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Aug. 25, 2020
 
 
 
 
ACCOUNTABLE CARE ORGANIZATIONS
 
 
Less than 20% of Medicare spending is value-based
HealthLeaders Media
Less than 20% of Medicare spending is value-based, according to a Coverys study released Aug. 18. The Boston-based health insurance company stated in its report that around $1 trillion of healthcare risk must shift from the federal government to hospitals in order to meet the Center for Medicare and Medicaid Services' goal for Medicare providers to be in a fully value-based reimbursement model by 2025.
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Proposed 2021 Medicare pay schedule: 9 things doctors should know
AMA
Significant positive changes are on the way for 2021 related to coding and payment for evaluation and management physician office-visit services. Also looming, however, are several potential negative changes, such an offsetting across-the-board payment cut for all physicians and other health professionals, as detailed in the proposed 2021 Medicare physician payment schedule issued by the Centers for Medicare and Medicaid Services.
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MANAGED HEALTHCARE NEWS
 
 
Survey finds nearly half of Americans having insurance coverage troubles
Fierce Healthcare
The first half of this year had 43% of working-age adults without stable insurance, an issue compounded by not just the COVID-19 downturn but by lingering problems with health plan affordability, a new survey finds. The survey, published Aug. 19 by the Commonwealth Fund, looks at reasons for instability in health insurance coverage, which has been thrown into disarray due to major job losses from the COVID-19 pandemic.
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SPONSORED CONTENT
Promoted by Moss Adams LLP
• Tips to Help Your Health Care Organization Combat Coronavirus Complications
• 4 Ways Lean Health Care Helps Hospitals Confront Sepsis and Other Safety Concerns
• Keep Physician Compensation Contracts in Compliance to Avoid Stark Law Violations (January 2019)
• On demand webcast: Patient Safety Awareness Week: Improve Patient Safety with Lean, featuring PeaceHealth
 
 
How technology can revolutionize outcomes-based care
Managed Healthcare Executive
Sometimes, big changes in how we work and live are driven by technology. Think smartphones, for example. At other times, social change and technological innovation dovetail perfectly to help us reimagine what we do. In healthcare, over the last decade, the focus on outcomes-based care has coincided perfectly with advances in network-based communication to open a new world of patient experience solutions that produce results for hospitals and the public.
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GENOMICS & BIOTECH
 
 
DNA nanoswitches may provide an inexpensive platform to rapidly detect emerging viruses
News-Medical.Net
Programmable DNA nanoswitches that bind to viral RNA in human body fluids may provide an inexpensive platform to rapidly detect a wide variety of emerging viruses, including SARS-CoV-2, according to a new study. This approach may make testing more manageable in resource-limited areas, since it does not require enzymes or significant laboratory infrastructure, only costs about ¢1 cent per reaction and can be performed within hours.
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There are 568 genes that can trigger cancer, researchers say
Becker's Hospital Review
Scientists in Spain have identified more than 500 genes with the potential to trigger cancer. Researchers from Institute for Research in Biomedicine Barcelona in Spain performed a computational analysis of about 28,000 tumors from 66 types of cancer. They pinpointed 568 cancer driver genes, which play specific roles in the regulation of cell growth, the cell cycle and DNA replication.
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Genomics study shows multiple and diverse SARS-CoV-2 introductions in the US capital region
News-Medical.Net
A recent study led by the researchers from Johns Hopkins University reveals multiple and diverse introductions of severe acute respiratory syndrome coronavirus 2 in the U.S. National Capital Region during the initial phase of coronavirus disease 2019 pandemic.
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SPONSOR SPOTLIGHT
 
 
 
 
BEHAVIORAL HEALTH
 
 
Concern over rising number of children with behavioral health problems in hospital ERs
New Hampshire Union Leader
Medical professionals said Aug. 19 an emerging concern in dealing with COVID-19 was the rising number of children with behavioral health problems waiting in hospital emergency rooms for a psychiatric bed. The National Alliance for Mental Illness in New Hampshire reported there were 23 children and 42 adults housed in emergency rooms last week.
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Mental health a concern as students head back to class
KCNC-TV
Even before coronavirus, teen suicide was a problem across the nation. Now, as students head back to class, some worry how the pandemic has added pressure will affect students. “This upcoming school year I am worried, because there’s so many uncertainties for students,” said Kari Eckert. Eckert is the founder of Robbie’s Hope, named after her son, who took his own life in 2018.
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FEATURED ARTICLE
Tolmar Affirms Supply of FENSOLVI®
Promoted by TOLMAR Pharmaceuticals, Inc
Tolmar Affirms Supply of FENSOLVI® (leuprolide acetate) for Pediatric Patients with Central Precocious Puberty; Company increases U.S. manufacturing capacity of drug to ensure uninterrupted supply amid industry shortage
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Alert system for mental health crises advanced by lawmakers
The Associated Press
A Virginia Senate committee has approved legislation that would establish an alert system to dispatch mental health providers along with police to help stabilize people in crisis situations, a move prompted by the police killing of a high school teacher in Richmond police two years ago.
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NAMCP UPDATES
 
 

In late 2018, the National Association of Managed Care Physicians (NAMCP) decided to create the Value Based Care Council (VBCC). The VBCC mission supports empowering medical directors with information and resources to assist them in making value based decisions that support achieving the Triple AIM of improved outcomes and the patient experience while reducing overall costs. The goal is to improve the integration of cost, quality, and access in the clinical decision making process so as to enhance the effectiveness and efficiency of extracting value from the associated spend in order to optimize outcomes.

Pursuant to the above, and in response to an unmet need in the marketplace, the VBCC developed a short form in order to enhance the effectiveness and efficiency with which value propositions can be shared between industry and the medical leadership of various payers throughout the country. This same short form provides a concise and consistent manner with which value propositions can be shared and provides the ability to align expectations prior to actually conducting conversations or having a meeting regarding a product or service.

The Product Value Proposition Customer Engagement Short Form can be found on the NAMCP website (www.namcp.org) in the Value Based Care Council subsection of the Councils tab, under tools and resources. Please contact Will Williams at wwilliams@namcp.org with questions or for additional information.


Jazz Pharmaceuticals is excited to announce the approval of ZEPZELCA™ (lurbinectedin) for the treatment of adult patients with metastatic small cell lung cancer (SCLC) with disease progression on or after platinum-based chemotherapy. ZEPZELCA is a second-line therapy that has been studied in both platinum-sensitive and -resistant SCLC patients. Please click here for more information.


Takeda Pharmaceuticals is part of, "The Fight Is In Us", an initiative to maximize the individual and societal benefit of COVID-19 plasma. The campaign will focus on recruiting COVID-19 survivors to donate their plasma at licensed blood and plasma donor centers.
  • If you’ve recovered from #COVID19, your immune system has antibodies that could be used as a treatment. See if you can help others by donating plasma www.TheFightIsInUs.org. #TheFightIsInUS

  • The antibodies that helped you or someone you know fight off COVID-19 may be able to help others. Visit www.TheFightIsInUs.org to see if you qualify to donate plasma. #TheFightIsInUs
You are a survivor, now you could be a hero. Plasma from recovered #COVID19 patients could play a key role in creating a potential therapy for coronavirus. Learn how you can donate at www.TheFightIsInUs.org #TheFightIsInUs


Biodesix, Inc., a leading diagnostic company in lung disease, recently announced a partnership with Bio-Rad Laboratories, Inc. (NYSE: BIO and BIOb) to bring a COVID-19 Droplet Digital PCR (ddPCR) test to the FDA for an Emergency Use Authorization (EUA) approval to support the escalating need for testing in the U.S. Two studies published this month, ahead of peer review, reported that ddPCR testing showed superior sensitivity and precision for clinical detection of SARS-CoV-2 (the virus that causes COVID-19) compared to existing test methods that are performed using qPCR. Biodesix currently has a focus on lung disease and offers other diagnostic testing for lung cancer utilizing the ddPCR platform.Click here for more information.


"Modeling Cost-Effectiveness of On-Demand Treatment for Hereditary Angioedema Attack" was recently published in the Journal of Managed Care Pharmacy's February 2020 issue. Hereditary angioedema (HAE) is a rare disease that causes painful and potentially fatal episodes of swelling (attacks). HAE attacks can be unpredictable and the need to treat sudden attacks promptly and effectively is critical to minimize risk of hospitalization, morbidity, and mortality. A cost-effectiveness model was evaluated that considers evaluation of on-demand medications, healthcare utilization and patient well-being. For access to the publication, please click here.


Biodesix, Inc. announced initiation of the next phase of their biomarker development program with Merck KGaA, Darmstadt, Germany and Pfizer Inc. The companies have completed initial discovery and development of a new proteomic test that identifies likely responders to the anti-PD-L1 checkpoint inhibitor (BAVENCIO®) (avelumab). Development efforts will now focus on transferring the test into Biodesix's CLIA lab in Boulder, CO for clinical phase test validation. The new test was developed through retrospective analysis of the circulating proteome of cancer patients treated with the investigational drug candidate, utilizing the proprietary Biodesix Diagnostic Cortex™ artificial intelligence (AI) platform. Click here to read the full press release.


The NAMCP Medical Directors Institute recently held the first meeting of its Executive Leadership Council (ELC) at the recent Fall Managed Care Forum. The NAMCP Medical Directors Institute decided in late 2018 to create the Value Based Care Council (VBCC) with a mission to empower medical directors with information and resources to assist them in making value based decisions that support achieving the Triple AIM of improved outcomes and the patient experience while reducing overall costs. Click here to view an overview of the genesis, formation, and work of NAMCP's Value Based Care Council. Please click here to view the press release.


LivaNova PLC (NASDAQ:LIVN), a market-leading medical technology and innovation company, today announced the first patient enrolled in "A Prospective, Multi-center, Randomized Controlled Blinded Trial Demonstrating the Safety and Effectiveness of VNS Therapy® System as Adjunctive Therapy Versus a No Stimulation Control in Subjects With Treatment-Resistant Depression" (RECOVER). The study will evaluate Vagus Nerve Stimulation Therapy (VNS Therapy) for Treatment-Resistant Depression (TRD) in accordance with the U.S. Centers for Medicare & Medicaid Services (CMS) National Coverage Determination as part of its Coverage with Evidence Development Program. The first patient was enrolled by Dr. Azfar Malik in St. Louis. Click here to read the full press release.


Biodesix, Inc. this week highlighted findings from multiple studies demonstrating the significance and clinical utility of its VeriStrat® blood-based proteomic test as a predictive biomarker for patient survival outcomes and as a diagnostic tool to improve the clinical management of patients with non-small cell lung cancer (NSCLC). This information is vital to implementing optimal treatment strategies for patients and supports disease state monitoring. To date, VeriStrat testing has helped more than 50,000 patients in determining the best treatment for their lung cancer. Click here to see the full press release.
 
 
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