December 3, 2020 | Pandemic hurts children’s mental health
INDUSTRY NEWS
HHS discusses impact of Stark, anti-kickback changes
Before Thanksgiving, the Trump administration finalized changes to physician self-referral and anti-kickback rules; the changes are intended to boost value-based care by making it easier for providers, suppliers and others to work together. In an interview with Modern Healthcare, HHS Secretary Alex Azar and Deputy Secretary Eric Hargan discussed the impact of the changes. “The final rules give providers more flexibility to take part in value-based arrangements and coordinate and manage patient care by reducing their potential liability and administrative work in exchange for taking on risk. Providers get to decide how much risk to accept, but they'll have to deal with some trade-offs.” (Modern Healthcare*)
ACA payor participation rises for third year running
For the third year in a row, payor participation in the ACA marketplace is rising, according to the Kaiser Family Foundation. For 2021, 30 insurers are entering the individual market across 20 states; an additional 61 are expanding their service area within states they already operate. There will be an average of 5.0 insurers per state in 2021, up from a low of 3.5 in 2018 but below the peak of 6.0 in 2015. The share of marketplace enrollees with only one insurer option (3%) has continued to decrease and will be the lowest rate since 2016’s 2%. (KFF)
Ahead of an expected surge in U.S. demand for prescription drugs, the Canadian government has blocked the distribution of certain medications outside the country. The move comes in response to a new U.S. rule—set to go into effect this week—that would let pharmacists or wholesalers import certain prescription drugs in bulk. The rule was set to go into effect on Monday, but the Canadian government says it won't comply if sales would cause or worsen a drug shortage. It may require companies to first assess potential shortages before any sales take place. (NPR)
INNOVATION & TRANSFORMATION
Whole-person senior care improves outcomes
Physicians in Humana's Partners in Primary Care, a senior-focused primary care practice in seven states, spend, on average, 45 minutes with each patient, according to Renee Buckingham, president of Humana's Care Delivery Organization. “Our value-based care model, focused on a whole-person health approach, encourages patients to be seen more frequently, not just when they’re sick.” In the past three years, patients averaged five visits per year. In South Carolina centers, the 30-day hospital readmission rates were almost 60% lower than those of the general Medicare population in 2019. (Managed Healthcare Executive)
CONSUMERS & PROVIDERS
Hospital capacity: CMS launches Acute Care at Home
Because of the expected surge in COVID-19 hospitalizations, CMS last week expanded the ability of hospitals to treat acute care patients at home. “These flexibilities include allowances for safe hospital care for eligible patients in their homes and updated staffing flexibility designed to allow ambulatory surgical centers to provide greater inpatient care when needed,” according to a CMS statement. Patients tend to prefer at-home, especially during the pandemic, and some research finds it to be less costly and result in fewer readmissions, Healthcare Dive reports. Six health systems have been tapped to participate in the new Acute Hospital Care At Home, and CMS expects more to apply. (Healthcare Dive; CMS announcement)
If premiums and deductibles don’t fall this year, income lost during the current economic crisis will increase cost burdens for middle-income families, according to the Commonwealth Fund. Premium contributions and deductibles in employer plans accounted for 11.5% of median household income in 2019, up from 9.1% a decade earlier. People living in states with lower median incomes face higher absolute costs compared to people in states with higher median incomes. (Commonwealth Fund issue brief)
NEW & NOTED
Something’s missing: Last month, the Biden-Harris administration announced the members of the Coronavirus Task Force. It was missing one thing: a behavioral health expert. Writing in Medscape, two psychiatrists warn that this will “prove to be a mistake that could affect millions of Americans.” (Medscape)
Exacerbating rural closures: Primary care practices—many already struggling—continue to close because of the pandemic’s financial fallout. This is reducing access to health care services, especially in rural communities and areas already short on doctors. No one officially tracks closures, Kaiser Health News reports, but they appear to be in the thousands. (Kaiser Health News)
Community health workers as a hub: Including community health workers on the care team may provide relief for burned-out physicians, according to John Resendes, MA, of the NC Department of Health and Human Services. They can “function as the middle hub of the spokes on the wheel, connecting and navigating for these individuals so that they can have the resources to help quarantine and isolate.” (Healio)
MULTI-MEDIA
Pandemic hurts children’s mental health
Older populations may be more susceptible to the coronavirus, but the young are hit harder by pandemic depression. Even before the coronavirus hit, mental health problems, such as depression and anxiety were on the rise in children ages 6 to 17, according to the CDC, and research suggests social isolation can make these symptoms worse. Currently, there's little hard data about how the pandemic is affecting children's mental health, but the little that scientists have measured is concerning. (NPR)
MARKETVOICES...QUOTES WORTH READING
“But frankly […]Providers could effectively begin changing their conduct immediately because clearly we're not going to be pursuing enforcement in that area. We're hopeful we're going to get entities to come into the space very soon.” —Deputy HHS Secretary Eric Hargan on the changes to the anti-kickback and self-referral regulations, in an interview with Modern Healthcare*