Today's News and Commentary

About the public’s health

Big soda pours big bucks into California’s Capitol: As California considers a tax on sugared drinks, this article exposes the extent of lobbying against the proposal. “A California Healthline analysis found that 9 in 10 state senators and members of the Assembly, or a member of their staff, accepted a campaign contribution, gift or charitable donation in 2017 and 2018 from the American Beverage Association (or its political action committee), the Coca-Cola Co. or PepsiCo — the three largest givers in the industry.”

Read the story

Global, national, and urban burdens of paediatric asthma incidence attributable to ambient NO2 pollution: estimates from global datasets: Yet another reason (other than global warming) to control air pollution. This study documents the link between nitrogen dioxide pollution and new pediatric asthma cases. The primary source of the pollutant is autos.

Read the research

Can officials require vaccinations against measles? A century-old case may give them a foothold: In the face of the measles epidemic, questions have arisen about the legality of compelling immunization. This article recalls a 1902 Massachusetts case that concerned smallpox and discusses legal issues on this topic.

Read the article

Health care price check: A couple retiring today needs $285,000 as medical expenses in retirement remain relatively steady:This study comes from Fidelity Investments. The good news is that 35-year-old couple can potentially save $285,000 in 30 Years by investing $2,820 annually.

Read the article

FDA warns about risks of using home use test strips that are pre-owned or not authorized for sale in U.S., including those for glucose, warfarin: Test strips are being sold online on eBay, Craigslist, and Amazon, or directly from online sellers. The FDA warns that these strips may not perform to specifications and give erroneous results.

Read the warning

About healthcare IT

Executive Spotlight—Karen DeSalvo on what 'frustrates' her most about healthcare—and why she gives props to the Trump administration: In this interview, former National Coordinator for Health Information Technology Karen DeSalvo opines on current and future healthcare IT issues. One of the topics is patient centered systems. But we still do not have unique patient identifiers as do most other countries.

Read the interview

Electronic Capabilities for Patient Engagement among U.S. Non-Federal Acute Care Hospitals: 2013-2017: This research is from the Office of the National Coordinator. The upshot is we still have a long way to go before electronic capabilities reach their potential. For example, most “hospitals (62 percent) reported that fewer than 25 percent of their patients activated their access to their patient portal.”

Read the report

About health insurance

Republican senators float bill with protections for pre-existing conditions: Republicans are afraid that if the ACA is eliminated they will be blamed for what Americans like most about it: no denials for preexisting conditions and no health-related premium adjustments. So a group of GOP senators led by Sen. Thom Tillis of North Carolina is proposing a bill to address those concerns. However, it allows insurers to exclude any preexisting condition from coverage, even if they issue a policy for all other health care possibilities. The bill does not have widespread support so Republicans will have to go to “Plan B.”

Read the story

July hearing expected in Obama health care law case: Judge Leslie Southwick of the U.S. Court of Appeals for the 5th Circuit in New Orleans has agreed to expedite hearing the appeal of the ruling that invalidated the ACA.

Read the announcement

Oak Street Health and Aetna Team Up to Expand Access to Value-Based Care in Indiana and Michigan: One more example of an insurer partnering with primary care clinic providers.

Read the announcement

Idaho becomes 2nd state to support scaled-back Medicaid expansion: The people of Idaho and Utah voted to participate in Medicaid programs under the ACA. But Republican administrations in those states chose to limit the expansion.

Read the story

New Consumer Testing Shows Limited Consumer Understanding of Short-Term Plans and Need for Continued State and NAIC Action: Republicans are touting short term health plans as an affordable alternative to ACA offerings. But this study from the National Association of Insurance Commissioners shows that people do not know what they are buying. The results are not surprising given other older studies that showed poor understanding of basic health insurance terms.

Read the research

Today's News and Commentary

About pharma

Most Osteoporosis Drugs Don’t Build Bone. This One Does: The FDA has approved Evenity, Amgen’s new drug to treat post menopausal osteoporosis. The drug works by a new mechanism that encourages new bone growth. Once the patient has grown enough new bone (after about a year), she is then placed on maintenance therapy with a bisphosphonate to prevent further loss. The downside is a contraindication if the patient has has a heart attack or stroke in the year before administering the medication. Pricing is still unknown.

Read the article(NY Times but appears to be open access)

CVS, Cigna, Humana blame Big Pharma at Senate hearing for skyrocketing US drug prices: As previously mentioned, yesterday was the day big pharma benefit managers (PBMs) testified before the Senate Finance Committee about their role in high drug costs. Predictably, their fingers pointed to “Big Pharma” and not those who manage the benefits.

Read about the hearing

Hikes on Medicare drug premiums could be delayed until after 2020 elections: In a related article, the Trump administration has proposed giving any drug rebates back to patients. Because insurers count on those rebates, their loss would cause an increase in premiums. 2020 proposals for Part D are due in 8 weeks and the rebate issue is still not settled. CMS directer Verma has told companies to use old criteria for their pricing bids. We will need to wait to see how all theses changes play out.

Read the article (Washington Post but appears to be open access)

Invisible Middlemen Are Slowing Down American Health Care: This in-depth article provides a good working insight into how PBMs work (or often do not work).

Read the article

Walgreens Unveils Latest Primary Care Partner: VillageMD: In the latest pair-up of pharmacies and healthcare providers, Walgreens is partnering with Chicago-based VillageMD to set up primary care clinics next to their stores in the Houston area. This move is seen as a competitive strategy to answer expanded in-store healthcare services CVS is setting up.

Read the story

Sanofi turns to subscriptions to offer patients insulin at $99 per month: Netflix comes to pharma. For a monthly fee of $99, diabetic patients can get all their insulin from Sanofi.

Read the article

About health insurance

UnitedHealthcare to expand bundled payments in its Medicare Advantage plans: Continuing a trend of value-based payments, UnitedHealthcare is expanding its bundled payments to providers caring for members in the insurer’s Medicare Advantage plans. The bundles will cover single and double hip joint replacements, single and double knee join replacements, non-cervical spinal fusion, cardiac valve replacement, coronary bypass, and percutaneous coronary intervention. 

Read the announcement

About healthcare IT

Provider, health IT groups praise proposed bills to change patient privacy regulations: Care of opioid-addicted patients requires knowledge about all their health problems. But the law governing disclosure of patient information about substance abuse (so-called 42 CFR Part 2) is very strict and makes necessary information sharing difficult. Now lawmakers are finally standardizing these privacy requirements to harmonize them with HIPAA.

Read the story

Federal agencies charge 24 in $1.2B Medicare telemedicine fraud scheme: Did you ever get a robocall asking about your backspin and offering a helpful device that Medicare will cover? If so, your intuition was correct- it was most likely part of a huge international fraud scheme. Read this article for the details and check the youtube video link.

Read the story

Today's News and Commentary

About insurance

Blue Cross and Blue Shield of Texas and Sanitas USA to Open Medical Centers in Dallas and Houston: In another cross functional joint venture, these two companies are opening primary care clinics in Dallas and Houston. The difference from many other examples in this category is that they will be open to self-pay and Medicare patients as well as Blue Cross members.

Read the announcement

Here are two articles summarizing the federal governments thoughts about revamping the way it pays for care. The first is about MedPAC’s thoughts regarding Medicare abandoning fee for service. The second reports on Adam Boehler’s (director of the Center for Medicare and Medicaid Innovation) speech yesterday at the American Hospital Association conference. The focus was on post-acute care bundles.

Mulvaney, administration officials emerge from Camp David summit planning health care rollout 'fairly shortly': In the latest update on when the GOP will offer its own healthcare proposal, it will not wait for after the 2020 election as the President most recently announced. Instead, his acting chief of staff said it will come “fairly shortly.”

Read the article

DOJ asks for speedy hearing in case that could kill Obamacare: On the theme of “repeal (or kill) and replace,” the Justice Department has asked for an accelerated appeal of the ruling that could invalidate the ACA.

Read the announcement


About the public’s health

Lost Productivity From Heart Attack, Stroke Are Twice Direct Medical Costs, Study Finds: In addition to paying attention to social determinants of health, this article is a reminder that we should account for non-medical costs of illness in making cost-benefit decisions.

Read the article

The Economic Burden of Elevated Blood Glucose Levels in 2017: Diagnosed and Undiagnosed Diabetes, Gestational Diabetes, and Prediabetes: Speaking of costs, those for diabetes are still growing. “The economic burden associated with diagnosed diabetes (all ages), undiagnosed diabetes and prediabetes (adults), and gestational diabetes (mothers and newborns) reached nearly $404 billion in 2017…” More multifaceted approaches are still needed. More taxes on sugary drinks, for example?

Read the research

In a Poor Kenyan Community, Cheap Antibiotics Fuel Deadly Drug-Resistant Infections: This is a well-written article about antibiotic resistance as a global issue. Because generic antibiotics are cheap and plentiful in developing countries, and because they are available without a prescription, they are being used indiscriminately—causing bacterial resistance to emerge. Mobile populations spread these organisms, causing global public health problems.

Read the article (NY Times but appears to be open access)

New York orders measles vaccinations in Brooklyn amid outbreak, mayor says: The mandate covers all unvaccinated people and carries a $1000 fine for non-compliance. More governmental entities are moving to these mandates as measles continues to be spread.

Read the story (Washington Post but appears to be open access)

Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians: These guidelines come from the academic professional society of internal medicine (adult medicine) specialists and concerns the frequency of mammography for normal risk women. One screen is out- physician exam for breast masses. Self-exam was eliminated as an effective detection strategy for screening normal risk women a number of years ago.

