This Week in Managed Care: June 4, 2016

The top managed care stories this week included an update to the American Society of Clinical Oncology's value framework, a study that reported readmission rates among safety net hospitals after cancer surgery, and findings that bariatric surgery can benefit patients with diabetes.

Hello, I’m Brian Haug, president of The American Journal of Managed Care. Welcome to This Week in Managed Care, From the Managed Markets News Network.

Updated ASCO Value Framework

The American Society of Clinical Oncology (ASCO) has updated its value framework, which helps clinicians and patients in making decisions about cancer treatment.

The ASCO framework calculates a Net Health Benefit, a score that includes results from clinical trials, toxicity, and symptom palliation. Major changes from last year’s conceptual framework are:

The Net Health Benefit better reflects differences between treatments.
All side effects, not just high-grade toxicities, are evaluated.
The framework only includes therapies studied in head-to-head clinical trials.
ASCO’s tool will keep its focus on cancer drugs, since costs here are rising the fastest.

ASCO will take comments from stakeholders for 60 days, and the framework will be distributed through software to allow clinicians to use it at bedside.

Readmissions After Cancer Surgery

Safety net hospitals are more likely to see patients readmitted after cancer surgery. A new study in the Journal of the American College of Surgeons found that both 30-day and 90-day readmission rates were higher among hospitals that identified themselves as safety net institutions or had high numbers of Medicaid patients.

Hospitals that serve the poor have long insisted that the demographics of the clients they serve must be factored into reimbursement formulas that tie payment to readmission rates.

In addition, the study found that patients admitted for cancer surgery in these vulnerable hospitals were more likely to be from poor neighborhoods, more likely to be enrolled in Medicaid, and more likely to be readmitted through the emergency department.

Reversing Diabetes

Bariatric surgery offers more than a treatment for obesity, according to the American Diabetes Association.

In its journal Diabetes Care, the ADA outlined 32 recommendations for using what it now calls “metabolic surgery” to reverse diabetes in patients who have not responded to other treatment. The special issue featured research on when surgery is appropriate for teenagers, and why patients with a BMI of less than 35 should receive surgery to treat diabetes.

As author Dr Francesco Rubino wrote in the article: “The new guidelines recognize for the first time surgery as a legitimate diabetes treatment and should inform physicians and policymakers about the appropriate selection of patients for surgical treatment. Both practically and conceptually, it is one of the greatest innovations in diabetes care in recent times.”

Maternity Bundled Payments

The temporary nature and high cost of maternity care make it ideal for bundled payments, according to AJMC contributor Dr Katy Kozhimannil. In discussing a new white paper on the topic, Dr Kozhimannil outlined the policy issues for payers as they consider a one-time fee to providers who deliver a baby. They are:

How to incorporate patient-reported outcomes into metrics.
Which groups that create standards should have priority when payers select measures.
How to get good data on the cost of midwife care and include midwives in bundles.
How to properly assess the cost of “discharge planning for poor women, who may have a limited window in Medicaid.
How to incorporate providers like doulahs, whose work has been shown to improve outcomes.

Read Dr Kozhimannil’s article.

Preventing Disease

Finally, only 6% of Americans say they do 5 cost-effective things that the CDC recommends to prevent heart disease, cancer, and other chronic illness. Many reported doing 2 or 3, but not all 5. These are: