This Week in Managed Care: February 6, 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.

Insurers Concerned Over ACA Exchanges' Sustainability

This week, the big news was the future of the Affordable Care Act, as another giant insurer asked whether the exchanges that are a central feature of healthcare reform can last for the long haul.

Aetna, which has 750,000 customers on exchanges in 15 states, has lost $100 million in ACA business thus far. Like other payers, Aetna said CMS must stop the abuse of special enrollment periods, which are causing some consumers to wait until they are sick to sign up for coverage. CMS is starting to crack down on this practice, and it is believed that the higher penalty for not being insured will push more healthy consumers onto the exchanges.

But out west, the director of Covered California, Peter Lee, said this week that UnitedHealth only had itself to blame for its losses on the insurance exchanges and should stop complaining about Obamacare.

A report from the Urban Institute seemed to agree that UnitedHealth’s network strategy left the insurer with more than its share of the sickest patients.

UnitedHealth lost $435 million on the ACA in 2015, and it is projected to lose $500 million this year.

National Health Policy Conference

Meanwhile, many in the healthcare industry met this week at AcademyHealth’s National Health Policy Conference in Washington DC, where Dr Patrick Conway, deputy administrator for innovation and quality at CMS, spoke with AJMC about the pace of payment reform. Watch the video here.

This week’s National Health Policy Conference also featured a panel of health economists and policy leaders who asked what can be done about rising drug prices and their effect on consumers, including seniors.

The problem with limits on price is their effect on the long run according to Dana Goldman, PhD. “Any markup on a product will limit access. So from a social perspective, we can set prices at cost of production. The problem is that in the long run, we need incentives for innovation.”

The panelists discussed the used of value-based pricing and increasing brand transparency, as well as changing incentives for physicians. Read the full story.

A Link to Autism in Children

Is a mother’s obesity or diabetes linked to a child’s autism? A study published in the journal Pediatrics says yes.

The study examined records of more than 2700 children born between 1998 and 2014 and found that obese women with diabetes were 4 times more likely to have children with autism. Unfortunately, it is not clear why diabetes and obesity contribute to the risk. Researchers also found a similar pattern of increased risk of intellectual disabilities.

CDC Warns About Drinking Before Pregnancy

Finally, the CDC is warning women in their childbearing years: If you might try to become pregnant, drinking alcohol is not worth the risk. Researchers found that 3.3 million women in the United States are at risk of an alcohol-exposed pregnancy in any given month.

Women are drinking at rates almost as high as men, and because one-half of pregnancies are unplanned, public health officials worry more about the harm caused in the first weeks of pregnancy, before mothers know they are expecting.

Health effects of alcohol use during pregnancy include mental health disorders, social problems at school and at work, and substance abuse. Read the story.

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