2019 Medicare Shared Savings Program ACO Performance: Lower Costs And Promising Results Under ‘Pathways To Success'
(9/14, Seema Verma, Health Affairs Blog) comments “...In 2019, nearly all the ACOs continued to meet the quality performance standard. CMS extended the quality reporting submission period and provided additional relief to ACOs and their health care providers in response to the COVID-19 public health emergency, allowing nearly all ACOs to satisfactorily report quality data. In addition, 92 percent of eligible ACOs earned quality improvement reward points in 2019, with ACOs showing the greatest improvements in the patient safety and care coordination quality domain. ACOs continued to show comparable or better quality performance on measures compared to other physician group practices.” Full
Value-Based Care Now at Risk
(9/12, Merrill Goozner, Modern Healthcare) reports “...[CMS Administrator Seema Verma] in May waived consideration of COVID-19 costs when calculating ACO savings and losses this year. The new emergency regulations also reduced the amount of downside risk. No doubt she was responding to an April survey by the National Association of ACOs that showed more than half the organizations in at-risk models planned to drop out of the program because of pandemic-related losses. It remains to be seen if the relaxed requirements will maintain the current level of engagement. The pandemic-induced revenue collapse has revealed the dark truth behind the ‘one foot on the dock, one foot in the canoe’ metaphor.” Full
Precision Medicine Could Yield Significant Cost Savings in RA Treatment
(9/11, Laura Joszt, The American Journal of Managed Care) reports “...Using a decision-analytic model could save more than $7 million in overall ineffective health care costs per 1000 patients by predicting which patients with rheumatoid arthritis will have an inadequate response to anti–tumor necrosis factor therapies, according to a study published in Rheumatology and Therapy...‘Identifying anti-TNF therapy inadequate responders could yield significant direct cost savings to the healthcare system in terms of both total spend and ineffective treatment spend for biologic drugs, non-biologic drugs, and total medical cost spend,’ the authors wrote.” Full
Trump Signs New, Expanded Executive Order to Lower U.S. Drug Prices
(9/13, Doina Chiacu, Susan Cornwell and Richard Cowan, Reuters) reports "...It extends the mandate to prescription drugs available at a pharmacy, which are covered under Medicare Part D. The July version focused on drugs typically administered in doctors' offices and health clinics, covered by Medicare Part B. Specifically, it would pay a price for a drug that matches the lowest price paid among wealthy foreign governments. Medicare, the government healthcare program for seniors, is currently prohibited from negotiating prices it pays to drugmakers." Full
UK: AstraZeneca Changes Minds at NICE, Winning Tagrisso Coverage in 2 Lung Cancer Indications
(9/11, Angus Liu, Fierce Pharma) reports “Despite Tagrisso rapidly establishing itself as the new standard of care for EGFR-mutated non-small cell lung cancer, its maker AstraZeneca has had a hard time convincing England's drug cost watchdog of its worth. As of Friday, though, it's made some progress in that department, convincing the The National Institute for Health and Care Excellence to reverse a negative decision. England's cost-effectiveness gatekeeper now recommends Tagrisso for routine NHS coverage in previously untreated EGFR-mutated NSCLC and as a second-line treatment for the T790M mutation subtype, it said.” Full
UK: NICE Backs Portola's Ondexxya
(9/11, Selina McKee, PharmaTimes) reports “The National Institute for Health and Care Excellence (NICE) has published the outcome of an appraisal consultation document backing NHS funds for restricted use of Portola's Ondexxya (andexanet alfa) as an option for reversing anticoagulation from apixaban or rivaroxaban in adults with life threatening or uncontrolled bleeding.” Full
Clinical Utility and Cost Savings in Predicting Inadequate Response to Anti-TNF Therapies in Rheumatoid Arthritis
Martin J. Bergman, et al.
2020, Rheumatology and Therapy
Rheumatology and Therapy
Replication of Randomized Clinical Trial Results Using Real-World Data: Paving the Way for Effectiveness Decisions
Kristin M Sheffield, et al.
September 11, 2020, Journal of Comparative Effectiveness Research
Journal of Comparative Effectiveness Research
Patient-Centered Oncology Care: Impact on Utilization, Patient Experiences, and Quality
Lindsey M. Roth, MPP, et al.
September 14, 2020, The American Journal of Managed Care