Social Determinants of Health

FDA’s Rinvoq Approval Brings New Ulcerative Colitis Option

The FDA recently gave an additional indication to AbbVie Inc.’s Rinvoq (upadacitinib) in ulcerative colitis, broadening that therapeutic class even more. And while a study revealed some concerns around another agent with a similar mechanism of action, payers and gastroenterologists last year expressed interest in Rinvoq over other late-stage pipeline agents.

On March 16, the FDA expanded the label of Rinvoq to include the treatment of adults with moderately to severely active ulcerative colitis who have had an inadequate response or intolerance to at least one tumor necrosis factor (TNF) blocker. The agency initially approved the Janus kinase (JAK) inhibitor on Aug. 16, 2019. The recommended starting dose for the tablet is 45 mg once daily for eight weeks, followed by a maintenance dose of 15 mg once daily. The wholesale acquisition cost for a 30-day supply is $5,671.26.

Studies: Telehealth Ups Low-Income Members’ Care Access

Several new studies have found that telehealth flexibilities introduced during the COVID-19 pandemic increased access to care for patients who would otherwise struggle to get it. However, the same researchers say that telehealth can’t solve health care disparities on its own — and that lots of work needs to be done to make sure that the incremental improvements made possible by improved telehealth access are durable.

A study published in the May edition of the journal Health Affairs by researchers from Johns Hopkins University found that Medicare patients “living in the most deprived neighborhoods had the highest rates of telemedicine use….Overall, our findings are encouraging, as they suggest that the Medicare telemedicine coverage waiver could improve access to health care for people in the most disadvantaged US neighborhoods without worsening disparities.”

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Notion of Value-Based Care Within Life Sciences Is Shifting

The notion of value-based care certainly is not a new one. But the concept of what it involves within the health care system and how it can be measured is undergoing a shift, asserted two industry experts. Life sciences companies in particular have an important role to play to ensure that quality and equity in health care are truly achieved.

A value-based care approach “is not centered around a certain payment model or a certain program demonstration,” maintained Taylor Musser, associate principal in the healthcare transformation practice at Avalere Health. Rather, it’s focused on ways to improve the quality of care, she told attendees at a recent webinar sponsored by Avalere. Such an approach will “encompass what care could be delivered by a provider or health system or the care that is coordinated by health plans. And some of the quality objectives” include “are we getting the clinical outcomes we want, are we improving people’s general quality of life and what they experience day to day, [and do] the services or processes of care…align with clinical practice guidelines, for example? We know there are gaps there.” She stated that “avoiding inappropriate or low-value services…is still a concern in our health care systems.”

Various Components Play Important Role in Companies’ Definition, Demonstration of Drugs’ Value

As prices for health care services, especially drugs, continue to be under the microscope of public scrutiny, life sciences companies are under pressure now more than ever to make sure that they can demonstrate the value of their products. But this may be easier said than done, as a patient’s perception of value may be quite different than, for example, that of a payer. But these conversations are starting to happen and need to continue to evolve and include all industry stakeholders to truly incorporate value into the equation, say life sciences experts.

According to Daniel C. Lane, Pharm.D., Ph.D., director of US Access Marketing-Customer & Portfolio Value Generation for Bristol Myers Squibb, “Value is something that’s very individualized…If you think about value on a conceptual level, it’s a benefit being received over some type of value-assessment measure…At the elemental level, that’s what we as a life science industry are really trying to understand — how do we communicate that?”

Medicaid Plans Get Ready for Yearlong Postpartum Care

State Medicaid programs now have the option of applying to CMS to expand postpartum coverage for parents who have just given birth to 12 months, up from the default 60 days of coverage. Medicaid MCOs in states that have opted into the expanded coverage tell AIS Health, a division of MMIT, that they are taking steps to get ready for the new coverage and anticipate better outcomes for both new parents and new children as a result of the program.

