
This Week in Managed Care: November 21, 2015
The top stories in managed care were discussions of value-based care at the NAMCP Fall Managed Care Forum, hospitals are suing over Horizon Blue Cross Blue Shield of New Jersey's OMNIA plan, and CMS finalizes its bundled payments for joint replacement.
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.
March Toward Value-Based Care
Managed care experts from around the country gathered in Las Vegas last week for the Fall Managed Care Forum, presented by the National Association of Managed Care Physicians. (
Keynote speaker Dr Jacque Sokolov, chairman and CEO of SSB Solutions, said that government is leading the way into value-based care, particularly in Medicare, which will force others to follow.
Dr Sokolov also discussed the controversy surrounding Horizon Blue Cross Blue Shield of New Jersey, which has found resistance to its OMNIA plan. While some experts credited Horizon for making an effort to advance population health and cut costs, the plan faced criticism for excluding several hospitals that serve the poor. Horizon has also been criticized for a lack of transparency in creating the network.
This week, St. Peter’s Hospital of New Brunswick won the right to a court hearing, where Horizon will have to reveal why it did not include the Catholic hospital in OMNIA. The hearing is set for December 17. In addition,
Bundled Payments in Joint Replacement
In a move toward value-based care, CMS this week
Under the new model, hospitals will be accountable for the surgery and all related costs through 90 days after discharge. Hospitals that meet quality and cost targets can earn rewards, but some may have to return money. The new model starts April 1st in 2016.
Opioid Measures
The opioid epidemic has drawn attention from the nation’s top health officials and public policy makers. To help combat the problem, the Pharmacy Quality Alliance has recently established a set of measures to strike a balance between individual patient needs and trends that could be a sign of problems.
FDA Regulation of Laboratory-Developed Tests
The FDA issued a report this week that paves the way for
The new report offers 20 cases studies that show potential harm to patients because of gaps in today’s regulations.
SGLT2s in Type 1 Diabetes
Can SGLT2s be used to treat type 1 diabetes? That’s the question researchers are trying to answer.
This new drug class, approved to treat type 2 diabetes in 2013, has already been shown to have benefits beyond lowering A1C. In the current issue of Evidence-Based Diabetes Management, experts say the unique mechanism of action may prove beneficial for patients with type 1 disease.
For everyone at the Managed Markets News Network, I’m Justin Gallagher. Thanks for joining us.
Newsletter
Stay ahead of policy, cost, and value—subscribe to AJMC for expert insights at the intersection of clinical care and health economics.