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This Week in Managed Care: December 23, 2016


This week, the top managed care stories included CMS announcing more mandatory bundled payment models and a new track in the Medicare Shared Savings Program, the FDA approving a new use for Dexcom's continuous glucose monitor, and a greater emphasis on lifestyle management in the American Diabetes Association's care standards.

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

CMS Continues Value-Based Care Transition

With a month left in President Obama’s term, CMS isn’t slowing down the transition to value-based care. This week brought final word for new bundled payments models for cardiac care, expanded bundles for joint replacement, and a new track in the Medicare Shared Savings Program.

The changes will give more doctors a chance to select the Advanced Alternate Payment Model path, one of two choices under the Medicare Access and CHIP Reauthorization Act, or MACRA, which takes effect January 1.

But the American Hospital Association thinks CMS is moving too quickly, and President-elect Donald J. Trump’s nominee for Health and Human Services agrees.

Georgia Congressman Tom Price, R-Georgia, wrote this in a letter to HHS in September, concerning the Center for Medicare and Medicaid Innovation:

“We insist CMMI stop experimenting with Americans’ health, and cease all current and future planned mandatory initiatives.”

Read the full story.

Health IT

The American Journal of Managed Care this week published its sixth annual special issue on health information technology.

Special guest editor Joshua Vest, PhD, MPH, of Indiana University-Purdue University Indianapolis wrote that health IT is at a point of transition, as the wave of setting up systems is over. Now comes the hard part—making technology deliver better care.

Vest and his co-authors wrote that it’s time for health IT resources to align with the demands of population health. “To realize this alignment, healthcare leaders must think differently about the types of data their organizations need, the types of partners with whom they share information, and how they can leverage new evidence-based partnerships for evidence-based action.”

Read the full issue on health IT.

Palliative Care

The new issue of Evidence-Based Oncology looks at efforts to expand palliative care, which has been shown to improve quality of life and even extend it for patients living with cancer.

One challenge has been moving palliative care beyond hospitals and into community oncology practices.

EBO contributor Sharon Pearce, the vice president for public policy of the National Hospice and Palliative Care Organization, wrote about important shifts that are allowing tests of palliative care in community settings.

A CMMI demonstration project seeks to give more Medicare patients access to the hospice benefit, by allowing them to receive palliative services while still receiving “curative” care.

Pearce wrote that finding qualified providers is also a barrier. “Hospice and palliative care professionals require a multi-dimensional set of skills, attitudes, and competencies, including the ability to manage the myriad symptoms associated with advanced and comorbid illnesses; the ability to facilitate communication and problem solving between patients, their families, and their care teams; and the ability to coordinate and provide team-based care across a range of settings.”

See the full issue of Evidence-Based Oncology.

FDA Approves New Use for Dexcom CGM

Diabetes advocacy groups celebrated this week when the FDA approved a new use for Dexcom’s G5 mobile continuous glucose monitor: Patients can now make dosing decisions using the CGM data, without taking a finger stick test several times a day.

The change may lead to Medicare coverage for CGM, which until now has not been deemed necessary.

ADA Update

And, this week the American Diabetes Association released its 2017 update of the Standards for Medical Care in Diabetes, which put more emphasis on lifestyle management.

The ADA called for interrupting long periods of sitting every 30 minutes, and for doctors to pay close attention to disrupted sleep, since this is known to affect blood glucose levels.

Patient-Centered Diabetes Care 2017

Lifestyle management will be on the agenda at Patient-Centered Diabetes Care, our annual multistakeholder meeting set for April 6th and 7th in Teaneck, New Jersey.

Click here for more information and to register.

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

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