D.C. Week: Advisors Back Alternative Payment Model for IBD

— Also: proposed Medicaid redesign could hurt dual-eligibles

MedpageToday

WASHINGTON -- Policy experts who vet alternative payment models for the administration recommended two new frameworks for paying physicians, and the FDA approved the first ever drug for tardive dyskinesia, a common and disfiguring side effect of antipsychotic drugs..

PTAC Backs Alternative Payment Model for IBD

An alternative payment model gained endorsement from a body of policy experts tasked with helping the administration identify ways to shift physician payment from volume to value.

With one member absent, the Physician Focused Payment Technical Advisory Committee (P-TAC) voted 7-3 that Project Sonar, an "intensive medical home model" for targeting patients with inflammatory bowel disease (IBD), met the criteria to qualify as an advanced alternative payment model (APM) at a meeting on Monday.

The proposal now awaits a final decision from the U.S. Department of Health and Human Services.

The Project Sonar model reduces costs and improves care for patients with inflammatory bowel disease (IBD), by increasing patient engagement and leveraging evidence-based medicine, Lawrence Kosinski, MD, MBA, managing partner of the Illinois Gastroenterology Group (IGG) and president of SonarMD, in Chicago, told MedPage Today in a phone interview.

"Most of our savings have come from keeping patients out of the hospital. They're not only out of the hospital, they're keeping their colon; they're not having surgeries ... We really have positively affected their quality of life," he said.

FDA Okays First Tardive Dyskinesia Drug

The FDA has okayed valbenazine (Ingrezza), the first drug to treat tardive dyskinesia, the agency announced.

The small molecule drug, made by Neurocrine Biosciences, is an inhibitor of the vesicular monoamine 2 transporter (VMAT2) pathway, which plays a role in regulating dopamine levels in the brain.

Its efficacy was supported by a pivotal trial involving 234 patients that found that, over 6 weeks, those on the drug had improvements in the severity of abnormal involuntary movements compared with those on placebo. Those data were presented at last year's American Academy of Neurology meeting.

Side effects include sleepiness and QT prolongation, so the drug is contraindicated in patients with congenital long QT syndrome or with abnormal heartbeats associated with a prolonged QT interval, the agency said.

Medicaid Overhaul to Hit Millions of Medicare Beneficiaries, Too

Proposals to overhaul the Medicaid program, such as the recently withdrawn GOP repeal-and-replace bill, would significantly affect a large swathe of Medicare beneficiaries as well.

"Everyone says we're not touching Medicare. Per-capita caps do touch Medicare," Melanie Bella, MBA, a former director of the Medicare-Medicaid Coordination Office at the Centers for Medicare and Medicaid Services, during a Capitol Hill briefing hosted by the National Coalition on Health Care on Monday.

Bell, citing 2014 data from the Kaiser Family Foundation, said roughly 11 million Medicare beneficiaries -- one in five -- also rely on Medicaid.

Also, two-thirds of Medicaid spending goes towards long-term supports and services (LTSS), such as respite and attendant care. When states have budget shortfalls, these services are seen as optional.

Scientific Research Needs Better Oversight, Report Says

Scientific research needs to be better managed to reduce the incidence of fraud, retractions of research papers, and undue influence of industry, the National Academies of Sciences, Engineering, and Medicine said in a report released Tuesday.

"Serious cases of research misconduct -- including some that have gone undetected for years -- continue to emerge with disturbing regularity in the United States and around the world," Robert Nerem, PhD, chair of one of the two committees that wrote the report, said in the publication's preface.

"Increases in the number and percentage of research articles that are retracted and growing concern about low rates of reproducibility in some research fields raise questions about how the research enterprise can better ensure that investments in research produce reliable knowledge."

Next Week

Congress is on recess.

On Tuesday, Health Affairs will host a briefing on the future of value-based payment in healthcare.

And the Bipartisan Policy Center will discuss ways to evaluate patient treatment options.