Read the recommendations

Judge rules New York county can’t ban unvaccinated children from schools, parks: Recall the previous story about Rockland County, NY banning unvaccinated children from public places? Nevermind. A “a state judge put the injunction on hold.”

Read the story

Association Among Dietary Supplement Use, Nutrient Intake, and Mortality Among U.S. Adults: A Cohort Study: Many healthy people are still buying dietary/nutritional supplements hoping that it will reduce their mortality risk. This study found that: ‘Use of dietary supplements is not associated with mortality benefits among U.S. adults.”

Read the research abstract

About pharma

The 5 drugs to watch in 2019: In order to accurately recommend premiums and out of pocket costs, healthcare actuaries need to know not only current but future costs of care. Optum (the non-insurance part of United HealthGroup) issued its 2019 list of 5 drugs to watch for their impact on health care costs.

Read about these drugs

ViiV Healthcare's Dovato approved in US as first two-drug single-tablet regimen for patients with treatment-naïve HIV: HIV treatments have become simpler, as medications no longer need to be taken as often, and combinations pills have been introduced. This announcement is about approval of the first two-drug single-tablet for patients with treatment-naïve HIV.

Read the announcement

Two new research studies show promise for treating problems with aging brains. The first study (in mice) found that blocking the gene CD22 enhanced the ability of microglia to clear debris- improving spatial memory and associative memory. The second study used 25 min of electrical “stimulation, frequency-tuned to individual brain network dynamics…The end result was rapid improvement in working-memory performance that outlasted a 50 min post-stimulation period.”

Today's News and Commentary

About pharma

The top 15 pharma companies by 2018 revenue: For those of you into lists, here is one of the top 15 pharma companies by revenue.

Read the article

NIH to undertake first in-human trial of universal influenza vaccine: The National Institute of Allergy and Infectious Diseases announced it is starting human trials of a universal flu vaccine. If successful, it would not need to change each year in anticipation of a prevalent strain. The question remains: who will manufacture, sell and profit from it?

Read the announcement


About the public’s health

Chicago health tech incubator’s products reach 92 million patients: This article is an update on Matter, the Chicago health tech incubator. It has had great success identifying important healthcare problems and nurturing startup companies to solve them. [Disclosure: I have lectured there and advised several of the companies.]

Read the article

National Hospital Ambulatory Medical Care Survey: 2016 Emergency Department Summary Tables: The CDC just released this study (even though it is for 2016). It has a wealth of data including who went to the ED (age, sex, race, geography), when they went (time of day and season), how they got there, how long they waited, what their diagnoses and acuity of illness were, whether they were admitted, and what their insurance was. Overall, the number of visits was significantly increased from the previous year; Medicaid was the most common insurance; blacks had by far the highest utilization; stomach pain was the most common diagnosis, and 70% of patients are seen in an hour or less. Lots to think about with respect to lowering these numbers.

Read the full report

About health insurance

The Implications of “Medicare for All” for US Hospitals: As previously reported, the definition of this proposal varies across its diverse proponents. Nevertheless, expanding Medicare will have serious repercussions on the entire healthcare system.
In order to make up for lower Medicare rates, hospitals rely on their ability to charge higher amounts to private payers (“cost shifting”). This article quantifies how much hospitals will lose if they cannot cost shift: “Given the relative proportion of patients with each type of insurance, the estimated net effect on hospitals would be a 15.9% decline in revenue, equal to a loss of $151 billion nationally incurred by 5262 US community hospitals.”

Read the research

Medicare for All Might Require Student Debt Relief to Work: On the same theme as the above article, this one discusses the implication of Medicare for All on physician payments. Much of the article is about how payments are a lot higher in this country than in all others. It does not address the fact that physician behavior is behind overall higher costs- not just their incomes. Reducing charges alone will not solve our cost problems.

Read the article

CMS Finalizes Expanded Medicare Advantage Telehealth Coverage: Currently, telemedicine services are an add-on option for Medicare Advantage plans. Starting next year, CMS will start paying for them as a core benefit. This action is significant and may give a real boost to this communication sector.

Read the article

Centene and Washington University collaborate to advance personalized medicine research: In a continuing trend of public-private collaborations in population health, insurer Centene has agreed to fund up to $100 million over 10 years for research at Washington University. The studies will focus on personalized medicine approaches to Alzheimer's disease, breast cancer, diabetes and obesity. 

Read the announcement

Medicare Part D wasn’t built for costly specialty drugs. MedPAC wants to change that: Part D is the child of the Medicare Modernization Act of 2003. At that time, specialty pharmaceuticals were not as important to overall costs as they are today. In fact, they account for a large majority of the rising pharma costs. Policy makers thought this problem would be mitigated by the emergence of generic forms of these expensive drugs (so-called biosimilars). But their introduction has not lived up to expectations. MedPAC is therefore considering changing recommendations to update the structure of Part D to address these rapidly rising costs.

Read the article

U.S. judge expecting CVS merger hearing for May: It’s not over until it’s over. Although the CVS-Aetna deal closed in November, Judge Richard Leon of the U.S. District Court for the District of Columbia has taken the unprecedented step of agreeing to hear arguments from those who still oppose the deal, including the American Medical Association. While the justice department cleared the purchase, the judge is unsure of its antitrust implications.

Read the story

Medicaid expansion tied to fewer heart-related deaths, study finds: The title is self-explanatory but has implications if proposals to cut Medicaid go forward.

Read the story

Concerns Regarding the Proposed Rule to Restrict Drug Manufacturer Rebates in Medicare Part D and Medicaid MCOs: This analysis by Matrix Global Advisors reviews the evidence on what would happen if Medicare Part D restricts (or eliminates) drug rebates. There is a nice illustration of the value/cost chain on page 2 and summaries by various authorities/agencies that speak against the proposal as cost increasing. From a patient perspective, the argument is that insurers count on the rebates to subsidize costs; if the rebates are decreased, premiums will go up. This paper is worth reading for the thought process it forces on the careful reader.

Read the analysis

Plan to End Drug Rebates Adds Protections for Insurers: Continuing the above theme, the Trump administration is proposing to “offer a risk-sharing system” for insurers if Part D drug rebate losses would cause the companies to increase their premiums. So who pays the federal government to pay the insurance companies?

Read the story

Medtronic, Blue Cross sign glucose monitor deal linked to patient outcomes: This deal is another example of value-based products. The agreement requires Medtronic to pay rebates to Blue Cross of Minnesota if members with diabetes who use Medtronic's Guardian Connect device fail to keep their blood sugar levels within a targeted range for a specific period of time. Patients who use the device and participate in the Medtronic user-engagement program called the Inner Circle can earn up to $300 a year to offset the cost of the monitor and sensors.

Read the story

Walmart, Other Employers Get Choosier About Workers’ Doctors: Usually insurance companies are the ones imposing narrow provider networks. This interesting article explains how and why employers are now doing the same for their employees.

Read the article

About healthcare IT

CTA Brings Together Tech Giants, Trade Associations to Improve Efficiencies in AI and Health Care: More than 30 organizations, including Google and IBM, have joined the Consumer Technology Association to “examine and advance the impact of AI in health care by providing standards and recommend best practices to enhance the application of the technology.”

Read the announcement

Apple envisions devices that can 'smell' blood sugar, toxic gases: A quick read but fascinating. So much father along than “Star Trek” technology.

Read the article

Telemedicine tied to more antibiotics for kids, study finds: There is something still to be said for having a primary care doctor. Bottom line: “Children received prescriptions for antibiotics more than half the time during telemedicine visits, compared with 42% at urgent care clinics and 31% at doctors’ offices.”

Read the article

Today's News and Commentary

About the public’s health

Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China: The beneficial and deleterious effects of alcohol consumption have been debated for many years. This large study, published yesterday in The Lancet , concludes that: “Genetic epidemiology shows that the apparently protective effects of moderate alcohol intake against stroke are largely non-causal. Alcohol consumption uniformly increases blood pressure and stroke risk, and appears in this one study to have little net effect on the risk of myocardial infarction.”

Read the research

Association of Racial Disparities With Access to Kidney Transplant After the Implementation of the New Kidney Allocation System: In order to assure fairness, allocation systems for organ transplants have undergone many changes over the years. This article documents that the recent kidney allocation system had reduced racial disparities among transplant recipients but differences still exist. Further modification of this method still needs to be done.

Read the research

Global life expectancy up 5.5 years since 2000; income and access to care play key roles: WHO: Some good news! Global health initiatives (aided by economic improvements) are making a positive difference in life expectancies.

Read the story

Dubstep artist Skrillex could protect against mosquito bites: Serious science but fun music. “According to a recent scientific study, the way to avoid mosquito bites is to listen to electronic music - specifically dubstep, specifically by US artist Skrillex.”

Read the article

How to Minimize Exposures to Hormone Disrupters: The food we buy that is packaged in plastics and other materials can pick up carcinogenic toxins and can also modify hormone activity. This article offers some simple measures to avoid harmful products.

Read the article

About pharma

FDA’s Gottlieb heads back to AEI to tackle drug prices: Today is Dr. Scott Gottlieb’s last day as FDA Commissioner. He will be returning to the American Enterprise Institute where he says he will continue to fight for drug price reform.

Read the Washington Post interview (Appears to be open access)

CVS expands same-day prescription delivery nationwide: CVS is shortening the time from its previous minimum of 1-2 days. The next innovation will be delivery of your medication before you actually need it.

Read the announcement

FDA Clears Avanos Medical’s Drug Infusion Pump: Many patients get their first doses of opioids after an operation when they control the amount of their intravenous medication via a bedside pump. This newly approved device does not use opioids but instead uses “a catheter to continuously release numbing medicine near a patient’s surgical incision.”

Read the announcement

Lundbeck, Alexion and Jazz to pay nearly $123 million to settle US kickback allegations: This story highlights ongoing legal action for what the government euphemistically calls “misconduct.” Pharma companies set up foundations that help fund patients’ out of pocket expenses for costly pharmaceuticals. This process allows those companies to charge payers (including the federal government) much higher prices than they would if individuals had to pay large copays or deductibles. The federal government is now cracking down on such practices.

Read the article

AbbVie's massive Humira discounts are stifling Netherlands biosimilars: report: How can pharma companies fight introduction of less costly biosimilars? It appears that sufficiently lowering the branded drug’s price is a successful strategy- at least in the Netherland’s market. This strategy can also jjhave major implications in other markets and for other drugs.

Read the article

FDA's Assessment of Currently Marketed ARB drug products: In the ongoing story about carcinogenic contaminants in angiotensin receptor blockers, the FDA has supplied a list of safe medications in this class. Some are combination products.

Check the list

About healthcare quality

Study Identifies Potential Fix for Hospital Star Rating Program: Hospitals have often complained about the validity of the CMS-generated star ratings that characterize their quality of care. This research finds reason for this challenge and suggests an alternative method, including redistribution of weights for the measures.

Read the research announcement

About healthcare information systems

MedPAC to Recommend National Coding Guidelines for Emergency Departments: Citing large discrepancies in coding emergency department billing under the Outpatient Prospective Pay System, MedPAC is recommending national coding standards. This standardization could cut into the profits of EDs that routinely “upcode.”

Read the article

‘Alexa, find me a doctor’: Amazon Alexa adds new medical skills: Alexa is now HIPAA compliant, allowing the voice recognition software to provide help with health-related issues. For examples, you can ask Alexa to retrieve your blood sugars or find a doctor for a certain type of problem.

Read the story for more details

Today's News and Commentary

About the public’s health

Are worksite clinics an old-school solution to employers’ current cost problems?: Medical care at the workplace is a very old concept that is making a comeback. This article provides a nice overview of this topic.

Read the article

Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017: The importance of diet to health is not a new concept. This research quantifies this link: “In 2017, 11 million …deaths and 255 million… DALYs [Disability Adjusted Life Years] were attributable to dietary risk factors. High intake of sodium (3 million… deaths and 70 million… DALYs), low intake of whole grains (3 million … deaths and 82 million… –DALYs), and low intake of fruits (2 million… deaths and 65 million… DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries.”

Read the research

Avalere: Despite dropouts, BPCI Advanced participation shows providers open to greater risk: The CMS program called Bundled Payments for Care Improvement (BPCI) Advanced requires renewing participants, as of March 1, to assume financial risk as a condition to their participation. While a number of participants have decided to continue, there has been a significant dropout rate. Reports on these numbers are either “glass half empty of half full.” After this year will there be enough risk-bearing programs left to make a significant impact on the cost and quality of healthcare?

Read the article

About pharma

Key House lawmakers reach bipartisan deal to advance long-stalled drug pricing bill: The House Energy and Commerce Committee has achieved bipartisan support in passing measures to ease the process of getting generics to market. One of these measures is the CREATES Act (Creating and Restoring Equal Access to Equivalent Samples), which prevents branded drug manufacturers from withholding their products from generic companies who need reference samples for  testing their products.

Read the story
For more details on the dozen bills passed by the committee read this announcement

Cigna, Express Scripts Capping Insulin Co-Pays at $25 for Participating Commercial Members: To address the ongoing problem of high and rising insulin costs, Cigna and Express Scripts are limiting expenses to a $25 copayment for participating members.

Read the story

About insurance

Shifting Care from Office to Outpatient Settings: Services are Increasingly Performed in Outpatient Settings with Higher Prices: It has long been known that care costs more in the hospitals outpatient departments than when the same services are provided in a doctor’s office. This article has an interactive graphic that helps quantify these differences.

Read the article

Today's News and Commentary

Light news day

About healthcare IT

Proposed Regulatory Framework for Modifications to Artificial Intelligence/Machine Learning (AI/ML)-Based Software as a Medical Device (SaMD) - Discussion Paper and Request for Feedback: The FDA has issued a framework for regulating artificial intelligence/machine learning software and is asking for comments. This paper is very thought provoking and makes one consider the difference between a human-designed algorithm for machine use and the subconscious algorithms of humans themselves.

Read the paper

About insurance

UnitedHealthcare and the AMA Collaborate to Understand and Address Social Barriers Preventing People’s Access to Better Health: The purpose of this deal between these two organizations is to develop data gathering tools to assess Social Determinant of Health (SDOH). The process will start with creation of about two dozen new ICD-10 codes related to SDOH.

Read the announcement

Experts on Capitol Hill: Solution to surprise billing should fall to hospitals, insurers—not patients: This article is a report about yesterday’s Congressional hearing on surprise billing. Despite Congressional attention and testimony by experts on the topic, we will need to wait to see if any meaningful action occurs to fix this problem. My bet is no.

Read the story

Today's News and Commentary

About quality and safety

Healthcare groups renew calls for CMS to remove Hospital Compare ratings until methodology addressed: The title is self explanatory. It is not the first time the methodology has caused headaches for providers. When the first hospital rankings came out (about 30 years ago), they were not risk adjusted- resulting in some interesting results for “best places” to obtain care. Bruce Vladeck, the administrator of what is now CMS, did away with the rankings- but they are back.

Read the article for the latest concerns

About insurance

Trump, in Reversal, Says Replacing Obamacare Can Wait Until After Election: Remember yesterday’s story about a Republican health plan coming under White House direction? Never mind. The President new says the he will wait until after the 2020 election to do something. What will that be? Repeal and replace. Haven’t we been here before?

Read the reversal announcement

NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties: CMS issued its final rules and comments about Medicare advantage rate changes (up 2.53% for the coming plan year) and other guidances, such as allowable extra benefits these plans can offer.

Read the document

Two Republican attorneys general urge court to uphold Obamacare:Republican attorneys general from Ohio and Montana have joined Democratic colleagues in appealing the ruling to invalidate the ACA based on repeal of the penalty (tax) for not having insurance.

Read the story

The U.S. Healthcare Cost Crisis:
This Gallup poll has some interesting findings about American’s attitudes toward healthcare. Among the findings were: “Americans borrowed an estimated $88 billion in the past 12 months to pay for healthcare” and “ 65 million adults had a health issue but did not seek treatment due to costs in the past 12 months.”

Read the survey (Free signup required)

Association Between Insurance Status and Access to Hospital Care in Emergency Department Disposition: There used to be a term for transferring uninsured or poorly insured patients to other hospitals after ER stabilization: Dumping. Does this problem still exist? “After accounting for hospital critical care capability and patient case mix, the study found that uninsured patients and Medicaid beneficiaries with common medical conditions appeared to have higher odds of interhospital transfer.”

Read the research (Abstract is open access, full research requires subscription)

About the public’s health

Healthcare executives rate the industry's top 10 challenges: What keeps healthcare executives “up at night? This article explains the “top 10 challenges.” Most were on the list last year. New on this list are: “External market disruption” from such companies as Amazon, Chase, Apple, Walmart and Google; “Operational effectiveness” achieved by increased efficiency; and “Opioid management.”

Read about the 10 challenges

Today's News and Commentary

About insurance

Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey: The Kaiser Family Foundation just released its 17th annual report on Medicaid and the Children’s Health Insurance Program (CHIP) eligibility, enrollment, renewal, and cost sharing policies. It is a great update and worth reading- if only to get overall messages from the graphics.

Read the report

Doughnut Hole Is Gone, But Medicare’s Uncapped Drug Costs Still Bite Into Budgets: This article is a reminder that there is no cap on Medicare Part D expenses- even for those who purchase an insurance policy. At the highest payment levels, beneficiaries are still responsible for 5% of payments.

Read the story

Trent Haywood reflects on the BCBS Institute's first year: One year ago, the Blue Cross/Blue Shield Association set up the BCBS institute to develop partnerships and solutions addressing social determinants of health. This article is an interview with the institute’s president, Dr. Haywood. It is an interesting approach to addressing healthcare through the Association’s members.

Read the interview

White House to send 'principles' for Obamacare replacement plan to Capitol Hill: This article updates the back and forth between the White House and Republican members of Congress about the responsibility for crafting its party’s health care message. The President first claimed that healthcare would be a Republican issue in the next election, but left the details to Congress. Then some members of Congress were said to be gathering to work on it. Saturday, the Washington Post reported “Republicans have no intention of heeding President Trump’s urgent demands for a new health-care plan to replace the Affordable Care Act.” Now, Acting White House chief of staff Mick Mulvaney said the White House would be sending guidance to Congress on how to replace the ACA. Stay tuned for the next installment of this highly coordinated effort.

Read the article

Physicians score overwhelming victory in bid to fix prior authorization: As recently reported, The AMA documented widespread problems with physicians getting timely prior authorization (PA) responses from health plans. In the first instance of a law to correct these issues, Kentucky has passed legislation mandating certain changes to insurance company practices. Under the measure:  

—Physicians will receive responses on PA requests within 24 hours for urgent services and within five days for non-urgent services. 

—Prescriptions for chronic-condition maintenance drugs will be valid for one year, and any change in dosage during this period will be covered.   

