This Week in Managed Care: May 12, 2017

The replacement for the ACA heads to the Senate, Scott Gottlieb, MD, is the new FDA Commissioner,a nd Medicare can’t figure out how to pay for CGM. Welcome to This Week in Managed Care, I’m Laura Joszt.

Senate in Control of ACA Replacement

The spotlight is now on the Senate, after the House of Representatives voted 217 to 213 last week to pass the American Health Care Act, which replaces key provisions of the Affordable Care Act. The impasse ended after New Jersey Congressman Tom MacArthur offered an amendment that would give states flexibility over essential health benefits and community rating.

Several medical groups, including the American Medical Association, say the bill does not have enough funding for risk pools to cover those with high-cost pre-existing conditions. Before the vote, AMA President Andrew Gurman said: “None of the legislative tweaks under consideration changes the serious harm to patients and the healthcare delivery system if the AHCA passes. … Millions of Americans will lose their health coverage as a direct result of this proposal.”

For full coverage, read the article.

Gottlieb Confirmed for FDA Commissioner

Dr Scott Gottlieb is the new FDA Commissioner, following this week’s 57 to 42 Senate vote. Gottlieb has served in several posts at FDA, including deputy commissioner. While some critics say he is too close to the drug industry he will now regulate, his supporters say he has a deep understanding of the issues and his experience is greatly needed in a time of rising drug prices.

Dr Gottlieb has promised to recuse himself for 1 year from agency decisions involving more than 20 companies with which he had a relationship.

ACO Coalition Recap

Stakeholders from across the healthcare industry gathered in Scottsdale, Arizona, last week for the spring meeting of the ACO and Emerging Healthcare Delivery Coalition, which featured networking and up-to-the-minute presentations about a changing payment and care landscape.

Sachin Jain, MD, of CareMore took time to discuss a new program for seniors that tackles loneliness, a driver of poor health outcomes:

Watch the interview.

Dexcom's Coverage Limbo

In January, Medicare beneficiaries with type 1 diabetes were thrilled to hear about a rule change that meant they could get coverage for the Dexcom G5, a continuous glucose monitor that would warn them if they were in danger of hypoglycemia. But in recent weeks, many have learned that Medicare has not yet worked out payment details with suppliers, and those vendors are sending word that they won’t fill prescriptions until CMS finalizes the details.

It’s a source of frustration for those patients who had already gone through exhausting appeals and now must wait even longer.

Dexcom issued a statement that it is working with CMS on the problem: “We are focused on finalizing this process with CMS to ensure our current and new customers get what they need. We are working to resolve this situation as quickly as we can and hope to have it all resolved by summer.”

Coverage From Digestive Disease Week

Hospitalized patients who are obese are more likely to be readmitted to the hospital and have longer, more expensive hospital stays, according to a study The American Journal of Managed Care covered at Digestive Disease Week, held earlier this week in Chicago. While obese patients are more likely to be admitted the study found that their mortality improved.

See full coverage from Digestive Disease Week.

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