This Week in Managed Care: July 17, 2020

July 17, 2020

This week, the top managed care news included states facing COVID-19 spikes reporting health coverage losses; new COVID-19 data protocol raises concerns; and experts discuss key steps to reduce racial inequities in cancer care.

States facing COVID-19 spikes report greatest health insurance coverage losses, new COVID-19 data protocol raises concerns, and experts discuss key steps to reduce racial inequities in cancer care.

Welcome to This Week in Managed Care, I’m Matthew Gavidia.

States Facing COVID-19 Spikes Report Greatest Health Insurance Coverage Losses

According to an analysis by Families USA, states currently facing a surge of COVID-19 cases also report the greatest increases in residents who lost health insurance due to the pandemic.

Examining data from the US Bureau of Labor Statistics, researchers assessed changes in the number of unemployed workers outside the labor force in each state.

They then applied these numbers to research findings on coverage from the Urban Institute, which show the percentage of unemployed workers who became uninsured since the main coverage provisions of the Affordable Care Act took effect in 2014.

When it comes to Medicaid expansion, data show that states who adopted this measure of the ACA tended to report lower uninsured rates. Florida, Georgia, Mississippi, North Carolina, South Carolina, and Texas are among the 13 states that have not adopted Medicaid expansion; on average, 22.6% of unemployed workers become uninsured in states that did expand Medicaid, compared with 42.5% in states that did not.

Financial cuts imposed by the Trump administration to outreach programs, which helped individuals sign up for a marketplace plan in states that did not expand Medicaid, have also reduced awareness among unemployed individuals, potentially limiting them to available options.

“We knew these numbers would be big,” said Stan Dorn, director of Families USA’s National Center for Coverage Innovation. “This is the worst economic downturn since World War II. It dwarfs the Great Recession. So it’s not surprising that we would also see the worst increase in the uninsured.”

For more, visit ajmc.com.

New COVID-19 Hospital Data Protocol Raises Concerns

Following an announcement that hospitals are to bypass the CDC and send all COVID-19—related information to a central database, questions have been raised as to the future of COVID-19 data transparency and politicization.

Starting July 15, daily hospital data including information on deaths, bed capacity, and mechanical ventilator utilization, are no longer to be submitted to the site of the CDC’s National Healthcare Safety Network, or NHSN. Instead, the data are to be sent directly to TeleTracking, an HHS Protect system.

In a call with reporters, CDC Director Dr Robert Redfield noted that consolidation of already-reported data will help doctors determine which patients ought to receive new treatments as they become available. The new system allows for additional metrics to be reported, such as therapeutic developments or breakthroughs that may be administered at hospitals.

Redfield stressed that the change only functions to streamline data reporting and access for hospitals and healthcare professionals, stating “[data] access is the same today as it was yesterday.”

As hospitals have been reporting their data to the NHSN since the beginning the outbreak, some question whether the timing of the new reporting methodology is optimal, given the pandemic’s recent surge.

For more, visit ajmc.com.

Key Steps to Reduce Racial Cancer Disparities Include Supporting Minority Scientists, Diversifying Medical Schools and Clinical Trials

This week, The American Journal of Managed Care® discussed root causes of racial inequities in cancer care with Dr John Carpten, professor at the University of Southern California Keck School of Medicine, and Dr Russell Ledet, president of The 15 White Coats.

Notably, Carpten outlines what needs to happen to improve cancer outcomes for minority populations and support minority scientists, while Ledet, who is also a medical student at Tulane University School of Medicine, explains the steps to breaking down the barriers to medical school for those from marginalized communities.

For the full interview, visit ajmc.com.

PrEP Use Has Changed Following Implementation of Social Distancing Measures

In a late-breaking abstract presented during AIDS 2020, this year’s virtual meeting of the International AIDS Society, researchers detailed the effects that US shelter-in-place orders have had on trends in at-risk sexual behaviors and use of pre-exposure prophylaxis, or PrEP.

To gather data on PrEP access, use, and risk behaviors associated with HIV, researchers surveyed network providers and PrEP users over a 25-day period in April and May when shelter-in-Place orders were at the height of their use.

Compared with before the COVID-19 pandemic, when 95.3% of PrEP users took the medication on a daily basis and 4.7% on an event-driven basis, PrEP use stopped completely in an overall 32% after shelter-in-place orders were issued.

Among prescribers, the results show that even though more than 90% reported some sort of restrictions to their practice, 95% were still able to prescribe PrEP during shelter-in-place orders.

For more, visit ajmc.com.

Roche Invests in Blueprint Medicines, Maker of RET Inhibitor Pralsetinib

This week, Roche announced it will invest heavily in Blueprint Medicines on a global codevelopment and commercialization agreement for pralsetinib, an investigational precision therapy in late-stage development for individuals with alterations in the RET gene.

The 2 companies will jointly market pralsetinib in the United States, if it is approved, while Roche will be responsible for commercial activities outside the United States

“Beyond lung cancer, pralsetinib’s tumour-agnostic potential further expands Roche’s ongoing commitment to finding new approaches to treat cancer in a more personalised way based on the genetic mutation of the disease, irrespective of the tumour site of origin,” Roche said in a statement.

Roche will pay $675 million in cash in addition to a $100 million equity investment; Blueprint Medicines is eligible to receive up to $927 million in potential milestones, plus royalties on net product sales outside the United States.

For more, visit ajmc.com.

Paper of the Week

And, now our paper of the week, which looks back at some of the most important papers over the past 25 years of The American Journal of Managed Care® and why they matter today.

One of our most-read articles of early 2017, “Impact of a Pharmacy-Based Transitional Care Program on Hospital Readmissions,” was typical of payment reform initiatives seen after passage of the Affordable Care Act.

The study found that services provided by pharmacists could make a meaningful impact in keeping patients from returning to the hospital after an initial discharge—in this case, a 28% reduction at 30 days, and a 32% reduction at 6 months, compared with usual care.

For the full study, visit ajmc.com.

For all of us at AJMC®, I’m Matthew Gavidia. Thanks for joining us!