—Insurers’ PA procedures will be posted online as well as a complete list of services requiring PA. 

—Insurer PA reviewers will be licensed physicians and, when possible, of the same specialty as the requesting physician.  

—Physicians and other clinicians will be able to electronically request and transmit PAs.

The new law takes effect Jan. 1, 2020.

Read the article

About pharma

FDA Raises Impurity Threshold to Address Losartan Shortage: Many manufacturers of the antihypertensive drug losartan had their product contaminated with the potentially cancer causing substance N-Nitroso-N-methyl-4-aminobutryic acid. Withdrawal from the market of many sources  of this drug has caused a shortage. Now the FDA says it will allow a higher content of this impurity as a way to address the shortage. Losartan is an angiotensin receptor blocking agent (ARB). There are many other drugs in this class that can be substituted. However, manufacturers of two of the substitutes, irbesartan and valsartan, have also had their products recalled. One wonders if it is really necessary to “raise the impurity threshold” or are there other alternatives, like using ACE inhibitors.

Read the announcement

Delivering Better Health and Affordability: Express Scripts issued a report on its value-based system called SafeGuardRx®. The report says the program saved clients more than $2.4billion and slowed drug cost growth. Specific disease category initiatives (like diabetes) are also explained.

Read the report

Biosimilar Groups Seek ‘Structural’ Changes in U.S. Market: According to this article, the US needs to step up its efforts to facilitate development, approval and marketing of biosimilars. “Europeans now make up 90 percent of world biosimilar sales".”

Read the article

First TV drug ad featuring list price debuts today: This article from Friday features the first U.S. direct-to-consumer TV drug ad to disclose price: J&J’s Xarelto.

Read the article

About healthcare quality and safety

2019 Top 10 Patient Safety Concerns: each year ECRI publishes its top 10 patient safety concerns. Here is this year’s list:
1. Diagnostic Stewardship and Test Result Management Using EHRs
2. Antimicrobial Stewardship in Physician Practices and Aging Services
3. Burnout and Its Impact on Patient Safety
4. Patient Safety Concerns Involving Mobile Health
5. Reducing Discomfort with Behavioral Health
6. Detecting Changes in a Patient’s Condition
7. Developing and Maintaining Skills
8. Early Recognition of Sepsis across the Continuum
9. Infections from Peripherally Inserted IV Lines
10. Standardizing Safety Efforts across Large Health Systems

Read the report (May need to register at ECRI.org)

Appellate court case puts peer-review protections in danger: Peer-review documents have been shielded from discovery in malpractice trials. The reason for this confidentiality is to enhance physician compliance with quality-enhancing activities. This process has been put in danger by a recent court case in Michigan which has been appealed.

Read the article

Today's News and Commentary

About insurance

In Blow to Trump, Judge Blocks Health Care Law ‘End Run’: Like yesterday, today’s top story is about a judicial decision concerning insurance. The Trump administration issued a rule allowing formation of “association health plans,” which consist of employers from many types of businesses. The purpose of those plans was to avoid laws that the administration said were too constraining. In his ruling in the case of New York v. United States Department of Labor (filed by New York, 10 other states and D.C), Judge John D. Bates, of the Federal District Court for the District of Columbia said that the rule was: “clearly an end-run around the A.C.A.” Further, it violates ERISA provisions that define what an employer group is.

As an aside, when the ACA was passed, I confirmed with the Department of Labor that the law applies to ERISA plans.

Read the story (NY Times but appears to be open access)

Trump: Group of GOP senators writing 'spectacular' ObamaCare replacement: The President is bragging that healthcare will be a “Republican issue” in the coming election. But he is counting on Republican senators to come up with something to make good on this promise.

Read the article

About pharma

New York accuses six drugmakers including Johnson & Johnson, Purdue of deceptive opioid marketing: After Purdue’s settlement in Oklahoma, this round will have more players and bigger liabilities.

Read the article

National pharmacare to make prescription drugs more accessible and affordable: On the subject of controlling pharma costs, it is instructive to see what Canada is doing. You should understand that, for the most part, Canadians do not have drug coverage unless it is privately purchased- usually through the individual’s employer. The main three aims of the program, called “national pharmacare”, are:

-Creating a Canadian Drug Agency to assess the effectiveness of new prescription drugs and negotiate drug prices on behalf of Canada's drug plans. The goal is to lower costs by up to $3 billion per year in the long term.
-Developing a national formulary – a comprehensive, evidence-based list of prescription drugs – which would help promote coverage that is more consistent across the country.
-Establishing a national strategy for high-cost drugs for rare diseases.

Anything there sound familiar? The difference is they will do it!

Read the article

About the public’s health

“Prescribing” fruits and veggies would save $100 billion in medical costs: An economic study the looked at providing subsides for healthy food found that such a plan could save $100 billion in medical costs. The proposed interventions included a: “(1) 30% subsidy on fruits and vegetables (“F&V incentive”) and (2) 30% subsidy on broader healthful foods including F&V, whole grains, nuts/seeds, seafood, and plant oils (‘healthy food incentive’).” This approach is the opposite of suggestions to raise prices on foods that are unhealthy, like sugary drinks. What if we imposed the latter plan to pay for the former initiative?

Read the story
Read the original research

Disney bans smoking at U.S. theme parks: For a “family-experience” company, what took them so long? By the way, e-cigarettes and vape pens are included in the ban.

Read the story

EPA Science Panel Considering Guidelines That Upend Basic Air Pollution Science: Last year, the EPA disbanded its 20-person subcommittee called the Particulate Matter Review Panel, which recommended targets for air pollution control. Since then, the task has fallen to  the agency’s science panel. At a hearing yesterday, several members of this panel expressed their doubts about “the long-established scientific consensus that air pollution can cause premature death.” One of their arguments echoed the past defense of tobacco use- lack of randomized controlled studies. Obviously there is no ethical or economically feasible way to conduct such trials. More “experts” will be called in before policy changes are made, but this hearing provides another example of the actual or attempted dismantling of environmental safety protections.

Read the article

Today's News and Commentary

About insurance

Federal judge strikes down Medicaid work requirements in Kentucky, Arkansas: This news is today’s top story. The title is self-explanatory. The reason the judge gave for the decision was that the work requirement was not in the best interest of Medicaid’s purpose. However, he did not rule out other methods to save the program money.

Read the story

CMS Should Assess Documentation Necessary to Identify Improper Payments: The GAO reported that in fiscal year 2017, “Medicare FFS [fee for service] had an estimated $23.2 billion in improper payments due to insufficient documentation, while Medicaid FFS had $4.3 billion—accounting for most of the programs’ estimated FFS medical review improper payments.” The Medicare improper payments, while large, have been declining since a peak in 2014.

What if a private insurance company made such an announcement? Imagine what the number would be if we had a single payer system, i.e., the federal government.

“GAO is making four recommendations to CMS, including that CMS assess and ensure the effectiveness of Medicare and Medicaid documentation requirements, and that CMS take steps to ensure Medicaid’s medical reviews effectively address causes of improper payments and result in appropriate corrective actions. CMS concurred with three recommendations, but did not concur with the recommendation on Medicaid medical reviews. GAO maintains that this recommendation is valid as discussed in this report.”

Read the full report

About pharma

Louisiana has picked its 'Netflix' hepatitis C partner: Gilead's new generics unit: Continuing reporting on this story, Louisiana has chosen Gilead to receive fixed, global payments for however many state-funded patients need Hepatitis C medication.

Read the update

Walgreens to sell CBD products in 1,500 stores: Cannabidiol (CBD) is the “non-high” component of marijuana that claims to help anxiety and nausea. In addition to Walgreens, CVS started to offer CBD products in eight states earlier this month.

Read the story

Prevalence and Severity of Rationing During Drug ShortagesA National Survey of Health System Pharmacists: This research quantifies the problem of hospitals’ drug shortages. Some major takeaways: “All respondents [719] reported experiencing drug shortages in the preceding year and 498 respondents (69.2%) reported more than 50 shortages… Most respondents (664 [92.4%]) reported an average of less than 1 month from notification to active shortage…More than one-third of respondents (247 [34.4%]) reported an episode of rationing within the past year. Rationing occurred more frequently at academic hospitals …and academically affiliated hospitals…”

Read the article (Subscription required to full article from JAMA Internal Medicine)

Want to Reduce Opioid Deaths? Get People the Medications They Need: This NY Times editorial explains that while we want to make opioid addiction treatment more prevalent and accessible, the federal government has restricted use of approved medications.

Read the opinion piece

Pharmacy Benefit Managers: Practices, Controversies, and What Lies Ahead:As previously reported, one initiative being considered to lower drug prices is changing the drug rebate system- either eliminating the practice or giving rebates to patients instead of PBMs and payers. This article from the Commonwealth Fund is a great summary of the rebate practices and issues around changing where the rebates will go. Bottom line is it would help if we changed the rebate practices but need to do much more to control high pharma costs.

Read the article

About healthcare IT

CMS offers up to $1.6M in AI challenge for better healthcare prediction tools: In partnership with the American Academy of Family Physicians and the Laura and John Arnold Foundation, CMS announced it will fund projects up to $1.65 million each for its new CMS Artificial Intelligence Health Outcomes Challenge.

