This Week in Managed Care: February 7, 2020

A survey finds some oncology practices are ready to take on risk, experts warn of flu among children in detention centers, and a study establishes a link between circadian rhythm and type 2 diabetes.

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

OCM Participants Willing to Take On Risk

Practices taking part in CMS’ Oncology Care Model are mostly willing to take on 2-sided risk, according to a survey from the Community Oncology Alliance.

COA asked about readiness to assume risk after the December 3rd deadline, when practices had to decide what to do for the last year of the OCM.

Results from 68 practices showed:

• 47.1% opted to stay in the OCM with 1-sided risk
• 36.8% chose to remain and enter into 2-sided risk
• 32.4% chose 2-sided risk, even though they had not received a performance-based payment
• 16% said they were dropping out of the OCM

Said COA’s Bo Gamble, “No longer are incentives purely about utilization. Now there are numerous attempts to design a model with emphasis on quality, value, and meaningful quantifiable outcomes. The OCM, and the 20-plus other models, are consistent with that message.”

The OCM is a 5-year pilot from the Center for Medicare and Medicaid Innovation to help oncology practices and Medicare learn how to offer rewards for care coordination, palliative care, and the flexibility for same day appointments. A successor model called Oncology Care First has been proposed to start in 2021.

For more, visit ajmc.com.

Experts Warn of Child Flu Outbreak in Detention Centers

There’s been plenty of attention on the coronavirus, but experts warn that the flu presents real danger to children in detention centers run by Customs and Border Patrol.

Infectious disease experts at the University of Maryland School of Medicine warned this week that detainees at the border, especially children, are in urgent need of influenza vaccines.

A release from the medical school stated: “Over the past year, at least 7 children have died from diseases, including influenza, while being detained by the US Department of Homeland Security’s Customs and Border Protection agency.”

A report in the New England Journal of Medicine shows that the failure to vaccinate children in detention centers led to deaths. Complicating things this year is a viral strain of influenza B; there have been 68 pediatric deaths, including 45 from the B virus.

The president-elect of the American Academy of Pediatrics, Dr Sara Goza, issued a statement on conditions for children at the border: “The U.S. Customs and Border Protection’s imprudent decision to deny migrant children the flu vaccine while they are detained at a border detention center is reprehensible and irresponsible. Flu outbreaks are common at CBP holding facilities. Unsanitary conditions, overcrowding, and poor nutrition increase the risk for infectious diseases to spread quickly.”

Circadian Clock Closely Linked to T2D

Disruptions to circadian rhythm have long been suspected to be a factor in development of type 2 diabetes, but now there is proof.

Researchers have found a link between circadian disturbances in pancreatic and type 2 diabetes, which has been published in Proceedings of the National Academy of Sciences.

Time zone changes, irregular work schedules, and aging can keep cells from functioning properly, they found by comparing pancreatic cells from organ donors with type 2 diabetes with those from healthy controls.

Using time lapse photography, the researchers showed that pancreatic islet cells from the donors with diabetes showed signs of disrupted circadian clocks, which altered hormone secretion.

Researchers also identified a molecule called nobiletin which may help repair disrupted cellular clocks. They wrote: “Our study emphasizes a link between the circadian clockwork and T2D and proposes that clock modulators hold promise as putative therapeutic agents.”

For more, 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.

This week’s paper, “Medication Noncompliance in Patients With Chronic Disease: Issues in Dialysis and Renal Transplantation,” examines the problems with patients who must undergo a kidney transplant but still don’t stick with basic medication regimens for conditions like hypertension, which add to their medical challenges.

The article identifies issues like poor socioeconomic background and lack of family and social support as factors in poor medication adherence, which today are recognized as social determinants of health.

CMS is implementing new models for renal treatment called Kidney Care First, all designed to give nephrologists a stronger hand in patients’ overall health.

For the Paper of the Week, visit ajmc.com.

For more about Kidney Care First, see ajmc.com.

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