This Week in Managed Care: July 28, 2017

This week, the top managed care stories included the Senate rejecting multiple measures to repeal and replace the Affordable Care Act; calls for new payment models in behavioral healthcare; and 2 studies on empowering consumers to find the best prices for medications.

The Senate revives the healthcare debate, CMS wants new ideas for behavioral health, and AJMC® publishes 2 studies on the high cost of prescription drugs.

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

Senate Healthcare Efforts

The Senate this week revived debate on repealing the Affordable Care Act, with Vice President Mike Pence casting the deciding vote Tuesday to allow debate to move forward.

But so far, Senators have been unable to agree on a replacement plan. The Better Care Reconciliation Act, which included the plan to allow lower-priced, deregulated health plans, failed to pass by a vote of 43-57.

On Wednesday, senators rejected the “clean repeal” bill, which would repeal major parts of the ACA without providing a replacement.

The Senate may now have to move forward with a bill that repeals parts of the ACA, but leaves it mostly intact. [NOTE: Since filming the news, the Senate has rejected the skinny repeal option.]

Said Senate Majority Leader Mitch McConnell: “We can’t let this moment slip by. We talked about this far too long.”

For the latest developments, follow

Behavioral Health Payment

CMS wants input on new payment models that would boost access, increase quality, and lower costs for behavioral healthcare.

This week, it published a notice in the Federal Register that it will hold a meeting September 8 in Baltimore to seek input before creating alternative payment models under MACRA.

CMS will hold panel discussions on 4 topics:

  • Substance abuse disorders, including opioid use
  • Mental disorders with comorbid conditions
  • Alzheimer’s and other forms of dementia
  • Challenges in the behavioral health workforce

Read more.

Diabetes Metrics

A who’s who in diabetes care gathered in Bethesda, Maryland, last Friday when the diaTribe Foundation hosted a daylong meeting, “Glycemic Outcomes Beyond A1C: Standardization and Implementation.”

Diatribe Founder and Chair Kelly Close convened the meeting as a follow up to last year’s session with FDA, which brought consensus that future drug and device approvals should consider how well they control hypoglycemia and time in range.

This year, the group discussed the role of continuous glucose monitoring, or CGM, in bringing better data to clinical trials. Experts examined patient surveys, heard from European regulators, and then broke into workshops to pin down the metrics that the group would recommend to FDA.

Said Close: "We all know the very high dangers of hypoglycemia, but only by speaking with one voice—as researchers, clinicians, and patients, with leaders from different professional organizations—can we stay ahead of those dangers. To achieve that, we hope that CGM is used more often in clinical trials, and then that information is used to guide care for patients. If our goal is to improve outcomes at lower costs—and minimize hypoglycemia—that path will take us there.”

Diabetes Technology

The role of technology is getting more attention all the time in diabetes care. As Eda Cengiz, MD, MHS, FAAP, recently told AJMC®, the advances aren’t just from big projects like the artificial pancreas.

Watch the interview.

Drug Costs in AJMC

Prescription drug costs have been big news for a while now, and the current issue of The American Journal of Managed Care® has 2 studies that show the need to empower consumers to find the best prices.

A study led by Jeffrey Kullgren, MD, MS, MPH, found the accuracy of drug pricing information on state websites in Michigan, Missouri, New York, and Pennsylvania, was “often deficient” and consumers didn’t always use it. But, the study found, “When prices are reported, there can be a significant variation in the price of prescriptions, which could translate into substantial savings for consumers who pay out-of-pocket for prescription drugs.”

A second study led by Sanjay Arora, MD, finds the private sector may do a better job of helping consumers shop for drugs. A survey using telephone calls and web-based services found that going this route to compare prices was worth the trouble.

Finding the lowest price may improve medication adherence, the authors said.

Health IT Issue

Finally, AJMC is pleased to announce that Jacob Reider, MD, will be the special guest editor of our annual Health IT issue, which publishes at the end of 2017.

Reider is a family physician and the former chief medical officer with the Office of the National Coordinator for Health IT. He is now CEO for the Alliance for Better Health, a care transformation group focused on Medicaid members and the uninsured in upstate New York.

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