Payers

Employers did not intentionally set out to address social determinants of health, but the programs they were implementing were doing so, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

While freestanding emergency departments (EDs) can reduce wait times and reduce the burden on overcrowded EDs, they increase utilization of emergency care and local market spending.

A Colorado-based company, SonderMind, seeks to take on the financial risk associated with reimbursement for mental healthcare so that therapists will be more willing to see patients using their insurance coverage.

The change to the public charge rule has had a negative impact on immigrant patients, who are disenrolling or declining to enroll in Medicaid and are delaying or avoiding care, according to a survey of community health centers.

Mental health care is an area of focus for the National Alliance of Healthcare Purchaser Coalitions, because this care is getting worse despite there being more acceptance regarding the need for improved mental health, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

More practices than expected seem to be interested in staying in the Oncology Care Model (OCM) and taking on downside risk, said Mike Fazio, senior vice president of client services, Archway Health.

Rare diseases may affect a small number of people, but they have fiscal impacts beyond just healthcare costs. A new study in Orphanet Journal of Rare Diseases used a public economic framework to identify how hereditary transthyretin-mediated amyloidosis has a public economic burden beyond just health costs in the Netherlands.

Although minimal residual disease (MRD) is increasingly being used to predict treatment outcomes and as a surrogate marker of progression-free survival, there remains controversy over whether it is ready to be used in treatment decision making.

High-deductible health plans have been popular, but it’s becoming clear they are not right for all employees, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

A recent survey of patients with bipolar I disorder showed the extent to which they are so bothered by side effects to antipsychotic (AP) medications that they will stop taking them, or will trade more symptoms for fewer side effects.

The 2019 Kaiser Family Foundation Employer Health Benefits Survey results revealed significant rises in annual premiums, setting the context for the role of health insurance reform during the 2020 election cycle.

While current guidelines recommend that only women with breast cancer who have a family history or who meet clinical criteria undergo genetic testing, a new cost-effectiveness analysis suggests that genetic testing should be expanded to all women with breast cancer.

Low-wage earners in a company face a larger burden in access to care compared with high-wage earners, but not all employers recognize this and design benefits with this in mind, said Thomas Parry, PhD, president and founder of the Integrated Benefits Institute.

The marketplace is working to analyze and clean up real-world evidence so it can be used to inform decisions on treatment and coverage, said Scott Gottlieb, MD, former FDA commissioner (2017-2019).

President Donald Trump has issued an executive order that will protect Medicare and bolster Medicare Advantage (MA) in response to Democrats' Medicare for All proposals.

In the past few years, benefit designs have led to a reduction of both low-value and high-value care, and moving forward, new designs have to be tied more directly to value-based reimbursement, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

Employers have been talking about low-value care for years, but they’re trying to identify to remove the use of those services, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

The development and access to orphan indications rely on reimbursement models that require regulatory action toward out-of-pocket costs for patients, said Scott Gottlieb, MD, former FDA commissioner (2017-2019).

In the next 5 to 10 years, providers and health systems need to be thinking about how all the pieces of a new system that delivers holistic, value-based care fit together, said Will Shrank, MD, chief medical officer, Humana, during the opening plenary at the National Association of ACOs fall meeting.

As minimal residual disease (MRD) and other measures to detect cancer burden are increasingly used to predict outcomes and direct future treatment decisions, Amgen has chosen to partner with Adaptive Biotechnologies to use the clonoSEQ product to assess MRD across multiple drug development programs.

Unsustainable healthcare costs are driving seismic changes to the way payers do business and are requiring the ability to extract deeper insights from data assets.

As 2020 Medicare Advantage (MA) premiums will decline 14.0% from 2019, beneficiaries will have access to greater benefits, which has contributed to enrollment continuing to grow year over year, according to CMS.

While the number of employers who reported they had self-insured at least one health plan had increased from 1999 to 2016, there was a sharp decrease by 38.7% in 2018, according to research from the Employee Benefit Research Institute.

CMS is trying to make a 2-sided risk model in the Oncology Care Model enticing for practices, but there is still a lot of math practices need to work out before making the decision, said Blase Polite, MD, associate professor of medicine and the executive director for accountable care at the University of Chicago.

Novel therapies come with high costs, but they have the potential to more effectively treat some patients, and employers are struggling to handle the cost burden of them, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

Providing access to complex therapies through the Medicare market can benefit patients who are disproportionately ignored by socioeconomic status, said Scott Gottlieb, MD, former FDA commissioner (2017-2019).

Getting Americans in rural areas the right care at the right time is an issue that must be tackled at all levels. Ongoing efforts to coordinate care management and resources can prove beneficial for the rural communities that need it most.

CMS' new radiation oncology payment model is slated to begin on January 1, 2020, but the significant billing changes that the model requires will require more time.

Oncologists may be able to use circulating tumor DNA (ctDNA) to guide treatment decisions and predict which patients will have disease recurrence, according to 2 studies in JAMA Oncology.

To make headroom for expensive, potentially curative therapies in the pipeline, the healthcare needs to remove ineffective care from the system, said Susan Dentzer, visiting fellow at the Duke-Margolis Center for Health Policy.