Practice Transformation
Patients with cardiovascular disease who had worse composite scores for six social determinants of health—including education, 30-day food security and health insurance—were less likely to adhere to all the measures recommended to lower their risk of contracting and spreading COVID-19, according to research published in Circulation: Cardiovascular Quality and Outcomes. “Identifying and prioritizing individuals whose medical vulnerability is compounded by social adversity may optimize emerging preventive efforts, including vaccination guidelines,” the researchers conclude. (Circulation: Cardiovascular Quality and Outcomes; Medscape Medical News)
Telehealth use dropped for the second month in a row in March, though the rate of decline slowed a bit, according to new data tracked by nonprofit Fair Health. Telehealth claim lines, as a percentage of all medical claims among the commercially insured population, fell 5.1% nationally from February to March, following a sharper drop of 15.7% from January to February as vaccination efforts ramped up and COVID-19 cases declined as a result. (Healthcare Dive; Fair Health)
Evidence & Innovation
Making cancer detection, as well as early and effective treatment, a high priority can bend the cost curve, improve care quality and extend the lives of people with cancer. That may sound obvious, but one opportunity available to improve the scenario has not yet been fully leveraged, writes Joel Diamond, MD, FAAFP: Using genetic and genomic insights to identify risk earlier, arrive at diagnoses sooner and initiate the most effective therapy for each individual patient faster. Precision medicine can close care gaps to reduce incidence of cancer. (MedCity News)
The CMS Center for Medicare and Medicaid Innovation could mandate more participation in its models, Director Liz Fowler told attendees at a recent Health Affairs event. She wants to recapture the health care industry’s lost momentum on the transition from volume- to value-based care, which stalled in recent years because it’s relatively easy for most providers to continue practicing fee-for-service medicine, Modern Healthcare reports. “The penalties for doing so are really not that great,” Fowler said. (Modern Healthcare*)
Policy Solutions
Vaccinations matter, and we’re starting to see the consequences of low COVID-19 vaccination rates. States with higher vaccination rates now have markedly fewer coronavirus cases, but infection rates are rising in many places with lower vaccination rates, according to a new Washington Post analysis. States with lower vaccination rates also have significantly higher hospitalization rates. The connection between vaccine shots and coronavirus cases also hold up at the county level. (Washington Post)
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In Case You Missed It!
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.
This roundtable will be focused on payment, policy and practice reform to support optimized medication use. The event will be moderated by Susan Dentzer, Senior Policy Fellow, Robert J. Margolis Center for Health Policy at Duke University with welcome and introductions by GTMRx President Paul Grundy, MD, Chief Innovation Officer, Innovaccer. The rest of the agenda includes:
- Value Based Payment: Current Landscape
- Introduction by Brian Litten, J.D., Chief Strategic Growth Officer, Tabula Rasa HealthCare; GTMRx Pharmacogenomics Payment and Policy Taskforce Co-lead
- Andrew MacPherson, Managing Partner, Healthsperien, LLC
- Measures to Motivate Adoption
- Introduction by Kathy Pham, PharmD, BCPPS, Policy and Professional Affairs Director, American College of Clinical Pharmacy (ACCP); GTMRx Payment and Policy Solutions Workgroup Co-lead
- Curtis Haas, PharmD, FCCP, Chief Pharmacy Officer, University of Rochester Medical Center in New York
- Value Based Payment: CMS
- Introduction by Tom Kraus, J.D., MHS, VP Government Relations, American Society of Health-System Pharmacists (ASHP); GTMRx Pharmacogenomics Payment and Policy Taskforce Co-lead
- Amy Bassano, Deputy Director of the Center for Medicare and Medicaid Innovation (CMMI) at the Centers for Medicare and Medicaid
- Reactor Panel discussion
- Matt Salo, Executive Director, National Association of Medicaid Directors (NAMD)
- Allan Goroll, MD, Professor of Medicine, Harvard Medical School, Massachusetts General Hospital
More information can be found here. Interested in sponsorship or attending? Contact Jeff Hanson (e: [email protected]).
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.
Unless we get more needles in arms, more people will die. Even if we meet President Biden’s goal of 70% of U.S. adults at least partially vaccinated by July 4, that means 30% will remain completely unvaccinated. A lot of those people in that 30% have no plans to get the shot. We’re running out of people who want the vaccine. Read the rest of the blog here to see how we propose to overcome this.
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