This Week in Managed Care: October 24, 2015

This week in managed care, documents show Horizon Blue Cross Blue Shield of NJ rolled out OMNIA prior to receiving regulatory approval, 2 Harvard professors argue the merit of the annual physical, and experts weigh in on the successes and flaws of Medicare Part D.

Transcript (slightly modified for readability)

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.

Exclusive: Horizon's OMNIA Rollout

This week, The American Journal of Managed Care reported an exclusive: a high-profile effort to bring population health to half of New Jersey’s hospitals was launched in September several days before regulators had approved the network.

Horizon Blue Cross Blue Shield of New Jersey said its September 10 announcement of the OMNIA Health Alliance only outlined its relationships with 6 health systems and did not require approval from the Department of Banking and Insurance. But press accounts of the plan listed the hospitals where consumers could receive discounts on co-payments, and that network was not approved until September 15.

The leader of the state’s Catholic hospitals, which were mostly left out of the alliance, has called on regulators to halt the OMNIA plan.

The Annual Physical

This week, 2 Harvard medical school professors argued the merits of having everyone get an annual physical in a pair of editorials that appeared in the New England Journal of Medicine.

Dr Ateev Mehrotra says annual physicals cost 10 billion dollars a year, and they crowd out other more urgent health care needs.

But Dr Alan Gorroll argues that physicals should be improved rather than eliminated. Seeing the doctor in an unhurried visit helps build trust between the patient and the doctor. But this preventive care can be delivered in other ways, and can be helped through the use of electronic records. Dr Gorroll even argued for an end to reimbursement for annual physicals.

Medicare Part D

Medicare Part D, which pays for prescription drugs for seniors, has been a huge success—and an expensive one. That was the consensus of experts who weighed in on the program’s successes and flaws at the annual Medicare conference of America’s Health Insurance Plans in Washington, DC.

A panel discussing the 10th anniversary of Medicare Part D had different views on whether the recent wave of high prices for new drugs would threaten the program’s future.

Dr Ron Cohen of the Biotechnology Industry Organization said there are always patents expiring. But Dr. Steve Miller of Express Scripts said that prices went up 13 percent this year, and more increases are expected. He said prices are rising without a comparable benefit for patients.

Lori Reilly, executive vice president for PhRMA, which represents the drug industry, said that value is in the eye of the beholder. “Death is cheap. Oftentimes keeping someone alive is expensive. To patients and patients’ families that’s a cost that’s worth it.”

Recently, AJMC co-editor in chief Dr Mark Fendrick discussed how the principles of value-based insurance design apply when deciding whether to cover high-cost specialty drugs.

Fertility in Cancer Patients

Finally, the current issue of Evidence-Based Oncology features a commentary from 2 officials with LIVESTRONG about the movement to provide fertility services to adolescent and young adults before cancer treatment begins. You can find the commentary here.

For the Managed Markets News Network, I’m Justin Gallagher. Thanks for joining us.

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