Read more about the challenge


Today's News and Commentary

About insurance

Dems unveil plan to build up ObamaCare as Trump steps up attacks: Continuing commentary on yesterday’s top story, Democrats announced their plans to shore up the ACA in the face of the Justice Department’s plan to support legal action to nullify the entire law. The plan focuses on 1) abolishing “skinny plans, ” which offer fewer benefits at lower prices and 2) adding financial support in the forms of tax credits for more people to offset premium costs. (The skinny benefit plans are just another way of excluding people with high cost, pre-existing conditions.) Those two measure could be accomplished within existing laws. Another part of the Democratic proposal is reinstating support for out of pocket expenses. That action is more problematic since it was never part of the ACA and would require Congressional action to allocate funds for that purpose.
All this talk is moot, however, since the Republican Senate is not likely to pass Democratically-sponsored legislation.

Read the article

What Happens if Obamacare Is Struck Down? .Because the ACA touches so many areas, the answer to the title’s question is complex. This article is a great summary of the consequences if the ACA goes away.

Read the article (NY Times but appears to be open access)

Centene and WellCare to Combine to Create a Premier Healthcare Enterprise Focused on Government-Sponsored Healthcare Programs: Just when you thought the insurance market was taking a breather, the consolidation continues.

Read the announcement

Stanford Health Care Joins Sutter Health | Aetna Network: Network expansion is also continuing- even in California.

Read the announcement

Medacta, Geisinger pilot program to cover all future costs for plan members with knee replacement: This venture is a real breakthrough in quality guarantees for payers. Usually these guarantees on healthcare products have covered replacement of the product itself (in cases of devices) and/or costs the patient incurred because of the failure (for medications). This venture will also cover the hospital replacement costs which insurance companies have to pay. The catch is the patient must be part of Geisinger health plan and have services through Geisinger providers.

Read the announcement

How is Value-Based Care Changing Cancer Treatment Decisions?: Value-based payments are in effect or being proposed across the healthcare field. This survey (displayed in nice graphical form) provides oncologists’ opinions about this payment method. The biggest obstacle, no surprise, is pharmaceutical costs. The only way to craft reasonable bundles of care is in an environment of relatively stable prices. With many new treatments and modalities coming to market, such methods are not possible.

Read the survey results


About the public’s health

New York county, declaring emergency over measles, seeks to ban unvaccinated from public places: Unvaccinated children are kept away from school as the method of enforcing public health measures. In the wake of 153 cases of measles in Rockland County, NY, a 30-day state of emergency has been declared that bans unvaccinated children from all enclosed public places, including schools, houses of worship, and shopping malls. Enforcement may be difficult but officials see the action as sending a serious public message about the importance of vaccinations.

Read the article

FDA proposes mammography rule to provide women with breast-density information: Women with dense breast tissue often have problems getting accurately read mammograms. The fault lies with the limits of the technology, which can either miss cancerous tissue or falsely give the impression of an abnormality. The FDA is proposing a rule that would require “mammogram providers to notify women with dense breasts about how the condition could affect the accuracy of their mammograms and recommend they talk with their doctors about whether they should have additional tests to check for cancer.”

Read the article (Washington Post but appears to be open access)

Debate about birth of new neurons in adult brains extends to Alzheimer’s disease: As the population ages, Alzheimer’s disease has become a public health issue- to afflicted individuals as well as the family and caregivers. Treatments have focused on preventing or reversing the accumulation of proteins in nerve cells that are the hallmark of the disease.
This new research provides another possible route of attack. It was formerly thought that new brain cells cease to form at a young age. It has now been found that adults who normally age will continue to produce new cells in the hippocampus (though at declining rates). But new formation is markedly reduced in people who are developing and who have fully developed Alzheimer’s disease. Perhaps focusing on this abnormality will hold greater promise for prevention and cure of this devastating condition.

Read the article (This article is an editorial in Nature and is open access. The original research is by subscription)

About pharma

Purdue agrees to pay $270 million to Oklahoma to resolve OxyContin lawsuit: In the ongoing story about the origins of the opioid epidemic, the manufacturer of OxyContin has agreed to pay the state of Oklahoma to settle a suit over its role in promoting use of these drugs. It will undoubtedly be the first of such payments to governmental entities and individuals.

Read the story

Dignity Health and Shields Health Solutions Bring Affordable Medication and Services to Patients with Complex Chronic Illnesses: Pharma costs and availability have caused hospital coalitions to manufacture their own generic drugs. But high costs are really driven by specialty pharmaceuticals. So Dignity Health is partnering with a specialty drug company to get a handle on costs and continuity of care. The center of these activities will be a hospital-based specialty pharmacy at Dignity Health‘s St. Joseph’s Hospital and Medical Center in Phoenix, which will support all of the system’s locations. [Dignity Health and Catholic Health Initiatives have recently united as one ministry: CommonSpirit Health™.]

Read the announcement

White House, Pelosi in talks on drug pricing legislation: One issue that has bipartisan support is addressing high drug costs.

Read the article

About devices

Device-Safety Experts To FDA: Make Data Public: This article is an update on a previous story in this blog. Many safety device failures have not been made available to the public because of an alternative reporting pathway in the FDA. Read the story for a good refresher on this issue and what is proposed to remedy the problem.

Read the article

Today's News and Commentary

About insurance

ObamaCare enrollment declines slightly to 11.4M sign-ups for 2019: The final numbers are in and show ACA exchange enrollment down by 400,000 from last year. Premiums were up 1.5% on average, but most articles about this news item fail to report the huge price disparities among states. The exact reasons for the drop were not reported. Some blame Trump administration actions to limit enrollment assistance. Others raise the possibility that the fall is good news- more people are employed and are thus on their workplace insurance plans.

Read the announcement

In shift, Trump administration backs judge’s ruling that would kill Obamacare: The healthcare story of the day is that the Trump administration has changed its stance in the appeal of the legality of the ACA. Recall that a US District judge in Texas ruled that because the penalty for not having insurance was repealed, and because the Supreme Court based its constitutionality decision on the presence of the penalty (which the Court ruled was really a tax), the ACA should now be considered void in toto. The justice department originally said the whole law should not be repealed; now it sides with the District Court’s decision and will back it when several states’ attorneys general appeal the case.

Read the story
Read the legal brief of the appeal

Today, House Speaker Pelosi will announce a Democratic outline for a health proposal

You can access the speech here

State-by-State Estimates of the Coverage and Funding Consequences of Full Repeal of the ACA: To provide an understanding of the impact of ACA repeal, read this Urban Institute report published about a week ago.

Read the report

Extended Non-Enforcement of Affordable Care Act-Compliance With Respect to Certain Policies: When the ACA was passed in 2010, certain non-compliant plans were “grandfathered” in for a time. The idea was to give these plans time to come into compliance. CMS has just issued a notice that the grandfathered plans will be allowed for yet another year. This move is another attempt to undermine the ACA.

Read the announcement

About the public’s health

Americans are getting more miserable, and there’s data to prove it: American’s self-reported happiness is the lowest it’s been since at least 1976. Interestingly, Republicans are much happier than Democrats. Health status is also a significant contributor to happiness.

Read the article (From the Washington Post but appears to be open access)

Public Policies to Reduce Sugary Drink Consumption in Children and Adolescents: The American Academy of Pediatrics and American Heart Association have issued a number of recommendations to curb sugary drink use in children and adolescents. Two policies are noteworthy: imposition of increased costs (through such measures as higher taxes) and restrictions on advertising to this group.

Read the policy paper

New guideline recommends low-dose aspirin for many fewer patients: This new guideline has been in the news for the past week. The short article distills it with some other health recommendations from the American Heart Association and American College of Cardiology.

Read the report

Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study: Regardless of your personal feelings about the legality of cannabis availability, a major issue is safety. One problem with promoting safety is that cannabis preparations do not have standardized contents of the active ingredients (THC and CBD). The result is that: “ [Emergency Department, ED] Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected.”

Read the article abstract

About devices

FDA Issues Warning Over Paclitaxel-Coated Balloons, Stents: Paclitaxel is a chemotherapy agent that has been found to slow tissue growth inside blood vessels if it is coated on balloons that expand blockages or stents that hold the vessel open. Based on an updated review of a meta analysis published several months ago, the FDA has issued a warning covering use of such coated devices. The research showed “among the 975 subjects in… 3 trials, there was an approximately 50% increased risk of mortality in subjects treated with paclitaxel-coated devices versus those treated with control devices (20.1% versus 13.4% crude risk of death at 5 years).”

Read the short announcement
Read the FDA letter

About pharma

20 most expensive drugs in the US in 2019: This article is FYI. It excludes drugs that are administered by a healthcare provider. So they are not truly the most expensive. Still, it provides some useful information.

Read the list

Today's News and Commentary

About healthcare IT

Data sharing practices of medicines related apps and the mobile ecosystem: traffic, content, and network analysis: We know that a variety of apps share information with other apps. But to what extent is this practice happening in healthcare? This interesting study used four fake accounts on 24 healthcare sites to track what happens to the data. The bottom line: “19/24 (79%) of sampled apps shared user data.” An additional problem is that none of the sites allowed an opt out on sharing data. Time for more transparency and control of individual data?

Read the study

FDA, DHS Alert to Cybersecurity Flaws Affecting Medtronic Cardiac Devices, Programmers, Monitors: In addition to privacy, security is also an ongoing concern. The title of the article is self-explanatory. As we get more into a medical internet of things, we are increasing the hacking potential.

Read the story

Complying with information blocking rule will be a challenge without standardized APIs: HIMSS: In a related article, as government rules on information blocking are being implemented, lack of standardization among apps will make compliance problematic. Patient desire to not share all data among the apps that do communicate will further complicate compliance evaluation.

