Thursday, November 1, 2018
|
|
|
Regulations the administration proposed last week governing health savings accounts could allow 5 million Americans to use employer-provided HSA funds to pay individual health insurance premiums, an activity halted by the Affordable Care Act. Cash-for-coverage has long been advocated by those who believe it makes consumers more savvy purchasers and forces providers and insurers to hold down costs. The proposed law includes provisions to prevent health-based discrimination, but leaves the door open for funds to be used to buy short-term coverage plans
. (
Benefits Pro
;
Employee Benefit News
)
|
|
A survey of state Medicaid directors reported no overall growth in Medicaid enrollment for the first time in a decade, and states expect minimal growth over the next fiscal year. The stronger economy and fewer new enrollees accounts for the change. But spending for the program grew by 4.2 percent in 2018, and states project a 5.3 percent increase in spending next year. That’s largely because of a larger proportion of seniors and people with disabilities in the program, as well as increases in specialty drug costs, spending for substance use and mental health services, and higher payment rates for provider services. (
Kaiser Family Foundation
;
survey report
)
|
|
Innovation & Transformation
|
|
The administration announced a plan last week to pay a lot less for drugs through Medicare Part B. Initial response from the pharmaceutical industry isn't warm. The current system allows doctors to buy drugs and administer them directly to patients, and then bill Medicare for the cost plus a 6 percent markup. The practice incentivizes providers to use higher-priced drugs, especially for specialty drugs like chemotherapy treatments. The proposal includes previously-attempted tactics, like using private-sector drug vendors and paying providers a flat fee to administer them. It also proposes a new twist—surveying international drug prices to land on a fair reference price Medicare would pay. However, as noted in a
Health Affairs
blog, Medicare is still required to pay for “reasonable and necessary treatments” at any cost—and drug companies may simply refuse to sell their treatments at the lower reference price.
(
Health Affairs blog
)
|
|
The Trump administration isn’t the only one looking abroad for lower drug prices. Utah’s PHEP public employee insurance program is paying willing patients $500 to travel to Mexico and buy select prescriptions from a vetted provider there. Legislators who sponsored the plan believe the state can save thousands of dollars a month with pharmaceutical tourism.
(
The Salt Lake Tribune
)
|
|
An increasing share of health care dollars are linked to alternative payment models that reward for value over volume, but progress is slow. Just over a third of health care spending was tied to APMs in 2017, up from 23 percent in 2015, according to a study by the Health Care Payment Learning & Action Network. Most of the APM dollars were tied to shared savings models; only a third went to population-based or capitated payment models. LAN’s mission is to accelerate the move to APMs; its stated goal is to have 50 percent of all payments tied to the models by the end of 2018.
(
HealthLeaders
)
|
|
Health plan Anthem’s controversial practice of denying payments for emergency department visits it views as unnecessary is under scrutiny. An analysis of what Anthem has designated as nonemergent diagnoses finds the criteria applies to 16 percent of commercially insured ED visits. What’s more, the same presenting symptoms for those diagnoses are shared by 88 percent of ED visits. From the patient’s perspective, that means the most common symptoms triggering an ED visit may—or may not—be denied coverage using Anthem’s criteria. “This cost-reduction policy could place many patients who reasonably seek ED care at risk of coverage denial,” the authors note.
(
JAMA Network
)
|
|
More than a million Americans have already ponied up about $100 to add their DNA sequence to the genetic databases of companies like Ancestry.com and 23andMe. Some companies are paying consumers for the privilege of sequencing their DNA, and consumers are taking the deal. A recent study argues that once 3 million Americans have similarly provided their genetic data, nearly everyone will be identifiable by their DNA (plus a little critical reasoning), because one person's DNA includes information about entire families. Law enforcement was famously able to identify and arrest 72-year-old Joseph James DeAngelo, the “Golden State Killer," using a relative’s DNA and crime scene evidence. Most consumers are unaware that life insurance underwriters and other big-data crunchers may also get their hands on the data.
(
LA Times
;
Star Tribune
)
|
|
Do you have a colleague who needs to keep up with health news and trends? Share
H2R Minutes
today!
|
|
|
Innovative Medicaid waiver approved
:
North Carolina’s Medicaid waiver for a 5-year demonstration project focusing on integrated health was approved last week. The Medicaid managed care waiver allows the state to partner with health plans to manage physical and behavioral health, intellectual/developmental disabilities and services for youth in foster care. Enhanced case management will address social risk factors, like housing instability, transportation and food insecurity. (
HealthPayerIntelligence
)
|
|
New measure for prescribers
:
Research giant Mathematica has developed a Safe Use of Opioids—Concurrent Prescribing measure for providers to guard against sending patients home with more than one opioid prescription or a combination of an opioid and benzodiazepine prescriptions. Both powerful drugs are present in more than 30 percent of fatal overdoses; it's hoped the measure will be used to increase medication safety. (
Mathematica announcement
)
|
|
Big employer coalition pays for drug pricing transparency
:
Members of the National Drug Purchasing Coalition—comprising 18 big employers like PepsiCo and Chevron—will pay Express Scripts a flat administrative fee plus what the pharmacy benefits manager pays for drugs under the Total Performance Management program. The goal is to reinstate transparency in what’s become a labyrinthine system of markups, rebates and circular payments. NDPC members pay more than $1 billion a year for prescription drugs. (
NDPC press announcement
)
|
|
Safety-net health care providers in six states are consulting via telemedicine with volunteer specialists—many of them retired or semi-retired from long, successful careers. The Medical Alumni Volunteer Expert Network, or the MAVEN Project, includes about 100 doctors lending their time and expertise for free to 40 clinics in an effort to curb the physician shortage. Founder Laurie Green came up with the idea when she realized many retiring colleagues in her Harvard Med alumni association wanted to continue practicing on a limited basis. The MAVEN Project’s goal is to be live in all 50 states by 2023. (
PBS
)
|
|
MarketVoices...quotes worth reading
"When you start looking at the list at these higher-priced drugs people are taking, you think, ‘How in the world can there be such a big price differential between the U.S. and other countries? What’s going on? Why wouldn’t we fly our employee to Mexico?" —State Rep. Norman Thurston, R-Provo, who sponsored the legislation calling for pharmaceutical tourism incentives, as quoted in
The Salt Lake Tribune
.
|
|
Editor
Sandy Mau
Request Media Kit
703.394.5395
|
|
|
Copyright 2009-2018,
H2R Minutes
|
|
|
|
|
|
|
|
