This Week in Managed Care: March 3, 2017

This week, the top news in managed care included President Donald Trump's first address to Congress, which included guiding principles for replacing the Affordable Care Act, a leaked version of the House GOP's own draft for healthcare reform, and a study finds a concerning trend in colorectal cancer rates among young adults.

President Trump outlines what he wants from healthcare reform, while House Republicans call for ending Medicaid expansion.

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

Trump's Joint Address

In his first address before Congress, President Donald Trump said the Affordable Care Act (ACA) is “collapsing” and offered broad ideas on how he would fix it. Trump said any replacement for the current law should do the following:

  • Offer coverage for preexisting conditions
  • Use tax credits and health savings accounts to let Americans buy plans they want
  • Give states flexibility with Medicaid
  • Let Americans buy coverage across state lines
  • Reform the legal system
  • Bring down the cost of prescription drugs

Said Trump: “Everything that is broken in our country can be fixed.”

House GOP Draft

House Republicans floated a draft bill to repeal parts of the ACA that would go further than Trump.

The bill, which borrows from Speaker Paul Ryan’s plan called A Better Way, would phase out extra funding for those covered by Medicaid expansion, and create a per capita grant system of funding for the entire program.

The bill shares Trump’s call to end the individual mandate and make use of health savings accounts, but it also does the following:

  • Eliminate the requirement for 10 essential health benefits
  • Allow insurers to charge more for older enrollees so young adults can pay less
  • Give states $100 billion over 10 years for high-risk pools for the sickest patients

For more on efforts to replace the ACA, visit

President Trump’s message:

House Republican plan:

Higher Rates of Colorectal Cancer

A study from the American Cancer Society finds an alarming trend: colorectal cancer is rising among young adults. A person born in 1990 is 2 times as likely to be diagnosed with colon cancer and 4 times as likely to be diagnosed with rectal cancer than a baby boomer born in 1950.

Said lead author Dr. Rebecca Siegal: “Trends in young people are a bellwhether for the future disease burden. Our finding that colorectal cancer risk for millennials has escalated back to the level of those born in the late 1800s is very sobering.”

While the cause of the trend is not entirely clear, researchers see rising obesity and unhealthy diets, as well as a lack of physical activity, as possible reasons.

Read the full article.

Outcomes of In-House Pharmacy

A study from the Smilow Cancer Hospital at Yale finds that bringing a specialty pharmacy in-house can reduce errors and save costs. This is especially true when dispensing oral oncology agents.

The study uncovered several problems with the old drug delivery process, such as:

  • Lack of documentation in the electronic health record
  • Involvement of third-party pharmacies for refills
  • Poor self-administration because patients did not get proper instructions
  • Delivery delays

Today, a new treatment protocol reaches out to patients to monitor adherence. Hospital management has allowed 80% of patients to get their drugs within 72 hours, as opposed to 2 to 3 weeks.

The study will be presented later this year at the annual meeting of the American Society of Clinical Oncology.

ACO Outcomes

A new paper in JAMA Internal Medicine examined how accountable care organizations (ACOs) in Oregon and Colorado affected spending, access, and healthcare utilization.

Colorado created 7 regional care collaborative organizations as part of its Medicaid accountable care reforms, while Oregon moved most Medicaid enrollees into 16 care coordination organizations.

After 2 years, both efforts saw some successes. Oregon showed improvements in one set of measures, but not in a set that evaluated improvements in low-value care. The Colorado system also generated more savings.

Read the full article.

Attend the ACO Coalition

To learn more about how ACOs are changing healthcare, join us in Scottsdale, Arizona on May 4th and 5th for the spring meeting of the ACO and Emerging Healthcare Delivery Coalition.

For information and to register, visit the meeting page.

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

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