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.
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.
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.
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.
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.
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.
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.
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.
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.”
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.
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.
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.