This Week in Managed Care: February 16, 2018

Aging baby boomers will drive healthcare spending, long-term health concerns are part of the latest budget deal, and the American Society of Clinical Oncology (ASCO) finds major clinical pathways meet its guidelines.

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

Rising Healthcare Spending

Healthcare spending will rise 5.5% over the next 8 years, and will make up nearly 20% of the economy, according to a new report from CMS’ Office of the Actuary.

The report, appearing this week in Health Affairs, finds that tweaks to the Affordable Care Act won’t matter as much as demographics and rising medical costs. The actuaries found:

• Price growth for medical goods and services will rise from historic lows in 2014, going from 1.1% per year to annual increases of 2.5% per year through 2026.
• Medicare enrollment will grow 2.7% per year from 2021 through 2026, but spending per enrollee will grow 4.9% during that same period.
• Government will account for 47% of national health spending by 2026, up from 45% in 2016.

Despite the rising costs, healthcare spending will still grow at a slower rate than before the Great Recession.

For more, read the full article.

Congress Passes Healthcare Provisions

A few healthcare provisions with long-term impact were tucked into last week’s budget deal to reopen the government.

The Creating High Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017, known as CHRONIC, extends a Medicare Advantage (MA) model endorsed by Michigan University’s Center for Value-Based Insurance Design to all 50 states by 2020. It calls for flexibility in high-deductible plans for those with chronic conditions like diabetes.

Value-based insurance design (VBID) calls on health plans to fund services and therapies that offer clinical value to patients, especially those that will result in less health spending in the long run.

Said A. Mark Fendrick, MD, developer of the VBID concept and co-editor in chief of AJMC^®, “The nationwide expansion of the MA V-BID Model Test provides MA plans in all 50 states the flexibility to create benefit designs that promote personal responsibility, improve patient-centered outcomes, and lower healthcare expenditures.”

In a separate provision, the American Association of Diabetes Educators won language that will bring changes to Medicare’s competitive bidding program for supplies for people with the diabetes.

A series of surveys by the educators’ group, as well as a study published in the journal Diabetes Care, uncovered shortcomings in the bidding program that left patients without adequate supplies, causing increased admissions and even increased mortality.

Read more.

Reviewing Clinical Pathways

As commercial clinical pathways become more common, the leading cancer research organization has released a review of leading pathway vendors, which found that for most part, decision support tools meet key ASCO criteria for being up-to-date and driven by experts.

However, the ASCO Task Force on Clinical Pathways found that some pathways fell short in other criteria, such as having clear expected outcomes and public reporting of metrics. In some cases, users need more information about what makes a treatment on or off a pathway.

Said Task Force Chair Robin Zon, MD, FACP, FASCO, “We are encouraged to see that, by and large, prominent pathway programs are adhering to ASCO’s criteria for high-quality clinical pathways. We hope our assessment of the pathways landscape will help these programs make further refinements, with the ultimate goal of improving the care of our patients.”

Reversing Type 2 Diabetes

Can low-carb eating reverse type 2 diabetes?

A study released this week found that 60% of a group of patients with type 2 diabetes who were closely supervised on a special low-carb diet were able to bring their A1C below levels that meet the criteria for the disease, and they did so while slowly easing off most of the drugs they were taking, including insulin.

The study, led by Dr. Sarah Hallberg, medical director for Virta Health, found that 83% of the participants in this intervention were able to stick with the program after a year.

The program is designed to achieve nutritional ketosis, in which the body stops relying on glucose for fuel and instead burns fat. Patients had to take daily blood tests that were monitored remotely and make dietary adjustments based on the results.

Learn more.

An Update on ACOs in MSSP

Finally, a study published this week by The American Journal of Accountable Care examines how accountable care organizations (ACOs) are faring in the Medicare Shared Savings Program. After 3 years of rapid growth, including growing pains, ACO growth plateaued in the fourth year.

The authors found that ACOs improved quality for Medicare patients under their care, even though they were caring for older, sicker patients, which suggests it’s time for many of these groups to switch to increased levels of risk.

Read the study.

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