This Week in Managed Care: November 23, 2018

The federal government may invest in more social needs, work rules cost thousands their Medicaid coverage in Arkansas, and a shorter course of hepatitis C treatment may work for some patients.

Welcome to This Week in Managed Care, I’m Laura Joszt.

Addressing Social Needs Driving Health

Having transportation, a safe place to live, and healthy food make a big difference in a person’s health, and new government payment models may soon reflect these needs.

The Center for Medicare and Medicaid Innovation (CMMI) will become more involved in social determinants of health, HHS Secretary Alex Azar said in remarks this week. He said CMMI could allow flexibility to reflect regional needs, such as more help for rent in cities and more help with transportation in rural areas.

Said Azar, “We believe we could spend less money on healthcare—and more important, help Americans live healthier lives—if we did a better job of aligning federal health investments with our investments in nonhealthcare needs.”

Azar’s remarks were welcome news to an official with the Camden Coalition of Healthcare Providers, which looks for ways to aid patients with the most complex medical and social needs.

Mavis Asiedu-Frimpong of the Camden Coalition told The American Journal of Managed Care^®, “Having the Medicaid program really value social determinants of health and really value the idea that health is not just about healthcare—it’s about the conditions in which we live and work—I think it’s a critical step forward for the administration and a critical step forward for the field as well.”

Work Rules Grow Ranks of Uninsured in Arkansas

Arkansas has removed more than 12,000 people from its Medicaid expansion program for not complying with its new work and community engagement rules, and another 6000 may lose coverage in December.

But advocates for the disabled have asked HHS to halt the program because they say it lacks safeguards to ensure that enrollees understand the requirements. Last week, the Medicaid and CHIP Payment and Access Commission endorsed this position.

According to Joan Alker, MPhil, of Georgetown University, large share of those losing coverage are likely disabled and should be protected under the Americans with Disabilities Act. She said, “Many of these folks are probably unaware of the fact that they have lost coverage and will only learn that they are uninsured when they next need to fill a prescription or show up at a doctor’s office or clinic for care.”

Shortening HCV Treatment Time

Fifty percent of patients in a study received hepatitis C therapy for as few as 6 weeks instead of the usual 12 weeks without compromising the response. The study, presented at the American Association for the Study of Liver Diseases, could be significant for managed care, because the drugs are so expensive.

Said study author Harel Dahari, PhD, “There’s potential to save up to 20% of the costs of hepatitis C drugs.”

Researchers at Loyola Chicago tested patients after a few weeks of treatment to gauge how much their hepatitis C virus levels had decreased and used mathematical models to decide when patients could safely stop treatment.

A multicenter trial is now under way to validate the results.

Debate Over Stricter Blood Pressure Guidelines

A study published this week finds the new blood pressure guidelines adopted a year ago by cardiologists could prevent up to 3 million cardiovascular disease events over 10 years. The study in the journal Circulation supports lowering the threshold for high blood pressure to 130/80 mmHg in light of the SPRINT study, published in 2015.

Said lead author Adam Bress, PharmD, MS: “Treating high blood pressure is a major public health opportunity to protect health and quality of life for tens of millions of Americans. Achieving these lower goals will be challenging.”

But there’s still controversy over how to treat older patients with borderline hypertension, and some guidelines still call for starting treatment at higher levels to avoid adverse effects.

Franz Messerli, MD, and Sripal Bangalore, MD, MHA, writing last month in the Journal of the American College of Cardiology, noted the disagreement in guidelines among the American and European societies, as well as even high treatment thresholds advocated by groups that represent family physicians.

They wrote: “Unless we make a concerted effort to do so, as the number of guidelines is increasing more rapidly than does iron-clad evidence, we are prone to see more and more schism among recommendations, confusion among physicians, and anxiety among patients.”

Takeaways From PCOC^® 2018

Stakeholders shared the finer points of the transition to value-based oncology and discussed how to respond to the latest proposals from CMS at last week’s meeting, Patient-Centered Oncology Care^®, held in Philadelphia.

During the meeting, Erin Trish, PhD, of the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California, received the 2018 Seema S. Sonnad Emerging Leader in Managed Care Research Award.

Keynote speaker Barbara McAneny, MD, an oncologist who is the president of the American Medical Association, discussed the pros and cons of the Oncology Care Model, and outlined a rival model she will soon present at the Physician-Focused Payment Model Technical Advisory Committee, known as PTAC.

Promoted by a group of practices called the National Cancer Care Alliance, the model is called Making Accountable Sustainable Oncology Networks, or MASON.

The model, “creates an accurate cost target that will be a valuable tool for optimizing patient management while avoiding actuarial risks of adverse patient clinical characteristics."

McAneny said it seeks real-time quality measurement, so practices can fix problems with outliers right away.

See all the coverage from the seventh annual meeting of Patient-Centered Oncology Care^®.

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