Medicare enrollees with multiple chronic illness will get extra benefits under the Chronic Care Act, which was included in recent budget legislation. Social services, home improvements (like wheelchair ramps), transportation to doctor’s offices and home delivery of hot meals can improve health, keep people independent and out of the hospital. Passage of the law was a rare instance of bipartisan cooperation.
(
The New York Times
)
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The U.S. Justice Department filed a brief saying the part of Obamacare requiring individuals to have health insurance is unconstitutional. The brief was filed in federal court on behalf of Texas and 19 other states suing the federal government, which makes the Justice Department filing unusual. The suit challenged the constitutionality of the Affordable Care Act because the tax law passed in late 2017 eliminated tax penalties on individuals who don’t have health insurance—and that, the government argues, rendered the individual mandate illegal.
(
Reuters
)
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Innovation & Transformation
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A network of business coalitions is working with software platform Remedy Partners to accelerate development of a bundled payment model that can be used nationwide. The National Alliance of Healthcare Purchaser Coalitions, representing more than 12,000 employers, wants to give commercial payers a single national platform to contract for bundled payments for defined episodes of care, like hip replacement or spinal fusion. While some large employers have used bundled payments in discrete markets, the platform would leverage the strength of a much larger employer base to lock in a global price. The effort, if successful, would have a much larger footprint than the Amazon, Berkshire Hathaway and JPMorgan Chase & Co. alliance formed earlier this year.
(
Forbes
)
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Montana’s health benefits lead had what she calls a “holy cow” moment when directed to get spiraling health care costs for the state’s 35,000 workers under control. Prices varied widely for common hospital services across the state, so now the state’s reference based pricing methodology pays all hospitals in the state a common price for standard procedures, pegged at 234 percent of Medicare rates. By telling hospitals what it will pay—enough to cover costs and earn a modest profit—the state hopes to curb overall costs.
(
Bakersfield.com
)
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A lawsuit brewing over what constitutes a mail order pharmacy may open the door to the lucrative business to Amazon. CareZone is an app that allows people to get their medications at home, dispensed through the CareZone Pharmacy locations and delivered to their door. CareZone Pharmacy was among Express Scripts’ network of providers, but was removed from the network after the PBM accused CareZone of acting like a mail-order pharmacy. But CareZone says it never mails anything. If CareZone wins its lawsuit against Express Scripts, Amazon could have the legal footing to set up contracts with pharmacies all over the country for home delivery of drugs. (
Axios
)
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Five big myths permeate the discussion about alternative payment models and their ability to improve care while controlling costs: (1) APMs lead to physician employment and consolidation, which inhibits competition and raises prices; (2) physician-led models should be given precedence over hospital-led ones; (3) health systems don’t have an incentive to participate and innovate; (4) ACOs have had lackluster results; and (4) savings from system-led ACOs only come from post-acute care. In this evidence-based blog from Premier, Inc., the myths are busted.
(
HealthAffairs
)
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G.E. spins off health care division:
The once-mighty General Electric announced it will spin off its health care business into a new publicly-traded company. The unit manufactures MRI machines and other equipment. G.E. leadership says the company will focus on its aviation, power and renewable energy divisions.
(
The New York Times
)
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FDA approves first cannabis drug
:
The first drug with an ingredient derived from marijuana was approved by the Food and Drug Administration. Cannabidiol (Epidiolex) can be used to treat a rare form of epilepsy. It's made from a chemical component of the plant that does not cause intoxication or euphoria effects.
(
MedPageToday
)
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Patients with diabetes enrolled in Geisinger Health System’s Fresh Food Farmacy program receive a prescription for 15 hours of diet and healthy living, followed by 10 free, nutritious meals a week for their families. Across the country, 260 Virta Health diabetes patients connect virtually with coaches and doctors for tailored ketogenic diet advice. Both diet-based programs are money-saving alternatives to traditional insulin and medical costs associated with the disease. (
CNBC
)
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MarketVoices...quotes worth reading
“Employers are looking to invest in and implement one system for healthcare payment and delivery reform in all of the locations where they have employees, which is the purpose of our collaboration. An essential part of this effort is to help employees get and seek care from high value providers.” Remedy Partners senior vice president François de Brantes, as quoted by
Forbes
.
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Editor
Sandy Mau
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