This Week in Managed Care: June 25, 2016

This week in managed care, the top stories included House Republicans' new plan to repeal and replace the Affordable Care Act, new funding from HHS to help small practices follow the Medicare Access and CHIP Reauthorization Act, and the Supreme Court rules on a patent lawsuit that impacts pharmaceutical companies.

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

House GOP Health Plan

Republicans in the House of Representatives this week unveiled their plan to repeal and replace the Affordable Care Act, a move that Speaker Paul Ryan said shows what healthcare could look like if voters elect a Republican president.

The biggest change in the GOP plan calls for ending the requirement that everyone have health insurance, an element that helps hold down the cost of coverage for older, sicker Americans by balancing their costs with those who are younger and use less healthcare services. The House GOP plan would also phase out the federal government’s support for Medicaid expansion, raise the Medicare eligibility age to 67, and use tax cuts and health savings accounts to make coverage more available and portable to those who cannot obtain it through their job.

The policy outline did not include cost estimates or projections of how many Americans would remain insured, but a separate action by the Obama Administration suggests getting young adults to enroll is already challenging, even with the individual mandate:

Stepping Up ACA Outreach

The Department of Health and Human Services plans to step up its outreach to those under the age of 35. Those who start an account on but do not enroll will receive emails reminding them of increased penalties under Obamacare if they do not obtain coverage.

Erica Hutchins Coe, a partner in the Center for US Health System Reform at McKinsey and Company, told AJMC recently that while more young adults have health coverage than did before the ACA, the GOP observation that the law has created narrow networks is valid. Watch the interview.

Patent Rule

The US Supreme Court has upheld a new process for challenging patents that the pharmaceutical industry opposed, and some believe this ruling could boost the number of generic drugs and push down prices.

A new US Patent Office regulation makes it more likely that patents could be overturned, which could make it harder for pharmaceutical companies to keep information away from generic manufacturers.

Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, and Chip Davis of the Generic Pharmaceutical Association, praised the ruling: “Today’s decision from the Supreme Court is a significant win for consumers. By protecting and reaffirming the importance of the inter partes review, the court recognizes the vital need for an effective patent review process—one that promotes a competitive, affordable prescription drug market.”

Following MACRA

HHS this week unveiled plans to spend $100 million over the next 5 years to teach small physician practices how to follow the Medicare Access and CHIP Reauthorization Act, or MACRA, which calls for greater use of value-based reimbursement.

The difficulty that small practices have in embracing new payment models and understanding how to stay afloat financially under healthcare reform has concerned officials who do not want to lose practices that help rural or medically underserved areas. Groups that seek funding under the program must say how they will educate small practices without charging the groups or individual doctors. MACRA allows physicians to select quality care metrics that match the work they do in their practices, and this new program should help small practices select metrics that make the most sense.

Reimbursement, Quality

Aligning reimbursement with quality in cancer care is the theme of the new issue of Evidence-Based Oncology, which features commentary and coverage from recent meetings on value-based payment. The issue features:

  • A commentary on the ASCO CancerLinQ data initiative
  • Insights on the challenges of biosimilars
  • Updates from the spring conference of the Community Oncology Alliance, including a panel discussion featuring payers and providers

Read the full issue of Evidence-Based Oncology.

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

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