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This Week in Managed Care: November 10, 2017


This week, the top managed care stories included a vote in Maine to expand Medicaid and other election day 2017 results; CMS issued final rules for the DIabetes Prevention Program; and a report from the American Society of Clinical Oncology highlighted the link between alcohol consumption and cancer.

Maine voters approve Medicaid expansion, ASCO highlights the link between alcohol and cancer, and CMS issues final rules for the Diabetes Prevention Program in Medicare.

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

Election Day 2017 Results

Healthcare played a role in several elections on Tuesday, starting with Maine, where voters approved a ballot measure supporting Medicaid expansion by a margin of 59% to 41%.

However, Governor Paul LePage said Wednesday he would not follow through on expansion until state lawmakers find a way to pay for it. LePage has vetoed Medicaid expansion 5 times.

He said Wednesday: “Credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget. Therefore, my administration will not implement Medicaid expansion until it has been fully funded by the legislature at the levels [the Department of Health and Human Services] has calculated, and I will not support increasing taxes on Maine families, raiding the rainy day fund or reducing services to our elderly or disabled.”

In Virginia, Democrat Ralph Northam won by a wider margin than expected. An exit poll by CBS News showed that healthcare was the leading issue among voters, with 37 percent saying it was their top concern. Virginia’s legislature has also declined to approve Medicaid expansion, and it appeared Democrats might take control of its House of Delegates.

Meanwhile, CMS moved ahead with plans to let states add work requirements to Medicaid.

As voters went to the polls Tuesday, CMS Administrator Seema Verma laid out plans for waivers that conservative governors have sought for years, but may be challenged in court.

Verma told a gathering of the National Association of Medicaid Directors: “Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration. Those days are over.”

Medicare Payment and DPP

CMS this week finalized the Physicians’ Fee Schedule for 2018, which included the final rule for the Medicare Diabetes Prevention Program, which will launch in April. The rule settled several issues, including:

  • CMS will pay providers over a 2-year period, including a full year of maintenance
  • Beneficiaries can only try the program once
  • Medicare will not pay for digital programs in 2018, but will test this format through the Innovation Center
  • Medicare Advantage plans must offer community-based programs

Learn more.

When Medicare agreed to pay for the Dexcom G5 continuous glucose monitoring system earlier this year, seniors who rely on insulin rushed to find out if they qualified for coverage.

Dexcom’s Chief Commercial Officer Rick Doubleday recently visited AJMC®’s office to discuss how the company has responded to the demand for CGM from Medicare beneficiaries.

Linking Alcohol and Cancer

Alcohol consumption, at any level, contributes to a higher risk of several cancers—yet too few people realize this, announced the American Society of Clinical Oncology (ASCO) this week.

ASCO highlighted data showing alcohol contributes to 5% to 6% of new cancers and cancer deaths worldwide, with the strongest links to breast, colon, esophagus, and head and neck cancers.

ASCO made several recommendations, including:

  • Offer alcohol screening and intervention in clinical settings
  • Limit alcohol outlet density
  • Increase alcohol taxes and prices
  • Limit hours and days when alcohol is sold
  • Restrict youth exposure to alcohol ads

Payment Models at 2017 ACR Annual Meeting

Rheumatologists are among the specialists learning to navigate new payment models in response to MACRA. This week’s meeting of the American College of Rheumatology offered them a chance to learn about a new alternative payment model that meets the terms of the new law.

The 4 phases of the APM are:

  • Diagnosis and treatment planning
  • Support for primary care physicians in evaluating joint symptoms
  • Initial treatment of rheumatoid arthritis, based on patient characteristics
  • Continued care, with stratified monthly payments not tied to office visits

See the full coverage from the ACR annual meeting.

Patient-Centered Oncology Care®

Finally, there’s still time to register for Patient-Centered Oncology Care®, which takes place Thursday and Friday at the Loews Philadelphia Hotel.

To join us, visit the meeting page.

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

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