This Week in Managed Care: September 22, 2017

This week, the top managed care stories included a new direction for the Center for Medicare and Medicaid Innovation; a bipartisan group of governors spoke out against the latest effort to repeal the Affordable Care Act; and the World Health Organization warned that antibiotics currently being developed were not enough to fight antibiotic-resistant infections.

CMS seeks a new direction for its Innovation Center, governors weigh in on the latest attempt to repeal Obamacare, and today’s powerful pathogens are outrunning the pipeline of new antibiotics

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

New Direction for CMS Innovation Center

CMS wants consumers and competition to drive healthcare innovation, not the government. That’s the message CMS Administrator Seema Verma sent this week in an op-ed in The Wall Street Journal, which came with a 9-page proposal to reshape the focus of the Center for Medicare and Medicaid Innovation.

Known as the Innovation Center, this section of CMS was the hub for trying new payment models including one for hip and knee replacements that is now being overhauled. HHS Secretary Tom Price, MD, was a critic of the Innovation Center as a member of Congress, and his desire to let physicians have more flexibility is seen in the new CMS proposal.

The document draws on several guiding principles:

  • Promote competition based on quality, outcomes, and costs.
  • Focus on voluntary models and reduce unnecessary regulations.
  • Empower patients, their families, and caregivers to take ownership of their care.
  • Use data-driven insights to ensure cost-effective care that also improves outcomes.
  • Draw on partnerships and collaborations for a transparent model design and evaluation.
  • Test smaller scale models that can be expanded.

Wrote Verma: “We will move away from the assumption that Washington can engineer a more efficient health-care system from afar—that we should specify the processes healthcare providers are required to follow.”


With time running out before Congress must pass a budget resolution, the Senate is the scene of one final try to use that maneuver to overturn the Affordable Care Act (ACA) with 51 votes. But 11 governors—5 Democrats, 5 Republicans and 1 independent—oppose the bill from Senators Bill Cassidy of Louisiana and Lindsey Graham of South Carolina.

The state of Alaska may be critical, where Independent Governor Bill Walker opposes the bill and may work to convince Senator Lisa Murkowski to continue her opposition to efforts to get rid of the ACA.

The bill also faces opposition from the American Medical Association and the American Hospital Association.

Wrote AMA CEO Dr. James Madara: “We sincerely urge the Senate to take short-term measures to stabilize the health insurance market by continuing to fund cost-sharing reduction payments.”

Antibiotics Pipeline

The World Health Organization (WHO) says that the current pipeline of antibiotics in development won’t be enough to fight the pathogens that are becoming resistant to available drugs.

In a new report, the WHO cites the need for new antibiotics to fight the bacteria that cause tuberculosis and C. diff infection. Only 5 of the 32 new chemical antibiotics being developed against priority pathogens represent a new chemical class, and only 8 agents meet at least 1 of the 4 tests to be considered innovative.

The director general of the WHO said in a statement, “Antimicrobial resistance is a global health emergency that will seriously jeopardize progress in modern medicine. There is an urgent need for more investment in research and development for antibiotic-resistant infections including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery.”

Shingls Vaccination Recommendation

Shingles is on the rise for no known reason, leading to a new recommendation that people age 50 and older be vaccinated to prevent this disease. The guidance from the American Academy of Ophthalmology and the American Dermatology Association lowers the recommended age for vaccination by 10 years.

Shingles is a painful condition that consists of an itchy rash on the skin and the formation of blisters and scabs. Some patients have a disfiguring complication called herpes zoster—the same virus that causes the chicken pox—which can lead to blindness. One in three people are expected to develop shingles, most in their 50s.

Said Elisabeth Cohen, MD, “The number of people affected is growing, and the health consequences are significant. The zoster vaccine is safe and effective. If you are older than 50 and are eligible, just do it.”

US Psych Congress 2017

Finally, The American Journal of Managed Care reported last weekend from the US Psychiatric and Mental Health Congress in New Orleans, where physicians learned about the benefits of Mydayis, a new treatment for adult ADHD that lasts 16 hours, and attended sessions on treatment resistant depression, opioid use, and the importance of social connections.

Thomas Kosten, MD, told AJMC that payers have helped drive progress in the fight against opioid abuse, but there is still some unwillingness to pay for abuse-deterrent formulations.

Watch the video.

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

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