Managed Care Cast

With the cost of healthcare rising, consumers are being asked to shoulder more of the financial burden and make more cost-conscious decisions regarding their healthcare. One method to do this is through the use of consumer-directed health plans, which are high-deductible health plans coupled with a health savings account or a health reimbursement arrangement. Neeraj Sood, PhD, co-authored a paper in the April issue of The American Journal of Managed Care (AJMC) evaluating the impact of enrollment in consumer-directed health plans on financial burden associated with healthcare utilization.

Read Sood's paper “Financial Burden of Healthcare Utilization in Consumer-Directed Health Plans” in the April issue of AJMC: http://www.ajmc.com/journals/issue/2018/2018-vol24-n4/financial-burden-of-healthcare-utilization-in-consumer-directed-health-plans

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included final numbers for 2018 enrollment in Affordable Care Act plans; an increase in Medicare Advantage payments; National Public Health Week highlighted the importance of community relationships in improving health.

Read more about the stories in this podcast:

What We're Reading: 2018 ACA Enrollment; Spread of Rare Superbug; Off-the-Shelf CAR T Therapies: www.ajmc.com/newsroom/what-were-reading-2018-aca-enrollment-spread-of-rare-superbug-offtheshelf-car-t-therapies

CMS Final Rule Lowers Maximum Co-Payment Amount for Biosimilars: www.centerforbiosimilars.com/news/cms-final-rule-lowers-maximum-copayment-amount-for-biosimilars

CMS Raises Medicare Advantage Payments, Tweaks Opioid Language for Patients With Pain: www.ajmc.com/newsroom/cms-raises-medicare-advantage-payments-tweaks-opioid-language-for-pain-patients

Strong Community Relationships Key to Improving Health, Said Speakers at National Public Health Week Forum: www.ajmc.com/newsroom/strong-community-relationships-key-to-improving-health-said-speakers-at-national-public-health-week-forum

What We're Reading: 2018 ACA Enrollment; Spread of Rare Superbug; Off-the-Shelf CAR T Therapies: www.ajmc.com/newsroom/what-were-reading-2018-aca-enrollment-spread-of-rare-superbug-offtheshelf-car-t-therapies

Guidance That Allows for Higher A1C Misses the Mark: www.ajmc.com/journals/evidence-based-diabetes-management/2018/march-2018/guidance-that-allows-for-higher-a1c-misses-the-mark

Evidence-Based Diabetes Management—March 2018: www.ajmc.com/journals/evidence-based-diabetes-management/2018/march-2018

Locations, Types, and Characteristics of Data Breaches in Hospitals by Managed Care Cast

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included another insurer announcing it would pass on drug rebates to consumers; FDA approved a new continuous glucose monitor and created a new medical device class; new guidelines address how to treat people with both HIV and cancer.

Read more about the stories in this podcast:

What We're Reading: Accidental Medicaid Enrollment; Cracking Down on Opioids; Passing on Drug Rebates: www.ajmc.com/newsroom/what-were-reading-accidental-medicaid-enrollment-cracking-down-on-opioids-passing-on-drug-rebatesUnitedHealthcare to Pass Drug Company Rebates Back to Consumers: www.ajmc.com/newsroom/unitedhealthcare-to-pass-drug-company-rebates-back-to-consumers

Out-of-Pocket Costs for Insulin Are a Problem. Litigants in Case Disagree on Who Is at Fault: www.ajmc.com/newsroom/out-of-pocket-costs-for-insulin-are-a-problem-litigants-in-case-disagree-on-who-is-at-fault

Brenda Schmidt Discusses Getting Ready for the Launch of Medicare DPP: www.ajmc.com/interviews/brenda-schmidt-discusses-getting-ready-for-the-launch-of-medicare-dpp

FDA Approves Dexcom G6, Streamlines Review for Similar Interoperable CGMs: www.ajmc.com/newsroom/fda-approves-dexcom-g6-streamlines-review-for-similar-interoperable-cgms

