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This Week in Managed Care: February 14, 2020


This week, top managed care stories included CareMore Health successfully managing complex patients; HHS standing by its rules on interoperability; healthcare costs rising faster than wages.

CareMore Health successfully manages complex patients, HHS stands by its rules on interoperability, and healthcare costs rise faster than wages.

Welcome to This Week in Managed Care, I’m Christina Mattina.

Complex Care Management Saves Money, Decreases Hospital Admissions

Healthcare experts were disappointed with last month’s news that the Camden Coalition’s long-term work with hotspotting failed to trim hospital admissions.

But research in the new issue of The American Journal of Managed Care® suggests that complex care management can work, if programs are designed correctly.

Authors from CareMore Health reported on an initiative in Memphis that saved $7700 per patient a year.

The authors found:

  • The savings came from a 44% drop in admissions and a 59% drop in bed stays.
  • Better management of risk factors may have limited acute incidents linked to chronic disease.
  • Patient engagement may have helped medication adherence.
  • There was no drop in visits to the emergency department.

For the full article, visit ajmc.com.

HHS Stands Behind Interoperability Rules

A presentation at this year’s AcademyHealth National Policy Conference makes it clear that HHS is standing by its final rules on interoperability of patient data.

HHS Secretary Alex Azar and ONC Coordinator Dr Don Rucker said control of patient data is about access and choice. They pushed back at suggestions from the largest supplier of EHR software, Epic, that the rules be delayed.

Said Azar: “Patients should be able to access their electronic medical record at no cost, period. Providers should be able to use the IT tools that allow them to provide the best care for patients, without excessive costs or technical barriers. Unfortunately, defenders of the balkanized, outdated status quo have fought our proposals fiercely.”

Rucker rejected suggestions that pushing through the rules will put privacy at risk.

For more from the AcademyHealth conference, visit ajmc.com.

Healthcare Costs Increased Twice as Fast as Worker Wages

Worker wages aren’t keeping pace with healthcare costs, according to new research.

The Peterson-Kaiser Health System Tracker found that health spending at larger employer plans by families rose 2 times faster than wages over the past 10 years.

The study found:

  • The average family spent $4706 on premiums and $3020 on cost-sharing in 2018, an 18% increase compared with 2013.
  • Over the past decade, health spending by families at large employers rose 67%, including a 51% increase in premiums for family coverage.
  • Health spending reaches nearly $6000 per person among those with large employer coverage.

The report found: “When considering the affordability of healthcare, it is important to put it in context with the relatively low increases in workers’ wages.…While average payments towards deductibles are still relatively low, they have increased considerably in the context of total household budgets.”

For more, visit ajmc.com.

CVS Invests in Affordable Housing

CVS is addressing social determinants of health through affordable housing.

CVS Health will spend $75 million in 2020, a 12% increase from what it spent in this area in 2019.

The spending on rental units, made in partnership with Aetna, is part of a plan to avoid hospital stays and acute healthcare costs.

Paper of the Week

Finally, we bring you Paper of the Week, which looks back at research and commentary from the past 25 years in The American Journal of Managed Care®, and why they matter today.

This week’s paper, “Metabolic Syndrome and Mental Illness,” is one of many over the years that has addressed the challenges of complex patients.

The 2007 paper examined the elevated risks for cardiovascular disease and type 2 diabetes for patients who have schizophrenia or bipolar disorder.

Author John W. Newcomer reported that these patients have a life span 25 to 30 years shorter due to their combination of risk factors.

For the paper, visit ajmc.com.

For more about complex patients, visit ajmc.com.

For all of us at AJMC®, I’m Christina Mattina. Thanks for joining us.

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