Today's News and Commentary

About health insurance

A look at how providers could fare in CMS' new primary care payment models: As previously reported, starting in January 2020 CMS will start a demonstration project to incentivize primary care physicians to accept risk arrangements with quality bonuses. This scheme is separate from the ACO program. This article is a nice summary of what the primary care payment models will look like.

Problems Remain for Ensuring That All High Risk Medicaid Providers Undergo Criminal Background Checks: The Office of the Inspector General of HHS surveyed states’ compliance with measures to assure “high risk” individuals were appropriately screened before being allowed to participate in the Medicaid program. The OIG “found flaws with States' implementation of fingerprint based criminal background checks for high risk Medicaid providers. Eighteen States missed the deadline for implementation that CMS had set, and 13 of those 18 States had still not implemented these checks as of January 1, 2019.” Recommendations are included in the report.

About healthcare IT

Surescripts files motion to dismiss FTC's antitrust case: Recall that in April the FTC filed suit against Surescripts for monopolizing the e-prescribing market. This article provides an update on that story.

About pharma

Advocates frustrated over pace of drug price reform: Despite all the talk in Congress (by both parties) about addressing high drug prices, nothing has been done; and the August recess is fast approaching. This article is a nice summary of what is (or is not) happening.

How pharma, under attack from all sides, keeps winning in Washington: This article provides a different spin than the one above by focusing on the role of the pharma lobby.

Limited Information Exists on the Effects of Synchronizing Medication Refills: “Medication synchronization is a process whereby a pharmacist aligns the refill dates of two or more of a patient’s medications to a single day.” The GAO was mandated to do a survey about this issue and found scant data. Some findings support increased drug adherence. But there are problems with this process. A major one is that patients stagger their filling of prescriptions because they need to spread out the costs. Perhaps the problem could be solved with a utility-like payment method that “smooths” payments rather than requiring a periodic lump sum. For example, instead of paying the out-of-pocket costs of several 90-day supplies of medications all at once, the patient could be billed equal amounts each month for 3 months.