This Week in Managed Care: February 21, 2020

Medicaid work rules see an additional setback, another study finds more benefits from SGLT2 inhibitors, and researchers find unwanted end-of-life care causes stress.

Welcome to This Week in Managed Care, I’m Christina Mattina.

Panel Rejects Arkansas Medicaid Work Rules

A three-judge panel has rejected Arkansas’ plan to force those who receive healthcare through Medicaid expansion to work or perform community service.

The DC Circuit Court panel upheld a lower court ruling and found that HHS Secretary Alex Azar ignored warnings that the policy would cause people to lose coverage.

After Arkansas Works took effect, 12,000 people lost coverage in less than a year.

The opinion states, “A critical issue is the Secretary’s failure to account for loss of coverage, which is a matter of importance under the statute. The record shows that the Arkansas Works amendments resulted in significant coverage loss.”

Governor Asa Hutchinson said the state would appeal the ruling. He said, “It is difficult to understand how this purpose is inconsistent with federal law. The court’s ruling undermines broad public support for expanded health coverage for those struggling financially.”

For more, visit ajmc.com.

SGLT2 Inhibitors Help Patients With Diabetes Regardless of Cardiovascular Diagnosis

SGLT2 inhibitors have health benefits for all patients with type 2 diabetes, no matter their cardiovascular status.

A new study in the Journal of the American Heart Association has found that the drug class offers protective benefits across a broad group of patients.

Said lead author Clare Arnott, “We found SGLT2 inhibitors protected against cardiovascular disease and death in diverse subsets of patients with type 2 diabetes regardless of their cardiovascular disease history.”

The meta-analysis captured more than 38,000 patients, including the following:

• 22,800 had cardiovascular disease
• 7700 had reduced kidney function
• 4500 had heart failure
• 3800 had major cardiac events, such as heart attacks or strokes

Including results from last year’s CREDENCE trial, which showed that canagliflozin could halt renal decline, boosted the study’s power to show the benefits of the SGLT2 class.

The authors wrote: “Our results call for a reevaluation of current guideline recommendations for SGLT2 inhibitor therapy, with a view to include those with and without established CVD. The overview findings support consideration of SGLT2 inhibition in primary, as well as secondary, prevention settings.”

Unwanted End-of-Life Care Increases Emotional Distress

A new study in JAMA finds that use of Physician Orders for Life Sustaining Treatment is linked to lower rates of intensive admissions among patients who have said they don’t want such care.

But the study found 38% of patients with these orders still had care out of line with their preferences.

While unwanted end-of-life care is associated with added costs, this study shows it’s also tied to unwanted stress. The authors found problems occur if patients do not update documents as circumstances change.

They wrote: “[Protocols] depend on predictions made at a single point in time to determine what will happen at a future time.…Clinicians sometimes object to providing care that they perceive will be unbeneficial or even harmful. These conflicts between clinicians and patients or their surrogates are a common problem in ICU care and are seen as a major contributor to distress and frustration among clinicians.”

For more, visit ajmc.com.

Evidence-Based Oncology™ Issue Focuses on Clinical Pathways

The rise of clinical pathways has changed cancer care, creating opportunities for both academic centers and community practices to adhere to the latest in evidence-based medicine.

The current issue of Evidence-Based Oncology™ addresses how pathways are developed and used across networks, featuring:

• Authors from Dana Farber Cancer Institute addressing how they develop their pathway technology with Philips
• The chief medical officer of US Oncology Network discussing the distribution of pathways across a care network
• And the use of episodes of care within the pathway paradigm

For the full issue, visit ajmc.com.

Paper of the Week

Finally, we bring you Paper of the Week, which looks back at research and commentary from the past 25 years in The American Journal of Managed Care^®, and why they matter today.

With our current issue of Evidence-Based Oncology™ focusing on clinical pathways in cancer care, we look back at one of our most-read papers of 2016.

“Care Pathways in US Healthcare Settings: Current Successes and Limitations and Future Challenges” predicted that pathways would continue to take hold as a way to improve healthcare quality and patient outcomes.

Funded by the National Pharmaceutical Council, the paper called for key elements in pathways:

• Increased use of pathways with specialty drugs in episodes of care
• Transparency in development, implementation, and evaluation
• More research on the effect of pathways

For the full paper, visit ajmc.com.

For all of us at AJMC^®, I’m Christina Mattina. Thanks for joining us.