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This Week in Managed Care: March 10, 2017


This week, the top managed care news included a bill from House Republicans to repeal and replace the Affordable Care Act, a new program at Walgreens to train pharmacists on an advanced cancer-care curriculum, and findings that health coaching helps the neediest patients most.

After 7 years of trying, House Republicans have their plan to repeal and place Obamacare.

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

After weeks of leaks, House Republicans have unveiled the American Health Care Act—which would end funds for Medicaid expansion and replace the individual mandate with harsh penalties for dropping coverage.

Said House Speaker Paul Ryan, R-Wisconsin: “Obamacare is rapidly collapsing. Skyrocketing premiums, soaring deductibles, and dwindling choices are not what the people were promised 7 years ago. It’s time to turn a page and rescue our healthcare system from this disastrous law.”

President Donald Trump supports the plan, but some Republicans have doubts—including senators and governors from states that expanded Medicaid. Others are concerned that the Congressional Budget Office has not said how much the bill will cost or how many people will lose coverage.

Key parts of the law would:

  • Add a 30% surcharge for people who let their coverage lapse for 60 days.
  • Keep provisions that bar insurers from refusing to cover preexisting conditions and allow children to stay on family coverage until age 26.
  • Cancel a host of taxes that paid for the Affordable Care Act, including those on high earners, medical devices, and tanning salons.
  • Replace Medicaid expansion with funds to states for hospitals that serve the poor and uninsured.
  • Replace ACA subsides with tax credits based on age instead of income.
  • Nearly double the contribution limits for Health Savings Accounts, and expand how they can be used.

While Republicans in Congress want to change the parts of the ACA that provide coverage, there is bipartisan support for moving away from the fee-for-service system. Aetna’s Executive Vice President and Chief Medical Officer Harold L. Paz, MD, recently spoke with AJMC about the insurer’s goals for value-based care. Watch the interview.

Specialty Cancer Care Training

Walgreens has trained pharmacists and pharmacy technicians at 50 specialty pharmacy locations in an advanced cancer-care curriculum. The coursework covered the 4 most common diseases of colorectal, lung, prostate, and breast cancer, as well as several blood disorders, including leukemia, lymphomas, and multiple myeloma.

Created in partnership with the Oncology Nursing Society and the Leukemia and Lymphoma Society, the training program is designed to help staff better serve patients with cancer. Walgreens’ Matthew Farber said pharmacists not only need to explain today’s cancer therapies, but they must be ready to address cost issues.

“We are continually looking for ways to better support and educate our cancer patients on their medication regimens, while helping to improve their quality of care," he said. “With the continued advances in new oral therapies for cancer care, our pharmacists at these specialty locations are playing an integral role in working with patients’ physicians, nurses, social workers, and financial counselors.”

Targeting Coaching Efforts

Health coaching helps all patients with diabetes, but the greatest clinical gains come for patients who were faring the worst before coaching began, according to a study in the journal Preventing Chronic Disease.

The study examined the effects of a program that featured an in-person session, followed by a year of phone calls from a health coach. The authors say the results show it would be cost-effective to target coaching efforts at those with the poorest glycemic control, since these patients would benefit the most.

Both in-person and digital health programs to prevent diabetes are scheduled to become part of Medicare starting in January 2018.

Evidence-Based Diabetes ManagementTM

Paying for digital health is one of the topics covered in the current issue of Evidence-Based Diabetes ManagementTM, which examines current evidence to support lifestyle management. The issue features a review of behavioral evidence from cardiologists who include Kim Allan Williams, MD, FACC, the immediate-past president of the American College of Cardiology.

Check out the full issue.

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

Thanks for joining us.

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