Practice Transformation
CMS’ vision: coordinated, team-based and equitable care
The future of value-based care includes reducing the number of payment models and increasing health equity, according to CMS. It plans to prioritize coordinated, team-based care, outcomes measurements that matter to patients, and holding providers more accountable, CMS and CMS Innovation Center leaders wrote in a recent Health Affairs Blog post. Their objective: a health system that eliminates disparities through high-quality, affordable and person-centered care. The agency plans to put health care equity at the center of each model going forward. (Modern Healthcare*; Health Affairs Blog)
Evidence & Innovation
CBD may alleviate clinician burnout
Frontline clinicians working with COVID-19 patients had fewer emotional exhaustion symptoms when treated with cannabidiol (CBD), according to research published in JAMA Network Open. However, five of the 118 participants in the CBD group experienced serious adverse events; they recovered once treatment was discontinued. “Cannabidiol may act as an effective agent for the reduction of burnout symptoms among a population with important mental health needs worldwide,” researchers wrote. “However, it is necessary to balance the benefits with potential adverse and undesired effects when making decisions regarding the use of this compound.” (MedPage Today; JAMA Network Open)
Researchers find potential COVID/AD link
Post-COVID memory problems may be linked to Alzheimer’s disease. PET scans suggest that the infection can cause changes that overlap those seen in Alzheimer’s, and genetic studies are finding that some of the same genes that increase a person’s risk for severe COVID-19 also increase the risk of developing AD. If there is any upside, it’s this: Studies of people who have had COVID-19 may help scientists understand the role infections play in Alzheimer’s and other brain diseases. (NPR)
Policy Solutions
FDA grants full-approval to Pfizer COVID-19 vaccine
Monday, the United States Food and Drug Administration granted the Pfizer-BioNTech COVID-19 Vaccine full approval for those 16 and older. It will remain under emergency-use authorization for those who are 12-15 years of age. “While millions of people have already safely received COVID-19 vaccines, we recognize that for some, the FDA approval of a vaccine may now instill additional confidence to get vaccinated. Today’s milestone puts us one step closer to altering the course of this pandemic in the U.S,” said Acting FDA Commissioner Janet Woodcock, M.D. (FDA; GTMRx vaccine report)
Biden to Congress: Address drug costs
President Joe Biden is calling on Congress to include strict controls on prescription drug prices in the mammoth social policy bill that Democrats plan to draft this fall. He wants at least three measures included in the legislation: He wants Medicare to be granted the power to negotiate lower drug prices, pharmaceutical companies to face penalties if they raise prices faster than inflation, and a new cap on how much Medicare recipients have to spend on medications. (New York Times)
Chamber sues over transparency rule
In its recently filed lawsuit, the U.S. Chamber of Commerce contends that the new rules under Transparency in Coverage Rule are both unlawful and overly burdensome, Modern Healthcare reports. Among the defendants: HHS, CMS, the Department of Labor, the Department of the Treasury and the IRS. The suit specifically targets a provision that requires insurers to post on their websites three machine-readable files: one that shows the in-network rates they’ve negotiated with providers, one with their allowed out-of-network rates and a third that shows the rates for prescription drugs. (Modern Healthcare*)
PBMs sue, too
The Pharmaceutical Care Management Association, an organization representing PBMs, has sued to block the transparency rule requiring them to disclose the net prices they negotiate with drug companies. Defendants include HHS, the IRS and the Department of Labor. The rule threatens to “drive up the total drug price ultimately borne by health plans, taxpayers and consumers by advantaging drug manufacturers in negotiations over price concessions,” according to the association. (Reuters)
Telehealth: Some restrictions return
During the pandemic, many states allowed medical professionals licensed elsewhere to hold telehealth visits with their residents. Some are making the licensing change permanent. Others are not. Among those that plan to return to pre-COVID restrictions are New York, Minnesota, Florida and Alaska. In contrast, Arizona made pandemic-related telehealth waivers permanent, including requiring insurers to cover audio-only visits and allowing out-of-state medical professionals to conduct telehealth visits with patients in the state. (Healthcare Dive)
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In Case You Missed It!
The GTMRx Institute released a 5-minute survey, open until Aug. 25, seeking insight into successful payment models in place for CMM services. If you’re organization is providing CMM services, your input is welcomed. (survey)
EmpiRx, a company focused on value-based care in the pharmacy benefits industry, has dedicated to repairing the United States’ $528 Billion and 275,000 deaths a year suboptimal medication management problem by joining the GTMRx Institute as a bronze Strategic Partner.
We are sharing new survey results that assess the medication management habits and needs of over 1,000 people. Nearly one quarter of people cited that their medications are not routinely reviewed and evaluated by their medical team—shocking, given that one-third are taking four or more medications and/or supplements per day. The GTMRx Institute staff, workgroup and taskforce leaders and participants have created a set of tools to help inform and educate the consumers of health care services—and providers who have direct contact with the consumers—about why it’s important to get the medications right. We invite you to read more, share these tools and join us to ensure appropriate use of medications.
Leadership from GTMRx’s PGx Payment and Policy Taskforce and Payment and Policy Solutions Workgroup have created 5 policy recommendations on PGx + CMM that policymakers should consider to ensure that patient medications are managed safely and effectively based on the unique characteristic of an individual patients’ genetic profile, including:
- Add the assessment of patient medications and drug-gene interactions to Medicare (Welcome to Medicare visit) and Medicaid benefits,
- Require CMS to reimburse preemptive multi-gene panel testing as one single test with one standard compensation code,
- Require CMS to reimburse members of the care team trained to evaluate/manage all medications based on patient’s genotype, multi-drug interactions, Rx metabolism, etc.,
- Direct the National Quality Forum (NQF) to review and make recommendations on drug-gene interaction efficacy and safety checks prior/post admin of drugs within CMM,
- Recommend the U.S. Preventive Services Task Force evaluate evidence of PGx testing and CMM, for drugs with known drug-gene interactions, as a preventive health care practice that addresses patient outcomes/medical expenditures and that should be covered by ACA plans.
In addition to development of Vaccine Confidence Leagues (VCLs) and community-building activities, the task force’s recommendations include:
- Accelerated approval of vaccines
- Public education
- Payment reform
- Improved vaccine access for primary care practices
- More effective immunization information systems (IIS)
- No cost-sharing for certain patients
- Enhanced diversity, inclusion, and equity
Find the report Frequently Asked Questions here.
Read the report here.
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