About health insurance
Republicans can’t wait to debate 'Medicare for all': Both parties are now saying “bring it on” and looking for “gotcha'“ moments. The Democrats think they have a winner in “Medicare for all” but Republicans are betting that when people see the cost and that (in some versions) they will lose the private coverage they now like, the debate will turn in their favor.
Universal health care in California: $17 billion a year, says one estimate: Not all states are waiting for the federal government to solve their healthcare coverage problems. UC Berkeley health policy researchers (including former colleague Steve Shortell) presented a plan for covering all Californians. What is different from most plans is that they offer not only a cost for the proposal but also details on how to pay for it.
Why UnitedHealthcare wants to expand diagnostic codes to the social determinants of health: You can’t measure something if you can’t capture the information. In order to capture and track social determinants of health, UnitedHealthcare has added diagnostic codes it wants its providers and other organizations to use. The article says the insurer is adding ICD10 codes but that is not correct- only the WHO can do that.
Judge rejects Oscar’s request for injunction against Florida Blue in spat over broker agreements: Health insurer Oscar challenged the Florida Blue plan saying the latter’s exclusive arrangements with insurance brokers prevented its expansion in the state. The trial judge disagreed and cited Centene’s market share to show that a plan can build membership despite the Blue’s lock on the brokers. While this story seems to be local, it raises issues of anticompetitive behavior in a market with a dominant player.
UnitedHealthcare demands drug rebates even if pharma cuts list prices: analyst: A federal proposal to lower drug prices would mandate that rebates go to patients, not PBMs or payers. Instead of continuing the rebates, pharma manufacturers may lower prices in response. In anticipation of these possible changes, OPTUMRx (part of UnitedHealth Group) asked for seven quarters’ notice before a price drop and will apparently also be asking for some of its rebates to continue. It is not clear how all these changes will play out, so stay tuned.
PCSK9 price-cut matchup is on, as Regeneron and Sanofi slash Praluent list tag 60%: In a price fight that is reminiscent of Hepatitis C treatments, companies are now lowering their prices for the very-expensive cholesterol-lowering PCSK9 drugs. According to the article: “ Repatha and Praleunt carried original list prices of a bit more than $14,000 a year. But drug pricing watchdogs at the Institute for Clinical and Economic Review (ICER) argued at the time that the PCSK9 inhibitors needed to bear prices of $5,404 to $7,735 to be cost-effective, drawing counterattack from Amgen and Regeneron.” Perhaps we now have a model of what competition does to extremely high cost medications.
Effect of Financial Bonus Size, Loss Aversion, and Increased Social Pressure on Physician Pay-for-Performance: One of the considerations about methods to increase quality of care is changing the financial incentives of physicians. Behavioral economic studies have generally found loss aversion is the strongest motivator in financial decisions. However, in this small, “randomized clinical trial of 54 physicians and cohort study including 66 physicians and 8188 patients, increased bonus size was associated with improved quality relative to a comparison group, although adding increased social pressure and opportunities for loss aversion did not improve quality.” It is an interesting finding but the study needs to be done on larger scale, across different specialties and geographic areas.
Cigna Value-Based Care Participation Tops 50%, Saving $600M:The movement to value-based care has been slow and statistics about its progress are often misleading. For Cigna, this reported milestone means: “More than 240 primary care organizations, more than 500 hospitals, and over 270 specialist programs in six areas of care are engaged in reimbursement through some type of pay-for-performance contract.” The figure we really need to see is that more than 50% of revenues for healthcare organizations are through pay-for-performance contracts.
Hospital Mergers Improve Health? Evidence Shows the Opposite: There is nothing new in this article from today’s NY Times but it provides a nice summary of the evidence behind the increased prices and possibly adverse quality resulting from the continuation of hospital mergers.
About healthcare IT
ONC unveils long-awaited information blocking rule: In response to requirements of the “Cures Act,” the ONC has issued its final rules, many of which are aimed at increasing interoperability of information systems. The one measure which this article highlights is preventing venders from blocking transmission of healthcare information from another vender’s system. Other measures include adopting of the United States Core Data for Interoperability (USCDI) as a standard and updating the electronic prescribing (e-Rx) SCRIPT standard.
About the public’s health
5 Things That Took Center Stage at AcademyHealth National Health Policy Conference: AcademyHealth is the association of academics who study healthcare. This article highlights the major issues they discussed at their annual meeting.
The one graphic you need for accurate blood pressure reading: In a previous post I mentioned that blood pressure determination must be done properly to get a correct reading. For example: NO BLOOD PRESSURE READING OVER CLOTHING. This one page graphic demonstrates the correct procedure. Make sure if you are getting your pressure taken it uses these measures.
A 5-Step Population Health InitiativeCould Reduce Your Asthma ED Admissions by Half:This article could also be listed in insurance, device or quality. It is a fascinating case study of how Dignity Health's innovation arm used “digital sensors from Propeller Health that slip over patients' inhalers and connect via wireless technology to their smartphone app and a clinician dashboard.” The result was a 57% reduction in ED-visits combined with hospitalizations. The article goes through important implementation steps, like having a physician champion.