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Health Affairs Web First: New ACA Coverage Enrollees Increased Prescription Use And Lowered Spending
This study will also appear in the September issue of Health Affairs.
Source: Health Affairs Blog - August 17, 2016 Category: Health Management Authors: Lucy Larner Tags: Costs and Spending Elsewhere@ Health Affairs Featured Insurance and Coverage Medicaid and CHIP chronic conditions Health Affairs journal Web First Source Type: blogs

How the System is Rigged - Johnson and Johnson Board Member Pretends to be Independent Brookings Institution Scholar
DiscussionIt is hardly news that US health care is broadly dysfunctional, that it suffers from ever rising costs, and questionable quality, while access has only somewhat improved after the 2009 Affordable Care Act.  The big question is why these problems seem so intractable.Our latest case illustrates that the problem may be that health policy making is dominated by people withconflicts of interest.  In the current case, one of the more influential voices on health care policy turns out not to have just a garden variety conflict of interest.  He actually has a duty to uphold the corporate interests of one o...
Source: Health Care Renewal - August 10, 2016 Category: Health Management Tags: boards of directors Brookings Institution hepatitis C Johnson and Johnson revolving doors You heard it here first Source Type: blogs

Risk Adjustment Gone Wrong
By JONATHAN HALVORSON The Affordable Care Act was intended to usher in a new era of competition and choice in health insurance, and at first it succeeded. But increasingly, provisions in the law are undermining competition and wiping out start-up after start-up. If something isn’t done soon, the vast majority of new insurers formed in the wake of the ACA will fail, and many old-line insurers that took the opportunity to expand and compete in the new markets will leave. It’s a classic story of unintended consequences and the difficulties of regulation. Flush with optimism after the ACA passed, dozens of new insurers for...
Source: The Health Care Blog - August 7, 2016 Category: Consumer Health News Authors: Jonathan Halvorson Tags: Uncategorized ACA HealthRepublic UnitedHealth Source Type: blogs

Striving For Equity In Access To And Use Of Specialty Care
In 2015 the Bristol-Myers Squibb Foundation launched a grant-making initiative called Specialty Care for Vulnerable Populations to address inequities in access to, and utilization of, specialty care services in the United States. The goal of this national initiative is to catalyze sustainable improvement and expansion of specialty care service delivery by safety-net providers, so as to achieve optimal and more equitable outcomes for the people they serve who are living with complex diseases such as cancers, cardiovascular diseases, and HIV/AIDS. Funding and partnerships focus on efforts to complete systems of care through ...
Source: Health Affairs Blog - August 1, 2016 Category: Health Management Authors: Patricia Mae Doykos Tags: Costs and Spending Drugs and Medical Technology Equity and Disparities GrantWatch Organization and Delivery Population Health Quality Access cancer care Health Care Costs Health Care Delivery health care equity Health Philanthropy Source Type: blogs

The Spectacular Incompetence of 3rd Party Payers
By SAURABH JHA, MD To paraphrase Tolstoy, all competence is alike, but every incompetence is incompetence in its own way. Every time I think I’ve seen the horizon of incompetence, I’m dealt a surprise. The sun never sets on incompetence. In healthcare, incompetence can be found in odd places, such as three recent examples I encountered with third party payers. Case 1: Downgrading Caviar to Boiled Salmon A patient was referred for a CT angiogram run off – which is a CT scan of the arteries of the belly, pelvis, both legs and feet – a very detailed and costly study. The cardiologist suspected a pseudoaneurysm of the ...
Source: The Health Care Blog - July 31, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

UnitedHealth ' s Optum Division Settles Case Alleging it Enrolled Non-Terminally Ill Patients in Hospice, Thus Risking Their Deaths Due to Treatable Illnesses
Discussion The problem of fraudulant enrollment of non-terminal patients in hospice continues, despite our efforts over five years to make the problem more public.   The latest case involved a very big, very wealthy for-profit health care corporation which has had its share of troubles in the past .   Yet the latest case is as anechoic as earlier ones, including smaller cases this year. These enrollments may be motivated by the desire for more money, but they put patients at risk.   Nonetheless, such abuses by hospices get little press coverage, seemingly are ignored by health care regulators and law enf...
Source: Health Care Renewal - July 19, 2016 Category: Health Management Tags: fraud hospices legal settlements UnitedHealth Source Type: blogs