Read the article

About pharma

What's it cost to resolve 25,000 Xarelto lawsuits? For Bayer and J&J, $775M: A complication of Xarelto, and other similar anticoagulant medications, is, of course, bleeding. But a number of studies have shown that this complication is less frequent than with the traditionally used medication Coumadin (warfarin). The six cases that have gone to trial thus far have all been decided for the defendants. But the companies want to move forward and avoid the cost of future litigation- so they are willing to come up with $775million to pay plaintiffs. Another victory for our tort system.

Read the article

Drug Prices on TV? They May Be Coming: As previously reported, one federal initiative aimed at lowering pharmaceutical costs is to require pharma-sponsored tv advertising to include price information. Some companies are starting to voluntarily comply by providing on-screen information or listing a website where complicated pricing can be better explained. This article is a nice review of what is happening and who the stakeholders are.

Read the article (NY Times but appears to be open access)

About devices

FDA clears Genetesis’ heart imaging device: This device is a real breakthrough. It can measure a number of cardiac abnormalities by mapping the heart’s electromagnetic fields. The concept has been around for a few years but previous machines required supercooling technology; this version does not- allowing for greater use, including diagnoses in the ER.

Read the announcement
Read about the technology

About insurance

Why hospital associations are dipping their toes into state-based Medicare ACOs: This consolidation has been a long time coming. When hospitals each have their own ACOs, they are responsible for patients who go outside their systems. If hospitals banded together, they could coordinate care and keep “out of network” pricing down. Further, they can also pool resources to get economies of scale and scope. It makes sense that hospital associations would coordinate such activities. Carried to its logical conclusion, you would have state-specific insurance plans that originated from individual hospital plans. What a novel idea! Oh…wait, I forgot about the origin of Blue Cross plans in 1929.

Read the article

Estimated Costs of a Reinsurance Program to Stabilize the Individual Health Insurance Market: National- and State-Level Estimates: One proposal to stabilize the individual health insurance market is to offer federal subsidies for reinsurance to companies who offer this product. This research puts a cost on this plan: “… a reinsurance program with an 80% payment rate and a $40,000 to $250,000 reinsurance corridor would cost $9.5 billion in 2020, or $30.1 billion for 2020-2022 (assuming 5.5% inflation in medical expenditures).”

Read the research

State Innovation Models (SIM) Round 2: RTI prepared this report for CMS to evaluate the second round of the Center for Medicare and Medicaid Innovation's State Innovation Model (SIM). The aim of the project is to get study states to have 80% of payments be value-based (VBP) models (public and private programs). The report found some progress in three areas:

“(1) aligning commercial stakeholder interests toward payment reform,
(2) advancing behavioral health integration and primary care transformation, and
(3) establishing the infrastructure for population health planning and coordination.
The next report, AR4, will explore state experiences related to the impact of specific strategies in each of these three areas.”

However, the report also identified three ongoing obstacles to achieving success: “recruiting small, independent practices to participate in VBP contracting; …. statewide shortages of health care workers essential for delivery transformation; …and lack of federally facilitated models to transform delivery and payment in rural markets, where Medicare is a dominant payer.”

Read the report

The Uncertain Effect of Financial Incentives to Improve Health Behaviors: This opinion piece is a nice summary of the pitfalls of providing financial incentives to change physician behavior.
Many of these programs are just payments for doing something specific- prescribing a stain, for example. But these methods are usually layered on the broken pay-by-volume system, so they have to be substantial in dollars to attract any attention.

Read the research (From JAMA but appears to be open access)

Today's News and Commentary

About the public’s health

WHO reveals delayed pick for H3N2 flu vaccine strain: The WHO delayed by about a month its 2019-20 recommendations for flu vaccine coverage to make sure the chosen strains accurately predicted what would be prevalent. The recommended components were issued yesterday. While hopefully more accurate, the wait will cause a delay in manufacturing- so expect availability a bit later than this season’s vaccines.

Read the story

The Missing Diversity in Human Genetic Studies: Genetic analyses are being used as guides to research and treatments for many different conditions. This study found a lack of diversity in the sampling. For example about 78% of genome-wide association studies were done on populations of European origin.

Read the research (Subscription may be required)

Poll: More Americans say too little spending on health: Perhaps you read that headline twice? In a poll by The AP-NORC Center for Public Affairs Research and General Social Survey staffs, 70% of Americans said we should spend more on “improving and protecting the nation's health.” For comparison, only 52% said we should spend more for law enforcement and infrastructure (highways and bridges).

Read the story

Blue states threaten to drop family planning program over Trump abortion rule: Title X programs provide significant federal funding to states for birth control and reproductive health services for low-income women. But new regulations will pull that funding if centers receiving the money provide or refer out for abortion services. According to the article, “of 23 states, including the District of Columbia, suing over the policy changes, only four told POLITICO they plan to stay in the program, citing concerns about giving up those federal dollars even with strings attached.”

Read the article

A Reason to Be Skeptical of the Workplace Wellness Industry: This research concluded that a comprehensive workplace wellness program didn’t “change employees’ behavior or health care costs in the first year. Employees who took part didn’t become healthier or more productive, and were not more likely to go to the gym or run in a local race. Total health care costs didn’t drop, either.” This study was published in the prestigious Scientific American. I am really surprised it got into print. As someone who has been following workplace wellness programs for many years, I found the following problems with the study: 1) It was based one program in Illinois. Outcomes vary by type of organization and geography. 2) Outcomes vary by specific type of intervention (like exercise, tobacco cessation, etc.); so if overall results, such as costs, are reported, less successful programs can cancel more successful ones, making the entire program seem worthless. 3) Perhaps most importantly, the study was for one year (which the authors noted). Uptake of programs, change in corporate culture that foster them and resultant health effects can take longer.

Read the research and decide on the validity of findings for yourself

About pharma

Bayer is taking collaboration with health care start-ups to the next level: Bayer is now consolidating some of its disparate initiatives in IT into one focus on digital health. Since its launch into this area in 2013, Bayer has supported over 149 digital health companies. The program is called G4A.

Read the article

UPS eyes in-home health services with U.S. vaccine project: In yet another cross-industry activity, UPS is planning to provide at-home flu shots this fall in a venture with Merck. Nurses will go to the homes to administer the vaccines.

Read the story

Drug Company Protections Are Latest Stumbling Block for Nafta Rewrite:As previously reported, the United States-Mexico-Canada Agreement provides for 10 years of protection for biologics before biosimilars can be introduced. Now House Democrats are threatening to hold up approval of the treaty, claiming this protection is excessive and will continue to contribute to high pharma prices.

Read the article (From the NY Times but appears to be open access)

About devices

A smart toilet seat to detect heart failure?: Engineers at Rochester Institute of Technology have begun preclinical studies using a toilet seat that measures blood pressure, heart rate, oxygenation and cardiac output. The aim is to detect early heart failure in at-risk patients.

Read the story

About insurance

Maryland legislators OK plan to use tax returns to help residents with insurance enrollment: “Seven out of 10 people who are uninsured and qualify for help file Maryland income tax returns.” To take advantage of this finding, the Maryland legislature approved a program to allow people to sign up for insurance on their tax forms. Some states have also proposed allowing signups when renewing drivers licenses.

Read the story

The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities: Based on a survey of 62 inpatient psychiatric facilities, the National Association for Behavioral Healthcare (NABH) estimated that compliance with three regulatory requirements “impose $1.7 billion in compliance costs each year nationwide. Put another way, these burdens represent 4.8 percent of an average facility’s annual revenue for all inpatient psychiatric services from all sources.” [Emphases in original.] Read the report and form your own opinion if the costs are worthwhile given the protections the rules require.

Read the study

What Characterizes the Marketplaces with One or Two Insurers? An Update: This research from the Urban Institute updates their 2017 report on ACA marketplaces with only one or two plans. Bottom line is that the number of such plans is lower than last year but still not as low as 2017. However, like all other statements about the ACA, geographic differences are pronounced.

Read the research

VA is gearing up for a massive shift of health care to the private sector. But Democrats are fighting back: This article updates a previous post about Democratic opposition to Republican implementation of private options for veterans who have access problems to care. It is a nice summary of the different stakeholders and their stances on the issue.

Read the article (From the Washington Post but appears to be open access)

Today's News and Commentary

About Healthcare IT

9 top Internet of Things trends for 2019: Interesting list from a healthcare IT trade publication. It has some good thoughts about current and future trends in this area. Worth at least a quick read.

Read the annotated list

Geisinger program improves internal communication between doctors: This system has an internal communications program called Ask-A-Doc. Primary care physicians can ask specialists questions through this e-channel to get faster answers and avoid unnecessary referrals. According to an internal study of nearly 22,000 physician consultations, “the Ask-A-Doc program significantly reduced turnaround time between primary and specialty doctors to 6.5 hours vs. traditional referrals, which range from weeks to months.” In addition to reducing turnaround time, the program reduced costs 20% in its second month, largely due to lower ER visits and a 74% drop in specialty visits.

Read the article
Read more about how the process works

Disconnected: a survey of users and nonusers of telehealth and their use of primary care: This research looked at who is using telehealth services. The conclusion was: “ …users of live video visits were educated, employed, and largely urban based. Compared with nonusers, they were less likely to have a primary care USC [ usual source of care], and many unsuccessfully sought to obtain in-person care.” Having the availability of telehealth is laudable, but not as a substitute for having an ongoing primary care physician relationship.

Read the research

Data Note: Public’s Experiences With Electronic Health Records: This research from the Kaiser Family Foundation has a number of interesting findings (you should look at the whole report). One interesting result was that only about 45% of respondents thought EHRs improved the quality of care or physician interaction. Overall, 54% are concerned about unauthorized access, but results vary by age- younger respondents are more trusting.

