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This Week in Managed Care: October 27, 2017


This week, the top managed care news included a judge ruling President Donald Trump can end the cost-sharing reduction subsidies; findings on awareness of the Choosing Wisely campaign; and conference coverage from around the nation.

A federal judge lets President Trump halt Obamacare subsidies, a campaign to cut low-value care struggles to gain traction, and AJMC was on the road this week in Nashville, Las Vegas, and around the nation’s capital.

Welcome to This Week in Managed Care, I’m Kelly Davio.

Cost-Sharing Reduction Payments

A federal judge ruled this week that President Trump can cancel cost-sharing reductions that helped insurers hold down premiums under Obamacare.

Eighteen states and the District of Columbia had sued to restore the subsidies after Trump announced he would cancel them October 12. But Judge Vince Chhabria refused to grant a preliminary injunction in the case, suggesting the case has little chance of success.

Meanwhile, the Congressional Budget Office this week found that bipartisan legislation to restore the subsidies would cut the deficit by $3.8 billion.

Low-Value Care

Choosing Wisely, the 5-year old campaign from the ABIM Foundation to eliminate low-value care, has raised awareness among professional societies. But that awareness isn’t growing among front-line physicians, according to results released this week by Health Affairs.

A 2017 phone survey found that just 25% of physicians were aware of Choosing Wisely, and this rate rose to 42% when the doctors heard a description of the program. Although professional groups have made 500 recommendations about ow-value-care, those percentages are only a few points higher than they were in 2014.

A commentary that appeared with the survey recommended more aggressive steps:

  • New goals must be clinically meaningful and bring high cost savings
  • Professional societies must consolidate recommendations and target specific populations.
  • Patients must see the connection between low-value tests and out-of-pocket expenses.

Conference Coverage

AJMC is on the road this week bringing you news about value-based care from around the country. Our first stop was Tyson’s Corner, Virginia, for an update on the Oncology Care Model from the Community Oncology Alliance summit on Oncology Payment Reform.

Culture change is the biggest challenge to implementing the OCM, but oncologists are also hampered when different patients are on different reimbursement paths. Said Tennessee Oncology’s Aaron Lyss: “Just tracking the patient through the process is fundamental to participating in this model … and we have made much progress compared with a year ago.”

See the full coverage of the COA Payer Exchange Summit.

Consumers were the focus of Value-Based Insurance Design Summit in Washington, DC, where AJMC co-editor in chief Dr. Mark Fendrick led a discussion on how cutting out of pocket costs has become a top political priority.

Read more.

Clinician burnout and the climate on Capitol Hill were all on the agenda this week in Nashville when AJMC presented its fall meeting of the ACO and Emerging Healthcare Delivery Coalition.

Dr. Shantanu Agrawal, CEO of the National Quality Forum, opened the meeting with a discussion on health equity and risk adjustment. Watch the video.

For full coverage of the ACO Coalition meeting, visit ajmc.com

And finally, AJMC brings you coverage from the NAMCP Fall Managed Care Forum in Las Vegas, which brings together medical directors, nursing executives, and other health system leaders to discuss advances in care delivery and clinical therapies.

Our coverage runs through this weekend.

For all of us at the Managed Markets News Network, I’m Kelly Davio.

Thanks for joining us.

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