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This Week in Managed Care: January 17, 2020


This week, the top managed care stories included AJMC®’s annual health information technology issue; a debate over the value of PrEP; rates of heart disease falling among survivors of childhood cancer.

Our annual Health IT issue features some of healthcare’s top influencers, a debate arises over the value of PrEP, and AJMC®’s 25th anniversary will bring a new feature to highlight our top papers.

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

AJMC® Releases Ninth Annual Health IT Issue

This week, AJMC published its health information technology issue, which always offers some of our most anticipated research of the year.

Guest edited by Emory University’s Dr. Ilana Graetz, the issue highlights advances in predictive technology and ongoing barriers to full use of electronic health records. Said Graetz:

“Now that the nation’s healthcare providers have achieved widespread adoption of EHRs, the next phase of research, highlighted in this year’s annual health IT issue, explores innovative methods for using data to improve population health, the role of trust and provider relationships, and enduring barriers to interoperability.”

The issue highlights include:

  • A commentary co-authored by AJMC® board member and CareMore Health CEO Dr Sachin Jain that calls for portable medical licensure to fully exploit telemedicine.
  • A study that finds only 38% of clinics had all health IT functionalities in 2016
  • Two studies with different findings on the value of predictive technology in showing who will end up in the emergency department

And the first of a special 25th anniversary interview series featuring top healthcare leaders. For our Health IT issue, Senior Editor Allison Inserro interviews Dr Eric Topol.

Topol and Jain were among the top social media influencers in healthcare you should know in 2020, according to FierceHealthcare.

For the full health IT issue, visit ajmc.com.

Debate Arises Over Safety, Value of PrEP

A recent article asks whether the FDA acted correctly last summer when it lifted certain postmarketing safety precautions for Truvada and its generics.

FDA removed the Risk Evaluation and Mitigation Strategy requirement, or REMS, which suggested that both Truvada and Descovy, which is a different tenofovir combination, were being safely prescribed and taken by their target populations.

Gilead, in fact, claims Descovy is safer and more effective than Truvada, but authors of an article in Annals of Internal Medicine say that’s not the point. The same at-risk populations were not tested for each therapy in clinical trials, they write:

“In the future, no HIV prevention drug should be allowed to undergo Food and Drug Administration review without data addressing all key populations at risk for HIV.”

Using Descovy instead of Truvada in some populations would be a “clinical leap of faith,” the authors say.

For more, visit ajmc.com.

Survey Results Show Patient Interest in House Calls

Could the house call make a comeback? Yes, if the healthcare system embraces survey results released this week by CareMore Health and Aspire Health.

Participants in The Harris Poll survey were evenly divided between those younger and older than 65, and yet 64% were interested in the idea. Selling points were convenience, personal attention, and less stress.

Respondents told the survey:

  • 92% felt the quality of a house call would be as good as or better than an office visit
  • 87% said they wanted a provider to treat them like a member of the family
  • 79% felt they would be better able to manage their care
  • 64% said the provider might gain insights such as whether patients lacked food or were being exposed to poor air quality

Said Dr Prakash Patel of the Diversified Business Group at Anthem, which includes CareMore and Aspire: “It’s clear an evolution of our care delivery models is required, and we are meeting this need by building an integrated set of offerings to support the whole person.”

Heart Disease Risk Drops Among Survivors of Childhood Cancer

Rates of heart disease are falling among survivors of childhood cancer, according to a new study.

BMJ reports that efforts to protect children from the most toxic effects of cancer treatment, such as radiotherapy, appear to be working. Risk of coronary artery disease fell steadily, from 0.38% in the 1970s to 0.19%.

The findings are based on results from more than 23,000 adults in the Childhood Cancer Survivor Study who had the most common cancers diagnosed before age 21 in the 1970s through the 1990s.

While the number of survivors who had cardiotoxic treatments increased, the doses they received decreased. Radiation exposure fell from 77% in the 1970s to 40% in the 1990s.

The authors wrote: “These results suggest that efforts to modify cancer therapies in children and promote health surveillance are beginning to show benefits not only in overall survival but also in late adverse cardiac effects.”

Celebrating 25 Years With Paper of the Week

Finally, welcome to the first edition of “Paper of the Week,” which will look back at some of the most influential research articles and commentary that have appeared in The American Journal of Managed Care® over the past 25 years, and why they are important today.

This week’s paper is from March 2002. “Health-Related Quality of Life in Early Rheumatoid Arthritis: Impact of Disease and Treatment Response” used two different scoring systems to measure both general health status and specific effects of RA, both before and after patients received the biologic etanercept, sold as Enbrel.

The authors showed that starting patients on etanercept early in the progression of RA brought a rapid response in their quality of life.

The paper has been cited more than 200 times, and Enbrel went on to become Amgen’s top-selling product.

Enbrel is so important that Amgen went to court last year and won a major federal patent case to protect Enbrel against biosimilar competitors. AJMC®’s sister site, The Center for Biosimilars®, has covered the patent dispute, and you can learn more from the podcast Not So Different.

To read our Paper of the Week, visit ajmc.com.

And for the podcast, visit our Center for Biosimilars.

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

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