Oscar Health to enter MA market in 2020 | CVS program lets payers assess cost-effectiveness of pricey new drugs | Simplified tool found lacking in determining children with elevated BP
August 15, 2018
AHIP Solutions SmartBrief
Top Stories
Oscar Health to enter MA market in 2020
Google's parent firm Alphabet plans to invest $375 million in Oscar Health, and the New York City-based health insurer said it intends to use the money to enter the Medicare Advantage market in 2020 and expand its presence in the individual and small-group markets. Oscar has focused on data science and technology to improve the consumer experience and contain costs, with more than 60% of interactions between the health care system and members occurring on a virtual basis.
Modern Healthcare (tiered subscription model) (8/14),  Healthcare Finance (8/14) 
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CVS program lets payers assess cost-effectiveness of pricey new drugs
CVS Health's pharmacy benefit manager unit, CVS Caremark, launched a new program that will let employers and insurers assess cost-effectiveness of therapies and exclude coverage of drugs with extremely high launch prices. The program, which aims to pressure drugmakers to reduce drug costs, will not target drugs with FDA breakthrough status.
The Hill (8/14) 
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The Continuing Need for Evidence in Healthcare
In this free, downloadable white paper from MCG Health, learn about the history of evidence-based medicine, its practical challenges, and challenges around competing recommendations, transparency, and conflicts of interest. Download it here.
Providers & Suppliers
Simplified tool found lacking in determining children with elevated BP
The American Academy of Pediatrics' simplified pediatric blood pressure table based on updated guidelines yielded 99.9% sensitivity and 100% negative predictive value, but only 84.4% specificity and 46.9% positive predictive value in identifying youths with elevated BP, according to a study in JAMA Pediatrics. Researchers suggested that basing the simplified table on a higher height percentile for sex and age, rather than BP cutoffs at the fifth percentile, may improve the tool's specificity and PPV without significantly affecting its sensitivity and NPV.
MedPage Today (free registration) (8/13) 
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Federal Policy and Medicare’s Economic Impact
The first in a series of white papers that will explore the health system, the role of providers, and patient care. Learn about opportunities for differentiation and financial success in a healthcare environment facing looming crises. Access the white paper.
Medical Update
Secondhand smoke exposure in childhood may increase RA risk later
Smoking and nonsmoking women who were exposed to secondhand smoke in childhood had increased odds of developing rheumatoid arthritis, compared with those who were not exposed to secondhand smoke as children, researchers reported in the journal Rheumatology. The findings were based on data involving 98,995 French women followed for up to 30 years.
MedPage Today (free registration) (8/14) 
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HF patients sent DASH diet meals have lower readmission risks
Heart failure patients who received prepackaged meals that followed Dietary Approaches to Stop Hypertension diet recommendations had a lower risk of hospital readmission within 30 days of discharge, according to a 66-patient study in the journal Circulation: Heart Failure. Both groups in the study were given information about following a sodium-restricted diet, but those who also received meals were limited to 1,500 milligrams of sodium a day.
HealthDay News/American Heart Association (8/14) 
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Top 50 U.S. Hospitals Report
Are you targeting current leading hospitals? Stay focused in today's new normal with help from IQVIA. We support commercial managers with targeting data. Let our Top 50 U.S. Hospitals Report guide you with insights on facility type, market size, bed counts, and additional key areas. Get free market insights now.
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Emerging Trends
Report: 38% of Medicaid spending went to managed care in 2012
A Congressional Budget Office report showed Medicaid managed care accounted for 38% of total program spending in 2012. Most US states use some type of managed care in their Medicaid programs, the report said, and in 2014 there were 33 states with comprehensive managed care programs under the Affordable Care Act's Medicaid expansion program.
Health Payer Intelligence (8/14) 
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Medicare Part D is popular but costs are increasing
Medicare Part D has a 73% participation rate among Medicare beneficiaries and premiums have shown little or no growth since the prescription drug program began in 2006. The cost to taxpayers, however, increased from $46 billion in 2007 to $79 billion in 2016, driven mainly from increasing enrollment and higher drug prices, but also by how the program's structure promotes cost growth, writes Austin Frakt of The Incidental Economist.
The New York Times (tiered subscription model) (8/13) 
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Driving HSA Engagement with Technology
As the market continues to grow for Health Savings Accounts (HSA), so does the importance for education around accountholder behavior. Read the latest UMB Healthcare Services' white paper that discusses how Technology and Data Segmentation can drive HSA Engagement. Read here.
Health Insurance Provider Company News
Quality Measurement & Reporting Success
View Inovalon's Insight Brief for lessons learned from the 2018 quality reporting season and Inovalon's 2019 quality reporting checklist for success. Access here.
Solutions Provider News
Pharma News
FDA commissioner: Patients' perspectives should be heard
At a National Health Council briefing, FDA Commissioner Scott Gottlieb discussed the importance of patients' perspectives for drug development, reviews and prescribing practices. Gottlieb shared his experience of being diagnosed with stage 1 Hodgkin lymphoma in 2006 and how daunting it was even with his physician saying he had more than a 90% chance of a complete cure.
MedPage Today (free registration) (8/13) 
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Policy Watch
Immigration proposal could jeopardize public health, advocates say
A Trump administration proposal that would count legal immigrants' use of public health programs such as Medicaid and the Children's Health Insurance Program against them in applications for permanent residency could hurt public health efforts, according to health care leaders and advocacy groups. The proposed changes could increase uncompensated care costs, raise use of emergency departments, put maternal and infant health at risk, increase the risk of disease outbreaks, and shift expenses to state and local governments, they said.
Modern Healthcare (tiered subscription model) (8/14) 
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Lawsuit challenges Medicaid work requirements in Ark.
The National Health Law Program filed a lawsuit against the Trump administration to stop the implementation of Medicaid work requirements in Arkansas, arguing the administration has no authority to impose such provisions without action from Congress.
The Hill (8/14) 
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States work on legislation to lower drug costs
Several states are working on legislation to address the rising cost of drugs, which affects constituents' ability to afford needed medications. In Nevada, the bipartisan Senate Bill 539 will add transparency in formulary changes, pricing and negotiated drug rebates.
MedPage Today (free registration) (8/13) 
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Digital/Consumer Health Forum topics announced
Empowered patients, digital health to serve complex populations, the intersection of health care and innovation, life-saving technologies, balancing the digital and human health experiences, and empowering consumers are just a few of the general sessions at AHIP's Consumer Experience & Digital Health Forum. You'll leave with big ideas to drive big results. Enjoy big savings before Sept. 25.
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DM programs to improve care while managing costs
AHIP's DM Direct members offer products, services, and strategies that can help health plans leverage their disease management programs to improve care and deliver value. Envolve is the life, health and wellness company dedicated to helping people transform their lives with support, encouragement, and motivation. The company offers an inclusive people-centered approach designed to help in all stages of life.
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Secure your AHIP 2018 conference sponsorships
Sponsorship opportunities are available for upcoming conferences such as the National Conferences on Medicare, Medicaid & Duals, Oct. 14 through 18 in D.C., and Consumer Experience & Digital Health Forum, Dec. 11 through 13 in Nashville. Reach hundreds of health care decision-makers who attend AHIP conferences to learn and network. Contact AHIP's Business Affairs Team for details.
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