Read the report

About the public’s health

A prospective study of tea drinking temperature and risk of esophageal squamous cell carcinoma: This scientific research was the most cited in the media today. It also has the most immediate practical implication. Bottom line: To avoid increasing your risk of esophageal squamous cell carcinoma (by 90%), make sure your hot drinks are below 60 degrees Celsius (140 degrees Fahrenheit). For comparison, those of you who prepare coffee by French press method know the initial brewing temperature is 200 degrees Fahrenheit.

Read the research (May need subscription)
In case you cannot access the research read this story

New Zealand to Ban Military-Style Semiautomatic Guns, Jacinda Ardern Says: While not medical, this announcement was really the biggest public health story today and showed tremendous courage and leadership. US implications are, unfortunately, obvious.

Read the article (from NY Times but appears open access)

About insurance

Community Factors and Hospital Readmission Rates: Medicare penalizes hospitals with excessive readmission rates. But to be helpful, payments must be based on factors over which hospitals have control. This research quantifies the effect of social determinants on the penalties. Researchers studied cases of heart attack, congestive heart failure and pneumonia. They found that for those conditions alone, adjusting for such factors as  poverty, disability and living in a disadvantaged neighborhood accounted for $35 million in penalties for safety net and affluent hospitals. Overall, “Fifty‐eight percent of national variation in hospital readmission rates was explained by the county in which the hospital was located.”

Read the research (Subscription may be required)
If you cannot get access to the research, read this article

The risk of death from this cancer went down in Kentucky after Medicaid expansion: Simple message: Medicaid expansion increased colon cancer screening and decreased mortality. For example: “In Appalachian Kentucky, where cancer rates are the highest in the state, colon cancer screenings went up 43 percent and the risk of death declined by … 27 percent.” Another case to show that insurance coverage matters in quality of care.

Read the story

Today's News and Commentary

About insurance

Where Do U.S. Health Reform Proposals Fall on the Medicare-for-All Continuum?: With all the Medicare-for-all stories in the news I am reposting the Commonwealth Fund site that allows you to compare the spectrum of proposals.

Check the website

Following Medicare’s ACO Program Overhaul, Most ACOs Stay—But Physician-Led ACOs Leave At A Higher Rate: This analysis looks at what types of organizations are dropping out of the ACO program. As the title indicates, physician-led organizations have a higher exit rate than those led by hospitals. The article speculates on the reasons but my take has always been that lack of adequate financing and expertise with risk-taking have consistently plagued these physician ventures.

Read the article

 Mercer’s National Survey of Employer-Sponsored Health Plans-2018: Some of the findings in this annual survey are not surprising- specialty pharmaceutical are a major driver of costs (see pharma articles below). But what employers are doing or not doing about rising costs is puzzling. For example, while 80% offer telemedicine options, only 18% offer a high performance network and 25% steer employees to centers of excellence for transplants. Employers need to get serious about their quality concerns before employees will consider narrower networks.

Read the survey highlights (Free signup required; do not use Safari- the signup form does not load)

A spinal surgery, a $101,000 bill, and a new law to prevent more surprises: One of the hot issues in insurance is surprise bills- patients receiving large bills from providers they thought were in-network with their insurers or from ERs when they did not have time to check provider status. Sarah Cliff at Vox has reported extensively on those ER bills. Here, she reports on NY state’s new law mandating arbitration for such circumstances. It could become a national prototype.

Read the article

Health Plans For State Employees Use Medicare's Hammer On Hospital Bills: I have always wondered why many states and private insurers continue to pay hospitals according to non-benchmarked rates. Finally, some states are taking action by using Medicare rates as a reference point. For example, in North Carolina the state Treasurer  plans to “start paying most hospitals Medicare rates plus 82 percent — a figure he says would provide for a modest profit margin while saving the state more than $258 million annually.” This is a great article that could portend shifts in payment methods.

Read the article

About pharma

Sage Therapeutics' Zulresso becomes first treatment for post-partum depression approved in US: This story may have the most media coverage today. The title explains what it is about. Good news is not only that it works, but works quickly—over days instead of the weeks with older medication. Bad news is
“the list price for the drug [will] be $7450 per vial, resulting in a projected average cost of $34 000 per patient before discounts” not counting the costs of the hospital stay required to administer the drug. The company is working on an oral version.

Read the announcement

 Soaring cost of new specialty drugs the next front in war over high prescription prices: While the article is recent, the news is very old. Specialty pharmaceuticals have been the cost driver in this sector for years. The impact of biosimilars has yet to be realized.

Read the article

Long-term Effects of Metformin on Diabetes Prevention: Identification of Subgroups That Benefited Most in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study: In patients at high risk for developing diabetes, such as those who had gestational diabetes or elevated HbA1c, those taking 850 mg metformin twice daily significantly lowered the rate of subsequent disease. Unlike many short term studies, this one was conducted over 15 years.
This treatment could become a standard and dramatically increase metformin prescriptions. The good news is that the medication is inexpensive and generic.

Read the research

About devices

FDA approves 6 MRI-safe pacemakers from Biotronik: One of the latest developments in pacemakers is making them able to be used with MRIs. Interesting principle- we are modifying older technology so it can be used with newer technology.

Read the announcement

Reports of Breast Implant Illnesses Prompt Federal Review: This title could have been from the last decade or two, instead of yesterday’s NY Times. Read the article for an update of this problem.

Read the article (From NY Times but appears to be open access)

About the public’s health

Spinach, strawberries and kale top annual report on the most pesticide-tainted produce: This article makes a great case for buying organically grown produce, especially for certain items. The subtitle on the article is: “Annual analysis finds almost 70 percent of U.S. fruits and vegetables have pesticide residues.”

Read the article

San Francisco proposes restricting vape sales. One official would like Juul's headquarters 'gone yesterday': I recently wrote about India’s health ministry trying to block Juul from that country. Now San Francisco is doing the same thing. Hopefully it is a trend.

Read the article

WHO expert panel paves way for strong international governance on human genome editing:
The WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing is starting its work to, among other things, develop a directory of genome editing activities, issue ethical guidelines and create more transparency about genome editing.

Read the article

Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study: It has long been known that diet matters for healthy living. But how do we quantify the benefits? This research was done to answer that question. You will need to read the article for the diet and methodology, but, in short, the outcome was that: “Over a lifetime, the F&V [fruit and vegetable] incentive would prevent 1.93 million cardiovascular disease (CVD) events and 0.35 million CVD deaths and save $40 billion in healthcare costs. The healthy food incentive would prevent 3.28 million CVD cases, 0.62 million CVD deaths, and 0.12 million diabetes cases and save $100 billion in healthcare costs.” Depending on the specifics of the intervention, the costs were in the range of $10-20,000 per Quality Adjusted Life Year (QALY). The article makes a good case for implementing the program.

Read the research

Today's News and Commentary

About insurance

CMS grants Maryland a Medicaid waiver: This announcement is interesting for a few reasons. First, it provides an example of what a CMS document looks like that grants a waiver to a state for specific Medicaid programs. Second, unlike broad waivers allowing managed care plans to substitute for traditional Medicaid, this one provides for specific services eligible to receive federal matching funds. The programs covered in this waiver are: a Diabetes Prevention Program (DPP); expanded medically managed intensive inpatient services; an adult dental pilot program; an  Assistance in Community Integration Services (ACIS) pilot program with an annual enrollment cap; and “modification of the family planning program effective… so that women of child bearing age who have a family income at or below 200 percent of the FPL and who are not otherwise eligible for Medicaid, CHIP, or Medicare, but had Medicaid pregnancy coverage, will be eligible for the HealthChoice family planning program for 12 months immediately following the 2-month post-partum period.” The third part of interest is the last benefit- family planning- especially given current federal attitudes toward this topic. (This service does NOT include abortions).

Read the CMS letter

Medicaid work requirements could cost hospitals up to $4.1B in revenue in 2019—report: Yesterday’s blog noted how many people in Arkansas could be off the Medicaid rolls with a work linkage. This Commonwealth Fund report estimated that, nationally, lost Medicaid payments due to work ineligibility would cost hospitals $4.1 billion in revenue.

Read the article
Read the original report

When medicines are unaffordable, here’s how patients cut costs: This article is a nice summary of strategies patients use to cut costs for expensive prescriptions. It also has some instructive graphics how these methods have changed. One piece of good news is that these behaviors declined starting in 2014, when the ACA started.

Read the article

Payer Roundup—Amazon now accepting consumers’ FSA, HSA: Interesting development. The title is self-explanatory.

Read the article

VA’s Private Care Program Headed for Tech Trouble, Review Finds: The VA system is gearing up to provide private options to certain beneficiaries. But this study showed the IT solutions for this insurance option is largely flawed.

Read the article

Today's News and Commentary

About pharma

Amgen Announces New Four-Year Outcomes Study To Examine Long-Term Effects Of Repatha (evolocumab) In High-Risk Cardiovascular Disease (CVD) Patients Without Prior Heart Attack Or Stroke: Repatha is in the newest class of cholesterol lowering drugs. It is also, by far, the most expensive class. In addition to cost, longer term effects are not known. This study will look at patients who receive this drug for at least four years. This research is very much needed to more accurately assess the cost benefit of this medication.

Read the announcement

Amgen and Jay Leno Partner to Sound the Alarm on High Cholesterol and its Link to Heart Attack and Stroke in Patients Most at Risk: In a related story, Amgen chose Jay Leno to promote its cholesterol lowering campaign.

