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This Week in Managed Care: September 7, 2018


This week, the top managed care stories included a study on the impact physician burnout is having on care quality; the latest Affordable Care Act showdown took place in a Texas courtroom; the share of employers offering health coverage increased for the first time since 2008.

Physician burnout is linked to lower quality care, drug prices are falling, but consumers may not benefit, and an effort to strike down the Affordable Care Act (ACA) is under way in Texas.

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

Physician Burnout and Patient Safety

Last year, a Medscape Physician Lifestyle Report found that half the nation’s doctors showed signs of burnout. Now there are signs it’s affecting patient care.

A meta-analysis in JAMA Internal Medicine finds that physician burnout is associated with greater risk of patient safety incidents, lower quality care, and reduced patient satisfaction.

The researchers found: “This study is essential to acquire a holistic understanding of the association between physician burnout and healthcare service delivery and confirm the need for dynamic organization-wide resolutions to mitigate burnout.”

Burnout among doctors plays itself out as emotional exhaustion, depersonalization, symptoms of depression, and emotional distress. The authors found that the effects of burnout on patient safety did not differ much among younger and older doctors, but lack of professionalism attributable to burnout was greater among early-career physicians.

Drug Price Tactic

Real US drug prices fell in the past quarter, but consumers may not be seeing the benefits. Analyst Richard Evans wrote that employers and payers are likely seeing benefits of copay accumulators. Under these designs, drug makers’ assistance like coupons no longer count toward deductibles or out-of-pocket maximums, so drug companies that want patients to use expensive specialty drugs must keep up the assistance, causing lower net prices.

Said GlaxoSmithKline spokeswoman Ashley Mahoney, “We continue to assess the impact of accumulators being offered in the health insurance market.”

Insurers continue to guide patients toward less expensive drugs by making them pay more toward the drug’s costs, while pharmaceutical companies respond with more creative forms of “copay assistance.” But pharmacy benefit managers say these actions shield consumers from the true cost of drugs.

ACA Battle Underway

A Texas courtroom is the setting for the latest showdown over the future of the ACA. A group of Republican attorneys general will face off against their Democratic counterparts over whether elimination of the individual mandate in last year’s tax bill makes the entire healthcare law unconstitutional.

While the Trump administration is technically the defendant, the administration has said it will not fully defend the law in court.

Congress is watching the proceedings and 10 Republican senators introduced a bill to protect coverage of pre-existing conditions, the most popular part of the law.

Said North Carolina Senator Thom Tillis, “This legislation is a common-sense solution that guarantees Americans with pre-existing conditions will have healthcare coverage, regardless of how our judicial system rules on the future of Obamacare.”

Employer Health Coverage

The share of private sector employers offering health coverage increased last year for the first time since 2008, according to new research. The Employee Benefit Research Institute (EBRI) found there was erosion of employer-based coverage after the Affordable Care Act, amid uncertainty over how the law would affect employer-sponsored coverage.

According to EBRI’s Paul Fronstin, since 2015 the number of workers eligible for coverage has been rising. He said, “Furthermore, the 76.8% of workers eligible for health coverage in 2017 was much higher than the percentage of employers offering such coverage. The juxtaposition between the 2 trends suggests that workers have been migrating to jobs that offer health coverage.”

EBRI’ based its findings on the Medical Expenditure Panel Survey, which interviewed more than 40,000 private sector establishments.

High-Touch Care

Finally, a study in the current issue of The American Journal of Managed Care® finds that Medicare Advantage patients who have frequent encounters with the health system for preventive services actually ended up costing the system less, due to fewer hospitalizations.

According to the study, the median cost per member per month was $34 less for the “high touch” model, even though physician visits and medication use was higher.

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

Thanks for joining us.

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