This Week in Managed Care: October 3, 2015

The top managed care stories this week include a new PhRMA head and recommendations to update measurements designed to improve health and control costs in the Medicaid program.

Transcript (slightly modified for readability)

Hello, I’m Justin Gallagher, associate publisher of The American Journal of Managed Care.

Welcome to This Week in Managed Care, from the Managed Markets News Network.

New PhRMA Head

This week, the Pharmaceutical Research and Manufacturers of America, better known as PhRMA, named Stephen J. Ubl as its next CEO. He will replace John Castellani, who had previously announced plans to retire at the end of the year.

Ubl, a veteran Washington lobbyist, comes from AdvaMed, which represents medical device makers. He steps in at a time when drug makers are under fire for rising prices and some presidential candidates are unveiling plans to control the cost of drugs. He is credited with improving relations between FDA and device makers and has lobbied for repeal of the 2.3% medical device excise tax.

Opioid Abuse

High-cost patients who suffer from opioid abuse have some things in common, according to a study published this week in the Journal of Managed Care and Specialty Pharmacy. Claims data show these patients have higher rates of chronic conditions and mental health problems, and were also more likely to be female and older, compared with lower-cost patients.

The average healthcare cost for high-cost patients was about $89,000, compared with $11,600 for a low-cost patient. Not only were these patients more likely to end up in the hospital, but they had longer stays, according to the study. Researchers said the study shows the need for doctors to take a complete medical history and psychosocial history before prescribing opioids, especially for patients in Medicaid.

New NQF Recommendations

Keeping track of patients’ behavioral health, and especially how it affects their diabetes or cardiovascular health, is important to improving the overall health of patients in Medicaid.

That’s the bottom line of a long list of recommendations the National Quality Forum made recently to HHS, as part of an annual effort to update a list of measurements designed to improve health and control costs in the Medicaid program. The NQF recommendations are consistent with recent discussions at major professional meetings in the field of psychiatry, which are recognizing how depression and major disorders affect physical health.

Medications to control psychosis may even cause diabetes or cardiovascular conditions, and with many mentally ill patients enrolled in Medicaid, these health effects need careful tracking, according to the NQF.

Improving Quality of Care

HHS Secretary Sylvia Mathews Burwell this week awarded $685 million to 39 healthcare networks that are striving to improve quality of care and patient access to information.

The Transforming Clinical Practice Initiative, which is part of the Affordable Care Act, is designed to help doctors at the individual practice level with things like communicating with patients through email, offering real-time alerts about high-risk patients, offering better mental health screening, and giving better warning about substance abuse incidents across multiple care settings.

Professional societies will also receive funds to update practice guidelines and teach members to use new ways of communicating with patients as well as alternate payment models.

In a recent interview with AJMC, Marc Boutin, CEO of the National Health Council, said patient communication is a vastly underused tool:

Value-Based Insurance Design

The American Journal of Managed Care will be covering what’s new in alternate payment models this week, when we visit the annual summit on Value-Based Insurance Design at the University of Michigan, hosted by our co-editor-in-chief, Dr. Mark Fendrick.

Look for our coverage later this week at ajmc.com.

For everyone at the Managed Markets News Network, I’m Justin Gallagher. Thank you for joining us.