This Week in Managed Care: August 21, 2020

Survival improves among wait-listed heart transplant candidates, the Trump administration offers a progress report on its kidney care initiative, and panelists say choice is vital to the biosimilar savings picture. Welcome to This Week in Managed Care, I’m Matthew Gavidia.

Survival Improves Among Wait-listed Heart Transplant Candidates

Based on study results published last week in JAMA Cardiology, there was an almost 99% increase in the 1-year survival rate among candidates on the United Network for Organ Sharing, or UNOS, waiting list for a heart transplant from 2011 to 2017 compared with 1987 to 1990.

The retrospective, cross-sectional analysis mined the UNOS database for individuals at least 18 years old placed on the heart transplant waiting list between January 1, 1987, and December 2017, for a total study cohort of 95,323.

One-year survival rates increased among wait-listed candidates across the board for changes in listing preferences, changes in mechanical circulatory support indications, and candidates with and without ventricular assist devices, or VADs, as well as from the decade prior to the decade after the 2006 UNOS allocation policy.

From 2011 to 2017, there was a 67.8% rate of 1-year survival compared with 34.1% during 1987 to 1990 among those patients whose listing preferences changed. Meanwhile, compared with 1996 to 2000 during which candidates with VADs had a 10.2% 1-year survival on the transplant wait list, 2011 to 2017 saw this rate jump to 70.0%, or a 586% increase.

“Our data suggest that survival on the waiting list is increasing faster than survival after transplantation,” the authors concluded. “Continued improvement in outcomes for heart failure therapy among patients on the waiting list may support continued attention to balancing the survival benefit of existing supportive therapies against the indication for heart transplantation.”

For more, visit ajmc.com.

Administration Offers Progress Report on Kidney Care Initiative

This week, HHS offered a progress report on its yearlong initiative, Advancing American Kidney Health, which sought to reduce the risk of kidney failure, increase access to home-based dialysis, and boost availability of kidney transplants.

The report detailed progress toward each goal laid out by HHS secretary Alex Azar on the initiative, which was launched last year through an executive order by President Donald Trump. The initial goals included:

• Reduce the number of Americans with end-stage renal disease, or ESRD, by 25% by 2030
• Have 80% of new ESRD patients using at-home dialysis or receiving a transplant by 2025
• Double the number of kidneys available for transplant by 2030

Featured examples of progress ranged from research initiatives within the National Institutes of Health to efforts to protect civil rights of dialysis patients and end discrimination in allocation of kidneys available for transplant.

The report also came with a clarification from CMS that patients should get surgery for kidney transplants, despite the general guidance to avoid unnecessary surgery due to the COVID-19 pandemic.

Focusing on patients with ESRD, is both a quality of life and cost issue for HHS, as fee-for-service Medicare spent $114 billion on kidney care, or $1 of every $5 the program spends.

For more, visit ajmc.com.

Choice Is Vital to Biosimilar Savings Picture, Panelists Say

This year, several trastuzumab biosimilars have been launched, and 6 FDA-approved adalimumab biosimilars are lined up for launch in 2023, but a cornucopia of lower-cost therapies is not looked upon by providers as favorably as might be expected.

The reason? Payer policies make it difficult for providers to use the lowest-cost biosimilars available.

In a webinar hosted by The American Journal of Managed Care® and The Center for Biosimilars®, a panel of experts discussed how industry dealmaking is affecting treatment decisions and the use of resources at the provider level.

For a full review of the webinar, visit ajmc.com.

Do ICD-10 Codes Accurately Reflect COVID-19 Symptoms?

In a study published this week in JAMA Network Open, researchers assessed whether ICD-10 codes accurately capture presenting symptoms of fever, cough, and dyspnea among patients being tested for COVID-19.

ICD-10 codes, which are uniformly used throughout health care treatment facilities as a way to efficiently reference symptoms and document clinical concepts, have been shown in previous research to not accurately reflect clinical diagnoses and concepts such as atrial fibrillation, stroke, and acute kidney injury.

In this retrospective cohort study, investigators analyzed ICD-10 codes of over 2000 patients who underwent RT-PCR testing for COVID-19 at the University of Utah Health between March 10 and April 6, 2020.

Analyses revealed ICD-10 codes performed poorly in capturing COVID-19-related symptoms, highlighting the critical need for meticulous data validation to feed multicenter registries built from electronic medical records.

“Symptoms are an essential part of data collection for SARS-CoV-2 and COVID-19 surveillance and research,” the researchers wrote, “but symptom-specific ICD-10 codes lack sensitivity and fail to capture many patients with relevant symptoms; the false-negative rate is unacceptably high.”

For more, visit ajmc.com.

This week, the American College of Physicians, or ACP, and the American Academy of Family Physicians issued new guidelines cautioning providers against treating patients with acute pain from musculoskeletal injuries with opioids.

Published in Annals of Internal Medicine, the joint guideline was based on an assessment of 207 trials including 32,959 patients with musculoskeletal injuries. The review showed that topical nonsteroidal anti-inflammatory drugs, or NSAIDs were among the most effective for pain reduction, physical function, treatment satisfaction, and symptom relief.

"The evidence shows that there are quality treatments available for pain caused by acute musculoskeletal injuries that do not include the use of opioids," said Dr Jacqueline W. Fincher, [MD] president of ACP, in a statement. "There are a number of recommended interventions that are not opioids to choose from, and topical NSAIDs should be the first line of treatment."

In 2010, musculoskeletal injuries accounted for more than 65 million health care visits in the United States, with an estimated annual treatment cost of $176.1 billion in 2010.

For more, visit ajmc.com.

And, now our paper of the week, which looks back at some of the most important papers over the past 25 years of The American Journal of Managed Care® and why they matter today.

This week’s progress report on the Trump administration’s kidney care strategy shows how much the idea of care coordination has been embedded into value-based payment models. A step beyond is collaborative care, which puts mental health services under the same roof as primary care services, so that patients with diabetes or other comorbidities are more likely to receive care from doctors who are sharing information about the patient.

A pioneer in this field, Dr. Wayne Katon, was senior author on the November 2014 paper, “Population Targeting and Durability of Multimorbidity Collaborative Care Management,” which found that specifically targeting these complex patients can bring rapid, sustained improvement both glycemic control and in alleviating depression. Seeking out these patients brings greater cost savings, too.

For the paper, visit ajmc.com.

For all of us at AJMC, I’m Matthew Gavidia, thanks for joining us!