This Week in Managed Care: June 14, 2019

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This week, the top managed care news included the Community Oncology Alliance submitting an alternative to the Oncology Care Model; more study results demonstrating diabetes drugs can prevent renal failure; US task force recommending pre-exposure prophylaxis for HIV prevention.


Community oncologists offer an alternative payment model, more results show a class of diabetes drugs can prevent renal failure, and a US task force offers new guidelines for HIV prevention.

Welcome to This Week in Managed Care, I’m Samantha DiGrande.

COA Submits OCM 2.0 Proposal

This week, the Community Oncology Alliance released its long-awaited alternative to CMS’ Oncology Care Model. Dubbed OCM 2.0, the model is centered on standardized clinical improvements and baseline payment criteria, with 4 key features:

  • It can be a template for payment reform for all aspects of care—for all payers
  • It rewards high quality and value in cancer care
  • It has simple, transparent reporting requirements
  • It addresses drug prices by including value-based initiatives and takes on payment problems that reward suboptimal care.

Said COA President Michael Diaz, MD, and a practicing medical oncologist at Florida Cancer Specialists & Research Institute: “The proposal reflects a commitment to helping build the cancer care system of the future that patients, providers, and payers all want. We urgently request that the committee take the recommendations of community oncology practices who are on the frontlines of treating this devastating disease and help us transform cancer care for generations to come.”

Diabetes Drugs Prevent Renal Failure

Studies that show newer diabetes drugs can prevent renal failure dominated this week’s meeting of the American Diabetes Association (ADA). Additional results from DECLARE, the cardiovascular outcomes study for dapagliflozin, showed that the sodium glucose co-transporter 2 inhibitor made a difference even in patients with healthy kidney function—which showed investigators how much diabetes affects the renal system.

Also at ADA, more results from CREDENCE, the dedicated renal outcomes study for canagliflozin, show the drug provides protection against kidney failure for people with and without pre-existing cardiovascular disease.

Said Naeem Khan MD, vice president of Medical for US Cardiovascular and Metabolic Diseases, AstraZeneca, the maker of dapagliflozin, “The evidence has brought us to a point where we say, diabetes is a risk factor that affects other vital organs, and the organs are the heart and the kidney.”

In other news from ADA, the PIONEER trial showed that Novo Nordisk’s oral semaglutide is safe and can reduce the risk of cardiovascular and overall death by nearly 50%. Oral semaglutide is the first glucagon-like peptide 1 receptor agonist in a pill form, and FDA approval is pending.

For full coverage of the ADA sessions, including our technology update, visit

USPSTF Issues Guidelines for HIV Prevention, Screening

The US Preventive Services Task Force has issued a new guideline for the use of pre-exposure prophylaxis, or PrEP, for HIV prevention. The task force also updated its 2013 recommendations for screening people at risk for HIV.

The recommendation appearing in JAMA said: “The USPSTF found convincing evidence that PrEP is of substantial benefit for decreasing the risk of HIV infection in persons at high risk of HIV infection, either via sexual acquisition or through injection drug use.

The USPSTF also found convincing evidence that adherence to PrEP is highly correlated with its efficacy in preventing the acquisition of HIV infection.”

For more visit

Teaching Hospitals Have Similar, Lower Costs of Care as Nonteaching Hospitals

New research says teaching hospitals, compared with nonteaching hospitals, having similar or lower costs of care for Medicare patients. A study in JAMA Open said that efforts to steer patients to high-value care appear to be working. The researchers looked at total cost of care, not just inpatient costs.

They found that initial costs appear to be higher at a teaching hospitals, in part because they care for sicker patients. But over the long haul, the costs even out because teaching hospitals have been processes for reducing readmissions and other post-acute costs. After 90 days, costs were similar.

For more, visit

Employers Need to Get Informed on Healthcare

Finally, The American Journal of Managed Care® last week covered business and employer leaders as they work to lower costs of care. At the 2019 Annual Conference of the Greater Philadelphia Business Coalition on Health, leaders heard from David Blumenthal, MD, president and chief executive officer of the Commonwealth Fund, who said leaders must get more informed about the costs and quality of healthcare.

Said Blumenthal: “Costs are going up, you’re not controlling them, and the insurance that your employees are getting isn’t protecting them from the cost of illness nearly as well as it used.”

For the full article, visit

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