Waste in health care could well top $1 trillion—enough to fund the entire Medicaid program twice over. Who pays for unnecessary care that results from administrative waste and bureaucracy, or low-value services like imaging for a simple headache? Insurers, employers and, ultimately, the consumers who pay premiums, say researchers. And when it comes to failure in care coordination, Medicare pays too much—which means taxpayers do, too.
(
Health Affairs
)
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Payments for drugs under Medicare Part D rose 62 percent between 2011 and 2015—factoring in discounts and rebates—although the actual number of prescriptions
fell
17 percent. A new report from the Office of Inspector General notes the unit cost for Medicare drugs rose six times faster than the inflation rate, and the number of individuals who spent at least $2,000 per year for drugs nearly doubled over five years. (
Axios;
OIG report
)
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Innovation & Transformation
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Apple announced this week that, as soon as this fall, consumers will be able to move electronic health record data stored in their iPhone Health app to third party applications that have used the Apple programming interface. Apple says the health data pulled from a user's connected EHR is stored directly on their own iPhone, not on the Apple servers, to ensure data remains private. (
Modern Healthcare
)
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The Food and Drug Administration made many over-the-counter genetic health risk tests free from review this week—as long as the manufacturer has successfully received pre-market authorization from FDA for a genetic health risk test. The FDA said there are exceptions to the new rule, such as prenatal and cancer predisposition testing, because results of those types of tests may be associated with morbidity or mortality. (
MobiHealthNews
;
Federal Register
)
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Without incentives to choose high-value care, consumers who are flocking to high-deductible health plans for lower rates aren’t benefiting from better value. Analysts say it will take nudging from providers to steer patients to high-value care, but providers need carrots to do so. Successful initiatives to steer consumers to high-value care include reference pricing, “smart shopper” programs and making preventive care free for patients. (
Managed Care Magazine
).
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A recent survey shows just as many Americans over age 40 are ready to access virtual health care as the younger crowd. For seniors with difficulty getting to and from a provider’s office, using Skype or a smartphone application for routine check-ins makes sense, and more than half of adults of all ages would be comfortable with it. Although the interest is there, however, Medicare reimbursement for telehealth and virtual visits remains limited. (
Associated Press
)
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Athenahealth CEO steps down
:
Jonathan Bush, CEO of the EHR system vendor, resigned Wednesday. The news came in the wake of a May takeover bid from Elliott Management, closely followed by news he settled a sexual harassment suit and has a history of physical violence with his now ex-wife. CFO Marc Levine will take the lead at Athenahealth until a new CEO is named.
(
Modern Healthcare
)
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California considers taking custody of homeless
:
A bill that’s moving forward in the California legislature—and supported by office holders in San Francisco—would bring back the idea of conservatorship for the chronically homeless and mentally ill. Those in favor of institutionalization say the current system doesn't provide the care needed by those who are gravely disabled or a danger to themselves. California closed its asylums in 1967 when it reformed its mental health laws. (
The Economist
)
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Health insurance practices that limit covered cancer drug prescriptions to mail-order pharmacy delivery mean cancer patient treatment is often delayed a week—and sometimes up to 30 days. Patients and doctors in cancer treatment centers say the medicines patients need are available immediately and locally, but when insurance plans contract with pharmacy benefit managers, patients have to wait to receive them from approved providers. That can take weeks, and delays put patients at risk. (
The Columbus Dispatch
)
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MarketVoices...quotes worth reading
“Rather than filling a prescription I have on the shelf, I have to tell the patient they have to go home and wait for a phone call from the pharmacy and arrange having this medicine sent to you. I can’t give it to you today. Your insurance won’t allow it.” Christine Pfaff, pharmacist for the Zangmeister Center, a Columbus, Ohio cancer-treatment facility, as quoted by
The Columbus Dispatch
.
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Sandy Mau
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