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This Week in Managed Care: July 16, 2016


The top stories in managed care this week included coverage of JAMA’s special issue on healthcare transformation under the ACA, changes in the proposed 2017 Physician Fee Schedule promoting value-based care, and more.

Welcome to This Week in Managed Care, from the Managed Markets News Network.

Hello, I’m Cate Douglass with The American Journal of Managed Care.

Obama Writes About the ACA in JAMA

This week, Barack Obama became the first president to publish in JAMA, which unveiled a special issue on how healthcare has changed under the Affordable Care Act. Obama said the rate of Americans without health coverage has dropped 43 percent because of the law, and fewer people report they are in fair to poor health.

The president wrote: “Americans can now count on access to health coverage throughout their lives, and the federal government has an array of tools to bring the rise of healthcare costs under control.”

The president argued that overall healthcare spending has declined, and new payment models are improving the quality of care. However, Jonathan Skinner and Amitabh Chandra, writing in the same issue, said the slowdown in spending is more likely due to the recession. Obama called on Congress to do more to rein in prescription drug process and to revisit the “public option” as a way to bring competition to parts of the country where 1 or 2 insurers dominate the market. To read more about the special issue of JAMA, visit ajmc.com.

Juno Therapeutics CAR-T Trial

Juno Therapeutics had an eventful week, after it first halted, and then resumed its trial involving leukemia patients receiving CAR-T cell treatment. The trial stopped briefly after three patients died. Juno had tried giving these patients a pretreatment combination, hoping it would make them more responsive to CAR-T treatment. The FDA gave Juno permission to restart the trial after showing it would remove one therapy from the pretreatment. The Boston Globe has reported that FDA is giving greater scrutiny to several companies develop CAR-T cell treatments

Value-Based Care in Physician’s Fee Schedule

HHS included several changes in the proposed 2017 Physician Fee Schedule that promote preventive services and value-based care. Secretary Sylvia Mathews Burwell joined the American Diabetes Association to unveil how Medicare will pay for the Diabetes Prevention Program, starting in January 2018. Those familiar with the plan say Medicare is taking its time to roll out the program, to allow time for providers to gain technical expertise to protect patient privacy, to do electronic billing, and to prevent fraud.

Studies have shown the Diabetes Prevention Program lowers the risk of a person with prediabetes progressing to the disease by 58 percent. Separately, CMS proposed paying for collaborative care, which puts behavioral health providers into primary care practices. Patients treated this way are more likely to pursue treatment for depression and to take their medication, which improves their blood glucose and cholesterol levels.

Combination Therapy and Medication Adherence

Medication adherence is a challenge in diabetes care, but Dr. John A. Johnson of WellCare recently told AJMC Insights how combination therapy can change patient perceptions and lead to better care.

For the rest of our interview with Dr. Johnson, visit ajmc.com.

Register for Patient-Centered Oncology Care

Registration is open for Patient-Centered Oncology Care, the annual multistakeholder meeting in Baltimore from AJMC. The meeting, set for November 17th and 18th will mark the fifth year of PCOC, with sessions on clinical innovations, managed care, and policy development. For information and to register, visit ajmc.com.

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

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