January 16, 2020 | Medicaid expansion and opioid deaths
INDUSTRY NEWS
Individual marketplace remains steady
Even without the individual mandate penalty, the individual market last year was stable and profitable for payers, according to Kaiser Family Foundation analysis, which looked at the first nine months of the year. Overall enrollment in the individual market fell by 5% and premiums generally held steady. Moreover, claims costs in the first nine months of 2019 grew while average hospital time dipped, indicating the market didn’t have disproportionately sicker patients. (Healthcare Dive; Kaiser Family Foundation)
Next Generation ACO savings? It depends
The Next Generation ACO model didn’t save Medicare money during the first two years (2016 and 2017) according to an analysis prepared for CMS by the University of Chicago. CMS, instead, added $93.9 million to net Medicare spending during the first two years of the program. However, in a Health Affairs Blog post, CMS Administrator Seema Verma points out that if shared savings payouts were not factored in, the Next Generation ACO model “would appear to have decreased spending across performance years one and two; the net values provide the full story.” (Modern Healthcare; analysis; Health Affairs Blog)
INNOVATION & TRANSFORMATION
Camden Coalition approach doesn’t save money
Dr. Jeffrey Brenner and his Camden Coalition came up with an innovative approach to control costs: Focus most intently on the sickest and most expensive patients. But a rigorous—and bitterly disappointing—study published in the New England Journal of Medicine finds the approach didn’t save money. Patients receiving extra support were just as likely to return to the hospital within 180 days as those not receiving that help. The results were a blow to Brenner and his supporters. “It’s my life’s work. So, of course, you’re upset and sad,” he said. (Kaiser Health News; NEJM; Tradeoffs podcast)
Calif. generics: Big idea, small benefit?
Gov. Gavin Newsom wants California to sell its own brand of certain generic prescription drugs. The goal: Increase competition and drive down prices. Experts warn that, although it’s a good step, it probably wouldn’t lead to large savings for the state. “I wouldn’t oversell it. It will make a modest dent in overall drug spending and drug pricing in California. You are benefiting a modest group of patients, but you are benefiting them in a significant way,” USC health economist Geoffrey Joyce tells the LA Times. (Los Angeles Times)
CONSUMERS & PROVIDERS
JAMA: Five practices to improve communication
What are some best practices for physicians to connect with patients? A mixed-methods study published in JAMA identifies five ways to improve doctor-patient communication. One of them was to listen intently and completely, without interruption. “When physicians listen attentively and avoid interruptions during opening monologues, patients communicate more, provide more medical information and report greater satisfaction,” the authors wrote. The other four: prepare with intention; agree on what matters most; connect with the patient’s story; explore emotional cues. (JAMA)
The Lown Institute released the 3rd Annual Shkreli Awards, a list of the 10 worst examples of profiteering and dysfunction in health care, named for the infamous “pharma bro” Martin Shkreli. First place was shared by several litigious hospitals that claimed to care about patients but nevertheless sued them, garnished wages and seized houses. Lown called out several: UVA Medical Center, Mary Washington Hospital, Carlsbad Medical Center, Methodist Le Bonheur Healthcare, Poplar Bluff Regional Medical Center and Ballad Health. Second place: The private equity firms that spent $28 million to defeat “surprise billing” legislation. (Lown Institute; Modern Healthcare)
NEW & NOTED
No psych beds: MedPage Today tells the “Kafkaesque” story of how a 15-year-old boy spent 25 days in the emergency department waiting for an inpatient psychiatric bed. (MedPage Today)
Medicaid expansion and opioid deaths: Medicaid expansion may have saved as many as 8,132 people from fatal opioid overdoses, according to research published in JAMA Network Open. One possible reason: increased access to mental health and substance use disorder services. (Washington Post; JAMA Network Open)
Believer beware: Some state regulators are beginning to scrutinize nonprofit Christian cost-sharing ministries. They offer far lower rates because they are not classified as insurance, making them appealing to those struggling to pay for insurance. The catch: They have no legal obligation to pay medical claims. (New York Times)
MULTI-MEDIA
Value-based care and digital health
In this HIMSS TV video, Rob Lieberthal of MITRE discusses the role of digital health in value-based care, and some of the biggest obstacles to reimbursement: lack of interoperability and patients not owning their data. (Healthcare IT News)
MARKETVOICES...QUOTES WORTH READING
“We built a brilliant intervention to navigate people to nowhere.”—Dr. Jeffrey Brenner, founder of the Camden Coalition, talking about the disappointing study in the New England Journal of Medicine in the Tradeoffs podcast.