- Cost and Quality Problems
- Improving Value
- Advocate Resources
- State News
By April Dembosky | Kaiser Health News | Oct. 9, 2017
The California Governor signed a sweeping drug price transparency bill that will force drugmakers to publicly justify big price hikes, according to Kaiser Health News. The new law will require drug companies to give 60 days’ notice to state agencies and health insurers anytime they plan to raise the price of a drug by 16 percent or more over two years on drugs with a wholesale cost of $40 or higher. They must also explain why the price increases are necessary. The bill drew support from a diverse coalition, including labor and consumer groups, the hospital industry and even health insurers. But some experts say that transparency alone is not enough to bring down drug prices, and that California’s law may lack the muscle being applied in other states to directly hold drug prices down.
By Jacqueline Belliveau | RevCycle Intelligence | Oct. 6, 2017
The quality measures used to reimburse Medicare providers for high-quality, cost-efficient care do not necessarily translate to a pediatric population. With collaboration in mind, the Pediatric Care Network, a clinically integrated network of more than 1,400 providers and the Children’s Hospital Colorado was established, according to a news article in RevCycle Intelligence. The network aimed to define value-based care in the pediatric space. To start the collaborative journey to value-based pediatrics, the network focused on increasing data sharing to gain a comprehensive view into the pediatric care continuum. The Pediatric Care Network intends to break down the data silos between private practices, hospitals, and other pediatric care centers.
By Jennifer Reck | National Academy for State Health Policy | Oct. 10, 2017
Colorado, Delaware and Oklahoma have received $300,000 in grants to help develop innovative policy solutions to tackle high prescription drug prices in their states, according to the National Academy for State Health Policy. The funds will help these states explore the following promising policy approaches: Colorado will develop a new payment system for physician-administered drugs; Delaware will develop a shared preferred drug list to maximize savings with agencies and hospitals; and Oklahoma will develop a value-based purchasing agreement.
The Florida state Telehealth Advisory Council unanimously approved a final report and legislative recommendations to remove barriers to the use of telehealth, according to a news article from WJCT. The report recommends that lawmakers require Florida health insurance plans, excluding Medicare plans, to provide reimbursement “parity” for health services provided through telehealth or in person. The report includes a limit on the recommendation to make clear that the legislature should “not require insurers to add additional service lines or specialties, mandate fee-for-service arrangements, inhibit value based payment programs, or limit healthcare insurers and practitioners from negotiating contractual coverage terms.”
In Africa and India, the idea of using non-traditional healthcare workers was born of necessity. They simply didn’t have the money or resources to do it any other way. Unlike sub-Saharan Africa, Upper Manhattan is rich in hospitals, medical schools and pricey specialists. But it’s poor in effective community-based primary care, particularly the kind of care that can reach into kitchens and living rooms of patients, according to a news article in Politico. City Health Works is a promising approach that differs from a lot of other health coaching or community groups. It was co-designed with clinicians in its community, from places like Mount Sinai Hospital, who are open to a team-based approach and who understand that peer workers can sometimes reach where a physician cannot.
Central Ohioans could soon see at least two new small hospitals as part of a nationwide trend.
These so-called “microhospitals” typically have eight to 10 inpatient beds and such core services as emergency care, outpatient services, labs, imaging and pharmacies, according to a news article in The Columbus Dispatch. They target communities that might not need a full-blown facility. It’s a way to introduce a higher level of care to a community in a manner that is appropriate for the community size and healthcare needs. These facilities can be more cost-efficient than full-service hospitals for handling lower-acute needs.
According to an article in Dallas Morning News, Texas legislators are entitled to details about how pharmaceutical giant Pfizer priced drugs offered through the state's Medicaid program after a judge’s ruling. State lawmakers have been seeking methods to offset soaring costs and generate hundreds of millions in savings from Medicaid programs.
Access to powerful new cholesterol-lowering drugs is so tightly controlled and patients' out-of-pocket costs are so high that less than a third of people whose doctors prescribe the drugs receive them, according to a report in the Chicago Tribune. While highly effective, the new drugs cost as much as $14,000 annually, leading some insurers and pharmacy benefit managers to require doctors to get preapproval for them. For example, only 47.2 percent of people who were prescribed the drugs Praluent and Repatha received that insurance green light, and just under two-thirds of those patients filled their prescriptions.
