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?

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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.

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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.

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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.

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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.

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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).”

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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)