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This Week in Managed Care: February 24, 2017


This week, the top managed care stories included Republicans releasing an outline for replacing the Affordable Care Act, pharmacy benefit managers and pharmaceutical companies pointing fingers over drug costs, and findings on engagement for patients with chronic conditions.

House Republicans have an outline to replace Obamacare, small and rural practices will get help to comply with MACRA, and the blame game over prescription drug prices heats up.

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

ACA Repeal

House Republicans are circulating ideas to replace the Affordable Care Act (ACA), which Speaker Paul Ryan, R-Wisconsin, said will be introduced after Congress returns from its winter recess.

A policy memo shows the plan will draw on the proposal Ryan released last June, called A Better Way. House Republicans still plan to use the budget reconciliation bill to repeal the ACA, and the replacement features:

  • Universal tax credits
  • Health savings accounts
  • Changes in age ratings, so that older Americans pay more and young adults pay less

Republicans also want to repeal Medicaid expansion and restore direct aid to hospitals that treat the poor and uninsured. Finally, the plan would offer state grants to set up high-risk pools for those with complex medical needs.

Improving Opinion of ACA

As protesters who oppose repealing Obamacare fill town hall meetings this week, a poll from POLITICO and Morning Consult shows the number of Americans who support the healthcare law has climbed since early January.

Before President Donald Trump took office, only 41% of Americans favored the law, but now Americans are evenly divided, with 45% supporting the ACA and the same share opposed.

Moving Forward With MACRA

Meanwhile, CMS is moving forward with the Medicare Access and CHIP Reauthorization Act (MACRA), the new law that changes how physicians and other providers are paid. CMS announced $20 million in grants this week, which will be used to train small and rural practices to comply with the new payment rules.

Kate Goodrich, MD, director of Clinical Standards and Quality at CMS, discussed at the most recent meeting of AJMC®’s ACO & Emerging Healthcare Delivery Coalition® how MACRA was changed to help small practices. Watch the video.

Blame Game Over Drug Costs

Consumers are fed up with high drug costs, and that has manufacturers and pharmacy benefit managers (PBMs), pointing fingers over who’s at fault.

This week, a leaked e-mail from an association of PBMs shows how the managers plan to fight back against accusations from drug makers about the current system of discounts and what pharma called “bloated supply chains.”

PBMs have pushed back against the findings of a recent white paper by the Community Oncology Alliance, which found that the fee system has evolved in a way that now works against consumers.

For more on this dispute, read the article.

Engagement for Chronic Conditions

A new report finds that patients with chronic conditions often lack confidence to manage their disease or pain, and that they want engagement with doctors between appointments.

The results of 2 surveys—one from patients and one from providers—shows that only 39% feel “somewhat knowledgeable” about condition management. Women, in particular, feel they need more help. The report also found:

  • 59% say they aren’t doing all they could to manage their condition
  • 40% would like more help when they have symptoms
  • 39% say they need help during “daily life”
  • 36% say they would like to have help when they’re in pain

Doctors don’t disagree that patients lack knowledge of chronic conditions, but the report found they spend little time during appointments discussing disease management. Read the full article.

Coaching Diabetes Patients

The good news is, giving patients more personalized coaching to manage their diabetes keeps them out of the hospital.

A new study in the current issue of The American Journal of Managed Care finds that when coaching sessions are tailored to meet patients’ individual needs, they have fewer trips to the emergency room, fewer admissions, and better glycemic control.

Patients in the study received different types of coaching from the same group of nurses.

The authors wrote: “The findings suggest that coaching interventions that are based on activation level may help care managers engage in more effective interactions that strengthen a patient’s role in managing his or her healthcare.”

Read the full study.

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

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