This Week in Managed Care: October 4, 2019


This week, the top managed care news included Medicare cuts hospital payments over readmissions; a second-generation chimeric antigen receptor T-cell therapy shows promise; a diabetes drug is approved to prevent kidney failure for the first time.

Medicare cuts hospital payments over readmissions, a next generation chimeric antigen receptor (CAR) T-cell therapy looks promising, and for the first time, a diabetes drug is approved to prevent kidney failure.

Welcome to This Week in Managed Care, I’m Laura Joszt.

Medicare Issues Readmission Penalties

This week, Medicare cut payments to nearly 2,600 hospitals that failed to meet terms of the Hospital Readmission Reduction Program (HRRP). This key piece of the Affordable Care Act was designed to force hospitals to develop better discharge plans to keep patients from returning to the hospital within 30 days. But there has been debate whether it has continued to improve care since it began in 2012. This year, 83% of the hospitals evaluated faced a penalty.

Karen Joynt Maddox, MD, MPH, co-director for the Center for Health Economics and Policy at Washington University in St. Louis, told Kaiser Health News: “A lot of hard work has gone into trying to reduce readmissions, and the needle has not moved very far. It’s been a huge investment by hospitals but not very much in outcomes, but some good things have come out of it.”

Research presented at the American College of Cardiology has questioned whether the HRRP triggered a rise in mortality among some heart failure patients who should be readmitted but are not. But CMS strongly rejects these findings.

The focus on readmission has drawn attention to the impact of social determinants of health, and Maddox and others say CMS should factor this into account at the patient level.

A report from PwC Health Research Institute released last week addressed the need to take on social determinants of health.

Said PwC’s Kelly Barnes, head of global and US health industries, “Innovative medical treatments are rendered ineffective if people don’t have social support and access to resources readily available to help keep them well. This is not optional; healthcare and government organizations that don’t act on social determinants will spend more and more money, only to watch health status decline.”

For more, visit

Second-Generation CAR T-Cell Therapy

A second-generation CAR T-cell therapy has shown promise in clinical trials, and a human study is planned. The study by City of Hope, which appeared in Science Translational Medicine, involves a treatment that targets an alternative surface marker called B cell activating factor receptor. This prevented relapse of lymphoma and leukemia and led to 100% long-term survival in laboratory studies, including mouse models.

Preventing relapse is important from both a clinical and reimbursement perspective, since 30% of patients relapse after CAR T-cell therapy, and CMS has grappled with what to do when patients need more than one treatment.

Said Larry Kwak, MD, PhD, vice president and deputy director, Comprehensive Cancer Center, of City of Hope, “This new treatment offers hope for patients whose tumors have returned after initially successful CAR T-cell therapy, a currently unmet need. If successful, it could ultimately be used as initial, frontline treatment, and thereby change the face of leukemia and lymphoma therapy globally.”

FDA Approves Canagliflozin to Prevent Kidney Failure, Hospitalization for Heart Failure

Canagliflozin, the sodium glucose co-transporter 2 (SGLT2) inhibitor sold as Invokana, this week became the first diabetes therapy to receive FDA approval to prevent kidney failure. The drug was approved to treat diabetic kidney disease and patients with type 2 diabetes who have this condition, and it is also indicated to prevent hospitalization for heart failure.

Said Janssen’s James List, MD, PhD, global therapeutic area head, cardiovascular and metabolism, “This significant advancement addresses serious unmet needs and could change the trajectory of care for the many millions of patients living with type 2 diabetes and diabetic kidney disease.”

Canagliflozin was the first of its class of drugs to treat type 2 diabetes by shipping excess blood sugar out of the body through urine. That unique mechanism is key to its ability to prevent kidney failure—one of the most expensive conditions in Medicare. The decision is based on results of the CREDENCE trial.

For more, visit

UPS Receives Approval for Drone Deliveries for Healthcare

The Untied Parcel Service (UPS) this week received federal approval to start using drones to ship drugs and medical specimens, and the company said it plans to ramp up service between hospitals right away. The Wall Street Journal reported that UPS plans to create a fleet of unmanned aircraft that will help speed deliveries in suburban and rural areas. The federal approval does not cover urban areas.

Amazon and Uber have also announced plans to look into drone for deliveries, but the UPS approval is specifically aimed at shipping medical products in North Carolina across hospital campuses.

Said UPS’ chairmand and chief executive offiver David Abney, “It just gives us a lot of capabilities. We’re going to move ahead quickly and expand rapidly. It’s not going to be a small operation.”

Patient-Centered Oncology Care Conference

Finally, there’s still time to register for Patient-Centered Oncology Care, which takes place November 8 at the Sofitel Hotel in Philadelphia. Former FDA Commissioner Scott Gottlieb, MD, will join the meeting to address, “Innovation and Quality: New Directions in Oncology Value-based Care,” and Keynote Speaker Joshua Ofman of Grail, Inc., will discuss his company’s mission of early cancer detection.

To join us, visit

For all of us at AJMC, I’m Laura Joszt. Thanks for joining us.

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