UnitedHealth's Optum Division Settles Case Alleging it Enrolled Non-Terminally Ill Patients in Hospice, Thus Risking Their Deaths Due to Treatable Illnesses
Discussion The problem of fraudulant enrollment of non-terminal patients in hospice continues, despite our efforts over five years to make the problem more public.  The latest case involved a very big, very wealthy for-profit health care corporation which has had its share of troubles in the past.  Yet the latest case is as anechoic as earlier ones, including smaller cases this year.These enrollments may be motivated by the desire for more money, but they put patients at risk.  Nonetheless, such abuses by hospices get little press coverage, seemingly are ignored by health care regulators and law enforcement,...
Source: Health Care Renewal - July 19, 2016 Category: Health Management Tags: fraud hospices legal settlements UnitedHealth Source Type: blogs

Health Expenditure Projections: When Does ‘New’ Become ‘Normal’?
The Centers for Medicare and Medicaid Services (CMS) has released its latest forecast of medical spending for the next decade. The headline number is that medical care as a share of gross domestic product (GDP) is expected to increase from its current 17.5 percent of GDP to 20.1 percent by 2025, resuming an upward increase after a several year slowdown. Forecasting is an inexact science. To make guesses about the future, analysts typically examine the past. The history of medical spending can roughly be described using Fuchs’ law: medical spending increases have exceeded GDP increases by about 2.5 percentage points annua...
Source: Health Affairs Blog - July 13, 2016 Category: Health Management Authors: David Cutler Tags: Costs and Spending Featured Insurance and Coverage Medicaid and CHIP Medicare Payment Policy ACA ACOs Alternative Payment Models MACRA spending projections Source Type: blogs

Labor, IRS Propose New Health Plan Reporting Requirements; CMS Makes Its Case On Cost Sharing
Most of the regulations and guidance analyzed in the “Following the ACA” Health Affairs Blog series are issued by the Centers for Medicare and Medicaid Services of the Department of Health and Human Services. HHS shares jurisdiction over the implementation of the ACA’s insurance reforms, however, with the Employee Benefits Security Administration (EBSA) of the Department of Labor (DOL) and the Internal Revenue Service (IRS) of the Department of the Treasury. On July 11, EBSA posted a proposed rule on annual reporting and disclosure while EBSA, the IRS, and the Pension Benefit Guaranty Corporation (PBGC) posted an ide...
Source: Health Affairs Blog - July 12, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Source Type: blogs

Time To Fix The Black Hole In Medicare Data
Every year, the Medicare program pays for nearly 500,000 hip and knee replacement surgeries for America’s seniors. At the same time, approximately 25,000 patients undergo procedures to remove and replace a previous artificial joint, sometimes because it failed before the end of its expected useful life. Remarkably, and largely due to inadequacies in the systems that collect data through routine billing, the Medicare program is unable to identify product failures and patient safety problems, or to measure and promote high-value care with medical devices. This problem is serious, but can, and should, be fixed. A number...
Source: Health Affairs Blog - June 29, 2016 Category: Health Management Authors: Ben Moscovitch, Josh Rising, Gregory Daniel and Joseph Drozda Tags: Costs and Spending Health IT Health Policy Lab Health Professionals Medicare Public Health Quality Alternative Payment Models Congress medical device safety medical devices unique device identifier Source Type: blogs

