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This Week in Managed Care: September 29, 2017


This week, the top managed care stories included the end of the latest attempt to repeal the Affordable Care Act; a call to better include the patient's voice in cancer quality metrics; and an argument for caution regarding the newly approved CAR T-cell therapy, Kymriah.

A final attempt to repeal the Affordable Care Act (ACA) before the budget deadline fails, leaders in cancer care want the patient’s voice in metrics, and 3 oncologists warn of the limits of the new CAR T-cell therapy.

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

On Tuesday, Senate Majority Leader Mitch McConnell said the Graham-Cassidy bill to repeal the Affordable Care Act would not move forward, ending plans to overturn the healthcare law through the budget resolution process before this weekend’s deadline.

The decision came less than 24 hours after Senator Susan Collins of Maine said she would not support the bill, in part because it sought large cuts to Medicaid. Said Collins: “Expert projections show that more than $1 trillion would be taken out of the Medicaid program between the years 2020 and 2036. This would have a devastating impact to a program that has been on the books for 50 years.”

McConnell said that healthcare will take a back seat to tax reform, but it will return to the agenda. In the meantime, Republican Senator Lamar Alexander of Tennessee and Democratic Senator Patty Murray of Washington will work on a bipartisan stabilization plan.

For more, visit ajmc.com.

Patient Voice in Metrics

Quality measurement is now common in cancer care, but the patient’s voice is still missing in the metrics even though more providers accept the idea of patient centric care, according to a leader in informatics who spoke this week at a policy conference of the National Comprehensive Cancer Network in Washington, DC.

Ronald Walters, MD, MBA, MHA, MS, of MD Anderson Cancer Center said what is available is often a provider’s interpretation of the patient’s experience, rather than a metric gathered directly from the patient. He asked: “Why aren’t these measurements a key part of the health system yet?”

Walters also reviewed other important quality measures for systems of care, which he said are:

  • Cost
  • Resource utilization
  • Site of care
  • Care coordination

Read more.

Promise of CAR T-Cell Therapies

FDA’s recent approval of the CAR T-cell therapy Kymriah to treat young adults with acute lymphoblastic leukemia set off wave of excitement. But given the $475,000 price tag, 3 oncologists from Memorial Sloan Kettering say the promise of this “impressive science” must be tempered by the challenges, side effects, and the cost.

Writing in JAMA, the authors say the therapy will only be available in a few institutions capable of handling the complex delivery method, and that the hype surrounding the treatment will make it hard to explain the benefits and risks to patients. They wrote:

“The reason is that the term cure will connote to some patients that a single infusion of this scientifically mystifying, genetically driven therapy will first vanquish their disease and then reset their life expectancy to normal. Perhaps one day data will support such a hope; as of yet the available data are insufficient to claim much more than CAR T treatments have large promise at an enormous price.”

Conciege-Style Care

Low-income seniors with multiple chronic conditions account for high Medicare costs, but also offer opportunities for savings.

AJMC contributor Dr. Christopher Chen writes his practice has achieved this in a full-risk Medicare Advantage practice through “concierge-style” care, which puts an emphasis on spending lots of time with patients.

Up front investments helped the practice, ChenMed, achieve the following in 2015. Compared with other Medicare beneficiaries, the patients had:

  • 33.6% fewer emergency department visits
  • 28% lower hospital admissions
  • 25.7% fewer inpatient hospital days

Learn more.

Diabetes Technology Partnerships

Technology is changing both diabetes care and prevention, and new partnerships are cropping up every day among payers, providers, startups, and well-known tech giants like Google and Apple.

The new issue of Evidence-Based Diabetes Management focuses on technology and features an interview with Dr. Paul Chew of Omada Health, who discusses why digital health is needed to keep more people from progressing to diabetes.

Watch the interview.

Check out the full issue of Evidence-Based Diabetes ManagementTM.

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

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