, the predictions cover therapy, surgery, technology, and value-based care.

Among the trends expected are:

  • More use of direct oral anticoagulants.
  • Increased interest in the use of artificial intelligence
  • Greater use of wearable technology and integration of patient-collected data into care
  • More focus on the cost-effectiveness of PCSK9 inhibitors, in light of new cholesterol recommendations and steps by drug makers to cut prices

However, in an interview with The American Journal of Managed Care®, Richard Kovacs, MD, FACC, said so far, he’s not hearing many results from an agreement with Sanofi and Express Scripts to make it easier to prescribe the PCSK9 inhibitor Praluent. “Regardless of the PBM, the prior authorization process is still taking time. I think that our own prescribers have tried to adapt to the system, but it’s still taking about the same amount of time.”

December EBO

Finally, the current issue of Evidence-Based Oncology looks at what’s next in cancer care, featuring cover stories about upcoming trends in cancer screening, and novel financing mechanisms to pay for investment in pediatric cancer research.

In an essay, The Future of Cancer Care, Editor-in-Chief Joseph Alvarnas, MD, discusses the challenge of balancing innovation and cost, writing: “It will be impossible to deliver the transformational level of care that genomics and innovative therapeutics promise equitably, effectively, or sustainably unless we create a transparent, data-rich system of care that can sustain and deliver these consistently. … This linkage between the needs and voice of the patient, genomic testing data, and the creation of a care ecosystem that aligns clinical risk, goals of care, the patient experience, and meaningful outcomes with reimbursement, is perhaps the best finish line for the end of the beginning of our road toward sustainable, patient-centered oncology care.”

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

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