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:


Repeal Ripples: Five Obamacare Exchange Chiefs Contemplate An Uncertain Future

Kaiser Health News reports: The health insurance marketplaces created by the Affordable Care Act are in their third year of selling health insurance plans to people who don’t get insurance through work.

Kaiser Health News, January 27, 2017


Senators' ObamaCare replacement bills highlight GOP divide

The Hill reports: As House and Senate Republicans unveiled an aggressive plan to repeal and replace the Affordable Care Act within the next three months, disagreement over two Senate bills introduced this week shows the stark divide within the party over a way forward.

The Hill, January 26, 2017


What President Trump's executive order means for hospitals & physicians: 14 key thoughts

Becker's Hospital Review reports: President Donald Trump signed an executive order on Jan. 20 to reduce the economic burden of the ACA. Fourteen academics and leaders of healthcare companies and hospitals discuss the executive order's implications on hospitals and physicians.

Becker's Hospital Review, January 24, 2017


Judge blocks major health insurance merger

Politico reports: A federal judge has blocked Aetna’s merger with Humana after finding that the health insurers’ $37 billion deal would leave seniors with fewer and costlier options for private Medicare coverage.

Politico, January 23, 2017


Lingering FTC concerns could stall $9.4B Walgreens-Rite Aid merger

Becker's Hospital Review reports: With the deadline fast approaching to close the merger between Deerfield, Ill.-based Walgreens Boots Alliance and Camp Hill, Pa.-based Rite Aid, Federal Trade Commission lawyers still have concerns about the transaction, people familiar with the matter told Bloomberg.

Becker's Hospital Review, January 23, 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. 


Living in a Retro Health Care System

by Kim Bellard, January 26, 2017


Living in the 21st century is cool, right?  We've got smartphones, ultra-thin tablets, the Internet, wearables, Uber, self-driving cars, virtual/augmented reality, drones, digital currency, and all the TV/movies/music you could want available for streaming anytime, anywhere.  It makes Back to the Future II's 2015 look drab by comparison (except maybe for the hoverboards!).   


So why does it seem like so many people are entranced with the 1980's?


Take, for example, the resurgence of vinyl. Vinyl is back, set to become a billion dollar industry (again).  

People are falling in love with cassette tapes again.  Their sales rose 74% in 2016. People are even inventing new ways to listen to old formats.  The Verge reports on Love, "the first intelligent turntable.”  


Retro isn't confined to music.  One of the hottest Christmas presents was the Nintendo NES Classic. Hey, we've got the Today show doing a 1970 retro show, the NFL going crazy with throwback uniforms, and the predicted reemergence of flip phones.  People even want retro computers.  


If any industry would keep its eye relentlessly on the future, you might expect it would be health care.  Few of us would want to go back to what health care was like in the 1980's, and none of us would accept the health care of the 1950's (except maybe those house calls).  


No, in health care we expect the kind of futuristic -- or, at least, modern -- experience that tech-based start-ups are promising.  If health care went retro, why, we'd usually make appointments to see our doctors in their offices instead of seeing them on-demand 24/7, wait long periods in their bland waiting rooms, fill out lots of paperwork, have our white-coated doctor listen to us with their stethoscope, have lots of unnecessary or even harmful tests and procedures, even have our information sent by fax.  No one would want to go back to all that.


Oh, wait -- that is our health care system, for the most part.  It hasn't gone retro because we haven't yet moved past retro.  


Get this: fax machines remain the predominant form of communication in health care, with fax volume hitting new records.  That's not retro, that is insanity.  


Get this: physicians hate their EHRs so much that they are cited as a leading reason for physician burnout, and in their frustration with them physicians are turning to medical scribes to do the inputting.  


Get this: after seeing a consumer revolt in the 1990's against managed care's capitation, small provider networks, and restrictive medical management, they're all back in vogue, in one form or another.


I get retro.  But I do not want to get care in a retro health care system.  


EHRs are a perfect example of how we took something that should revolutionize health care, and turned it into something that not only no one is happy with but that many feel often impedes care, to the point some want to go back to paper records.  We didn't do the wrong thing with EHRs, we just are doing it wrong.


We should be thinking big and bold about how we want our health care system to work in the 21st century.   We should be looking forward, not backward. We have all the technology we need to make our health care experience, well, if not like magic, then certainly more like a 21st century health care should seem.  Let's get there first -- then maybe we can think about how we can do some cute retro to it.  


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


Understanding Impact of Socioeconomic Data on Health Outcomes

By Claire Thayer, January 26, 2017

While advancements in medical technologies have contributed to improved health outcomes, health care systems are increasingly retooling their focus to understanding the basic socio determinants of health, the underlying factors of how socio and economic conditions are correlated to health outcomes of patient populations along with the role of local communities in addressing these issues.  As health care providers undertake more risk with population health management and value-based payment arrangements, health care providers are being held accountable not only health care costs, but also the health of their patient populations.

