This Week in Managed Care: June 6, 2015

CMS released their third round of annual data, detailing how exactly hospitals spent $62 billion in 2013 as well as the $90 billion paid to providers and supplies. For the first time in the report’s history, CMS released information regarding which prescription medications were the most popular in the Medicare Part D program.

CMS acting administrator, Andy Slavitt, additionally announced a plan to allow entrepreneur’s access to Medicare acclaims data. Until this recent change in regulation, all Medicare acclaims data was off-limits for any for-profit venture as the data can be used to create products and software for value-based billing systems.

The American Society of Clinical Oncology (ASCO) held its annual meeting last weekend in Chicago, IL. In ASCO’s year long value initiative, topics ranging from defining value in cancer care to the promise of new biomarkers in immuno-oncology gained new ground. Many patient concerns with costs include co-payments, the cost of travel, and whether insurance will cover the best drugs available.

In clinical news, Luis A. Diaz, Jr, MD, associate professor of oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center reported on patients with high mutational burden with mismatched repair who responded to checkpoint inhibition to PD-1.

This is the first year insurers have full claims data for new enrollees under the ACA.

The cost of specialty medications along with the rise of claims form the newly insured is being cited around the country as payers seek great increases for 2016. Blue Cross Blue Shield will file for hikes of 20% or more in several states, although many expect regulators to refute those requests. Some health insurers price themselves below the competition and now need to implement rate hikes to cover the cost they see coming in through claims, according to Cathy Murphy-Barren, vice president, American Academy of Actuaries.

The American Journal of Managed Care travels to Boston, MA for their 75 Scientific Sessions of the American Diabetes Association. Coverage of the meeting begins this weekend, which will include highlights from the Tiques trial, an important case study for every therapy in the DPP4 class.

Managed Care Minute Weekly Poll Results:

CMS' new proposal for Medicaid managed care includes rules to make it easier to find specialists in areas like pediatrics and dentistry. Which will do the most to help Medicaid clients find specialists: