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.ACCOUNTABLE CARE ORGANIZATIONS
The future success of ACOs depends on fixing current challenges
AJMC
When the Affordable Care Act passed, accountable care organizations seemed like the future hope for health care in the U.S., but the reality 10 years later is that implementing ACOs and changing health care has not been as simple as initially expected, said Francis J. Crosson, MD, immediate past chair of the Medicare Payment Advisory Commission, during a session at the National Association of ACOs fall meeting.
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Differences in savings and quality by type of ACO model
AJMC
The evolution in the accountable care organization payment model initiatives by CMS reflects an increased understanding of the benefits and hurdles of using such an advanced payment model. As the Medicare Access and CHIP Reauthorization Act requires Medicare providers to choose an incentive-based payment track, which can include participation in an ACO, understanding what is achievable in the different types of ACO models is important.
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.MANAGED HEALTHCARE NEWS
New transparency rules mean health plans, PBMs must disclose their accumulators, maximizer programs
Managed Healthcare Executive
Coupon accumulators have been controversial for many reasons, but one of them is the element of surprise. Plan members use coupons to cover their copays and out-of-pocket costs. The savings may be a huge relief, but members haven’t always realized that because their health plan or its PBM was using an accumulator, the value of the coupon not counting toward the deductible.
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New state copay accumulator laws complicate the coupon compliance landscape
Managed Healthcare Executive
In recent years, the federal and state legal requirements governing drug distribution and reimbursement have become increasingly discordant. This has stemmed in part from a politically divided Congress, which has made it difficult to pass comprehensive federal legislation, and the fact that many states have pioneered ahead with ambitious reforms. It also stems from the differing incentives and concerns facing federal and state lawmakers.
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.GENOMICS & BIOTECH
Researchers use genomics to identify diabetic retinopathy factors
University of Illinois at Chicago via ScienceDaily
In a search to discover the genetic factors underlying diabetic retinopathy, University of Illinois Chicago researchers also have identified a new approach that can be used as a template to study other diseases.
In the paper, "Integration of genomics and transcriptomics predicts diabetic retinopathy susceptibility genes," published in eLife, researchers identified genes that respond differently in response to high glucose in individuals with and without diabetic retinopathy.
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CTU’s new grant provides incoming students enrolling in the RN-BSN degree program 20% off tuition for those who apply and start courses by Jan. 5, 2021.
- Program costs starting at $9,984, with grant savings applied
- Save up to $2,496, with grant applied
- Available to apply from Oct. 1, 2020 – Jan. 5, 2021
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Reviewing various biomarker settings for patients with prostate cancer
Cancer Network
Kara N. Maxwell, MD, PhD, expanded upon the available biomarkers for use in prostate cancer in a presentation during the 21st Annual Meeting of the Society of Urologic Oncology. She explained how the available biomarkers can be applied at various points, while also guiding toward which treatments can improve patient care.
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Apollo delivers evidence-based guidelines in an easy to use format, available 24/7 from any internet-connected device. No software download required. Streamline utilization reviews and lower your costs today. Click here  to begin your risk-free trial, or call to learn more! 888.276.5563
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.BEHAVIORAL HEALTH
How to transform the response to those having a mental health crisis
PEW Charitable Trusts
On any given day in the U.S., far more people with serious mental health needs are in jail than in mental health facilities, according to the Treatment Advocacy Center. In Miami-Dade County, Florida, a large percentage of adults suffer from a mental illness such as bipolar disorder or schizophrenia.
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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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COVID-19 fuels depression in pregnant women, new moms
WebMD
COVID-19 may be behind a concerning rise in the number of women suffering anxiety and depression before and soon after childbirth, a new study says.
Researchers from Brigham and Women's Hospital in Boston surveyed more than 1,100 pregnant and postpartum women between May 21 and Aug. 17.
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.NAMCP UPDATES
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| Biodesix, Inc., a leading data-driven diagnostic solutions company with a focus in lung disease, today announced publication of an analysis of the company’s Nodify XL2® lung nodule test. The test supports clinical decision-making for suspicious nodules by more accurately identifying patients with a very low risk of malignancy and shifting those patients into surveillance, thereby minimizing invasive procedures on those with benign nodules. Please click here to view the full press release.
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| LivaNova PLC, a market-leading medical technology and innovation company, today announced the publication of a new study in the International Journal of Bipolar Disorders that showed adding Vagus Nerve Stimulation Therapy (VNS Therapy®) to treatment as usual (TAU) significantly improves outcomes in patients with treatment-resistant bipolar depression (TRBD). The study examined patients from a five-year prospective registry and found 63% of TRBD patients treated with adjunctive VNS Therapy in addition to TAU had a significant reduction in depressive symptoms, as measured by a 50% or greater reduction in the Montgomery–Åsberg Depression Rating Scale (MADRS), compared with 39% of patients in the TAU alone group. Click here to view the entire press release. Click here to view the entire press release.
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| Additionally, LivaNova PLC announced a publication in Contemporary Clinical Trials, which details the design for “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” or the RECOVER clinical study. RECOVER is currently under way as part of a Coverage with Evidence Development framework of the U.S. Centers for Medicare & Medicaid Services’ (CMS) National Coverage Determination process. Click here to view the entire press release.
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| 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.
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| 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.
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| 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
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| 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.
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| "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.
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| 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.
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| 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.
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| 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.
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| 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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