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This Week in Managed Care: September 13, 2019


This week, the top managed care news included a report showing the US uninsured rate rose in 2018; the Trump administration indicating it will ban all flavors of e-cigarettes except for tobacco; new research showing the prevalence of hemophilia is 3 times larger than originally believed.

The US uninsured rate is on the rise despite a strong economy, the Trump administration moves to ban all flavors of e-cigarettes except for tobacco, and the population of patients with hemophilia is 3 times larger than originally believed.

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

Uninsured Rate Risesnew research showing the prevalence of hemophilia

The health insurance gains made since the implementation of the Affordable Care Act (ACA) may be starting to erode. The US Census Bureau has reported that the number of Americans without health insurance increased to 27.5 million in 2018 from 25.6 million in 2017. The decline in coverage appears to be driven by a decrease in Medicaid coverage. The decline in health insurance coverage comes in the midst of a strong economy. Last year, the poverty rate fell for the fourth straight year.

Said Robert Greenstein, president of the Center on Budget and Policy Priorities (CBPP): “This backsliding almost certainly reflects—at least in part—Trump administration policies to weaken public health coverage. While the uninsured rate remains far below its pre-ACA level, the gains achieved through the ACA will entirely disappear if the administration ultimately succeeds in its continued efforts to repeal the law through legislation and the courts.”

According to the CBPP, policies from the administration that have contributed to the decline in health insurance coverage include:

  • The 90% cut in federal outreach and advertising for the ACA marketplace
  • Policies that have led to immigrants being afraid to enroll in the marketplace and subsidized coverage despite their eligibility
  • Policies that have weakened Medicaid coverage
  • The repeal of the ACA’s individual mandate, which technically took effect in 2019, but the impact began in 2018

Trump Administration to Take Action Against Vaping

The number of cases of serious breathing illnesses related to vaping has surpassed 450, up from 215 a week ago, according to numbers reported to the CDC across 33 states and the US Virgin Islands. In addition, a sixth person has now died from lung disease related to vaping. The illnesses resemble an inhalation injury and symptoms include shortness of breath, fatigue, chest pain, and vomiting.

US health officials are urging people to stop vaping as they evaluate the cause. The CDC is looking into several ingredients, but no single vaping device, liquid, or ingredient has been linked with the illnesses.

In the wake of the increasing number of vaping-related illnesses, the Trump administration on Wednesday said it will develop guidelines to remove all e-cigarette flavors except tobacco from the market.

Said HHS Secretary Alex Azar, “The Trump administration is making it clear that we intend to clear the market of flavored e-cigarettes to reverse the deeply concerning epidemic of youth e-cigarette use that is impacting children, families, schools and communities. We will not stand idly by as these products become an on-ramp to combustible cigarettes or nicotine addiction for a generation of youth.”

For more, visit ajmc.com.

Prevalence of Hemophilia

New research published in Annals of Internal Medicine has shown that the global population of patients with hemophilia is 3 times larger than previously believed. The new analysis has shown that more than 1.1 million men around the world have the bleeding disorder, compared with a previous estimate that only 400,000 people globally had the disease.

The life expectancy for people with hemophilia is significantly shorter than the general population, especially in lower-income countries, where the standard treatment may be unavailable. For people born with hemophilia, the chance of living a life of normal duration and quality is reduced by 64% in upper-middle-income countries, by 77% in middle-income countries, and by up to 93% in low-income countries.

Lead author Alfonso Iorio, MD, PhD, FRCPC, professor, McMaster University, hopes the findings will renew interest and investment in hemophilia. He said, “I hope that showing the need will commit more young hematologist[s] and researcher[s] to invest time and energies to close the gap. Also, I hope that this can be an example for other rare diseases. To me, one important lesson learned here is that it is worth spending time to create and maintain disease registries, as they allow you to answer question[s] no one else was able to answer before.”

Employers Recognize Need to Improve Employee Health

As healthcare costs continue to rise, companies are focusing more on restructuring health benefits. New research conducted in partnership with Harvard Business Review Analytic Services has found that employers are recognizing the need to modernize the employee health experience. Executives Of the 238 executives surveyed, 90% said employee health benefits are a reflection of the organization’s understanding of employees’ needs. However, greater employee education is needed regarding health benefits.

According to 58% of respondents, employees are unaware of the company-provided health benefits they are entitled to and 63% said employees do not know enough about leveraging their benefits. Other findings include:

  • Only 28% reported that employees engage with all benefits offered
  • 68% reported there are opportunities to improve their organization’s health benefits costs
  • 68% are open to changing their employee healthcare experience

For more, visit ajmc.com.

Patient-Centered Oncology Care Registration

Finally, registration is open for our annual meeting of Patient-Centered Oncology Care, which will be held November 8 in Philadelphia. Led by co-chairs Joseph Alvarnas, MD, vice president of government affairs and senior medical director for employer strategy, associate clinical professor in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope; and Kashyap Patel, MD, chief executive oficer of Carolina Blood and Cancer Center, this meeting’s agenda will provide valuable insight on the rapidly changing oncology landscape, including chimeric antigen receptor T-cell therapy updates, value-based care, and patient-reported outcomes.

In addition, Former FDA Commission Scott Gottlieb, MD, will speak on innovation and quality in cancer care.

For more information on speakers and to register, visit ajmc.com.

For all of us at AJMC, I’m Laura Joszt. Thanks for joining us.

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