Maternal mortality rates in the United States are disturbingly high compared to other developed countries — in 2018, 17 women per 100,000 live births died, compared to three in the Netherlands, Norway and New Zealand, per the Commonwealth Fund — and the U.S. is the only developed country to see that rate increase in recent years. Most of those deaths were preventable.

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Health Insurers Invest Billions in Affordable Housing Projects

Health care organizations across the country have poured billions into housing investments in recent years: In the past month, Kaiser Permanente and UnitedHealth Group both announced investments of over $100 million in affordable housing projects. Several health plans tell AIS Health that while they do expect a modest return on investment or reduction in costs from their efforts, they mostly see these expenditures as an act of altruism in line with their missions as stewards of public health.

According to the organizations themselves, total capital allocations to affordable housing investments by Kaiser Permanente, UnitedHealth Group and CVS Health Corp. amount to approximately $1.65 billion combined. A large portion of those funds are allocated to finance investments in affordable housing through the Low Income Housing Tax Credit (LIHTC), a financial instrument rolled out by the federal government in the late 1980s and early 1990s to encourage investment by the private sector in affordable housing.

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Despite Growth, Barriers Remain to Driving MA Benefit Innovation

Innovative, mostly non-medical supplemental benefits have seen tremendous growth in the few years the Medicare Advantage program has allowed them. But that growth is still from a base of zero, and industry experts suggest that numerous barriers are keeping adoption of these new supplemental benefits at a relatively slow pace.

Starting with plan year 2019, MA organizations began offering a wider range of benefits such as Adult Day Care and In-Home Support Services thanks to CMS’s reinterpretation of the definition of “primarily health-related supplemental benefits.” And with the passage of the CHRONIC Care Act of 2018, MA plans in 2020 began offering Special Supplemental Benefits for the Chronically Ill (SSBCI), a category of “non-primarily health related” items and services that can be made available to certain beneficiaries.

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Despite Growth, Barriers Remain to Driving Benefit Innovation

Innovative, mostly non-medical supplemental benefits have seen tremendous growth in the few years the Medicare Advantage program has allowed them. But that growth is still from a base of zero, and industry experts suggest that numerous barriers are keeping adoption of these new supplemental benefits at a relatively slow pace.

Starting with plan year 2019, MA organizations began offering a wider range of benefits such as Adult Day Care and In-Home Support Services thanks to CMS’s reinterpretation of the definition of “primarily health-related supplemental benefits.” And with the passage of the CHRONIC Care Act of 2018, MA plans in 2020 began offering Special Supplemental Benefits for the Chronically Ill (SSBCI), a category of “non-primarily health related” items and services that can be made available to certain beneficiaries.

News Briefs: Lawmakers Urge CMS to Rethink 8.5% Medicare Advantage Plan Rate Increase

Sen. Elizabeth Warren (D-Mass.) and other progressive lawmakers wrote CMS Administrator Chiquita Brooks-LaSure asking the agency to reconsider recently finalized policies that would lead to an average revenue increase of 8.5% for Medicare Advantage plans next year. Citing the Medicare Payment Advisory Commission’s March 2022 Report to the Congress, lawmakers wrote that MA plans last year were paid 4% more per enrollee than fee-for-service Medicare, even though the program was designed to generate savings by paying insurers rates set at 95% of those used by FFS Medicare. “To preserve Medicare and its Hospital Insurance (HI) Trust Fund, we urge CMS to mitigate the announced payment increases for Medicare Advantage plans so they are on par with payments to fee-for-service Traditional Medicare and take additional steps to address overpayments and increase transparency in the Medicare Advantage program,” they wrote on April 20.

CareFirst Aims to Bolster Public Health With New Program, Exec

CareFirst BlueCross BlueShield, a not-for-profit payer serving a population of 5.3 million in Maryland, Virginia and Washington D.C., has launched a new Public Health Infrastructure team and chosen a leader for its team: Djinge Lindsay, M.D.

CareFirst says its new public health initiative is all about improving health outcomes and health equity for its members. Lindsay tells AIS Health, a division of MMIT, that she and her team plan to leverage data and tackle the biggest barriers standing in the way of health equity.

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