This Week in Managed Care: July 7, 2017

Senators hear from their constituents about the healthcare bill, a dispute with a health insurer shuts down a state government for three days, and the FDA approves a new test for leukemias and lymphomas.

Welcome to This Week in Managed Care, I’m Kelly Davio.

Senators Hear Constituent Input on Health Bill

The Fourth of July holiday brings parades and fireworks. For Republican senators, that meant lively exchanges with constituents, who gave lawmakers an earful on both sides of the bill taking shape to repeal the Affordable Care Act.

Senator Susan Collins of Maine told The Washington Post she heard encouragement on her stance against the bill, but Senator Dean Heller of Nevada is getting feedback to support a revised bill, after he said he would not vote for a first draft.

insurers Seek Exchange Enrollment Caps

Meanwhile, the uncertainty is causing some insurers to consider asking CMS to cap their exchange enrollment in 2018. A Houston based insurer, Community Health Choice, said it might join insurers in Minnesota and Kansas in making this request to maintain state solvency requirements.

Karen Love, executive vice president for Community Health Choice, said the plan has grown from 40,000 members to 145,000 as other insurers have left the market.

Said Love, “We can’t financially take another big influx of members. We would like to very much stay on the marketplace and keep our current members, but not take on many new members in 2018.”

Insurer Dispute Leads to NJ Govenrment Shutdown

In New Jersey, the holiday weekend brought a government shutdown, including state-run beaches and parks—all over a dispute between the Governor and the state’s largest health insurer.

Governor Chris Christie insisted that the new state budget come with a plan for greater oversight of Horizon Blue Cross Blue Shield of New Jersey.

The dispute was resolved Monday night, in time for parks to open for the Fourth of July. The plan calls for the following:

• Legislative leaders will pick two new members for Horizon’s board.
• An independent actuary will determine if Horizon’s risk-based capital ratio exceeds a cap of 725 percent.
• Any excess will be returned to policyholders.
• New rules will make it easier to learn company earnings and executive pay.

For more, visit ajmc.com.

FDA Approves Liquid Biopsy Test

FDA has approved a new liquid biopsy test to detect several forms of leukemia and lymphoma.

The test, called ClearLLab, is developed by Beckham Coulter Inc, and uses flow cytometry to find cancer cells. It has been approved to detect the following:

• Chronic leukemia
• Acute leukemia
• Non-Hodgkin lymphoma
• Myeloma
• Myelodysplastic syndrome, and
• Myeloproliferative neoplasms

The test can find cells in blood, bone marrow and lymph nodes, and can document cell characteristics with a high level of sensitivity, making it useful to find minimum residual disease.

FDA has created controls to ensure safety, efficacy, and proper use, and advises that an expert review of test results is needed.

For more, visit ajmc.com.

Medical Malpractice Reform Bill Moves Through House

Finally, a sweeping medical malpractice reform bill is on its way to the Senate after passing narrowly in the House. The bill would cap non-economic damages, also known as “pain and suffering” awards, at $250,000.

The bill, called the Protecting Access to Primary Care Act, may face greater hurdles in the Senate, but President Trump has vowed to sign it should it pass.

Tort reform has been on the physician legislative agenda for years, and the Congressional Budget Office says the House bill will lower healthcare costs by $50 billion over 10 years.

While some statistics say medical liability costs only add 2.5% to healthcare spending, doctors have argued that the real costs come in the extra tests and other defensive steps taken in practice to avoid being sued.

In fact, clinical pathways have been promoted as a tool to combat malpractice suits, as long as physicians document why they deviate from a pathway.

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