Wednesday, February 22, 2017
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Thursday, top House Republicans unveiled their plans to overhaul health care, but according to the Associated Press, “a lack of detail, cost estimates and GOP unity left unresolved the problem that’s plagued them for years: What’s the party’s plan and can Congress pass it?” One proposal would replace the ACA tax increases with new levies on the value of some employer-provided health plans; that’s unlikely to fly with many conservatives. “You have to legislate with a sense of political reality,” says Rep. Tom Cole, R-Okla. That proposal “would set up an ad against you from multiple directions” during upcoming elections. (
AP)
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The Aetna/Humana deal is officially off; Aetna will pay Humana $1 billion in breakup fees, which Humana plans to use to buy back some of its shares in hopes of raising dividends. Bruce Broussard, Humana CEO, said they would be open to another offer. Meanwhile, Cigna is trying to end its deal with Anthem while seeking legal damages, but Anthem says they will move forward with the merger plans, in effect until the end of April. Lastly, Humana announced it will leave the exchanges after this year due to large losses in 2016. They reduced their offerings for 2017. (
Reuters;
USA Today)
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MIT economist Jonathan Gruber, who served as a consultant on Obamacare, says the “math” of insurance will work if healthy people subsidize coverage for sicker people. Avik Roy, president of the Foundation for Research on Equal Opportunity, supports tax credits for low-income people to use for insurance exchange coverage as well as having them contribute to health savings accounts. Gruber’s counterpoint is that poor families don’t
have money to set aside in an HSA. Roy, Gruber and other experts were participating in a forum at the Harvard Kennedy School. (
Boston Globe)
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Under pressure from payers, the Trump administration is seeking to calm an increasingly unstable health care insurance market,
HealthLeaders Media reports. The administration’s first move on Obamacare would shorten health plan enrollment periods and beef up pre-enrollment eligibility verification. CMS issued a proposed rule for 2018 that would make changes to, among other things, enrollment periods and guaranteed availability. The move was announced a day after Humana announced it would stop selling plans on the ACA exchanges. (
HealthLeaders Media;
proposed rule)
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Seema Verma, president, CEO and founder of national health policy consulting company SVC, expected to be the new CMS chief, will have a key role in the Trump administration’s plan to repeal and replace the ACA.
Becker’s Hospital Review
published a list of “things to k
now” about Verma. Among them: She is most widely known as architect of the Healthy Indiana Plan--the state’s version of Medicaid expansion--but she also played a role in Medicaid transformation in several other states. Verma has said she considers Medicaid outdated. (
Becker’s Hospital Review
)
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Innovation & Transformation
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Healthy groceries cost a lot less than diabetes treatment. That’s the theory behind Geisinger Health System’s Fresh Food Pharmacy pilot. Participants have lost weight, lowered their body mass indices, decreased their use of medication, lowered their cholesterol and improved their hemoglobin A1C levels. So Geisinger is expanding the pilot to include 50 more patients. It’s just part of a move to whole-person care that addresses such issues as housing and diet,
USA Today reports. Medicaid generally doesn’t pay for such services, but some health care providers have received funding through the CMS
Accountable Health Communities program. (
USA Today
)
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Michigan-based Trinity Health is among a growing number of health systems that reward executives when population health improves and penalize them when it doesn’t. The annual incentive pay for each executive, including CEO, is cut if Trinity’s total patient population doesn’t show reduced rates of obesity, smoking, readmissions and hospital-acquired conditions. Overall, executive pay is still primarily linked to hitting financial targets. (
Modern Healthcare)
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A federal appeals court struck down a Florida law that barred physicians from discussing guns with patients. The 11th U.S. Circuit Court of Appeals ruled that Florida’s “Docs and Glocks” law, which prohibited doctors from asking patients about guns in the home, violated a physician’s free speech rights. The court upheld only one portion of that law--the part that said doctors could not discriminate against patients because of their support of the Second Amendment right to be armed. (
Atlanta Journal Constitution)
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Despite an emphasis on PCMHs in primary care settings, parents of children seeking specialty care are more likely to perceive the presence of National Committee for Quality Assurance (NCQA) PCMH elements in specialty, rather than primary care, clinics. This happens despite the fact that primary care practices are frequently medical homes, and receive incentives to achieve NCQA certification. Researchers say primary care practices should make their medical home elements more apparent to patients and families, and they should address parents’ perceptions and interpretations of these services. (
AJMC)
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Medicaid reform isn't that simple: Republican Medicaid reform proposals focus on either block grants or per capita caps. “While these funding approaches may sound relatively straightforward, understanding the implications of such changes requires consideration of several factors,” according to a new report from Milliman. (
Healthcare Town Hall;
Milliman paper)
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No opioids for back pain: A newly released American College of Physicians clinical practice guideline calls for treating patients with nonradicular acute or subacute low back pain with non-drug therapies, such as heat and massage, first and using nonsteroidal anti-inflammatory drugs or muscle relaxants as initial choices if medication is necessary. (
AAFP News)
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How do the various replacement proposals compare to the ACA? How do they compare to each other? The Kaiser Family Foundation has developed an interactive tool that allows users to compare and contrast. (
Kaiser Family Foundation)
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MarketVoices...quotes worth reading
"It’s important to make sure you align incentives with desired outcomes.” --Richard Gilfillan, MD, president and CEO, Trinity Health, quoted in Modern Healthcare
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Copyright 2009-2017,
H2R Minutes
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