The CDC outlines some of the factors related to health outcomes as:

  • ·         How a person develops during the first few years of life (early childhood development)
  • ·         How much education a person obtains
  • ·         Being able to get and keep a job
  • ·         What kind of work a person does
  • ·         Having food or being able to get food (food security)
  • ·         Having access to health services and the quality of those services
  • ·         Housing status
  • ·         How much money a person earns
  • ·         Discrimination and social support

This week, a special edition of the MCOL Infographic, co-sponsored by LexisNexis Health Care, highlights many of the key socioeconomic factors impacting health outcomes for patient populations:




Additional reading:

Tackling Patients’ Social Problems Can Cut Health Costs, Kaiser Health News, January 23, 2017

Socio Determinants of Health: Know What Affects Health, CDC

Healthy People 2020 – Socio Determinants of Health, Health

Using Social Determinants of Health Data to Improve Health Care and Health: A Learning Report, Robert Wood Johnson Foundation, May 2016

Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Kaiser Family Foundation, November 4, 2015.



MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.



2017 MSSP ACOs By The Numbers

by Clive Riddle


CMS has announced their 2017 new and renewing ACOs, so we took a somewhat deeper dive into what comprises this year’s MSSP ACO roster, along with who dropped out. For starters, though, here’s the 2017 totals including the other active ACO types (there are also 9 remaining ACOs in the non-active Pioneer model):

  •          MSSP - 480
  •          Next generation - 45
  •          Comprehensive ESRD (CEC) – 47
  •          Total: 572


52 MSSP ACOs participating in 2016 dropped out of the program for 2017. 8 of these started in 2012, 11 in 2013, 22 in 2014, 8 in 2015, 3 in 2016.


For the 480 MSSP ACOs participating in 2017, with respect their track:

  •          Track 1 – 438
  •          Track 2 – 6
  •          Track 3 – 36


17 of these ACOs remain in the non-active Advance Payment program. 45 of these ACOs are the AIM program, and 25 are in the SNF 3 day waiver program.


With respect to geography, when classifying the MSSP ACOs by the primary state they serve (many ACOs serve markets in more than one state), 16 states comprise over two-thirds (68%) of the total:

  •          FL 44 ACOs
  •          TX 44 ACOs
  •          NY 34 ACOs
  •          CA 25 ACOs
  •          MI 20 ACOs
  •          NJ 19 ACOs
  •          NC 18 ACOs
  •          IL 17 ACOs
  •          GA 15 ACOs
  •          IN 15 ACOs
  •          MD 14 ACOs
  •          OH 14 ACOs
  •          KY 13 ACOs
  •          VA 13 ACOs
  •          PA 12 ACOs
  •          MA 11 ACOs


With respect to their initial year joining the program, MSSPs break down as follows:

  •          2012: 49 ACOs (14%)
  •          2013: 63 ACOs (13%)
  •          2014: 79 ACOs (16%)
  •          2015: 77 ACOs (16%)
  •          2016: 97 ACOs (20%)
  •          2017: 99 ACOs (21%)

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:


Trump’s Nominee For Agriculture Has Key Health Role

Kaiser Health News reports: Amid the cacophony of confirmation hearings for Cabinet nominees, President-elect Donald Trump reportedly has settled on former Georgia Gov. Sonny Perdue to fill the final Cabinet-department vacancy: Secretary of Agriculture. Although consumers may simply think of the Department of Agriculture (USDA) as responsible for overseeing the farming industry, it also plays a key role in promoting health.

Kaiser Health News

Friday, January 20, 2017


How Large Employer Health Plans Could Be Affected By Obamacare Overhaul

NPR reports: If you think that you wouldn't be touched by a Republican overhaul of Obamacare because you get health insurance through your job at a big company, think again.


Thursday, January 19, 2017


Anthem aims for 30% reduction in number of opioid prescriptions by 2019

Becker's Hospital Review reports: Indianapolis-based Anthem said it wants to reduce the amount of opioids prescribed to policyholders by 30 percent by the end of 2019. The insurer said in a Wednesday news release it is also committed to helping its affiliated health plans double the number of consumers who receive counseling as part of medication-assisted therapy for opioid addiction.

Becker's Hospital Review

Thursday, January 19, 2017



Health Law Repeal Could Cost 18 Million Their Insurance, Study Finds

The New York Times reports: Eighteen million people could lose their insurance within a year and individual insurance premiums would shoot upward if Congress repealed major provisions of the Affordable Care Act while leaving other parts in place, the nonpartisan Congressional Budget Office said on Tuesday.

NY Times

Wednesday, January 18, 2017


Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies

Kaiser Health News reports: More than 30 years ago, Congress overwhelmingly passed a landmark health bill aimed at motivating pharmaceutical companies to develop new drugs for people whose rare diseases had been ignored. By the drugmakers’ calculations, the markets for such diseases weren’t big enough to bother with.

Kaiser Health News

Tuesday, January 17, 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.