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This Week in Managed Care: October 28, 2016


This week, the top stories in managed care included an announcement that premiums on Obamacare plans are set to increase by 25% on average, a discussion of Medicare Advantage growth at America's Health Insurance Plans' National Conference on Medicare, and recommendations for success with the Oncology Care Model.

Hello, I’m Sara Belanger With The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

ACA Premiums Increase

A report from HHS this week found that benchmark health policies on the exchanges will rise by 25% on average for 2017, and consumers in many markets will have fewer choices than they did this year.

But there’s wide variation in the price hikes, with 11 states seeing reductions or increases in the single digits, and 20 states seeing price increase of 20% or more.

A report from Avalere Health pinpoints a problem that some experts identified back when the Affordable Care Act passed in 2010—the penalties for going without coverage are not steep enough to force young, healthy adults to buy coverage.

CMS has doubled its budget to encourage younger adults to enroll in 2017, and the CEO of HealthCare.gov, Kevin Counihan, said this week that the government will take steps to crack down on abuse of special enrollment periods in 2017.

Read the full article.

AHIP: MA Growth

Medicare Advantage has grown since the Affordable Care Act passed, and now accounts for 32% of all Medicare beneficiaries. That’s what keynote speaker Sean Cavanaugh, deputy administrator and director of the Center for Medicare, told those attending this week’s National Conference on Medicare, convened by America’s Health Insurance Plans.

Cavanaugh said that the ACA raised questions about Medicare Advantage that ended up being unfounded, and that 2017 is expected to bring a 4 percent reduction in premiums. However, Medicare Advantage won’t escape the challenges of rising drug costs that have affected all of healthcare.

Said Cavanaugh: “While we have successfully held down premiums, I think it’s very important to note that there are cost problems in the Part D program we have to address.”

See full coverage of the AHIP conference.

Out-of-Network Bills

This week, New Jersey became the latest state to address the problem of surprise medical bills, which have become a high-profile consumer issue as more patients have benefit designs with high out-of-pocket costs for out-of-network emergency care.

Katherine Hempstead of the Robert Wood Johnson Foundation recently told AJMC that changing benefit designs may be affecting consumer behavior when it comes to emergency care. Watch the video.

Oncology Care Model

What strategies are working for those practices that have seen success with the Oncology Care Model? An expert panel looked at that question this week at Payer Exchange Summit Five, sponsored by the Community Oncology Alliance.

Their recommendations included:

  • Building a nurse triage system into the platform
  • Forming a relationship with a palliative care company
  • Focusing on care coordination

However, panelists said the model needs some changes, including the ability to add staging and mutations data. Physicians encouraged CMS to give them faster access to outcomes data.

Patient-Centered Oncology Care

To hear more about payment models in oncology care, join us November 17th and 18th at Patient-Centered Oncology Care, which will mark its fifth year in Baltimore, Maryland. Highlights of this year’s event will include Dr. Michael Fratkin’s presentation on telehealth in palliative care and our expert panel, Oncology Care 2017.

For the agenda and registration, click here.

For all of us at the Managed Markets News Network, I’m Sara Belanger. Thanks for joining us.

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