Sept. 12, 2018 — The Personal Connected Health Alliance announced today that Cantina Consulting has joined the 2018 Connected Health Conference as its digital design and development partner. (more…)

LENEXA, Kan. — Sept. 11, 2018 — Mediware Information Systems, Inc., a portfolio company of TPG Capital, today announced its strategic transformation to WellSky, effectively merging more than 30 unique health care and human services brands. (more…)

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By Tim Rowan, Editor & Publisher of Home Care Technology Report

By Tim Rowan, Editor & Publishers of Home Care Technology Report

Savii Care, a supplier of private duty home care software solutions and mobile platforms, announced this week that it is set to expand following a change in leadership and significant investment from its new owners, H.A.S. Technology Group. An important addition to Savii Care is its new CEO Kristen Duell, (more…)

By Tim Rowan, Editor & Publisher of Home Care Technology of Home Care Technology Report

On August 7, CMS announced that it is fulfilling President Trump’s promise to negotiate better deals for Medicare patients and create competition among drugs used to treat the same conditions, with more than half of the savings required to be passed on directly to
patients

This will be welcome news to home health nurses who have seen their patients unnecessarily readmitted to a hospital after foregoing an expensive medication or halving their recommended dosage to make a prescription last longer. The remainder of the CMS news release is offered here without edits. Read editor Tim Rowan’s research into the issue of drug prices elsewhere in this week’s issue.

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For the first time, CMS will provide Medicare Advantage plans, currently used by 20 million Medicare beneficiaries (a third of all beneficiaries in Medicare), the option of negotiating for Part B drugs in a way that lowers costs and improves the quality of care. Medicare Advantage plans that also offer a Part D benefit will be able to cross-manage across Part B and Part D, so that patients receive the best medicine, whether it is physician-administered or self-administered.

CMS is also putting American Patients First by making sure that Medicare Advantage plans negotiate in a way that ensures patient choice and provides patient protections with guardrails, including that step therapy can only be applied to new prescriptions for patients who are not actively receiving a given medication.

“President Trump promised better Medicare negotiation and lower drug prices for the American people. Today, we are taking an important step in delivering on that promise,” said HHS Secretary Alex Azar. “As soon as next year, drug prices can start coming down for many of the 20 million seniors on Medicare Advantage, with more than half of the savings going to patients. Consumers will always retain the power to choose the plan that works for them: If they don’t like their plan, they don’t have to keep it. We look forward to seeing the results of tougher negotiation within Medicare, and expanding successful negotiation tools throughout our programs.”

“Under the President’s leadership, for the first time ever, CMS is bringing negotiations to physician-administered drugs and delivering on our promise to lower drug prices for patients,” said CMS Administrator Seema Verma. “For too long, Medicare Advantage plans have not had the tools to negotiate a better deal for patients. Today we begin lifting those barriers so plans can use private-sector tools to drive down the cost of expensive drugs while also offering new care coordination and drug adherence programs, to ensure that patients are getting high quality care at lower cost.”

In a memo sent to Medicare Advantage plans, CMS is giving them the option – starting January 1, 2019 – of ensuring that patients receive the most preferred drug therapy first and progress to other therapies only if necessary, as part of broader part of care coordination activities. Ensuring that patients receive the most preferred drug therapy first is known as “step therapy.” For example, plans may now ensure that a beneficiary who is newly diagnosed with a condition begin treatment with a cost-effective biosimilar before progressing to a more costly drug therapy if the initial treatment is ineffective, while ensuring that patient receives over half of the savings generated through these approaches. This change will only apply to newly prescribed medications.

CMS is allowing Medicare Advantage plans to take advantage of step therapy for Part B drugs, which constitute around $12 billion per year in spending by plans. Medicare also pays for prescription drugs through Part D, which covers patient-administered drugs that beneficiaries usually pick up at a pharmacy. As part of the policy announced today, Medicare Advantage plans that also offer a Part D benefit will be allowed to manage within their Part B benefit as well as cross-manage across Part B and Part D.

As Administrator Verma said in a speech to the Pharmacy Quality Alliance on May 16 2018, “We often don’t see the full benefits of competition in Part B, because some drugs within a therapeutic class have a competitor in Part D.” As a result of the agency’s action today, the Medicare Advantage plans that choose to offer this option will be able to have medicines in Part B compete on a level playing field with those in Part D. The agency will be closely following the impact of this policy as a model for further reform.

