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Practice Transformation

AMA to take on senior polypharmacy
Following up on recommendations from the AMA Senior Physicians Section, AMA delegates recently adopted “Reducing Polypharmacy as a Significant Contributor to Senior Morbidity.” It directs the AMA to work with appropriate stakeholders such as pharmacists, EHR vendors, PhRMA and AARP to, among other things, encourage physicians and their teams to initiate discussions with patients on improving their medical care through the use of only the minimal number of medications needed to optimize their health. Another recommendation: Include nonprescription medicines and supplements in medication lists and compatibility screens. (AMA; “Reducing Polypharmacy as a Significant Contributor to Senior Morbidity”)
Insulin rationing common even among the insured
In the US, insulin rationing due to cost is common even among those with private health insurance, according to a paper published in the Annals of Internal Medicine. The findings from the 2021 National Health Interview Survey suggest that about one in six people with insulin-treated diabetes in the US practice insulin rationing due to the price. The finding regarding privately insured individuals was “somewhat surprising,” lead author Adam Gaffney, MD, tells Medscape Medical News, noting that it likely reflects issues such as co-pays and deductibles, along with other barriers patients face in the private health insurance system. (Annals of Internal MedicineMedscape Medical News)

Evidence & Innovation

CBO issues report on controlling provider costs
The prices that commercial health insurers pay for hospital and physician services are much higher than those paid by public health insurance programs. In a new report, the Congressional Budget Office has identified policy approaches that federal lawmakers could adopt to address this. The CBO identified three broad categories: Promote competition among providers; promote price transparency; and cap the level or growth rate of prices. This third bucket, which would involve regulating prices paid to providers, would yield moderate to large price reductions, according to the CBO. (CBO report)
Providers still leaving the profession, report finds
An estimated 333,942 health care providers dropped out of the workforce in 2021 for reasons that include retirement and burnout, according to a report published last week by Definitive Healthcare. As a profession, physicians saw the biggest drop, with 117,000 individuals leaving in 2021, followed by nurse practitioners (53,295) and physician assistants (22,704). Internal medicine saw the largest exodus out of any physician specialty, losing 15,000 providers in 2021; family medicine came in second, losing 13,015 physicians. Definitive’s findings are based on claims data. (Healthcare InnovationModern Healthcare)
Policy Solutions
Biden to HHS: Develop payment models to address drug prices
President Biden is calling for new payment and delivery models that will lower drug prices in a new executive order. The executive order calls on HHS to craft a report outlining the payment models that will test how to improve access to innovative drugs and lower costs for those in Medicare and Medicaid. The order applies to models that can be tested under the Center for Medicare and Medicaid Innovation. The push to consider drug prices at CMMI comes as the center is incorporating new provisions to address gaps in health equity. (Fierce Healthcareexecutive order)
DOJ sues Cigna for MA fraud
The Justice Department has sued Cigna for Medicare Advantage fraud, alleging that it collected tens of millions of dollars in excess Medicare payments by exaggerating its members’ illnesses. According to the DOJ, from 2012 to 2019, Cigna hired providers—usually nurse practitioners—to visit members’ homes and falsely document medical conditions to increase the revenue it generated from taxpayers. The providers did not perform or order testing that would have been required to reliably diagnose those conditions, according to the DOJ. Other Medicare Advantage carriers are under scrutiny as well, reports Modern Healthcare. (Modern Healthcare)

In Case You Missed It!

October 2022 Policy Update: ERIC & GTMRx’s PBM Transparency Advocacy Campaign
After a short September of work in Congress, House and Senate members are once again back at home, campaigning in advance of the November election. They’ll be gone throughout October, although congressional staff will remain here in Washington, DC most of the time. They’re working to prepare for November and December, wherein Congress will address some must-pass legislation and potentially work to clear the decks before the new Congress convenes in January 2023.
ERIC and GTMRx are still working hard behind the scenes to advance legislation to improve care for patients.
GTMRx Blog |  Overcoming turnover, transitions and a troubled system: Making CMM work in long-term care
Getting the medications right can be a challenge for any patient. When it comes to seniors, however, teams face even more hurdles. Older patients are more likely to be sicker, frailer and on multiple medications, requiring knowledge, expertise and patience. But the greatest challenges for this population may be operational, not clinical.
GTMRx in Health Affairs | Underappreciated CMM is the missing ingredient to value-based models
Comprehensive medication management is the missing ingredient in value-based models, but despite evidence supporting its effectiveness and value, it remains underappreciated and underused, a group of GTMRx leaders write in Health Affairs Forefront. They highlight the evidence for CMM, including how it supports all five elements of the Quintuple Aim—including the newest aim, equity. Their a call to action: Align on the standardized definition of CMM “to promote well-defined CMM practice standards for consistent implementation, and to promote properly resourced CMM services in value-based contracting.” (Health Affairs Forefront)
New Report Available! Optimizing Medication Use for Accountable Care Success
A value-based care resource derived from an event sponsored by the GTMRx Institute & the Institute for Advancing Health Value
This report covers:
  • Comprehensive medication management (CMM) in ACOs/ enhancing value
  • The reported effects of CMM and pharmacy integration
  • The key elements of success for effective medication therapy management programs
  • Key issues impacting CMM success in ACOs, such as:
  • Population health
  • Social determinants of health
  • Using data to transform care
  • Change management/philosophy of practice
  • Network expansion and clinical integration
  • Accountability and relationship management

Read the report here.

Join us to be part of meaningful change
Irma, like many others, struggles as a result of our current trial-and-error approach to medication. That is why we advocate for a new, comprehensive approach to medication use and prescribing. As a non-profit 501(c)(3) and 501(c)(4) organization, the GTMRx Institute and Foundation relies on funding from our supporting members. We ask that you consider becoming a Supporting Signing Member so we can continue to provide relevant, timely resources to get the medications right!
If you’re interested in supporting the Institute or Foundation at a higher level, please contact us. Your dollars will bring about meaningful change for people like Irma.

Become a Supporting Member Today

AmazonSmile is an easy way for 0.5% of your qualified purchases go to the GTMRx Foundation at no cost to you. And signing up is simple—go to and select “Get the Medications Right Foundation” as your charity of choice. If you prefer to directly donate instead, you can do so here.
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.
The GTMRx Institute is supported by our Founding Funders, Executive Members and Strategic Partners.
  See past issues of our weekly news brief here

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