Thursday, January 3, 2019
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Legal appeals of the December federal court ruling invalidating the Affordable Care Act may not be resolved in 2019, but the issue will definitely affect the campaign focus in 2020 congressional and presidential races. ACA changes like required coverage of pre-existing conditions are voter hot-button issues. Republicans are unlikely to pass an acceptable ACA replacement with the new Congress, leaving a wide opening for attack by
Democrats on the campa
ign trail.
(
Houston Chronicle
)
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The Centers for Medicare & Medicaid Services made good on its promise to shift more ACOs into shared financial risk categories. In a final rule released at the end of December, CMS gives new “low-revenue” (or physician-led) ACOs three years to remain in a one-sided risk model, compared to the six years these ACOs had before. ACOs already in a low-risk category will have just one more year before taking on additional risk, and all other new ACOs will have two years. CMS also reduced the shared savings rate for this group to 40 percent, but kept the shared savings at 50 percent for ACOs taking financial risk.
(
Fierce Healthcare
)
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The administration overstepped its authority when it changed the payment formula by which hospitals are reimbursed under the 340B Drug Pricing Program, U.S. District Judge Rudolph Contreras ruled last week. The administration is free to make rate adjustments, but not to change the entire formula as it did in January 2018, he said. The ruling was lauded by the hospital groups bringing the lawsuit, but other groups said it could raise prices and patient cost burden. The judge did not order retroactive payments, noting that “the potentially drastic impact of this Court’s decision on Medicare’s complex administration gives the Court pause.”
(
Revcycle Intelligence
)
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Innovation & Transformation
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To remain profitable, the U.S. health system will need to treat patients like consumers by prioritizing efficiency and convenience, according to a new report from the PwC Health Research Institute. Other industries have already adjusted to this reality. Consumers surveyed said they’re ready to try new care deliver
y modes
; most want a “menu” of care options to choose from, offered by multiple providers, local or virtual. A majority would prefer to receive hospital care at home, as long as it costs less than the hospital. And a majority would try an FDA-approved app for treatment of a medical condition.
(
Benefits Pro
;
PwC report
)
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A swath of papers published in December—all focusing on the genetic roots of psychiatric disease—reveal the potential for big data and collaboration to more rapidly advance this research. The work, funded by a grant from the National Institute of Mental Health, produced 10 papers that are part of a project examining how the non-coding parts of the genome can affect they way psychiatric disorders develop. All the research tapped into a body of data gleaned from 2,000 human brains, a large sample set that will continue to be the foundation for collaborative research for years to come on a range of diseases, from autism to schizophrenia.
(
Stat
)
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Compared to women in 10 other high-income nations, women in the U.S. have the highest rates of skipping needed care because of cost and are least satisfied with care they receive, according to a new survey from The Commonwealth Fund. T
hey also are more
likely to die in pregnancy and childbirth than their international counterparts—a rate that has steadily risen over the past decades. However, they are more likely to have preventive screenings and they are able to access specialty care faster than women in other countries. (
The Commonwealth Fund
)
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Pharmaceutical manufacturers who promised the administration they wouldn’t rais
e prices in 2018 are
ready to announce increases first thing in January. “It’s time to play catch up,” said one health care analyst. Increases are likely to be in the high single-digits, on average. There will be political heat in response to the increases, but with dozens of companies raising prices in January, individual companies are less likely to be singled out by the administration or Congress.
(
Bloomberg
)
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We’re getting wider, not taller
:
A new report from the Centers for Disease Control and Prevention says average American body mass index is 29.1 for men and 29.6 for women—perilously close to a BMI of 30, the cutoff point for obesity. That puts the average American in the “overweight” category. While average waist circumference increased an inch for men and 2 inches in women, average height actually decreased from the previous study period. (
CNN
;
CDC report
)
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Google this new medication adherence partnership
:
Walgreens Boots Alliance is partnering with tech firm Verily (owned by Alphabet, Google’s parent company) to help patients with chronic illnesses find affordable medication solutions so they can better adhere to prescribed medication regimens. Verily’s diabetes company, Onduo, will work on a cost-saving solution for Walgreens employees and covered family members as a first step.
(
CNBC
)
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A year after
Kaiser Health News
and
National Public Radio
launched its “Bill of the Month” feature, the organizations revisit its stories, resolutions and lessons learned. Many of the bills “miraculously” were resolved after the feature put a spotlight on outrageous billing practices, and the Senate has proposed legislation to stop what’s frequently called “surprise billing” or “balance billing” by out-of-network providers.
(
Kaiser Health News
)
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MarketVoices...quotes worth reading
“While individually companies may do well, the price increases taken together would suggest Pharma is ‘tone deaf’ to public concerns. This is just around the time where the agenda for the upcoming Congress is being defined and action on drug costs is one option.”-- Ronny Gal, a pharmaceutical industry business analyst, as quoted by
Bloomberg
.
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Editor
Sandy Mau
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H2R Minutes
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