Today's News and Commentary

About health insurance

Governors weigh health care plans as they await court ruling: The headline is self explanatory. Governors gathered in Salt Lake city and discussed what would happen if the courts find the ACA is invalid.

2019 Wellness & Wealth Report: This inaugural report from Lively, Inc. found that healthcare benefits are the most important factor for employees- surpassing competitive salaries and 401 (k) plans.

Despite calls to start over, US health system covers 90%: This story was in a number of media today. Some spun it positively and others said “only 90%” of the population is covered. This article also points out that the adequacy of coverage is also important, as American face higher out of pocket costs.

Trump administration rejects Utah request for partial Medicaid funding: As previously reported, Utah and some other states were considering a partial expansion of Medicaid- more than current limits but not quite up to ACA expansion requirements. The Trump administration turned down the state’s request, setting this option aside.

Judge strikes down New Hampshire Medicaid work requirements program: Some states have tried to add work requirements to receive Medicaid benefits. This court decision is the latest (after Kentucky and Arkansas) striking down this condition for participation.

Aetna enlists AI to settle health insurance claims: Claims payments can get very complicated. This article explains how “Aetna allocates 50 employees to read notes about payment, deductible, and extraneous fee explanations in each contract, calculate pricing and update the claim. And with Aetna handling 2.4 million contracts per year, the process takes weeks to months, and often results in incorrect payment for claims.” The solution to this complex, often personnel-intensive process is use of artificial intelligence. This article is a nice summary of this use for AI.

HHS' OIG: CMS must review how MSSP overhaul is affecting ACO care: The HHS’ Office of the Inspector General interviewed 20 high performing Accountable Care Organizations to find out their secrets for success. Among the findings were the presence of care coordinators. But the one shortcoming was lack of a mechanism to share best practices with other ACOs.

Legislation introduced to back state Medicaid programs in addressing social determinants: Addressing social determinants of disease can reduce overall costs. But until legislation is passed, theses measures are not part of Medicaid funding. The model for expansion is what CMS allows Medicare Advantage plans to provide to their members.

About pharma

Restrictions on $2 Million Drug Highlight Challenge for Gene Therapies (Wall Street Journal, subscription may be required): The article deals with the specifics of Novartis’ gene therapy Zolgensma, which costs $2.1 million. The principles apply to other extremely expensive, life-saving or life-altering therapies.

Pfizer close to merging off-patent drug business with Mylan: report: This story was the top healthcare “business news” today and is the latest in the pharma sector’s ongoing restructuring.

NIH issues strict new requirements for fetal tissue research funding(Washington Post, subscription may be required) “In a notice spelling out the rule changes, NIH says that all grant applications and renewals for research relying on tissue collected from elective abortions must provide a detailed justification, documenting why no alternative methods could accomplish the same research goals. This and other changes for scientists at universities and other institutions take effect in two months.”

About healthcare IT

VA to spend $4.9B maintaining EHR over next decade as it rolls out Cerner replacement: This article is the latest on the VA EHR fiasco which is way over budget and time projections. The VA estimates that while it is rolling out its $10 billion Cerner system over the next 10 years, it will need $4.9 billion to maintain its legacy system, which has “130 versions or instances…across 1,500 sites.”

VUMC pilot to use voice commands to retrieve EHR data: It is often cumbersome to navigate an EHR. This pilot study at Vanderbilt will use voice commands to expedite searches.

HHS Awards Nearly $42 Million to Expand Health Information Technology In Health Centers Nationwide: “HHS, through the Health Resources and Services Administration (HRSA) awarded almost $42 million in funding to 49 Health Center Controlled Networks (HCCNs). These awards will enable the HCCNs to support 1,183 federally-funded health centers across all 50 states, the District of Columbia and Puerto Rico to expand the use of health information technology (health IT)…HCCNs are groups of health centers collaborating to improve operational and clinical practices by making technology easier for providers and patients to use, increasing the security of patient information and using data to improve patient care.”