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This Week in Managed Care: July 9, 2016


This week in managed care, the top stories included a report on how much Americans spend on complementary health approaches, more trouble with the Affordable Care Act's risk adjustment program, and researchers linked the BRCA1 gene to deadly uterine cancer.

Hello, I’m Justin Gallagher, associate publisher of The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

Complementary Health Approaches

Fifty-nine million Americans spent just over $30 billion in 2012 on healthcare items not covered by insurance, according to the National Center for Complementary and Integrative Health and the CDC.

This amount covered everything from yoga and meditation classes to massages, chiropractic care and supplements such as fish oil. The amount was about 30% of what they spent on services from physicians, according to the report.

Josephine Briggs, MD, director of the Center, said more research on these services is needed. “This underscores the importance of conducting rigorous research to know whether the products and practices being used are safe and effective.”

Risk Adjustment Program

Regulators in several states are calling on CMS to immediately fix a piece of the Affordable Care Act designed to stop insurers from avoiding patients with pre-existing conditions.

The Risk Adjustment Program calls for annual payments from insurers with comparatively healthy patients to those with sicker patients. But critics say the program is poorly designed, and it works against smaller, newer payers who lack a complete claims history on their clients. For the second straight year, small insurers were hit this week with huge assessments. Regulators in New York called for immediate changes, and a small Maryland insurer has sued over the program.

In Connecticut, the co-op HealthyCT was forced into runoff when it received an assessment of 13.4 million dollars. Insurance Commissioner Katharine Wade said, “This is not an action we take lightly, but did so in order to immediately protect the company’s 40,000 policyholders in Connecticut and make certain that their claims will be paid.”

BRCA1 Linked to Uterine Cancer

Researchers at Duke University have published a study linking the BRCA1 gene to deadly uterine cancer, suggesting that women who have this mutation consider having a hysterectomy once they have finished having children.

The findings, published in JAMA Oncology, involved nearly 1100 women in nine academic centers who had a deleterious BRCA1 or BRCA2 mutation and were followed for an average of 5.1 years. Women with the BRCA1 mutation developed uterine cancer at far higher rates of than would be expected, the researchers found.

Noah Kauff, MD, the study’s senior author, said, "Our study presents the strongest evidence to date that women with this genetic mutation should at least discuss with their doctors the option of having a hysterectomy, along with removal of their ovaries and fallopian tubes.”

Core Quality Measures

A recent effort by CMS and America’s Health Insurance Plans is bringing standardization and balance to quality care measures. AHIP’s Marilyn Tavenner, who previously was the administrator at CMS, spoke with AJMC about the process of implementing seven sets of new core measures. Watch the interview.

ACO Coalition Live Meeting

If you want to learn more about delivery system reform, join us in Philadelphia for the next meeting of our ACO and Emerging Healthcare Delivery Coalition, which takes place October 20-21.

For information and to register, click here.

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

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