Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:


Medicaid Expansion Takes A Bite Out Of Medical Debt

As the Trump administration and Republicans in Congress look to scale back Medicaid, many voters and state lawmakers across the country are moving to make it bigger.

Kaiser Health News

Friday, November 17, 2017

Medicare Seeks Comment On Ways To Cut Costs Of Part D Drugs

Noting that the true price of a drug is often hidden from consumers, Medicare officials requested comments late Thursday on how to use discounts and rebates to help decrease what enrollees pay for prescriptions.

Kaiser Health News

Thursday, November 16, 2017

Remembering Health Care Economist Uwe Reinhardt

Reinhardt, who died on Monday, helped shape the debate about health care by advocating for individual mandates and universal health care. Originally broadcast in 2009.


Thursday, November 16, 2017

Sign-ups hit 1.5 million in first two weeks of ACA open enrollment sign-ups continue to outpace last year's, with nearly 1.5 million people selecting plans during the first two weeks of open enrollment.

Modern Healthcare

Wednesday, November 15, 2017

Bill Gates says big data can help solve the Alzheimer's puzzle

Through his foundation, Bill Gates has focused on reducing global poverty, finding cures for infectious diseases, and promoting education and sustainable energy. Now Gates is getting into an area that's new for him: Alzheimer's disease.

Monday, November 13, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Patients Are a Design Problem

Patients Are a Design Problem

by Kim Bellard, November 15, 2017


When I say "patients are a design problem," I don't mean that the people who happen to be patients are a design problem.  They may well be, but that's an issue you'll have to take up with Darwin or your favorite deity (or, all-too-soon, perhaps a CRISPR editor...). 

No, I mean that making people into patients is a design problem.  And it's a big one.


Consider the following:

1.  Physician Respect: We treat physicians as something special. That white coat is no longer needed and may, in fact, 
be counterproductive, but serves to remind of us the deference the health care system believes physicians are due. 

2.  Patient experience: It's hard to get appointments.  The appointment time is often just a vague indicator of when we'll actually see our doctor.  We may have services done to us that we don't really understand and which not uncommonly are unpleasant, to say the least.   We may be asked to fast unnecessarily for hours before blood work or procedures.  We often are unsure about what is going to happen next, or when. It is not a patient-centered system.

3.  Medicalization:  We talk about the health care system, but we really mean the medical care system.  We almost never include, or pay for, the other things that impact our health, like diet, exercise, and environment. 

4.  Better, Soon: We've seen remarkable strides in what medical care can achieve.  We have become a nation of pill-poppers.  When something is wrong with us, we expect to be able to get it fixed, and we expect that to happen quickly. 

5.  Confusion reigns: Nothing about health care seems easy.  It's hard to pick a physician, or a health plan.  The terminology makes no pretense at being understandable to anyone not a health care professional.  The bills are practically indecipherable.  If you need multiple doctors, tests, or procedures -- which you almost certainly will -- you'll have to navigate the maze around getting them.  No one, lay or

professional, claims to understand the "system."

6.  Responsibility: We've delegated responsibility for our health to our health care professionals, especially our doctors.  It is more established than ever that regular exercise, moderate eating, and a balanced life would do more to improve our health than any regime of medical treatments.  Yet we continue to expect that the results of our increasingly poor habits will be "fixed." 


These are why we are "patients."  These are why we are expected to be patient.

We will always need physicians (although 
not always human ones!), and many other health care professionals.  That's a good thing.  They have knowledge and skills that can help us.  They deserve our respect. 

But we should design our health care system around us, not them. 

Make the "system" simpler.  Focus it around our health, not our care.  Expect us to have responsibility for our own health -- but ensure we have the tools we need to manage it.  Spend money to prevent health issues, not address them once they've happened.

If patients are a design problem, then maybe people can come up with a design solution.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting


The State of Medicaid in the States

The State of Medicaid in the States

by Clive Riddle, November 8, 2017


Mark Farrah Associates has just released their Mid-Year 2017 Medicaid Market and Enrollment Trends report which cites national Medicaid coverage was “74.3 million as of June 2017. This represents approximately 17.5 million more covered lives, a 31% increase, when compared to the population of Medicaid recipients prior to Affordable Care Act (ACA) implementation.”


They fix Medicaid managed care enrollment nationally at 48.6 million, and tell us “total year-over-year managed Medicaid grew by only 187,000 members, a substantial difference from the 3.6 million increase between 2Q15 and 2Q16. Most of the top five managed care companies– Centene, Anthem, UnitedHealth, Molina and Wellcare – did however, experience enrollment increases. Among the leaders, Centene commanded 12% of the Medicaid market share as of second quarter 2016, enrolling approximately 6 million members. Anthem and UnitedHealth increased year-over-year membership with both attaining 11% market share. Molina and WellCare rounded out the top five Medicaid managed care leaders accounting for 7 and 5 percent market share, respectively. These top five Medicaid companies control 45% of the overall Medicaid Managed Care market.”


Meanwhile, CMS Administrator Seema Verma this week gave a major speech discussing “her vision for the future of Medicaid and unveiled new CMS policies that encourage states to propose innovative Medicaid reforms, reduce federal regulatory burdens, increase efficiency, and promote transparency and accountability.”


CMS reports that Verma emphasized “her commitment to ‘turn the page in the Medicaid program’ by giving states more freedom to design innovative programs that achieve positive results for the people they serve and pledged to remove impediments that get in the way of states achieving this goal. She announced several new policies and initiatives that break down the barriers that prevent state innovation and improvement of Medicaid beneficiary health outcomes.”