A report in the Harvard Business Review looked at how U.S. hospitals and healthcare groups have experimented over the past decade with new management structures and alternative payment models to provide quality healthcare at lower cost. But physicians have been slow to embrace these for a host of reasons. Chief among them is that physicians feel excluded from the process. Authors recommend healthcare organizations bring physicians back into the decision-making process. After years of experimentation, doctors want evidence that new models for healthcare management, reimbursement and policy will actually improve clinical outcomes for their patients.
By David Jones and Christopher Louis | Milbank Memorial Fund | Oct. 12, 2017
In an analysis of three state health scorecards, researchers identified states that had significant and sustained improvements in at least one key health outcome measure, according to a report from the Milbank Memorial Fund. Visits to these states to understand exactly how they achieved these improvements were the basis of companion reports. Georgia and Florida reduced infant mortality rates, while Delaware and Iowa reduced the burden of chronic disease. The researchers argue that the findings are generalizable and the roles and responsibilities identified for the public and private sectors can be used to address other healthcare issues in any state.
Healthcare spending in the U.S. is a major problem and soaring healthcare incomes are partly responsible argues Dr. Peter Ubel. Having gone through the late nights, intense workloads and 80-hour work weeks to become a physician himself, Ubel argues that physicians deserve to be paid well, but questions just how much is too much. He does not just limit this notion to physicians, but includes executive administrators and others in the healthcare marketplace. With high healthcare spending burdening state and federal governments, as well as employers and patients, Ubel suggests several policies to combat the price of healthcare. For physician salaries he argues for malpractice reform and subsidized medical education so that healthcare professionals are not exposed to litigation debt and graduate with only modest debt, allowing them to take a job with modest pay.
This review of the book Nudging Health: Health Law and Behavioral Economics by Elizabeth Weeks Leonard offers insights to how the authors apply legal theory to health law and policy topics. The book is a compilation of forty-five essays that examine how behavioral science may be used to nudge health law and policy towards improved health and better healthcare spending. Weeks Leonard describes the book as an “essential reading for anyone interested in moving the health reform ball forward.”
MedPAC, a Medicare advisory panel, discussed how to stop physician-owned distributors from profiting excessively from medical device sales, according to MedPage Today. These physician-owned distributors are defined as “entities that derive revenue from selling or arranging for the sale of devices ordered by their physician owners for use in procedures the physician owners perform on their patients,” creating potentially large conflicts of interest and possible unnecessary Medicare billing. MedPac discussed the challenges and benefits to amending laws to close loopholes which allow for potential unethical behavior from physician-owned distributors.
Currently available quality measures are adequate to move forward with payment reform efforts, according to an article published in Harvard Business Review. The authors argue: 1) even imperfect measurement and transparency will accelerate quality improvement; 2) only by using the measures can we improve the measurement; and 3) returning to a fee-for-service system is not an option because of the clear waste, cost and quality of care issues that are produced using this system. They argue that payment reform efforts must continue to move forward even with the risk of imperfect measurement.
A missing debate from the discussion on the future of the Affordable Care Act is reducing costs for participating insurers, for federal government and enrollees, according to this commentary the New England Journal of Medicine. The author suggests narrowing or closing the differences in prices paid for the same medical services that are billed to different federal programs. He argues that in order to have a well-functioning health insurance market competition is a requirement among both insurers and providers. By reducing the cost disparity between commercial and Medicare pricing it could increase competition in the marketplace, help improve equity and lead to a level of affordability.
A new approach to quality measurement by the Centers for Medicare & Medicaid Services called Meaning Measures was announced by CMS Administrator Seema Verma. The approach will assess only those measures that reflect the core issues that are vital to providing high quality care and improving patient outcomes. This approach will look to reduce the burden of reporting on all providers, increase efficiencies and improve the patient experience by going through each reporting requirement and asking the purpose of it, it is required, does it meaningfully impact patient outcomes, care or safety, and if it doesn’t why is it there.