This Week in Managed Care: February 27, 2016

The top stories in managed care this week include findings on cancer survival disparities, CVS Health claimed drug spending growth slowed in 2015, and Horizon Blue Cross Blue Shield of New Jersey's OMNIA plan is interfering with existing patient-centered medical homes.

Hello, I’m Justin Gallagher, associate publisher, of The American Journal of Managed Care. Welcome to This Week in Managed Care, from the Managed Markets News Network.

Cancer Disparities Remain

This week, a report from the American Cancer Society found that while overall survival rates have improved, disparities persist between whites and African Americans in certain cancers.

Among the findings:

  • The overall death rate in men was 47% higher in American Americans than in whites in 1990, and had fallen to 24% by 2012.
  • Among women, the disparity in the death rate from cancer fell from 19% in 1991 to 14% in 2012.
  • Breast cancer rates death rates dropped 23% in black women and 37% in white women since 1990. Thus, while the death rate has fallen overall, the racial disparity has widened.
  • Colorectal cancer death rates declined faster in black women between 2003 and 2012, but declined more slowly for black men than in white men over the same period.

Read more.

Drug Spending Growth Slows

CVS Health said that plan drug spending grew only 5% in 2015, well below the 11.8% growth of the prior year.

The pharmacy giant, which manages drug benefits for more than 75 million Americans, said it kept costs down by carefully managing the list of drugs it would cover, according to Chief Medical Officer Troyen Brennan, MD, MPH. CVS also put limits on when it would cover high-priced drugs that entered the market, such as the new cholesterol drugs, the PCSK9 inhibitors. It also stopped covering many unproven pain medications.

Dr Brennan explained: “Most pharmaceutical manufacturers have built inflation into what they do. We see it for little-known drugs as well as major brand-name medications.”

CVS’ spending for hepatitis C drugs was flat compared with 2014, which also helped keep costs in check.

Obesity Reaches 28%

The obesity rate reached a record high in the United States in 2015, according to a new Gallup survey. Adult obesity increased from 25.5% in 2008 to 28% last year. In addition, another 35.6% of adults are overweight, 34.6% are normal weight, and just 1.8% are underweight.

While the obesity rate varied by racial group, the risk of diabetes does not, the pollsters found: “Overall adults who are currently obese are about 4.7 times more likely to be diabetic compared with those who are normal weight, a probability that doesn’t significantly vary for individual racial or ethnic groups.”

OMNIA Troubles Continue

In New Jersey, the conflict between Horizon Blue Cross Blue Shield and hospitals left out of its OMNIA plan continued in and out of court this week.

In an exclusive report by The American Journal of Managed Care, Rob Pedowitz, DO, of CentraState Medical Center in Freehold, NJ, explained how the tiering system is interfering with existing patient-centered medical homes that Horizon itself encouraged in the years before it created the OMNIA tiers.

Dr Pedowitz said that when he has to send his patients to a hospital outside the medical home, he loses control of whether they see specialists or have tests, defeating the point of the cost control measure. Sources who spoke with AJMC said the problem is not limited to CentraState and will have to be addressed by Horizon.

The Future of Diabetes Care

Where is diabetes care headed? To get the flavor of our upcoming meeting, Patient-Centered Diabetes Care, view a presentation from our meeting chair, Robert Gabbay, MD, of Joslin Diabetes Center.

See his presentation and register now for PCDC16.

For everyone at the Managed Markets News Network, I’m Justin Gallagher, Thanks for joining us.

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