CMS touts that they have published new public website content that reflects “CMS’s willingness to work with state officials requesting flexibility to continue to provide high quality services to their Medicaid beneficiaries, support upward mobility and independence, and advance innovative delivery system and payment models.” Veema emphasized their “commitment to considering proposals that would give states more flexibility to engage with their working-age, able-bodied citizens on Medicaid through demonstrations that will help them rise out of poverty.”  In shorthand, this means that states have a path to impose work requirements on applicable Medicaid beneficiaries and deny continued coverage for those that do not comply. 


Other changes CMS shares include:

·         Allowing states to request approval for certain 1115 demonstrations for up to 10 years;

·         Providing for states to more easily pursue “fast track” federal review

·         Reducing certain state 1115 reporting requirements;

·         Expediting SPA and 1915 waiver efforts through a streamlined process and by participating in a new “within 15-day” initial review call with CMS officials.

·         Developing “Scorecards that will provide greater transparency and accountability of the Medicaid program by tracking and publishing state and federal Medicaid outcomes.”


Meanwhile, the question of the day is what to make of the Maine election results this week approving Medicaid expansion, with their Governor subsequently stating he will block implementation.


Three Recent Studies and Three Different Perceptions of Value Based Payments

Three Recent Studies and Three Different Perceptions of Value Based Payments

by Clive Riddle, November 3, 2017


Three different recently released studies addressing value based payments fuel three different perceptions: (1) value based payments have solid momentum; (2) that hospitals view value based care is growing more slowly than anticipated; and (3) physicians prefer FFS systems to value based care.


The Health Care Payment Learning & Action Network has just released a report with survey results indicating “29% of total U.S. health care payments were tied to alternative payment models (APMs) in 2016 compared to 23% in 2015, an increase of six percentage points.” The Network states that “the survey collected data from over 80 participants, accounting for nearly 245.4 million people, or 84%, of the covered U.S. population.”  


While 29% of payments were value based and totaling “approximately $354.5 billion dollars nationally” in 2016, the Network determined that 43% of payments were “traditional FFS or other legacy payments not linked to quality” and 28% was “pay-for-performance or care coordination fees.”


Deloitte recently released results from their 2017 Survey of US Health System CEOs which includes are chapter on Population health and value-based care that provides these insights:

·         “Survey participants say the transition to value-based care is happening, but at a slower rate than initially anticipated. Still, many of the CEOs report that they are developing and expanding innovative delivery and payment models, and are focusing on MACRA and physician activation.

·         “Many CEOs also are looking into strategies to generate physician buy-in and encourage behavioral change, which will help them be better prepared for the transition to population health and value-based care.”

·         “Many of the surveyed CEOs express concern about operating under two different payment systems—FFS and value-based care—and having misaligned incentives. Moreover, moving towards population health and bearing financial risk likely will require a large patient population.”

·         “Many CEOs who previously had acquired and invested in physician practices report being more engaged and prepared for MACRA implementation than other survey respondents. “

·         “In our survey, some respondents indicate they are using tools including clinical integration, employment contracts with incentives, ACOs and risk-sharing agreements, among others to better activate physicians in care delivery transformation.”


Meanwhile, Bain & Company recently released their Front Line of Healthcare Report 2017, in which they surveyed 980 physicians and concluded that “more than 60% of the physicians we surveyed believe it will become more difficult to deliver high-quality care in the next two years as they struggle to cope with a complex regulatory environment, increasing administrative burdens and a more difficult reimbursement landscape. After years of experimentation, physicians now want evidence that new models for care management, reimbursement, policy and patient engagement will actually improve clinical outcomes. Without it, they see little reason to alter the status quo and move toward widespread adoption.”


Specific to physician receptivity toward value based care, Bain found that physicians very much prefer FFS if they had their druthers: “More than 70% of physicians prefer to use a fee-for-service model, citing concerns about the complexity and quality of care associated with value-based payment models. Fifty-three percent of physicians say that capitation reduces the quality of care, and most see little advantage from pay-for-performance models either. Further, many believe their organizations are not sufficiently prepared for the shift to value-based care.”


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:


House Tax Bill Would Scrap Deduction For Medical Expenses

The tax bill unveiled by Republicans in the House on Thursday would not, as had been rumored, eliminate the tax penalty for failure to have health insurance. But it would eliminate a decades-old deduction for people with very high medical costs.

Kaiser Health News

Thursday, November 2, 2017

Hospital groups to sue CMS over $1.6 billion cut to 340B program

Less than an hour after the CMS released the final rule, America's Essential Hospitals, the American Hospital Association and the Association of American Medical Colleges said they believe the agency has overstepped its statutory authority by cutting 340B drug payments by $1.6 billion, or 22.5% less than the average sales price.

Modern Healthcare

Wednesday, November 1, 2017

Panel Recommends Opioid Solutions but Puts No Price Tag on Them

President Trump’s bipartisan commission on the opioid crisis made dozens of final recommendations on Wednesday to combat a deadly addiction epidemic, ranging from creating more drug courts to vastly expanding access to medications that treat addiction, including in jails.

The New York Times

Wednesday, November 1, 2017

U.S. states allege broad generic drug price-fixing collusion

A large group of U.S. states accused key players in the generic drug industry of a broad price-fixing conspiracy, moving on Tuesday to widen an earlier lawsuit to add many more drugmakers and medicines in an action that sent some company shares tumbling.


Tuesday, October 31, 2017

Money For Health Law Navigators Slashed — Except Where It’s Not

Despite all the efforts in Congress to repeal the health law this summer and fall, the Affordable Care Act is still the law of the land. People can start signing up for health insurance for 2018 starting Nov. 1. But the landscape for that law has changed a lot.

Kaiser Health News

Monday, October 30, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.