January 20, 2022 | CMS to increase private sector partnerships

INDUSTRY NEWS

CMS to increase private sector partnerships

The federal government will increase its partnerships with private companies and community groups in 2022 to bridge health disparities and reduce costs for publicly-covered patients, CMS Administrator Chiquita Brooks-LaSure told the J.P. Morgan Healthcare Conference last week. "Our role with the private sector is really partnering and trying to align goals," she said, adding that companies such as Walmart "absolutely" play a role in lowering drug costs for Medicare, Medicaid, Children's Health Insurance Program and ACA exchange customers. (Modern Healthcare*)

The bigger picture: CMS leaders outline vision for Medicare

“Medicare can contribute to the meaningful, sustainable changes necessary in our health system to put the person at the center of care, CMS leaders Chiquita Brooks-LaSure, Elizabeth Fowler and Meena Seshamani write in a post for Health Affairs Forefront. Their goals for Medicare mirror those for CMS: “Advance health equity; expand access to affordable coverage and care; drive high quality, person-centered care; and promote affordability and the sustainability of the Medicare trust funds.” The piece focuses on how they are “furthering these goals and available opportunities to better align and partner across the health care system.” (Health Affairs Forefront)

INNOVATION & TRANSFORMATION

360x initiative seeks to close the loop

To enable care coordination, data exchange must be a closed loop, Holly Miller, MD, MBA, FHIMSS, chief medical officer of MedAllies, explains. That’s the goal of 360X, an ONC-backed to build data standards that enable coordinated and streamlined care between PCPs and specialists. The 360X referral process is a full circle, and the primary care staff will know immediately if the patient's been declined so they can find another specialist. Integrating the Healthcare Enterprise has approved 360X specifications for specialty referrals and for ambulatory/acute transfers to skilled nursing facilities, EHR Intelligence reports. 360X specifications use the Direct Standard. (EHR Intelligence)

Digital transformation: Much more work is needed

Much work remains as provider organizations integrate digital tools as a key strategy in addressing pressing health care challenges, Dori Cross, PhD, of the University of Minnesota School of Public Health, writes in The American Journal of Managed Care. She focuses on three areas: value-based contracting, whole-person patient care, and finding a sustainable approach to virtual patient engagement. “Digital advancement is not the end goal but instead a strategic approach to organizational learning, care process optimization and data-driven outcomes improvement,” she concludes. (The American Journal of Managed Care)

CONSUMERS & PROVIDERS

Transportation often fails Medicaid beneficiaries

States are required to set up transportation to medical appointments for those enrolled in the Medicaid program, but patients say the companies that deliver those rides are showing up late — and sometimes not at all — leaving them in bad weather, disrupting their care and even causing injuries. And patients say their complaints are ignored. Transport contracts can be worth tens of millions of dollars for transportation companies many of which contribute heavily to elected officials. (Kaiser Health News)

Pharmacists to take on larger patient care role

Pharmacists will be taking on more direct patient care responsibilities over the next decade, according to a report by Express Scripts and the Columbia University Mailman School of Public Health. Nearly 80% of patients surveyed said their pharmacist is integral to their care team, and 90% of physicians said they have a high level of trust in pharmacists to conduct their work. “As the shortage of doctors and nurses persists, and as complex new therapies and digital healthcare technology solutions are developed, the role of the pharmacist will continue to evolve,” Mailman’s John McHugh, PhD, said in statement. (Fierce Healthcare; analysis)

NEW & NOTED

And the winner (loser) is… The Lown Institute announced its 2021 Shkreli Awards for "worst examples of profiteering and dysfunction in healthcare." Many of the examples relate to drug pricing or patient billing. For example: A woman who waited in the Emory Decatur Hospital ER seven hours without being seen ended up being charged $700. (Lown Institute)

Big savings from biosimilars: Biosimilar drugs could drive down prices for expensive medicines, saving an $38.4 billion, according to a new RAND Corporation study published in the American Journal of Managed Care. The number could be higher with higher biosimilar use. (American Journal of Managed Care; RAND announcement)

Dementia rates to rise dramatically: Unless something changes, the number of people over 40 with dementia will nearly triple worldwide and double in the United States by 2050, according to a study published in The Lancet Public Health. The increase is largely driven by population growth and population aging, but researchers say that that expanding access to education and addressing risk factors. (The Lancet Public Health; Medscape)

MULTI-MEDIA

Emotional vulnerability in clinical practice?

A recent episode of the Anamnesis podcast, "Scar Tissue," explored the emotional vulnerability of clinical practice. It features three physician-told stories. (Anamnesis)

MARKETVOICES…QUOTES WORTH READING

“As if for-profit hospitals price gouging wasn’t bad enough… here’s a health system willfully driving financial ruin of people too impoverished to cover the bill. This is unacceptable."—Andrew Goldstein, MD, MPH, assistant professor at NYU School of Medicine, one of the judges for the Lown Institute’s Shkreli Awards, talking about one of the winners: a hospital system that filed 19,000 lawsuits for unpaid medical bills, while receiving $700 million in COVID bailout funds