NCCN's New Guidelines Promote Better Cancer Care for People With HIV: www.ajmc.com/conferences/nccn-2018/nccns-new-guidelines-promote-better-cancer-care-for-people-with-hiv

Institute for Value-Based Medicine—Advancing Quality in Oncology Care: www.ajmc.com/ivbm-registration

As the country searches a new way to address cost of care, value-based insurance design (VBID), is gaining traction as one way of encouraging the use of high-value services and discouraging the use of low-value services. VBID would give patients access to treatments and services with high clinical value at reduced or no cost sharing. Currently, health plans tend to value all treatments and services as equal in clinical value to all patients, even though this is not the reality.

On March 14, the University of Michigan’s V-BID Center hosted its annual VBID Summit with discussions on aligning around value, how public payers are adopting VBID principles, addressing the use of low-value care services, and creating a smarter high-deductible health plan.

Read coverage of the panels from the V-BID Summit:

The Challenge of Addressing Low-Value Care Once It's Identified: www.ajmc.com/conferences/v-bid-summit-2018/the-challenge-of-addressing-lowvalue-care-once-its-identified

How Public Payers Are Adopting VBID Principles Despite Constraints: www.ajmc.com/conferences/v-bid-summit-2018/how-public-payers-are-adopting-vbid-principles-despite-constraints

Aligning Around Value: Challenges With Quality Measures and Implementing Clinical Nuance: www.ajmc.com/conferences/v-bid-summit-2018/aligning-around-value-challenges-with-quality-measures-and-implementing-clinical-nuance

Path to a Smarter High-Deductible Plan Includes Flexibility, Disruptive Innovation: www.ajmc.com/conferences/v-bid-summit-2018/path-to-a-smarter-highdeductible-plan-includes-flexibility-disruptive-innovation

On March 14, advocates for community cancer centers took to Capitol Hill to speak with legislators and advocate for the issues important to them and their patients. At the Association of Community Cancer Centers' (ACCC) 44th Annual Meeting and Cancer Business Summit, Blaire Burnett of ACCC, George Spurlock of Southern Cancer Center, and Randall Oyer, MD, of Lancaster General Health, discussed their experiences with Capitol Hill Day and what issues they discussed with legislators.

For coverage of sessions and interviews with speakers from the ACCC 44th Annual Meeting and Cancer Business Summit, visit our conference page: http://www.ajmc.com/conferences/accc-2018.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included changes to the Next Generation ACO Model caused 7 accountable care organizations to leave the model; a report highlights how quickly hospital acqusition of physician practices is occurring; CMS finalizes coverage for Next-Generation Sequencing tests.

Read more about the stories in this podcast:

Seven ACOs Exit Next Generation Model, Blaming CMS for "Unilateral" Changes: www.ajmc.com/newsroom/seven-acos-exit-next-generation-model-blaming-cms-for-unilateral-changes

Accountable Care Delivery Congress: www.ajmc.com/acdcongress

Hospital Acquisition of Independent Physician Practices Continues to Increase: www.ajmc.com/focus-of-the-week/hospital-acquisition-of-independent-physician-practices-continues-to-increase

First-of-a-Kind Companion Test for Cancer Gene Profiling Gets FDA Approval: www.ajmc.com/newsroom/firstofakind-companion-test-for-cancer-gene-profiling-gets-fda-approval

CMS Finalizes Coverage for Next-Generation Sequencing Tests: www.ajmc.com/newsroom/cms-finalizes-coverage-for-next-generation-sequencing-tests

Incorporating Value Into Physician Payment and Patient Cost Sharing: www.ajmc.com/journals/issue/2018/2018-vol24-n3/incorporating-value-into-physician-payment-and-patient-cost-sharing

National Comprehensive Cancer Network 23rd Annual Conference: www.ajmc.com/conferences/nccn-2018

Society of Gynecologic Oncology 2018 Annual Meeting on Women’s Cancer: www.ajmc.com/conferences/sgo-2018

As the US healthcare system searches for a way to address the poor health and high healthcare costs of American, one concept has risen to the top and received a lot of attention: social determinants of health. These are the conditions in which people are born, live, and work that impact their health. And they are mostly responsible for health inequities.

