This Week in Managed Care: February 20, 2016

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.

Identifying Core Quality Measures

This week, CMS and America’s Health Insurance Plans (AHIP), which represents the nation’s insurers, unveiled 7 sets of core quality measures that the two agree represent the best way to judge whether doctors are doing a good job delivering care.

The movement away from fee-for-service has brought with it different ways to measure quality, and often each payer or reporting group had its own set of measures. The effort by CMS and AHIP, which was endorsed by the National Quality Forum, seeks to give doctors fewer, but more meaningful measures.

The 7 cores sets of measures will cover:

• Accountable care organizations, patient-centered medical homes, and primary care
• Gastroenterology
• HIV and hepatitis C
• Oncology
• Obstetrics and gynecology
• Orthopedics

Evidence of VBID's Success

As employers and health plans experiment with value-based insurance design, there’s more evidence that the idea works. In the current issue of The American Journal of Managed Care, a study involving employees in the Geisinger Health System found that removing co-payments for drugs to treat chronic conditions, such as diabetes and hypertension, drove down total healthcare costs by $144 per person per month.

That’s no surprise to AJMC’s co-editor in chief Dr Mark Fendrick, who said the study shows that value-based insurance design, or VBID, can benefit both patients and payers. “The fact that these positive findings occurred within the context of an employee wellness initiative should encourage those employers who have considered moving toward clinically nuanced benefit designs, but have been reluctant to make that leap.”

Read the full article.

Breakthrough Designation for PD-LI Inhibitor

There’s more good news this week in immuno-oncology. AstraZeneca announced that the FDA granted breakthrough designation to its PD-L1 inhibitor, durvalumab. The monoclonal antibody is being developed to treat PD-L1 positive patients with inoperable or metastatic urothelial bladder cancer, once their disease has progressed on standard therapies. The breakthrough designation is based on early data from a phase 1 trial.

AstraZeneca is also studying the drug as a first-line therapy for metastatic bladder cancer, which is an area of great unmet need.

Austism Screening Recommendations

The US Preventive Services Task Force caused controversy this week when it said there wasn’t enough evidence to screen all toddlers for autism, despite rising rates of the condition in recent decades. The nation’s pediatricians and autism advocacy groups strongly criticized the decision, which they say will cause some cases to be missed until children are much older.

The American Academy of Pediatrics has called for universal screening for autism since 2007, because early intervention and treatment leads to better outcomes. But the task force said more research is needed to learn whether there are potential harms to screening all children. The decision is important, because task force decisions guide whether health services are covered under the Affordable Care Act.

Patient-Centered Diabetes Care

Patient-Centered Diabetes Care is just around the corner. It’s coming April 7th and 8th in Teaneck, New Jersey, and our keynote speaker, Dr Lonny Reisman, discussed the clinical dimensions that will be part of his address. Watch the video interview.

Learn more about Patient-Centered Diabetes Care and register.

For all of us the Managed Markets News Network, I’m Justin Gallagher. Thanks for joining us.