This Week in Managed Care: January 12, 2018

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This week, the top managed care stories included CMS unveiling a new voluntary bundled payment model; coverage from the JP Morgan Healthcare Conference, including immunotherapy's impact on HIV treatment and biosimilars; and news that 2 key diabetes devices will be covered by Medicare.


CMS offers a new voluntary bundled payment plan, biosimilars are the big news at the JP Morgan conference, and 2 key diabetes devices will be covered by Medicare.

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

Voluntary Bundled Payment Models

CMS this week launched a new voluntary payment model, one that shows the Trump administration believes more providers will try value-based care through incentives than with mandates.

Bundled Payments for Care Improvement (BPCI) Advanced asks practices and health systems to take on risk through 32 clinical episodes, including 3 in the outpatient setting.

Taking part in BPCI Advanced qualifies as an advanced alternative payment model under MACRA, which would free providers of some reporting requirements.

Said CMS Administrator Seema Verma, “BPCI Advanced builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value. Under this model, providers will have an incentive to deliver efficient, high-value care.”

Healthcare experts had been waiting for a new voluntary program after the Trump administration canceled 2 Obama-era mandatory payment models, including 1 in cardiac care. Hospitals said CMS was moving too quickly with mandatory programs and that they were too bureaucratic.

Some of the work health systems did to prepare for the cardiac program may let them participate in 2 cardiac outpatient models under BPCI Advanced.

Read more.

JP Morgan Healthcare Conferences

Biosimilars, Bill Gates, and pharmacy benefit managers (PBMs) were only the start of the agenda at the 36th annual JP Morgan Healthcare Conference, which took place this week in San Francisco.

Express Scripts CEO Tim Wentworth called his PBM “the original patient advocate” as he described the challenges of paying for novel gene therapies with costs that approach $1 million. New payment models may allow financing over many years, like a mortgage.

Microsoft co-founder Bill Gates said the private sector can benefit from being more involved in research, and said the tools being used in immuno-oncology may one day be used to fight HIV.

He said, “Our hope is that it’s this immunotherapy research for cancer that will give us the insights to control all of these infectious diseases, which would be a huge victory for humanity, and, hopefully, also a significant market for life sciences.”

Biosimilar news was everywhere at the JP Morgan conference, with Mylan offering a hint that it may have a mid-2018 approval for its biosimilar for pegfilgrastim, sold as Neulasta. Mylan received a complete response letter for its proposed biosimilar in October.

Check out the highlights of the JP Morgan meeting.

Diabetes Devices

One year ago today, CMS made headlines when it approved reimbursement for the Dexcom G5, marking the first time Medicare beneficiaries could get coverage for a continuous glucose monitor. But CMS made the rollout difficult for Dexcom, and a scathing GAO report said the agency had to change its ways to encourage innovation in medical technology.

So, diabetes advocates cheered this week when Medicare approved both the Abbott Freestyle Libre CGM as well as the Omnipod insulin pump. Insulet, which makes the Omnipod, had been seeking reimbursement for more than a decade.

Officials with Abbott and Insulet say the devices will be distributed through the pharmacy chain, which they believe will create a better consumer experience.

For news on diabetes device reimbursement, visit our Diabetes Compendium.

Medication Syncrhonization

Finally, a new study finds that older adults who take many medications are more likely to take them on time if they use a synchronization program.

The study in Health Affairs says that these programs, which lead to fewer trips to the pharmacy, are becoming more popular and lead to more continuous adherence to medications for cardiovascular conditions, hyperlipidemia, diabetes, and hypertension.

Read more.

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