This Week in Managed Care: December 7, 2018

Life expectancy declines again in the United States, telemedicine use remains low among physicians, and another study adds to the debate over who should take statins.

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

Life Expectancy Continues Decline

New data from the CDC show that for the third straight year, life expectancy for someone born in the United States has declined. From 2016 to 2017, it fell slightly to 78.6 years.

While heart disease and cancer claim more lives overall, death rates from these causes are steady or falling. By contrast, death rates from suicide and drug overdoses are climbing, according to CDC data, which comes 3 years after Princeton economists Anne Case, PhD, and Angus Deaton, FBA, first reported on the rise of “deaths of despair,” particularly among middle-aged Americans.

Said CDC Director Robert Redfield, MD, “Life expectancy gives us a snapshot of the Nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable. CDC is committed to putting science into action to protect US health, but we must all work together to reverse this trend and help ensure that all Americans live longer and healthier lives.”

Telemedicine Uptake

Despite the potential for telemedicine to boost access to care, most physicians don’t use it, according to a new study. The study in Health Affairs found that in 2016, only 15.4% of physicians worked in practices that used telemedicine for a variety of patient interactions.

The study, which used the Physician Benchmark Survey of the American Medical Association, is the first national estimate for telemedicine use.

Researchers did find some variations, including:

• Specialties such as radiology, psychiatry, and cardiology were willing to use telemedicine for patient interactions.
• Emergency medical physicians and pathologists were willing to use technology for consults.
• Physicians outside metropolitan areas were much more willing to use telemedicine than those in urban areas.

Debate Over Statin Use

The 2013 recommendation from the American College of Cardiology and the American Heart Association to use statins to prevent cardiovascular disease in certain adults kicked off a debate that has not stopped.

Despite some support from the US Preventive Services Task Force, many physicians say the harms of statins outweigh the benefits for many patients, and too many patients complain of side effects.

Now, a new analysis in the Annals of Internal Medicine supports that view.

Authors from the University of Zurich conducted an extensive mathematical analysis that finds the 2013 guidelines should be revised to use much higher 10-year risk thresholds when recommending statins for prevention, and guidelines should be customized based on age, gender, and statin type.

An accompanying editorial found, “The authors consistently found that the harms outweighed the benefits until 10-year CVD risk thresholds substantially exceeded those recommended in current guidelines. … The results paint a nuanced—if less optimistic—picture of the net benefits of statins, particularly in older adults who may not live long enough to benefit.”

ASH 2018 Meeting

Results for chimeric antigen receptor T-cell therapies took center stage last weekend in San Diego at the annual meeting of the American Society of Hematology, as real-world results are now available. One study compared real-world results for Yescarta with those in the ZUMA-1 trial and found similar responses as well as similar toxicity.

Another study, presented by Tanya Siddiqi, MD, of City of Hope, found that the amount of time a patient stays in the hospital due to side effects—more than the cost of the therapy—is what drives the total cost of care.

And The American Journal of Managed Care^® spoke with Theresa H.M Keegan, PhD, MS, about the lack of participation by adolescents and young adults in clinical trials, and how this has stalled improvements in survival rates. Watch the interview.

Check out the full coverage from ASH 2018.

New Issue of AJAC

Finally, the new issue of The American Journal of Accountable Care^® features a study that found when mental health and diabetes care were delivered from the same primary care facility, outcomes in both conditions were improved among vulnerable patients.

The study suggests more support for coordination of care among patients who have multiple medical needs.

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