Government Appropriation Of Breakthrough Drug Patent Rights Would Deter Biopharmaceutical R&D And Innovation
In the May 2016 issue of Health Affairs, Amy Kapezynski and Aaron Kesselheim propose that the federal government invoke its patent use authority under Section 1498 to lower drug prices and increase access for breakthrough medicines in government-funded health care programs. Section 1498 allows the government eminent domain-type powers to circumvent an inventor’s patent exclusivity rights in exchange for “reasonable and entire compensation” — in effect a royalty on sales which would be determined through negotiation or by the courts. To date, application of Section 1498 has been limited to selective military and...
Source: Health Affairs Blog - June 20, 2016 Category: Health Management Authors: Henry Grabowski Tags: Costs and Spending Drugs and Medical Technology Big Pharma Cooperative Research and Development Agreements eminent domain hepatitis C Section 1498 Sovaldi Source Type: blogs

The World’s Greatest Health Care Plan
Wherever we look around the world today, we almost always find that normal market processes have been systematically suppressed in health care. As a rule, no one ever sees a real price for any medical service. No patient. No doctor. No employer. No employee. Further, we have not replaced the price system with an alternative that would allow people to make rational health care choices. As a consequence, in virtually every health care system in the world, people face perverse incentives. When they act on those incentives, they do things that make costs higher, quality lower, and access to care more difficult than otherwise w...
Source: Health Affairs Blog - June 16, 2016 Category: Health Management Authors: John Goodman Tags: Costs and Spending Featured Insurance and Coverage Organization and Delivery Payment Policy ACA replacement Bill Cassidy Pete Sessions Politics Source Type: blogs

A Pot Luck Health Wonk Review
The posts for this week’s Health Wonk Review are an interesting and varied lot. Accordingly, despite the absence of a post on medical marijuana, we’ll call this a “Pot Luck” edition of the Health Wonk Review. We start with Peggy Salvatore’s post at Health System Ed. Peggy describes a Google Hangout featuring Peter Diamandis, cofounder of the Human Longevity Institute, which seeks to extend and expand the “healthy, high-performance lifespan.” Diamandis described “Human Nucleus,” a project that could allow you, for a $25,000 payment, to have your genome completely sequenced and analyzed. “The ide...
Source: Health Affairs Blog - June 16, 2016 Category: Health Management Authors: Chris Fleming Tags: Drugs and Medical Technology Elsewhere@ Health Affairs Featured Insurance and Coverage ACA Marketplaces Cancer Colorado drug shortages Health Wonk Review Hillary Clinton personalized medicine Workers' Comp Source Type: blogs

How Patient Groups Have Begun To Influence The Value And Coverage Debate
In 2015, two issues related to medicine could be relied on to generate headlines: drug pricing and the proliferation of new value frameworks that claimed to define the value and even the price of drugs in seemingly easy-to-understand ways. In none of the high-profile skirmishes on pricing or frameworks was the voice or perspective of patients and patient groups very much in evidence. But that is beginning to change, in an evolution of a broader shift in the role that patients are playing in the research and development (R&D) enterprise. A New Culture of Engagement Patients and patient organizations are becoming ever mo...
Source: Health Affairs Blog - June 10, 2016 Category: Health Management Authors: Margaret Anderson and Kristin Schneeman Tags: Costs and Spending Health Professionals Organization and Delivery Quality clinical research patient use of evidence venture philanthropy Source Type: blogs

Obama Administration Acts To Stabilize Marketplaces, Implement Expatriate Coverage Legislation
On June 8, the federal departments tasked with implementing the Affordable Care Act (ACA) released a barrage of regulatory issuances, including fact sheets, guidances, a blog post, and a notice of proposed rulemaking (NPRM). These issuances serve two major purposes. First, several of them, as summarized in a press release and fact sheet released by the Centers for Medicare and Medicaid Services (CMS), are intended to stabilize the marketplace risk pool. They are, that is, intended to draw healthy as well as unhealthy enrollees into the market and to discourage potential gaming on the part of insurers or enrollees that migh...
Source: Health Affairs Blog - June 9, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Medicaid and CHIP Medicare ACA Marketplaces Essential Health Benefits expatriate coverage minimum essential coverage risk pools special enrollment periods Source Type: blogs