Read the announcement

About the public’s health

Exclusive: India's health ministry calls for blocking Juul's entry into country - document: Reuters obtained a copy of a letter from India’s health ministry to the prime minister with the recommendation that Juul not be allowed into the country. The company was planning to set up a subsidiary there later this year. India has a significant prevalence of tobacco-related illnesses. Finally some government is taking real steps to help.

Read the article

Daily low-dose aspirin no longer recommended as heart attack preventative for older adults:Recent research shows that older, healthy people do not benefit from taking low dose aspirin. This weekend, these findings were incorporated into recommendations by the American College of Cardiology and American Heart Association at their annual meeting. By the way, the preferred American term is preventive not preventative.

Read the article

Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018: Much of what happens in medicine is experience-based only- meaning that good clinical studies have not been done to support treatments. Notwithstanding the previous article, this study reviewed evidence-based recommendations in cardiology. It’s conclusion is that:
“In this systematic review of 51 current guideline documents that included 6329 recommendations, 8.5% of recommendations in ACC/AHA [American College of Cardiology/American Heart Association] and 14.3% of recommendations in ESC [European Society of Cardiology]   were classified as level of evidence A (supported by evidence from multiple RCTs), compared with 11.5% of recommendations in a systematic review of ACC/AHA guidelines conducted in 2009.”

In other words, more recommendations with fewer being evidence-based.

Read the research (Subscription required but abstract is available)

Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality: Another controversy is about whether eggs are bad for you. Older recommendations warned against egg consumption because of the cholesterol. Then recommendations said eggs were OK. Now this study appears to swing the pendulum back. The associations between egg consumption and cardiovascular and all-cause mortality were found to be monotonic- that is, the higher the consumption, the higher the mortality rates. The effect appears to be due to cholesterol consumption. Those who like egg whites need not worry.

Read the abstract (Full article requires subscription)
Read the NY Times article about the research

Age, Period, and Cohort Trends in Mood Disorder Indicators and Suicide- Related Outcomes in a Nationally Representative Dataset, 2005–2017:Tell your kids to get off their phones, take a break from social media and get more sleep. This research concluded that: “Cultural trends contributing to an increase in mood disorders and suicidal thoughts and behaviors since the mid-2000s, including the rise of electronic communication and digital media and declines in sleep duration, may have had a larger impact on younger people…”

Read the research
Read the general interest story on this topic

Twenty-Year Trends in Outcomes for Older Adults With Acute Myocardial Infarction in the United States: Now some good news. From 1995-2014, hospitalizations for heart attacks dropped 38% and 30 day mortality after the attack was reduced by more than a third to 12 %- an all-time low.

Read the research

About healthcare IT

Death By 1,000 Clicks: Where Electronic Health Records Went Wrong: READ THIS ARTICLE! It is a great summary of the problems with EHRs- some of which have been life-threatening or fatal. Most of the big players are mentioned as being part of the problem.

Read the article

Electronic Health Record Adoption and Nurse Reports of Usability and Quality of Care: The Role of Work Environment: As the authors point out, little is known about how the work environment affects perceptions of usability of IT systems. In short, they found that: “…independent of EHR adoption level—the hospital work environment plays a significant role in how nurses evaluate EHR usability and whether EHRs have their intended effects on improving quality and safety of care.” How the IT implementation process is carried out is undoubtedly due to management practices and the work environment it creates. One wonders, for example, if processes were improved before IT “solutions” were installed.

Read the research

About insurance

“Direct Enrollment” in Marketplace Coverage Lacks Protections for Consumers, Exposes Them to Harm: Online enrollment in an ACA exchange plan can help people find out the federally compliant coverage which might benefit them the most. Late last year the federal government allowed individuals to directly enroll in plans without ever accessing the federal marketplace. This article explains the problems that have and can occur with this new enrollment mechanism.

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Agency: 13K didn’t meet Arkansas’ Medicaid work requirement: Last month 13,000 Arkansas Medicaid beneficiaries lost coverage because they did not meet work requirements; an additional 6400 are expected to be added to that total by next month. In the meantime Ohio is going ahead with work requirements. As previously reported, the next step will be up to the courts to decide if federal waivers that allow work requirements are legal according to Medicaid law.

Read the article

Improving the Structure of Disproportionate Share Hospital [DSH] Allotment Reductions: The federal government has been planning across the board reductions in their subsidies to hospitals that serve disproportionately large Medicaid and uninsured populations. Instead of this indiscriminate approach, MedPAC is recommending that the reductions: are phased in more gradually over a longer period of time; apply first to places with unspent funding; and, are distributed “in a way that gradually improves the relationship between DSH allotments and the number of non-elderly, low-income individuals in a state.”

Read the report

MedPAC Releases Report to Congress on Medicare Payment Policy: Separately, MedPAC issued this press release summarizing payment recommendations for the coming year. It covers a wide range of programs so is hard to succinctly summarize. However, the most radical recommendation is consolidation of the The Hospital Inpatient Quality Reporting Program (IQRP), the Hospital Readmissions Reduction Program (HRRP), the Hospital-Acquired Condition Reduction Program (HACRP), and the Hospital Value-Based Purchasing (VBP) Program into one quality program based on methodology the Commission developed last year- called the he hospital value incentive program, or HVIP.

Read the press release

Today's News and Commentary

About insurance

Judge Vows To Rule On Medicaid Work Requirements By End Of March: The National Health Law Program and other plaintiffs have sued the federal government over its granting of Medicaid waivers that allow states to tie the program’s health benefits to work requirements. The rulings to date have supported the plaintiffs- the reasoning is that the work requirements do not further the health care goals of Medicaid. U.S. District Judge James Boasberg will rule about the specific work requirement in Arkansas. He is the same judge who blocked Kentucky’s waiver last year.

Read the article

Good Ideas Must Be Evaluated: Speaking of waivers, CMS Administrator Verma announced a new set of tools to helps states get and maintain their Medicaid waivers. These waivers would include those with a tie to work requirements (at least until now).

Read the announcement
Read about the Evaluation Resources

Out-of-Network Emergency Physicians Increase Health Care Prices for Consumers by $6 Billion Each Year: This study by UnitedHealthGroup found that:

“Inflated charges by out of network (OON) emergency physicians treating patients at in-network EDs totaled an estimated $6 billion.
OON emergency physicians charged an average of $538 (150 percent) more per ED visit than in-network emergency physicians were paid ($898 vs. $360).
Over one-quarter of visits to in-network EDs resulted in OON physician charges (12 million out of 44 million).”

Since patients often do not have a choice where they go in an emergency, these charges are the worst kind of monopolistic prices. Is it time for nationally- imposed rates- at least for emergency departments?

Read the study

Azar calls out ‘absurdity' in Medicare wage index: The Medicare wage index is an important component in deciding how much hospitals and physicians are paid for their costs of doing business. The formula is a complex blend of like-jobs and does not specifically look at healthcare employees. It is long overdue for reform.

Read the article (Modern Healthcare but appears to be open access)

Measuring progress in improving prior authorization [PA]: In January of last year the AMA issued a report that documented the burden on physicians of prior authorizations. It then called on insurance companies for certain measures to alleviate this problem. The report says there has not been progress in this area. Among the findings: “A strong majority (88% and 86%, respectively) of physicians report that the number of PAs required for prescription medications and medical services has increased over the last five years.” Further, phone and fax reminders by far the most-used methods of obtaining approvals. Time for the insurance industry to come into this century- that is, if they really want to do so.

Read the research

About the public’s health

Poll shows emerging ideological divide over childhood vaccinations: In a poll asking about federal mandates for childhood vaccines, 61 percent of registered voters were in favor and 39 percent were opposed. But the breakdown is strongly along political ideology: Seventy percent of liberal voters said they favor an immunization requirement compared to 54 percent of conservatives; sixty one percent of moderates were in favor.
Do we really need to make the public’s health about politics?

Read the analysis and survey results

Early Release of Selected Estimates Based on Data From January-September 2018 National Health Interview Survey: This CDC survey is a treasure trove of information ranging from access to insurance to health behaviors. Overall, the percentage of people who reported excellent or very good health was 66.3, statistically unchanged from the previous year.

Read the report

About pharma

Updated CMS drug dashboards show prescription price hikes sustained by Medicaid, Medicare: If you thought the federal government was on top of its own pharmaceutical prices, read this article. From 2013-2017, Medicaid prescription drug spending rose by nearly 15% and average spending per unit dose under Medicare Parts B and D rose 10.6% and 10%, respectivelyThese figures come from the
CMS Drug Spending website.

Read the article

Interim report from the Advisory Council on the Implementation of National Pharmacare: This report is from out northern neighbor. It states, in part, that: “Canada’s spending on prescription drugs is unsustainable…In fact, drug spending is now the second largest category of spending in Canadian health care, surpassing spending on physician services – only hospitals cost more. Canadians pay among the highest prices and spend more on prescription drugs than citizens of almost every other country in the world.”  We will have to see how they will address the same problem we have.

Read the brief

About quality

Variation in Surgical Outcomes Across Networks of the Highest-Rated US Hospitals:Popular press surveys are a common source of information for the public to help them make healthcare decisions. This study uses the 2018 US News & World Report Honor Roll hospitals to assess variations in select surgical outcomes of care among hospitals that were parts of the same systems. No surprise, there was a wide variation. The paper calls for systems to more closely monitor member hospitals but what I take away is that system rankings cannot be used as a proxy for individual institutional care- another case of caveat emptor in healthcare.

Read the research (Subscription required by abstract is accessible)