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This Week in Managed Care: December 21, 2018


This week, the top managed care news included a federal judge ruling that the Affordable Care Act is unconstitutional; new diabetes standards address cardiovascular risk; efforts targeting loneliness show improved health outcomes.

A federal judge strikes down the Affordable Care Act (ACA), new diabetes standards address cardiovascular risk, and efforts to treat loneliness are working.

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

ACA Ruled Unconstitutional

A Texas judge has declared the ACA unconstitutional.

US District Court Judge Reed O’Connor found that when Congress eliminated the tax for failing to carry health coverage in 2017, it caused the rest of the healthcare law to crumble. O’Connor wrote: “Congress stated many times unequivocally—through enacted text signed by the President—that the Individual Mandate is ‘essential’ to the ACA. And this essentiality, the ACA’s text makes clear, means the mandate must work ‘together with the other provisions’ for the Act to function as intended.”

Many disagreed with O’Connor’s ruling, and California’s Xavier Becerra vowed to lead fellow Democratic attorneys general in an appeal.

America’s Health Insurance Plans, which represents many major payers, opposed the ruling, stating: “The district court’s decision is misguided and wrong. This decision denies coverage to more than 100 million Americans, including seniors, veterans, children, people with disabilities, hardworking Americans with low-incomes, young adults on their parents’ plans until age 26, and millions of Americans with pre-existing conditions.

With the ruling coming the day before the end of open enrollment, HHS noted that the ACA remains intact for now, and said: “The recent US District Court decision regarding the Affordable Care Act is not an injunction that halts the enforcement of the law and not a final judgment. Therefore, HHS will continue administering and enforcing all aspects of the ACA as it had before the court issued its decision.”

CV Risk Calculator

The American Diabetes Association issued its 2019 Standards of Care this week, which call for embracing the cardiovascular risk calculator developed by the American College of Cardiology.

The standards call for:

  • Using SGLT2 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes who also have demonstrated cardiovascular risk.
  • Using a GLP-1 receptor agonist first before using insulin in patients with type 2 diabetes to control blood sugar.
  • Taking steps to reduce therapeutic inertia in primary care practice and more actively managing diabetes in overweight youth.
  • Simplifying medication for some patients who are age 65 or older.

The 2019 standards reflect closer collaboration between the ADA and the ACC, a month after the ADA endorsed the ACC consensus pathway for care for patients with type 2 diabetes and atherosclerotic cardiovascular disease.

Targeting Loneliness to Improve Health

The health concerns of Americans living alone as they age gave rise to CareMore Health’s Togetherness Program, designed to address the problem of loneliness among seniors. This week, CareMore reported that after a year, results show the program is working.

Results released by CareMore show:

  • Enrollees increased participation in exercise programs by 56.6%
  • Enrollees decreased emergency department use by 3.3% compared with their baseline
  • Hospital admissions were 20.8% higher in the intent-to-treat group compared with those in the Togetherness Program.

Said CareMore Health Chief Executive Officer Sachin Jain, MD: “As studies reveal that senior loneliness can increase a person’s risk of mortality—more than air pollution, obesity, and excessive alcohol use—it is more important than ever that we come together to exchange ideas and discuss solutions.”

CareMore’s Togetherness Officer Robin Caruso discussed the program earlier this year in Evidence-Based Oncology.

Oncology Value Frameworks

There’s strong alignment between the value frameworks of 2 major oncology organizations, according to a new study. A joint assessment of the frameworks of the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) found comparable measures for clinical benefits in roughly two-thirds of more than 100 drug comparisons.

The analysis appeared this week in the Journal of Clinical Oncology.

The ESMO Magnitude of Clinical Benefit Scale is used for several purposes, from grading clinical value to guiding public policy, while the ASCO Value Framework is primarily used to aid physicians and patients in shared decision making.

Chronic Opioid Therapy

Finally, a new study in The American Journal of Accountable Care finds that chronic opioid therapy for pain treatment other than cancer is associated with increased healthcare spending as well as hospital stays.

The study calls on payers to intervene before patients move beyond using opioids for a few days and transition to long-term use. Inpatient spending along among the chronic opioid treatment group was $2453 higher than that of patients who did not transition to long-term treatment.

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

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