The Centers for Medicare & Medicaid services issued final rules affecting individual health plans sold in the Affordable Care Act marketplaces that allow more wiggle room for health plans. States can now tailor their own set of essential benefits for plans from a much larger list, rather than use a nationally standard list of essential benefits mandated by the federal agency. States can also choose to modify the medical loss ratio formula—the proportion of premiums health plans must pay for medical claims. Finally, health plans can raise plan rates by up to 15 percent before they require scrutiny by state regulators.
(
Reuters
)
|
|
In 2016, employers paid $2.6 billion for employee benefits for opioid addiction—nearly a 10-fold increase over 2004 figures. A majority went to treat dependent children. Although opioid prescription use in employer health plans is dropping, the price for inpatient addiction treatment has increased from $5,809 to $16,104 during that period. (
Kaiser Family Foundation
)
|
|
Innovation & Transformation
|
|
The more than 75 million members of the millennial generation (born between 1981 and 1996) are less likely to have a primary care physician and more likely to seek care in walk-in clinics compared to their baby boomer parents, according to research from the Employee Benefit Research Institute. They are also more than twice as likely to rank telemedicine as an “extremely or very important” option for care. As the largest generation of Americans, millennials and their preferences are of keen interest to employers and providers. (
HealthcareITNews
)
|
|
Rather than using symptoms to define Alzheimer’s disease, scientists are working to identify biological changes in the brain—or biomarkers—to identify patients for studies to detect the disease sooner. Using a biomarker will better identify people to enroll in Alzheimer's disease studies, researchers say, because dementia symptoms can be associated with conditions other than Alzheimer’s. When the biomarker comes into use, it’s likely the number of people with Alzheimer’s disease will increase dramatically because of earlier identification, researchers say. And earlier detection may increase the odds of treating the disease. (
National Public Radio
)
|
|
The CEO's Guide to Restoring the American Dream offers a behind-the-scenes look at how public and private employers and unions across the U.S. are reducing their spending by 20 percent or more while improving care quality and access. The book uses real-life examples to outline how top-performing benefits purchasers take control of the purchasing process, align economic incentives and apply simple, practical and proven approaches.The new edition also unpacks how employers have been the key (unwitting) enabler of the opioid crisis and how smart employers are going upstream to solve the opioid problem before it happens. Now available to H2RMinutes subscribers as a free download
here.
|
|
The Blue Cross Blue Shield Association says ibuprofen and acetaminophen can treat pain more effectively than opioids and should be the first and second line of treatments. The association’s new guidelines align with the Centers for Disease Control and Prevention, although opioids may still be the best care for cancer and end-of-life care. Blue Cross North Carolina separately announced it will limit first-time short-acting opioid prescriptions to a 7-day supply and will require prior authorization for new extended-release opioid prescriptions; health plans in other states have made similar moves to combat overprescribing. (
Modern Healthcare [login required]
;
Blue Cross Blue Shield of North Carolina announcement
)
|
|
California sues Sutter:
The Golden State's attorney general has sued northern California’s largest health care system for its pricing practices. Mergers and acquisitions have resulted in 25 percent higher prices at Sutter facilities than any other California hospital, and a report last week from researchers at UC Berkeley found prices in northern California—Sutter’s home turf—are 30 percent higher than in Southern California. (
Healthcare Dive
;
San Francisco Chronicle
)
|
|
Do you have a colleague who needs to keep up with health news and trends? Share
H2R Minutes
today!
|
|
|
Google, AMA fund wearables contest:
If you’ve got the breakthrough ways to connect data from health wearables to electronic health records, the American Medical Association and Google have $50,000 in Google Cloud credits to help develop it. Ideas should be submitted by June 7; the three top ideas will share the credits.
(
Mobihealthnews
)
|
|
Boehler named to lead CMMI:
Seema Verma, administrator of the Centers for Medicare and Medicaid Services, announced Adam Boehler will lead the Center for Medicare & Medicaid Innovation. Boehler is the former CEO of Landmark Health. (
The Hill
)
|
|
Patient advocacy groups aren’t required to reveal their funders, but publicly traded drug makers are. The “Pre$cription for Power” database tracks $116 million pharma companies paid to patient advocacy groups in 2015—much more than they paid for lobbying activities. Although pharmaceutical companies say the payments are designed to reward innovation and ensure patient access to medicines, ethicists wonder if organizations like the American Diabetes Association and the Susan G. Komen breast cancer organization may be unduly influenced and, as a result, hesitant to stand up to drug companies over high prices. (
Kaiser Health News
;
Pre$cription for Power database
)
|
|
MarketVoices...quotes worth reading
“The opioids are half as effective but two to four times more harmful. But because of how they are marketed, physicians might think that is not the case." Dr. Trent Haywood, chief medical officer for the Blue Cross and Blue Shield Association, as quoted by
Modern Healthcare
about why physicians prescribe opioids for pain when, in most cases, ibuprofen and acetaminophen can treat pain more effectively.
|
|
Editor
Sandy Mau
Request Media Kit
703.394.5395
|
|
|
Copyright 2009-2018,
H2R Minutes
|
|
|
|
|
|
|
|
