This Week in Managed Care: October 5, 2018

Work in immunotherapy wins the Nobel Prize, physician-run ACOs bring savings for Medicare, and the struggle to limit antibiotics starts with patients.

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

Nobel Prize in Medicine

This year’s Nobel Prize in Medicine went to 2 pioneers who made the basic discoveries behind checkpoint inhibitors, which have offered an entirely new way to treat cancer.

James Allison, PhD, of MD Anderson Cancer Center, and Tasuku Honjo, MD, PhD, of Kyoto University, will share the $1 million prize for work performed in the 1990s.

Allison discovered that blocking the CTLA-4 protein could boost T-cell responses and he did the first experiments with mice to show that this mechanism could shrink tumors. He developed ipilimumab, which is sold as Yervoy by Bristol Myers Squibb.

Honjo’s team worked separately to understand the mechanism to block the PD-1 protein, which was developed into nivolumab (Opdivo) by BMS, and pembrolizumab (Keytruda) by Merck.

The American Journal of Managed Care^® (AJMC^®) was on hand in New York City when Allison appeared at an international immunotherapy meeting on the day of the announcement, where he talked about the uncertainty of science. He said, “How do you know what’s going to be relevant or not? I think you should pick your problem, work on it, do the best work you can.”

Savings by Physician-Led ACOs

Accountable care organizations (ACOs) led by physicians save more money than those organized by hospitals, and the benefits for Medicare have grown in the past 3 years, according to a new study.

Research in the New England Journal of Medicine, which was based on claims data from 2009 to 2015, found that physician-led ACOs had more reductions in spending per Medicare beneficiary than hospital ACOs, and the reductions were greater as the ACOs gained experience.

The authors, who include AJMC^® co-editor-in-chief Michael Chernew, PhD, say recent CMS calls to push ACOs to adopt downside risk on a faster timeline could be counter-productive.

They wrote: “Our results also suggest that shared-savings contracts that do not impose a downside risk of financial losses for spending above benchmarks—which may appeal to smaller organizations without sufficient reserves to withstand potential losses—may be effective in lowering Medicare spending.”

Unnecessary Antibiotics

Patients who receive an antibiotic are happiest with their doctor’s visit, whether or not they needed the drug. A study reported in JAMA found that concern about patient satisfaction scores may influence doctors to prescribe antibiotics even when they are not necessary.

The study looked at more than 8300 appointments for respiratory tract infections and found that 66% received antibiotics for a condition that rarely calls for one. Routine overprescribing of these drugs can lead to antibiotic resistance.

Health Impact of Assault, Harassment

Between 40% and 75% of American women have experienced sexual harassment in the workplace, and 36% of women have experienced sexual assault, and they experience health issues, as a result, according to research published this week in JAMA.

More women are acknowledging the problem as attention has turned to sexual assault allegations against Supreme Court nominee Judge Brett Kavanaugh.

The first study of women aged 40 to 60 found the following:

• 19% had a history of workplace harassment
• 22% had a history of sexual assault
• 10% had a history of both harassment and assault
• A history of harassment was associated with hypertension
• A history of sexual assault was linked to depression and poor sleep

A separate letter about sexual harassment in the medical field in Germany found that 70% reported some form of misconduct, and women reported that the harassers were 85% male, though fewer men reported the same.

Diabetes Educators

Finally, the current issue of Evidence-Based Diabetes Management is available featuring coverage on the topic of diabetes education and payment reform. Leading off the issue is a commentary from Hope Warshaw, a former president of the American Association of Diabetes Educators (AADE), on the need to remodel diabetes self-management education and support.

The issue features examples from Livongo and Welldoc, and coverage from the recent AADE annual conference in Baltimore, Maryland.

Read the full issue.

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