In the News: Aug 8–15

CAR T-cell Therapy Is Now Covered Under Medicare

A recent FierceHealthcare article highlights CMS’s decision to expand Medicare coverage for chimeric antigen receptor (CAR) T-cell therapy. CAR T-cell therapy is an innovative immunotherapy that uses a patient’s own immune cells to identify and destroy cancer cells; it holds promising results, particularly for hematologic cancers (eg, leukemia, lymphoma).

Previously, confusion existed among providers regarding coverage of CAR T-cell therapy due to an absence of a national decision. CMS first initiated a national coverage analysis in May 2018 and proposed a decision memo for intent to cover in February 2019. The approved coverage includes not only the CAR T-cell drug, but all related services, including the administration of the drug, collection of the cells, the process to put the cells back into the patient, and any necessary inpatient or outpatient care. Medicare will cover the therapies when they are provided at facilities enrolled in the FDA risk evaluation and mitigation strategies for FDA-approved indications. This therapy is still an emerging technology and comes with risks; CMS plans to closely monitor Medicare CAR T-cell therapy outcomes.

For additional insight on the applications of CAR T-cell therapy and how this treatment will impact patients, hospitals and health systems, read the Sg2 FAQ Chimeric Antigen Receptor T-Cell Therapy.

Medicaid Program Targets Mental and Physical Health

A recent NPR article outlines how Tennessee’s Medicaid program, TennCare, combines care for mental and physical illnesses to achieve low-cost, high-quality outcomes. Individuals hospitalized for both mental and physical complications tend to exhibit poor health status despite overutilizing health care services. TennCare’s program, Tennessee Health Link, incentivizes mental health professionals to navigate these struggling patients through an episode of physical illness.

Tennessee Health Link evaluates the care coordinators’ performance on a 1 to 5–star rating system, considering their assigned patients’ hospital and psychiatric admissions, as well as ED visits. Providers are eligible for a percentage of the Medicaid savings generated by the patients’ decreased health care usage. TennCare stated it is too early to determine how Tennessee Health Link has impacted patient cost and outcomes; however, an organization spokesperson reported a decrease in ED visits among enrolled patients, which is a positive indicator for a program using mental health services as a platform for improving physical health.

As health care organizations shift toward value-driven care models, payers and providers will look to form innovative partnerships to meet new strategic objectives and effectively adapt as today’s health care landscape rapidly changes. To learn more about creating forward-thinking strategic partnerships, please read the Sg2 report Strategic Partnerships for Tomorrow’s Health Care.

Obesity Epidemic Attributed to Equity and Food Deserts

A recent Kaiser Health News article reveals that equity is one underlying issue associated with high obesity rates among minorities residing in food deserts across the state of Colorado, affecting approximately 30% of the state’s population. Lower-income populations have a higher prevalence of obesity due to more limited access to healthy foods and beverages and safe community spaces.

Colorado has been making moves to accomplish Governor John Hickenlooper’s goal of reducing state obesity rates by 10% in 2020. For example, in Leadville, CO, community gardens and farmers markets were made available to residents, and playgrounds have been newly renovated to encourage outdoor activity and healthy lifestyles among children. However, change is not happening fast enough; funding for obesity prevention programs within Colorado only amount to 27 cents per state resident, compared to the 31 cents per citizen nationally, according to the CDC.

The patterns seen in Leadville are not unique to Colorado. Rather, they are a small sample of what the entire nation is experiencing. As we see an increased shift in outpatient volumes for surgical care, obesity is just one driving factor for understanding population health at the community level to allow for better preparedness for treatment. To learn more about other driving forces and their impact at the service line level, watch the Sg2 on-demand webinar Medicine and Surgery Landscape 2019.

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