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This Week in Managed Care: November 3, 2017


This week, the top managed care news included the first day of open enrollment; data from CMS that indicate the progress accountable care organizations are making; and findings that most people with obesity aren't get screened for it or getting care.

Open enrollment for ACA coverage begins, accountable care organization (ACO) data show it takes time for health transformation to yield savings, and there’s competition in CAR T-cell treatment.

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

Open Enrollment Begins

Wednesday marked the first day of open enrollment for 2018 under the Affordable Care Act, and this cycle will bring several changes. This year’s enrollment period is shorter, and most consumers will need to pick their plan by December 15.

President Trump’s decision to cancel cost-sharing reductions have created some odd rate dislocations, causing higher premiums for those who don’t qualify for premium tax credits and inflating subsidies for those who do.

Consumers are encouraged to shop around. While prices for silver plans have gone up an average of 37%, some gold plans with better coverage are cheaper than silver plans in some markets.

Read more at AJMC.com.

ACO Lessons Learned

There’s a lesson from the ACO data that CMS released last week: persistence pays. Of the 106 ACOs that began the Medicare Shared Savings Program in 2013, only 74 remain.

As Travis Broome and Farzad Mostashari, MD, of Aledade, explain on AJMC.com this week, this is to be expected. Data show that there’s typically not much early return from ACO participation, but the 73 most experienced ACOs have saved nearly $300 million a year.

They wrote: “Over time, population health initiatives pay off, and ACOs that cannot figure out implementation drop out, freeing up their physicians to join other ACOs that can.”

They noted that CMS has introduced Meaningful Measures, which promises to reduce the burden of quality reporting.

Read the full commentary.

CAR T-Cell Therapy Competition

Competition could be coming in CAR T-cell therapy, as Novartis has filed for a second indication for its Kymriah treatment, which FDA approved in August to treat pediatric acute lymphoblastic leukemia.

Now, Novartis is seeking approval to use the gene therapy to treat the much larger group of patients with diffuse large B-cell lymphoma, which affects 70,000 patients a year.

Last month, FDA approved another CAR T-cell therapy, Kite Pharma’s Yescarta, to treat this condition. The treatment was priced at more than $370,000.

Obesity Care Lacking

Most people with obesity aren’t screened for the disease and don’t get a referral for care, according to a study presented at Obesity Week. This happens even though the US Preventive Services Task Force recommended in 2012 that all adults be screened for obesity and those with a body mass index of 30 or higher be referred for behavioral intervention.

The ACTION study, funded by Novo Nordisk, found the following:

  • Only 23% of those with obesity reported 10% weight loss during the previous 3 years.
  • Of the 71% of those with obesity who see doctor’s help, only 55% get a formal diagnosis of obesity.
  • Employer wellness programs fall short for people with obesity even though the disease contributes to some of the top cost drivers in health plans, such as diabetes and cancer.
  • Only 24% of those with obesity get follow-up care after an initial appointment.
  • While obesity is now recognized as a disease, most people with obesity still think it’s their own responsibility, which may stop them from seeking medical help.

Todd Hobbs, MD, Novo Nordisk’s chief medical officer for diabetes in North America, told AJMC® that payer coverage is slowly improving for the obesity therapy Saxenda.

Said Hobbs: “Patients continue to face stigma, and there’s frustration that they don’t know how to discuss obesity with their physician … We really want to call out some these barriers.”

Patient-Centered Oncology Care®

Finally, join us in Philadelphia November 16 and 17 for Patient-Centered Oncology Care®, AJMC®’s annual forum on payment issues in cancer care. This year’s theme, Value of Care, will look at changes at FDA under its new commissioner, Scott Gottlieb, MD, a past participant at PCOC.

Michael Kolodziej, MD, will offer his keynote presentation before a reception at the Loews Philadelphia Hotel.

Learn more and register.

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

Thanks for joining us.

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