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This Week in Managed Care: June 12, 2020


This week, the top managed care news included HHS distributing COVID-19 funds to Medicaid and CHIP providers; the National Kidney Foundation issues a statement on health disparities and racial violence; a preview of our coverage of the American Diabetes Association 2020 Virtual Scientific Sessions.

HHS will send COVID-19 funds to help doctors who serve the poor, the National Kidney Foundation issues a statement on health disparities and racial violence, and AJMC® previews our coverage of the American Diabetes Association 2020 Virtual Scientific Sessions.

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

HHS to Send COVID-19 Funds to Medicaid, CHIP, Safety Net Hospitals

Following criticism of how it distributed billions of dollars in funding to health care providers, HHS said Tuesday it is sending $15 billion in COVID-19 relief to providers that take part in Medicaid and the Children’s Health Insurance Program, or CHIP.

HHS said Medicaid and CHIP providers will be able to use a portal to report their annual patient revenue, with the initial disbursement going to about 62% of all providers participating in these programs. The remaining 38% will receive the rest of the revenue, and HHS will distribute $10 billion in relief funds to safety net hospitals.

Meanwhile, as part of the overall plan by the Trump administration to reopen the country, CMS said it would make recommendations in places where there is no evidence of a rebound in infections. However, systems must still be prepared for potential surges of infection.

CMS recommended the continuation of telehealth to minimize the need for face-to-face visits, and said those at higher risk for severe COVID-19 illness should continue to stay home unless they need in-person health care.

The news comes as the average daily infection rate is rising in Mississippi, Florida, and South Carolina. Since the start of June, 14 states have recorded their highest-ever 7-day average of new COVID-19 cases since the pandemic began in the United States.

For more, visit ajmc.com.

National Kidney Foundation Issues Statement on Health Disparities, Racial Violence

Last week, the National Kidney Foundation, or NKF, issued a statement condemning ongoing patterns of health disparities, inequality, and racial violence in the wake of the death of George Floyd.

The NKF, which works to address health issues for 37 million people in the United States with kidney disease, said Floyd’s death and the ongoing COVID-19 pandemic both highlight disparities in health outcomes between minority groups and whites.

The statement by the NKF says that the group is providing data on “all tests, hospitalizations, discharges and deaths from COVID-19 so we fully understand the scope of the impact on minority communities,” along with supporting “investments in public health infrastructure in traditionally under-served communities; and increase funding for kidney research and targeted awareness.”

“The global pandemic has disrupted our lives in many ways. And that disruption has disproportionately affected communities of color with higher death rates and lack of access to healthcare. For our part, NKF is fighting for affordable health care for all, access to medication, patient choice, access to transplantation and home dialysis,” the statement from the foundation said.

For more, visit ajmc.com.

Previewing ADA Virtual Coverage

This week, the American Diabetes Association will present their 80th Scientific Sessions in a virtual format.

AJMC.com will bring you full coverage of the virtual meeting, which will take place from June 12th to the 16th.

Some notable session coverage to look out for include:

  • Late-breaking REDUCE-IT results
  • Findings from the DAPA-HF trial on SGLT2 use in cardiology
  • And an exclusive interview with the new chief scientific and medical officer at the American Diabetes Association, Dr Robert Gabbay

For full conference coverage, visit ajmc.com.

Diabetes Educators Release Updated Report on DSMES Accessibility, Usage

In other diabetes-related news, the Association of Diabetes Care & Education Specialists released a consensus report outlining strategies health care stakeholders can follow to increase access to and utilization of diabetes self-management education and support, or DSMES.

“The purpose of DSMES is to give people with diabetes the knowledge, skills, and confidence to accept responsibility for their self-management,” researchers said. “This includes collaborating with their health care team, making informed decisions, solving problems, developing personal goals and action plans, and coping with emotions and life stresses.”

The report was made in collaboration with several other organizations including the American Diabetes Association and Academy of Nutrition and Dietetics and is the first joint position statement to address diabetes self-management education and support since 2015.

The report calls for making DSMES widely available to the public and argues health systems, payers, and providers address barriers to utilization.

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.

A 2015 paper co-authored by Helaine Resnick, PhD, MPH, and our co-editor-in-chief, Michael Chernew, PhD, examined the phenomenon of providers who fail to intensify diabetes therapy even when patients’ A1C does not improve. The authors found more work was needed in this area, and since that time, the problem called “clinical inertia” has received more attention.

The hurdles put in place by prior authorization are one reason why providers may be reluctant to change a patient’s medication dose or switch to a new medication.

For the paper, visit ajmc.com.

For all of us at AJMC®, I’m Matthew Gavidia.

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