This Week in Managed Care: May 5, 2017

The Molinas are replaced at Molina Healthcare, feedback is coming in for the Oncology Care Model, and women are the focus of Healthy Vision Month. Welcome to This Week in Managed Care, I’m Laura Joszt.

Molinas Ousted at Molina Healthcare

The board at Molina Healthcare shocked the managed care industry this week by replacing the 2 brothers whose father founded the company. J. Mario Molina, MD, the CEO, and John Molina, the chief financial officer, were replaced by Chief Accounting Officer Joseph White, although both brothers remain on the board.

The board said the change comes after a period of disappointing financial performance for the Medicaid managed care company, said Dale Wolf, board chair: “With the industry in dynamic transition, the board believes that now is the right time to bring in new leadership to capitalize on Molina’s strong franchise and the opportunities we see for sustained growth.”

Molina Healthcare has been a key Medicaid insurer under the Affordable Care Act, and there was speculation Tuesday whether the company would re-evaluate its participation in the exchanges.

Feedback on the OCM

CMS has started letting practices using the Oncology Care Model (OCM) know how they are performing. The value-based payment model, which is in the midst of a 5-year pilot, offers plenty of data—which practices may find a little overwhelming.

A panel at last week’s meeting of the Community Oncology Alliance, offered advice on how to find meaning in the large amounts of data. One practice created 2 separate teams: one to look at clinical data and one to look at quality data.

Basit Chaudhry, MD, PhD, told AJMC that practices are providing feedback, too, and the OCM may change. Watch the video.

Women's Vision

May is Healthy Vision Month, an initiative of the National Eye Institute to encourage people to get regular eye exams. Women are the focus of this year’s campaign, since they account for two-thirds of those who experience limited vision or blindness due to conditions like macular degeneration, cataracts, or glaucoma.

Many of those who develop ocular conditions have diabetes. Despite a recommendation from the American Diabetes Association that people with diabetes have annual eye exams, a CDC survey found that only 38% of young adults get them.

Rachel Bishop, MD, MPH, of the National Eye Institute encouraged women to make eye care a priority. She said: “The majority of vision loss is preventable. And there are a number of things women can do to keep their eyes healthy.”

Out-of-Network Bills

Finally, a commentary in the current issue of The American Journal of Managed Care presents a unique solution to the problem of surprise medical bills.

A team of doctors and lawyers argue that basic contract law suggests that patients should not have to pay out-of-network fees set by a hospital’s chargemaster, because they have not agreed to them in advance.

Instead, the authors argue, the rates reached in contracts between hospitals and area payers should prevail, and recent rulings suggest patients should fight these chargemaster fees in court.

The authors find: “This leads to a stark conclusion. Providers have no legal authority to collect chargemaster charges that exceed market prices for out-of-network services, nor are payers under any obligation to pay such chargemaster prices.”

Read the full commentary.

For all of us at The Managed Markets News Network, I’m Laura Joszt.

Thanks for joining us.