This week's top managed care stories include a lawsuit between Anthem and Express Scripts, trouble with Medicare's bidding program for diabetes test strips, and the cost of reporting quality measurements.
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.
Anthem Sues Express Scripts
This week, the health insurer Anthem sued Express Scripts, saying the giant pharmacy benefit manager isn’t sharing enough of the discounts it extracts from drug companies.
Anthem’s long-term contract with Express Scripts has a provision that called for repricing to take place starting January 1, 2016. Anthem says the PBM owed it $3 billion in annual savings, but Express Scripts rejects that claim.
Right now, Anthem said it has not decided if it will break its ties with Express Scripts if a court grants that right. Some believe that if Anthem ends its contract, a new PBM will emerge.
Express Scripts spokesman Brian Henry told AJMC that Anthem’s claims are “without merit.”
“Express Scripts values its relationship with Anthem and will continue to honor its commitments under the contract … Express Scripts has consistently acted in good faith and in accordance with the terms of its agreement with Anthem," he said.
Diabetes Test Strip Controversy
This week, a study in Diabetes Care found that Medicare’s competitive bidding program for diabetes test strips has caused disruptions for seniors who need these critical supplies.
The study found that some seniors with diabetes lost access to test strips and checked their blood sugar less frequently or not at all. Instead of saving money, the program caused hospital costs to rise and even led to the early death of some beneficiaries.
Both the Government Accountability Office and the American Association of Diabetes Educators had previously raised red flags about the bidding program. The study’s authors called on CMS to suspend bidding on test strips until the program can be fixed.
Fewer Lung Cancer Screenings
Two years ago, the US Preventive Service Task Force called for annual lung cancer screenings for older Americans with a long history of smoking. Based on results of the National Lung Screening Trial, Medicare agreed to pay for these tests.
But now a study published in Lancet Oncology suggests that annual screenings might not be best for certain high-risk patients.
A team of researchers from Duke University went back through the data to find out how many patients developed lung cancer over five years after the first negative screening. They determined that most patients could probably skip the second annual screening if their first one was negative.
The number of patients who might develop lung cancer was very small and outweighed by the number of false positives, the study found.
The Duke team also believes better technology will allow screening to happen less frequently, which will limit chest radiation for patients.
Cost of Quality Reporting
Measuring quality is consuming more time and money for America’s doctors.
A study published in Health Affairs found that physician practices in four common areas—cardiology, orthopedics, primary care, and multispecialty practices—spend 785 hours per physician to report quality measures. That’s more than 15 hours per week each.
The process costs $15.4 billion a year, and the report found that while quality reporting is needed, the cost is too high and unnecessary. Halee Fischer Wright, president and CEO of the Medical Group Management Association, had this response to the study: “On top of the obscene waste of billions of dollars each year on quality measures, the most alarming thing about this study is that nearly three-fourths of the groups reported that the quality measures are not even clinically relevant.”
Recently, CMS, America’s Health Insurance Plans, and the National Quality Forum proposed 7 core sets of measures that would standardize reporting and cut down on costs.
To learn how to make quality measurement work for your healthcare organization, join us in Scottsdale, Arizona, April 28th and 29th for the spring live meeting of the ACO & Emerging Healthcare Delivery Coalition.
AJMC’s ACO Coalition offers a chance for professionals to share real-world experiences in the shift to value-based reimbursement. For information and to register, click here.
For all of us at the Managed Markets News Network, I’m Justin Gallagher. Thanks for joining us.