This Week in Managed Care: February 19, 2021

Entresto wins the first FDA nod in a hard-to-treat type of heart failure, President Biden nominates a new CMS administrator, and experts discuss the potential for Biden health reforms at AcademyHealth National Health Policy Conference.

Welcome to This Week in Managed Care, I’m Matthew Gavidia.

Entresto Wins First FDA Nod in Hard-to-Treat Type of Heart Failure

This week, the FDA approved Entresto, a combination therapy of sacubitril and valsartan, for the treatment of patients with heart failure with preserved ejection fraction, marking the first time a therapy has been approved for this population.

Already approved for heart failure with reduced ejection fraction, the approval could offer a new treatment choice for up to 2 million people with chronic heart failure, who until now have only had drugs to manage symptoms and comorbidities.

Notably, half of patients with heart failure will die within 5 years of showing symptoms, so finding better treatments has long been a concern to payers and health systems alike.

In the market for heart failure with reduced ejection fraction, Entresto faces competition from other drugs and other classes, including sodium glucose co-transporter 2 inhibitors, or SGLT2s, a treatment group first developed to treat type 2 diabetes that can reduce heart failure hospitalization through an entirely different mechanism.

In fact, some believe the future of care for patients with heart failure with preserved ejection fraction will involve treatment with both Entresto and SGLT2 inhibitors.

Without improved outcomes, the total US cost of care in heart failure would reach $69.7 billion by 2030. According to a statement from Novartis, the maker of Entresto, up to 5 million of the 6 million US patients with chronic heart failure could be candidates for the drug.

For more, visit AJMC.com.

Chiquita Brooks-LaSure Selected to Head CMS

This week, President Joe Biden will nominate Democratic health policy broker Chiquita Brooks–LaSure to lead CMS, according to The Washington Post.

If confirmed by the Senate, Brooks-LaSure, who served as a senior official at CMS under the Obama administration and worked on the implementation of the Affordable Care Act, will head Biden’s plans to expand the health care law.

As the second most powerful role in HHS, the CMS administrator oversees coverage for approximately 150 million people enrolled in Medicare, Medicaid, and the ACA.

For more, visit AJMC.com.

Kathleen Sebelius Reflects on the ACA, Potential for Biden Health Reforms

As 2021 promises to be a formative year for health care policy in the United States amid the COVID-19 pandemic and new Democratic majorities in Congress, former HHS Secretary Kathleen Sebelius and Sachin Jain, MD, MBA, AJMC^® board member and CEO of SCAN Group and Health Plan, took time this week to reflect on the advent of the ACA and examine the Biden administration’s opportunity to enact influential policy.

The two sat down for a conversation at the 2021 AcademyHealth National Health Policy Conference during a session entitled “What’s Next for the ACA and Health Reform.”

Touching on the challenging road ahead for President Biden’s HHS secretary nominee, California Attorney General Xavier Becerra, Sebelius, now CEO of Sebelius Resources LLC, endorsed the nominee’s previous defense of the ACA in his home state and lauded his previous work with immigrant children, family issues, and underserved populations.

The bigger challenge, says Sebelius, will be whether the Biden administration pauses to build a bipartisan coalition or take advantage of the Senate and House majorities to quickly enact reforms.

Capping out-of-pocket costs, removing barriers to Medicaid enrollment, and more robust subsidies could all aid in improving uninsured rates that spiked as a result of the pandemic, she added.

With newly proposed programs aimed at increasing health equity and public health more broadly, Sebelius hopes Biden-era policies will make it so “people will have less contact, hopefully, with the clinical side of health care and more contact with communities where they can live, and eat, and work, and breathe in, and live in a healthier fashion for longer lives.”

For more, visit AJMC.com.

Regional Payers Outline Challenges, Successes of Telehealth Implementation

In another session at the AcademyHealth National Health Policy Conference, representatives from 3 community health plans across the United States discussed how payers are driving telehealth access and utilization in the wake of the COVID-19 pandemic.

Moderated by Connie Hwang, MD, MPH, chief medical officer and director of clinical innovation at the Alliance of Community Health Plans, the panel discussion included:

• Lee Mills, MD, senior vice president and chief medical officer at CommunityCare in Oklahoma
• Richard Isaacs, MD, FACS, CEO and executive director at the Permanente Medical Group in California
• Namita Ahuja, MD, medical director of UPMC Health Plan in Pennsylvania

While COVID-19 telehealth visits are being conducted across all of their health plans, the panelists said federal changes are needed to reflect the expansion in telehealth access.

When it comes to policy interventions supporting these shifts in care, new guidance will have to weigh patient security with access, so as to not make platforms and technology too restrictive and limit adoption, noted the experts, who also said that new legislation will need to bear in mind certain geographic restrictions to technology use.

“We think of telehealth as a good resource, but are we going to be increasing the digital divide? …There are a lot of social determinants of health that factor into access and utilization of health care,” UPMC’s Ahuja said.

Although panelists stressed that telehealth will not be a replacement for all in-person visits, they said that providers and patients can work to strike the right balance of seeing the value in telehealth visits as opposed to traditional care delivery.

For more, visit AJMC.com.

Global and US Rates of New COVID-19 Cases Decline

In the past week, the rate of new COVID-19 cases has declined by 16% around the world, according to the World Health Organization, with average new daily US coronavirus infections dropping under 100,000 for the first time since November 4.

In addition to the decline in cases, the past week saw a 10% reduction in the number of deaths worldwide. However, health officials, including CDC Director Rochelle Walensky, MD, caution that COVID-19–related deaths remain high, with variants from the United Kingdom and South Africa posing a significant risk to progress.

"We are still at around 1500 to 3500 deaths per day. The cases are more than 2-and-a-half-fold times what we saw over the summer," said Walensky on NBC's Meet the Press.

In addition, an increasing amount of research conducted by scientists in the United Kingdom indicates that the COVID-19 variant first detected in Britain is linked with a higher risk of hospitalization and death than other known variants of the virus.

The novel variant, B.1.1.7, is known to be more contagious, but scientists last month cautioned that there was a possibility that the variant could be more lethal. Although reasons for the elevated death rate is not entirely clear, some evidence suggests that those infected with the variant may have higher viral loads, which may impact the efficacy of certain treatments.

So far, the variant has spread to at least 83 countries and is noted to be transmitted 35% to 45% more easily than other variants in the United States.

For more on the drop in US cases and global cases, visit AJMC.com.

For all of us at AJMC^®, I’m Matthew Gavidia. Thanks for joining us!