Practice Transformation
The pandemic accelerated the move from private practice to corporate medicine, Fierce Healthcare reports. Between Jan. 1, 2019, and Jan. 1, 2021, hospitals, payers and other entities acquired 20,900 practices, according to the Physicians Advocacy Institute. During that period, 48,400 physicians left independent practice to work for a larger employer. Most of this activity occurred between July 1, 2020, and Jan. 1, 2021. As of Jan. 1, 2021, nearly half of all U.S. practices were owned by hospitals or corporate entities, and 70% of physicians were employed by them. (Fierce Healthcare)
Evidence & Innovation
To engage community pharmacy in CMM, assess acceptability, appropriateness and feasibility: That’s a lesson Health Partners learned and shared. The team published its findings in the Journal of Managed Care &Specialty Pharmacy. “It is important to assess acceptability, appropriateness, and feasibility early when implementing new care models… since these outcomes can affect implementation success. The results of this assessment are important for the continual development of strategies to maximize CMM engagement and optimize medication outcomes and access to CMM for patients. The results could inform the development and implementation of similar CMM value-based care programs.” (JMCP)
July 1, Cigna began to pay members to switch to biosimilars. Providers object, arguing that the new policy crosses the line between covering medical expenses and practicing medicine; they also say it threatens patient health. Cigna says it expects patients to save at least 10% on their medicines in the short-term and that the health care system overall could save $375 billion over the next decade. UnitedHealth Group launched and abandoned a similar plan three years ago, Modern Healthcare reports. It also notes that some biosimilars actually cost more than the drugs they are intended to replace. (Modern Healthcare*)
Large, self-insured employers must align in order to negotiate for lower prices with providers, according to a study published in the American Journal of Managed Care. Market power does not always result in lower negotiated prices: As Becker’s framed it, “hospitals hold the cards in what they charge.” The authors identify two ways to gain some power at the table: Leverage employer coalitions to pool employees (which would require “a considerable number of employers”) or work with local government on purchasing alliances. (American Journal of Managed Care; Becker’s Hospital Review)
Policy Solutions
HHS will make approximately $103 million in American Rescue Plan funding available to tackle health care worker burnout and promote mental health. The funds will support programs to help health care organizations in rural and medically underserved communities build resiliency among newer health care workers and mentor providers on how to respond to stressful situations. “It is essential that we provide behavioral health resources for our health care providers … so that they can continue to deliver quality care to our most vulnerable communities,” HHS Secretary Xavier Becerra said in a statement. (Modern Healthcare*)
Anthem and Humana have invested nearly $140 million to form a new pharmacy benefit manager, even as criticism over traditional PBMs’ operations mounts. The insurers will hold a minority stake in the new joint venture, DomaniRx. SS&C Technologies, a fintech company, owns approximately 80% of the new business, Modern Healthcare reports. By combining claims administration with data analytics, DomaniRx aims to offer payers more transparency into their drug costs and help them better comply with changing government regulations. (Modern Healthcare*)
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In Case You Missed It!
Medicine is how we treat most conditions: Roughly 75%-80% of physician office and hospital outpatient clinic visits involve medication therapy. And more often than we would like, it is how disasters occur. More than 275,000 die each year because of medication misuse, overuse or underuse. The financial cost tops $528 billion annually, and employers are on the hook for a large portion of that.
Employers have the incentive, the leverage and the responsibility to change this. The evidence, best practices and tools are there to solve the systemic issues that lead to suboptimal medication use. Employers can lead the charge, through their contract authority and work with their suppliers, but they first must understand just how irresponsible doing nothing is. Download the issue brief for more.
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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Adding the foundation on AmazonSmile will help us continue to provide no cost educational webinars, issue briefs, weekly news briefs and promote the need for transformation of our current system of medication use through social media campaigns.
