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This Week in Managed Care: September 3, 2016


This week in managed care, the top stories included proposals from CMS to shore up the Affordable Care Act's marketplaces, research that highlighted the link between duration of obesity and cancer risk for women, and the results of an FDA diabetes workshop.

Hello, I’m Justin Gallagher, associate publisher of The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

CMS Proposes Marketplace Changes

After 2 national insurers retreated from the marketplaces in the past year, CMS this week proposed its 2018 payment guidelines more than 2 months ahead of schedule. The early announcement signals a desire to show health plans that the agency is listening to concerns about ending abuse and sharing risk for the sickest and costliest patients.

Proposed reforms include:

  • Changes to reflect risk for those who do not stay on plans a full year.
  • Adding prescription drug data to calculations for risk adjustment.
  • Creating a risk pool to share costs for patients whose bills exceed $2 million.

The proposal also calls for cracking down on abuse of special enrollment periods. Payers say too many people wait until they are sick to enroll on the exchanges, only to drop coverage after their medical issue was resolved.

Duration of Obesity and Cancer Risk

A new study in the journal PLoS Medicine adds to evidence linking obesity and cancer. Authors from the Agency for Research on Cancer in Lyon, France studied records from more than 73,000 women, with BMI measures taken over an average of 12 years. They found that the longer the women were obese, the more likely they were to develop an obesity-related cancer, such as postmenopausal breast cancer and endometrial cancer.

The researchers concluded: “How much of their adult lives women are overweight and how overweight they are play important roles in cancer risk. … Healthcare teams should recognize the potential of obesity management in cancer prevention and that excess body weight in women is important to manage regardless of the age of the patient.”

Engaging Consumers

Health plans and researchers frequently cite the need to better engage patients in their own healthcare. Recently, Jay Sheehy, senior vice president of product innovation at EmblemHealth, told AJMC that better patient engagement starts with thinking about patients as consumers, and understanding that women are the chief decision-makers. Watch the video.

FDA and Patients Discuss Diabetes Treatments

The FDA evaluates diabetes therapies based on how well they control A1C, and quality care measures use A1C as a basic metric of how well health systems are managing diabetes in their populations.

But a new study from the Mayo Clinic suggests that A1C doesn’t tell us everything. Doctors Victor Montori and Rene Rodriguez-Gutierrez, writing in Circulation: Cardiovascular Quality and Outcomes, studied 20 years’ worth of evidence and found that the focus on keeping A1C below 7 percent has not produced much benefit in microvascular or macrovascular outcomes. And, they write, the focus on A1C may prevent drug developers from working on therapies to prevent complications or improve quality of life.

Patients seem to agree, and they discussed these concerns in a workshop this week with the FDA. Read the story.

Negative View of Pharma

A new Gallup poll finds that just 28 percent of Americans have a positive view of drug makers, while 51 percent have a negative view. The poll found that only the business sector included in the survey that the American public holds in lower esteem is the federal government. The results suggest that controversies over rising drug costs are eclipsing scientific advances to treat diseases like cancer or hepatitis C.

To learn more, read the article.

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

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