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This Week in Managed Care: January 26, 2018


This week, the top managed care news included Senate confirming Alex Azar as the new HHS Secretary; a report found that healthcare prices rose in 2016; the accountable care organization movement continued to expand.

The Senate confirms a new HHS Secretary, healthcare prices rose in 2016, and the ACO movement is expanding.

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

New HHS Secretary

Alex Azar is the new HHS Secretary, following Wednesday’s bipartisan confirmation vote. He replaces Tom Price, MD, who resigned in September.

The former Eli Lilly executive said he opposes the Affordable Care Act as a matter of policy. But during his confirmation hearing, he offered some praise of former Secretary Sylvia Mathews Burwell, for her efforts to bring a transition to value-based care.

Azar was a deputy HHS secretary under President George W. Bush and a former clerk to Supreme Court Justice Antonin Scalia. One of Azar’s early tasks will be overseeing requests at CMS to require Medicaid recipients to work. A lawsuit was filed Wednesday to block the first waiver approved for Kentucky.

Less Care, More Costs

Drug prices, along with prices for surgery and emergency department visits, are driving up healthcare costs, which rose faster in 2016 than they did in the previous 5 years. That meant Americans spent more on healthcare last year even though they used about the same amount in services, according to the Health Care Cost Institute (HCCI).

The report is based on data from 4 major insurers: Aetna, Humana, United Healthcare and Kaiser Permanente.

Said HCCI president Niall Brennan, “It’s time to have a national conversation about the role of price increases in the growth of healthcare spending. Despite the progress in recent years on value-based care, the reality is that working Americans are using less care but paying more for it every year.”

Prescription drug prices grew 27% between 2012 and 2016, despite flat costs in generic drugs and less use of branded medications. The major cost drivers during the period were the cost of drugs for hepatitis C, skin and membrane agents, and hormone or synthetic substitutes.

Growing Number of ACOs

More accountable care organizations, or ACOs, are taking part in the Medicare Shared Savings Program in 2018, reaching 10.5 million beneficiaries. CMS announced this month that there are 124 new ACOs taking part in the program, bringing the total to 561.

With this growth, 82 percent of ACOs continue to take part in the 1-sided risk track of the program, which means the health system does assume a downside risk if they fail to limit growth in Medicare spending. But 46 ACOs are now in tracks that could require repayment of losses.

Clif Gaus, president and CEO of the National Association of ACOs, said CMS needs to improve the program so more ACOs are willing to take on downside risk.

Said Gaus, “ACOs play a critical role in transforming our nation’s healthcare system through value-based care. The growth of ACOs in 2018 shows the continued commitment from the administration to increase value in the Medicare program through ACOs.”

PCSK9 Prior Authorization

Will Sanofi’s PCSK9 inhibitor, Praluent, regain an edge in the quest for market share? We will find out March 10, when results for the ODYSSEY OUTCOME trial are presented at the American College of Cardiology (ACC) Scientific Session.

Last year, cardiovascular results for Amgen’s Repatha showed a cardiovascular benefit, but 1 that fell short of what payers were expecting. So far, physicians tell AJMC® that they still have trouble with prior authorization for both cholesterol-lowering medications.

A study published this month from Penn Medicine showed patients have trouble gaining access even when they have familial hypercholesterolemia, a genetic condition that should lead to easier access to the drugs.

Other highlights expected at ACC include:

  • New data from the CANTOS trial in type 2 diabetes
  • More data on the role of SGLT2 inhibitors in patients with heart failure
  • Information on the role of artificial intelligence in reducing healthcare costs

Read the full story.

End-of-Life Care Preferences

Patients with cancer want their doctors to ask about where they want to be for end-of-life care, according to a new study.

The Journal of the National Comprehensive Cancer Network received survey responses from 203 cancer patients and found that comfort is extremely important to those nearing the end of life.

The survey found:

  • 47% wanted to die at home or at the home of a relative
  • 34% wanted to be in a hospice or palliative care unit
  • 19% wanted to be in the hospital
  • While 93% had a preference where they wanted to die, only 7% had discussed it with their doctor.

The survey results showed family and support networks are key, because 41 percent of patients had discussed their wishes with those closest to them.

MIPS Webinar

AJMC® will present a live webinar with leading oncologists on January 31 to help physicians understand the requirements of the Medicare Access and CHIP Reauthorization Act.

The broadcast, “Implementing the Merit-Based Incentive Payment System for Improved Population Health,” will appear at noon, 3 pm, and 6 pm. Eastern. Register and learn more.

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

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