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This Week in Managed Care: February 10, 2017


This week, the top managed care stories included final enrollment numbers for the Affordable Care Act for 2017, a report that revealed low rates of lung cancer screening, and a study found that a population-based weight management strategies can prevent diabetes.

NOTE: After this newscast was filmed, 2 other big news stories broke: a judge blocked the Anthem-Cigna merger, and the Senate voted along party lines to confirm US Rep. Tom Price, R-Georgia, as HHS secretary.

Did canceled ads cause a drop in ACA enrollment? Are too few smokers being screened for lung cancer?

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

ACA Sign-ups

Sign-ups for coverage under the Affordable Care Act (ACA) are down for 2017, after the Trump administration canceled TV ads to remind people to enroll before the January 31st deadline.

Only 9.2 million people signed up on the Healthcare.gov exchange used by 39 states. Experts said that number fell by at least a half million, after the Trump Administration canceled $4 million in digital and TV ads designed to encourage people to enroll at the last minute.

A wave of sign-ups right before the end of open enrollment has been the norm since the federal exchange opened in 2013, but this year enrollment slowed in January after pacing ahead right after Election Day.

In the days before the deadline, health insurers worried that the lost enrollees were younger, healthier adults who would have balanced the risk pool and improved their bottom lines.

A Trump administration spokesman said the numbers show the ACA isn’t working. “Obamacare has failed the American people, with one broken promise after another. We look forward to providing relief to those who are being harmed by the status quo and pursuing patient-centered solutions that will work for the American people.”

Lung Cancer Screening

Rates of lung cancer screenings remain low, with no change since 2015, according to a study in JAMA Oncology commissioned by the American Cancer Society. Despite a recommendation to screen long-time smokers, many are unaware of the recommendation or lack access to screening, the study found.

The study estimated that of the 6.8 million current and former smokers who should be screened, approximately a quarter of a million received the test, which should be automatically covered under the Affordable Care Act.

The US Preventive Services Task Force lists who should receive an annual lung cancer screening:

  • Smokers age 55 to 80 who smoked a pack a day for 30 years, or 2 packs a day for 15 years, and
  • Former smokers meeting these criteria, who quit less than 15 years ago

Combating Diabetes With Weight Management

A study from Sweden finds that efforts to encourage everyone to maintain a healthy weight will do more to prevent diabetes than only targeting those who are overweight.

Using data from more than 33,000 health records, researchers reporting in BMC Public Health found that 21% of the cases of type 2 diabetes could be prevented by a broad-based campaign to help people avoid gaining weight. Current diabetes prevention programs target those who already have prediabetes and need to lose weight.

Said author Patrik Wennberg, MD, PhD: “When it comes to body weight and diabetes, from a public health perspective it would be advisable to consider both high-risk and population-based strategies for diabetes prevention.”

Population Health and APMs

A recent report finds that while nearly all health systems think it’s important to pursue value-based payment models, most don’t think they are ready to take on risk.

The findings by Numerof and Associates, prepared with David B. Nash, MD, MBA, of Jefferson College of Population Health, report that 74% of health systems have someone in charge of population health, but that front-line physicians still resist alternative payment models.

Said Numerof’s Michael Abrams: “Population health management will occupy a significant place in the future of healthcare, but the journey, for many, is formidable. Unlike the current model, providers must focus on the entire care continuum—from preventative care programs to post-acute facilities. Collaboration is key to success.”

Moving to APMs

What’s the best way to move to alternative payment models? Panelists told an audience at the Academy Health National Health Policy Conference that health systems have to “just do it.”

Michael E. Chernew, PhD, co-editor-in-chief of AJMC®, said the right way to measure the success of payment reform is to measure it against other alternatives, which are worse.

Said Dr Chernew: “No matter how much you hate it, you just have to hate it less than the other things.”

For more on the AcademyHealth discussion, read the article.

ACO Coalition Spring Meeting

To learn more about the next phase of payment reform, join us in Scottsdale, Arizona, in May for the next meeting of the ACO and Emerging Healthcare Delivery Coalition.

For information and to register, click here.

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

Thanks for joining us.

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