If a plan decides to offer this approach to enrollees in 2019, it must be explicitly communicated to beneficiaries through the Annual Notice of Change and Evidence of Coverage documents. Patients that do not wish to participate in a plan that takes advantage of this approach to lower costs will have the option to select a different plan. This new approach must be coupled with care coordination services to support a move towards paying for value. Care coordination must include discussing medication options with beneficiaries; providing beneficiaries with education and information about their medications; and implementing adherence strategies for beneficiaries on their medication regimen.

Bringing negotiation to Medicare Part B is a key pillar of the Administration’s Blueprint to reduce prescription drug costs, and the agency will continue to take actions that advance this goal. In another step to promote this objective, CMS recently released a Request for Information as part of the CY 2019 Medicare Hospital Outpatient Payment System proposed rule on how to develop a model test that leverages the authority provided to the agency under the Competitive Acquisition Program (CAP) to strengthen negotiations for Part B drugs.

To view the memo that was sent to Medicare Advantage plans, please visit: https://www.cms.gov/Medicare/Health-Plans/HealthPlansGenInfo/Downloads/MA_Step_Therapy_HPMS_Memo_8_7_2018.pdf.

To view a fact sheet on allowing Medicare Advantage plans the option of applying step therapy for physician-administered and other Part B drugs, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-08-07.html.
©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

–Hospice News. Contents from Hospice Quarterly Referring Program (HQRP)–[here, from the Apr.-June 2018 quarter] includes frequently asked questions received by the Hospice Quarterly Help Desk, and updates of events from the second quarter of 2018 and the Introduction to the Hospice Reporting Program; and registration information for the “Introduction to the HQRP Webinar.” Other inclusions are: 1)Details on the next new Medicare Card Open Door Forum, especially useful particularly for teaching family clinicians who submit OASIS assessments and who must learn changes to be submitted for numbers, and upper case letters; 2)Details are also provided for getting payment to become a Medicare Diabetes Prevention Program (MDPP
)Provider. Details are provided about length and times of training and for enrolling in this program. Links are provided for enrolling in this program and for receiving more information from the MDPP Learning Network.]

On August 7, CMS announced that it is fulfilling President Trump’s promise to negotiate better deals for Medicare patients and create competition among drugs used to treat the same conditions, with more than half of the savings required to be passed on directly to patients. This action, a CMS news release explains, gives Medicare Advantage plans the option of applying step therapy for physician-administered and other Part B drugs and is an important step within the Administration’s larger agenda to provide patients with more choices when picking a Medicare Advantage plan that best meets their needs.

This will be welcome news to home health nurses who have seen their patients unnecessarily readmitted to a hospital after foregoing an expensive medication or halving their recommended dosage to make a prescription last longer. The remainder of the CMS news release is offered here without edits. Read editor Tim Rowan’s research into the issue of drug prices elsewhere in this week’s issue of HCTR (Aug. 29, 2018).

By Tim Rowan, Editor & Publisher of Home Care Technology Report
We commend CMS administrator Seema Verma for the efforts she and her team have announced to, in her words, “fulfill President Trump’s promise to negotiate better deals for Medicare patients.” Those efforts, however, can only be fully understood within a broader context. A little historical research helps put prescription medication prices in perspective.

The full impact of the pharmaceutical industry’s influence over Congress, via its trade association PhRMA, becomes apparent when viewed across three very different administrations. Following the creation of Medicare Part D at the behest of George W. Bush in 2003, prescription prices began to skyrocket because of the provision preventing Medicare from negotiating volume discounts from drug manufacturers. At the time, which happened to be in the midst of the 2012 campaign season, we summarized the process whereby that law was passed in “Is Paul Ryan Another Tom Scully? Medicare Providers and Beneficiaries, on the Brink, Hope He Is Not.”

Quickly but quietly, Americans discovered they could purchase the same exact medications from Canadian and European pharmacies, who were more than willing to re-ship U.S. drugs sent to them back to U.S. consumers, at a fraction of what those consumers were paying local pharmacies, especially if they fell into the so-called doughnut hole provision of Part D.

by Lucian Bernard, Esq.

Liz Pearson, Esq. and I are pleased to announce the dates for our 8th annual “Compliance Cruise for Home Care and Hospice.” (more…)