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This Week in Managed Care: February 28, 2020


This week, top managed care stories included the United States grappling with coronavirus; oncologists warning that a new payment model represents a major shift; findings that Medicaid expansion did not always result in community investment.

The United States grapples with coronavirus, leading oncologists say a new payment model represents a major shift, and Medicaid expansion doesn’t always translate into community investment.

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

Coronavirus Concerns Intensify in United States

A California patient with no travel history has tested positive for coronavirus, deepening concerns raised by the CDC this week that spread of the disease in the United States was inevitable.

President Donald Trump named Vice President Mike Pence as the country’s point person in the public health response, after the White House asked Congress for an additional 2.5 billion dollars in aid for response.

Dr Anthony Fauci, director of Infectious Disease at NIH, appeared with President Trump to outline plans for testing a vaccine, which he said would take time.

Said Fauci: “In order to get a [coronavirus] vaccine that’s practically deployable for people to use, it’s going to be at least a year to a year and a half at best.”

In a separate interview, Fauci said the window had passed for travel restrictions to slow coronavirus, which has killed 3000 people and infected 81,000 worldwide.

For more, visit ajmc.com.

Oncology Care First Model Marks Step Toward Bundled Payments

Authors from OneOncology warned this week that the proposed shift to a new payment reform model would mark a major change for medical oncology practices.

Writing in JCO Oncology Practice, the authors said the proposed change from the Oncology Care Model to Oncology Care First would mean including core services in a bundled payment.

The Center for Medicare and Medicaid Innovation wants to start the new model in January 2021. The authors wrote: “These proposed changes not only represent a near-term progression toward the CMS’ goal to augment its value-based payment models for cancer, they also provide signals on how CMMI may view the future of value-based care in oncology.”

The OneOncology authors warn:

  • Under the new model, evaluation and management services and other costs would shift from fee-for-service and be folded inside a monthly bundled fee
  • New incentives would do more to address rapidly rising drug costs by building reimbursement on a cancer-by-cancer basis
  • Practices may be asked to gather patient-reported outcomes

The authors say bundling E/M and drug administration costs into a prospective payment is “a sign of what may come.”

For more, visit ajmc.com.

Medicaid Expansion Fails to Promote Community Benefit Spending

Nonprofit hospitals in states that expanded Medicaid saw large drops in uncompensated care. But that hasn’t always translated into community investment, a new study finds.

Findings in JAMA Network Open show that Medicaid expansion brought mean increases of 3.2 million dollars per nonprofit hospital from public healthcare programs. But at the same time, these same hospitals spent 2.8 million dollars less on uncompensated care in the first year after expansion.

The findings align with those seen earlier this year in JAMA Internal Medicine, which found top-earning hospitals were spending less on charity care.

For more, visit ajmc.com.

Diminishing Benefits of Mammography for Women Older Than 75

A new study has pinpointed the age at which mammography no longer offers benefits for older women.

Results from the Harvard School of Public Health, published in Annals of Internal Medicine, show no clear benefit for mammography in women over the age of 75.

Using data from 1 million women in Medicare, the results showed the following:

  • Women aged 70 to 74 had a significantly lower risk of death if they were screened than if they were not screened, but that difference disappeared after age 75.
  • The 8-year risk of breast cancer was higher in the group over age 75 for women who continued to be screened.
  • The positive predictive value for mammography was much higher for women younger than age 75 than those older than 75.

Wrote Dr Otis Brawley in an editorial: “Hopefully, breast cancer treatment of the geriatric population will improve, and future studies can show that quality screening and treatment lead to a reduction in ‘overall mortality’ instead of just ‘breast cancer—specific mortality.’”

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 comes from 2017, when authors funded by the National Cancer Institute determined that mammogram practice patterns were not well aligned with evidence-based care. Of the women in the study over age 75, 63% had a mammogram.

For the full paper, visit ajmc.com.

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

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