This Week in Managed Care: June 22, 2018

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This week in managed care, the top stories included Atul Gawande, MD, being named the CEO of the Amazon–Berkshire Hathaway–JPMorgan Chase healthcare venture; the Trump administration finalized rules for creating association health plans; an analysis found some cancer types are represented more than others in the Oncology Care Model.


Atul Gawande, MD, will lead a high-profile healthcare venture, President Donald Trump says new health plan rules will help small businesses, and the Oncology Care Model (OCM) may affect some cancer types more than others.

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

Gawande to Head Amazon—Berkshire–JPMorgan Venture

A joint healthcare venture among three business titans has a leader: Harvard surgeon Atul Gawande, MD, will lead the partnership formed by Berkshire Hathaway CEO Warren Buffett, Amazon’s Jeff Bezos, and JP Morgan CEO Jamie Dimon starting July 9.

The new company will be formed in Boston to engage with other biotech and medical research partners, and reports say it will be “free from profit-making incentives and constraints.”

Gawande said, "I'm thrilled to be named CEO of this healthcare initiative. I have devoted my public health career to building scalable solutions for better healthcare delivery that are saving lives, reducing suffering, and eliminating wasteful spending both in the US and across the world.”

Gawande will retain his posts at Harvard. No details have been released about the long-term joint venture, which was announced in January.

Implementing Association Health Plans

President Donald Trump said a new rule that allows groups of small businesses and self-employed people to buy health coverage together will make it easier to buy coverage across state lines, fulfilling one of his campaign promises

Speaking at the meeting of the National Federation of Independent Businesses, Trump said that the Affordable Care Act had been “especially brutal for small businesses.” The new rule follows an October 2017 executive order allowing the creation of Association Health Plans, which Trump said would bypass many requirements of the ACA.

A report last month from the Congressional Budget Office estimates that in 5 years, 4 million people will be enrolled in AHPs, which can bypass many insurance regulations.

Said Trump, “As a result of Obamacare, many small businesses, small business employees, [and] sole proprietors have no good or affordable options. But now they do.”

The National Federation of Independent Business sued unsuccessfully to overturn the ACA.

For more, read the full article.

Cancer Types in the OCM

Twenty-one percent of Medicare patients being treated for cancer see a physician who is using the Oncology Care Model (OCM), a payment model from CMS designed to bring better quality at a lower cost.

However, a new report from Avalere Health finds that trends in who takes part in the OCM could affect the transformation of cancer care, as some types of cancer are better represented than others. Breast cancer and lung cancer were the most common types of cancer seen in patients treated by doctors using the OCM model.

OCM Webcast

AJMC® will host a live webcast on implementing the OCM next Thursday, June 28th at noon, 3 p.m. and 6 p.m. Eastern Standard Time. Drs Bruce Feinberg, Bruce Gould, and Mark Liu will take part in the discussion, which is presented with the Community Oncology Alliance.


Cost of Living With Diabetes

People who live with diabetes spend plenty out of pocket to manage their disease, and a new survey finds 45 percent of them have skipped care at some point due to the cost.

The survey from UpWell Health examined both the financial and emotional costs of living with diabetes, such as the toll the disease takes on relationships with loved ones and co-workers.

The survey found:

  • 43% of those with diabetes paid up to $1000 a year out of pocket to treat their disease
  • 39% report feelings of depression, and 55% worry about the future
  • 37% say diabetes has harmed relationships
  • 62% say diabetes interrupts sleep regularly
  • 30% say having diabetes requires an extra 2 hours per week to shop and prepare meals

New Issue of Evidence-Based Oncology

Finally, technology at the point of care is transforming cancer care, and it’s the subject of the current issue of Evidence-Based Oncology™.

Our new issue features a commentary from authors at Flatiron Health, who review what’s working in the Oncology Care Model and call on policy makers to give technology developers a full seat at the table.

Authors from Foundation Medicine explain the parallel review process that led to approval of the FoundationOne CDx companion diagnostic test.

Check out the full issue.

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