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This Week in Managed Care: November 16, 2018


This week, the top managed care news included research that showed c​​​​ancer surpassed cardiovascular disease to be the leading cause of death in high-income counties; HHS Secretary Alex Azar announced a new mandatory payment model is coming to oncology; a policy change could make mental health treatment more available.

Cancer is now the leading cause of death in high-income counties, a new mandatory payment model is coming to oncology, and a policy change could make mental health treatment more available.

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

A New Leading Cause of Death in High-Income Counties

Cancer has passed cardiovascular disease as the most common cause of death in high-income counties, according to a new study in the Annals of Internal Medicine.

While death rates of cancer and cardiovascular disease have both dropped in recent decades, cardiovascular disease has declined more rapidly in wealthy counties, driving death rates below those of cancer.

However, cardiovascular disease remains more common in poor counties.

Declining smoking rates in the United States were cited by the authors, who wrote: “Heart disease has been the primary cause of death since the shift toward chronic disease as the leading cause of death in the United States in the early 1900s. [The change] has been largely attributed to decreased smoking, improved awareness of diet and physical activity as risk factors, and better treatment of cardiovascular risk factors and acute coronary syndromes.”

The findings are based on county level data from 2003 to 2015 from the National Center for Health Statistics. African Americans still have worse mortality than other ethnic groups in the United States, but their mortality rates have improved overall.

Shifting Back to Mandatory Bundled Payments

A new mandatory payment model is coming in radiation oncology, according to HHS Secretary Alex Azar.

President Trump’s top healthcare official made the announcement last week when he said that the administration is rethinking its decision to scrap bundled payment models in cardiac care and hip and knee replacements.

Said Azar, “We have now re-examined the role that models like these could play in value-based transformation.”

The announcement caught the American Society for Radiation Oncology by surprise, as it has been working with CMS on a value-based payment model but had concerns about the plan being mandatory from the start.

The group, known as ASTRO, issued a statement: “Care must be taken to protect access to treatments for all radiation oncology patients and not disadvantage certain types of practices, particularly given the very high fixed costs of running a radiation oncology clinic.”

More Mental Health Care Flexibility

Azar also announced this week that CMS will allow more flexibility to provide mental health treatment to Medicaid patients, something states have long sought to help deal with the opioid crisis.

In a speech to the National Association of Medicaid Directors, Azar said the administration will get rid of a rule called the IMD exclusion, which barred Medicaid from paying for treatment in mental health clinics with more than 16 beds.

The Obama administration allowed demonstration waivers to address this rule in 2015, and Azar said states can now apply for waivers from the restriction as long as they can show they have robust community-based treatment programs.

Said Azar: “Maybe the single most pressing need for inpatient treatment is where someone is experiencing a co-occurring substance use disorder and a serious mental illness.”

Diabetes Prevalence Grew

Wednesday marked World Diabetes Day, but unfortunately a new study finds that diabetes and obesity rose significantly over the past decade in the United States.

The Gallup-Sharecare 2017 State and Community Rankings for the Prevalence of Diabetes found that the nation’s overall diabetes rate rose from 10.8% to 11.5% between 2008-2009 and 2016-2017. This means an additional 1.7 million more people have diabetes than if the rate had stayed constant.

However, experts who spoke with The American Journal of Managed Care® say the distribution of diabetes, as well as obesity that helps drive the disease, are not uniform. Both are largely centered on states in the Southeast and are associated with high rates of poverty and smoking.

Said Dan Witters of Gallup, “The basic rule is for every 3% increase in obesity, there is a 1% increase in diabetes. You’ll find that in the states, too. And no states have seen obesity go down.”

Turning the tide on obesity and diabetes will require collaborations among local officials, healthcare providers, schools, grocery stores, and restaurants, according to Sheila Holcomb, RD, LD, CDE, of Sharecare, who said: “It starts in the home. Children do whatever they are being exposed to in the home, and that’s the habit they develop for the rest of their lives.”

SUD Focus in November Issue

Substance use disorder and pain management present some of the greatest challenges in managed care today. The current issue of The American Journal of Managed Care® features several articles on this topic, including:

  • Research from the University of Miami, which found that using injectable naltrexone and buprenorphine-naloxone after detoxification can present cost barriers to patients.
  • An evaluation of a high-intensity care management program based on principles developed by the Camden Coalition.
  • Patients were very satisfied with a specialized cancer pain clinic.

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

Thanks for joining us.

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