This Week in Managed Care: September 8, 2017

This week, the top managed care stories included more insurers rolling back participation in Affordable Care Act exchanges, while governors testify ways to stabilize the market; the FDA put 3 combination trials of nivolumab on hold; and a study finds very few visits to the emergency department are truly avoidable.

Insurers scale back plans to sell ACA coverage, FDA puts 3 nivolumab trials on hold, and a study asks whether patients can truly avoid the emergency department

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

Movement on ACA

More insurers are scaling back plans to sell coverage on the Affordable Care Act exchanges for 2018. Insurer Anthem, which covered all Kentucky counties in 2017, will cover only half of the state next year, although all 120 counties will still have at least one option under the Affordable Care Act.

Virginia may not fare as well, where Optima Health is rolling back its planned expansion after other insurers withdrew from the state. This will leave 48 counties and parts of 6 others at risk of having no ACA insurer for 2018.

Meanwhile this week, a bipartisan group of governors testified before the Senate Health, Education, Labor, and Pensions committee about ways to stabilize the individual market.

Read the full story.

Nivolumab Trials on Hold

FDA has put 3 combination trials involving nivolumab, the programmed cell death (PD1) agent sold as Opdivo, on hold. The trials were studying the agent in several combinations for patients with relapsed or refractory multiple myeloma.

The action came after combination trials involving a separate PD1 agent, Keytruda, were placed on hold following patient deaths. FDA reported this week that those deaths were caused by higher rates of serious adverse events, including cardiac events.

According to Bristol Myers Squibb, other nivolumab studies for multiple myeloma will continue.

Avoidable ED Visits

Keeping patients out of the emergency department is a priority for physicians and health systems—especially if patients have just been discharged from the hospital. But how many emergency visits are truly avoidable?

A new study in the International Journal for Quality in Health finds it’s very few—only about 3.3%. The analysis is based on data from the National Hospital Ambulatory Medical Care Survey from 2005 to 2011.

Here’s what lead author Renee Hsia, MD, MSc, of the University of California, San Francisco, found: “We found that many of the common conditions of ‘avoidable’ emergency department visits involved mental health and dental problems, which ERs are generally ill-equipped to treat. This suggests a lack of access to healthcare rather than intentional inappropriate use is driving many of these ‘avoidable’ visits. These patients come to the ER because they need help and literally have no place else to go.”

The top diagnoses for emergency department visits were alcohol abuse, dental disorders, and depressive disorders. The authors note that of the 46 states offering Medicaid coverage for dental care for most adults, 18 only cover emergency services.

Obesity Throughout Life

Half of all Americans have been obese at some point in their life, according to a new analysis of federal health data.

The study found that 50.8% of men and 51.8% of women have been obese at some point, but that 22% no longer were. Certain diseases associated with weight loss in aging were more likely to be seen in older Americans who had once been obese.

The study also found:

  • People aged 55 to 69 were most likely to be obese.
  • Attending college helped women avoid obesity, but made no difference for men.
  • African American women had the highest levels of obesity.

Obesity is associated with sleep apnea, diabetes, heart disease, and depression. Because health effects are cumulative, the study’s authors say a person who was formerly obese may be at higher risk for some outcomes than a person who has never been obese. Thus, it makes sense for public health officials to track whether people have ever been obese.

The study was published in the American Journal of Preventive Medicine.

ACO Coalition Plenary Speakers


Two plenary speakers highlight an exciting agenda for this fall’s meeting of the ACO and Emerging Healthcare Delivery Coalition, which takes place October 2627 in Nashville, Tennessee.

Shantanu Agrawal, MD, president of the National Quality Forum, and Clay Alspach, a principal of Leavitt Partners, have both been involved in government healthcare policymaking.

Dr Agrawal is the former deputy administrator at CMS and head of its Center for Program Integrity, while Alspach was chief health counsel for the chairman of the Energy and Commerce Committee.

Click here for more information and to register.

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

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