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What We’re Watching: May 14, 2019

WE KEEP TALKING ABOUT RISK-BASED PAYMENT MODELS

Last week, Premier and other groups called on HHS Secretary Alex Azar to improve and make permanent the Next Generation Accountable Care Organization Model (Next Gen ACO). Next Gen ACOs have improved quality and netted Medicare $62 million in savings in year one and are on track to achieve even more savings in year two. Recommended improvements include increased program flexibility and stability through benefit design and accounting for sicker patients.

What we’re saying: Next Gen ACO is the model that best equips providers to move to direct contracting models. Because of the significant implications of CMS’s new voluntary primary care and direct contracting payment models, Premier will be holding a series of webinars to discuss both their structures and implications. Premier experts help members evaluate these models and assess their impact.

SOME NOT SO GREAT NEWS ABOUT MATERNAL HEALTH

Last week, the CDC released a study that found that 60% of pregnancy-related deaths are preventable. Approximately 700 American women die each year due to pregnancy related issues. The timing for these deaths was split equally from pregnancy to delivery and the year following birth. Additionally, maternal mortality disproportionately impacts black, American Indian and native Alaskan women.

What we’re saying: You may recall that last month, Premier launched its Bundle of Joy™ campaign with the mission of improving the quality and cost of care for mothers and babies. Premier has detailed data on 1.2 million annual births to help providers analyze care delivery and compare outcomes and practices.

PAYMENT POLICY PROPOSALS

The FDA issued final biosimilar interchangeability guidance to assist biosimilar sponsors in demonstrating that a proposed therapeutic protein product is interchangeable with a reference product for the purposes of submitting a marketing application or supplement.

What we’re saying: This designation is important because, like in the case of generic drugs, pharmacies can automatically substitute interchangeable biosimilars. Premier is working to expand the biosimilar market to lower member costs. While we are pleased with the final guidance, we have urged the FDA to improve its guidance by addressing outstanding issues, such as a parallel pathway for biosimilarity and interchangeability, global harmonization and biosimilar to biosimilar interchangeability. We are also urging the FDA to reverse its current proposal on naming biosimilars, as the proposed process would create added confusion and favor branded biologic products over more cost-effective biosimilars.

IN CASE YOU MISSED IT

What We’re Watching is a weekly blog focused on the current events Premier is following and their relevance to the work of Premier and its members. Check out last week's update.

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