There are a number of conditions that are considered social determinants of health, including access to educational, economic, and job opportunities; transportation options; public safety; and housing.

In this podcast, we focus on the issue of housing, and how communities are working to get people into housing so their health can improve.

Learn more about social determinants of health:

Program Nets Substantial Savings by Housing Homeless Individuals With Health Issues

http://www.ajmc.com/focus-of-the-week/program-nets-substantial-savings-by-housing-homeless-individuals-with-health-issues

Developing State-Level Programs for Care of Complex Populations

www.ajmc.com/focus-of-the-week/developing-statelevel-programs-for-care-of-complex-populations

Food, Housing Focus of NQF Medicaid Report About Social Determinants of Health

www.ajmc.com/focus-of-the-week/food-housing-focus-of-nqf-medicaid-report-about-social-determinants-of-health-

Successful Interventions, Positive Outcomes: Understanding the Impact of Social Determinants of Health

www.ajmc.com/contributor/medecision/2018/01/successful-interventions-positive-outcomes-understanding-the-impact-of-social-determinants-of-health

Cross-Sector Partnerships to Address Health-Related Social Needs

www.ajmc.com/focus-of-the-week/crosssector-partnerships-to-address-healthrelated-social-needs

More Healthcare Execs Accounting for Social Determinants of Patients' Lives, Survey Finds

www.ajmc.com/focus-of-the-week/more-healthcare-execs-accounting-for-social-determinants-of-patients-lives-survey-finds

The Essential Facts of Life Are the Foundation of Health

www.ajmc.com/contributor/adam-sharp/2018/02/the-essential-facts-of-life-are-the-foundation-of-health

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included Sanofi offering a deal to payers for its cholesterol drug; a “right-to-try” bill is defeated in the House; and a forum of oncology pharmacists discusses “health insurance” versus “healthcare.”

Read more about the stories in this podcast:

With ODYSSEY Results in Hand, Talks With Payers Begin to Jump Start Praluent Sales: www.ajmc.com/conferences/acc-2018/with-odyssey-results-in-hand-talks-with-payers-begin-to-jump-start-praluent-sales

"Right-to-Try" Legislation Defeated in House Amid Doubts About Its Necessity: www.ajmc.com/newsroom/right-to-try-legislation-headed-for-a-vote-as-doubts-about-its-necessity-remain

Coverage of the American College of Cardiology’s 67th Annual Scientific Session & Expo: www.ajmc.com/conferences/acc-2018

Rep. Doug Collins: Providing Healthcare vs Health Insurance: www.ajmc.com/conferences/ncoda-spring-forum-2018/rep-doug-collins-providing-healthcare-vs-health-insurance

National Community Oncology Dispensing Association 2018 Spring Forum: www.ajmc.com/conferences/ncoda-spring-forum-2018

Pembrolizumab Granted Priority Review for Treatment of Cervical Cancer: www.ajmc.com/newsroom/pembrolizumab-granted-priority-review-for-treatment-of-cervical-cancer

Association of Community Cancer Centers' 44th annual meeting: www.ajmc.com/conferences/accc-2018

As hospitals are increasingly held accountable for what happens outside the hospital walls, they need access to better claims data. In a recent study published in November issue of The American Journal of Managed Care®, researchers with the Michigan Value Collaborative found that it is possible to derive episode-level utilization from claims data and it provides a level of postdischarge care precision that is superior to medical records that hospitals have access to.

Read the study:

Validation of a Claims-Based Algorithm to Characterize Episodes of Care: www.ajmc.com/journals/issue/2017/2017-vol23-n11/validation-of-a-claimsbased-algorithm-to-characterize-episodes-of-care