June 10, 2021 | Public health still under fire

INDUSTRY NEWS

UHC cracking down on ED visits

Effective July 1, UnitedHealthcare will begin denying some emergency department claims for commercial members if it determines the services were nonemergent. UnitedHealthcare will evaluate ER claims based on a patient's presenting problems, the intensity of diagnostic services performed and other patient factors and external causes, according to the insurer. This retroactive denial policy is similar to a policy Anthem already has in place, and provider groups argue they violate federal law. (JAMA Network; Becker's Hospital Review)

Public health still under fire

In the wake of the pandemic, states are passing laws that could endanger the public health, according to a new report from the National Association of County and City Health Officials. At least 15 state legislatures have passed or are considering measures to limit severely the legal authority of public health agencies. "It's like telling a bunch of doctors, 'We don't like the fact that you take out appendixes, so we're going to take away your authority to do surgeries.'” (MedPage Today; report)

INNOVATION & TRANSFORMATION

Integrate drug/medical benefits to save money, improve outcomes

Highmark group customers with integrated medical and pharmacy benefits saved an average of $150-$230 per member per year compared to those with carved-out pharmacy benefits, according to independent analysis by HealthScape Advisors. The savings were driven by shorter episodes of care, enhanced chronic care management and increased member engagement. The analysis is based on three years of claims data from 2017 to 2019. Group clients who offered integrated benefits saw the length of hospital stays reduced by 3.9% and that members were 14% more likely to engage in chronic care management programs. (Fierce Healthcare; study announcement)

CMMI may mandate participation in some programs

The CMS Center for Medicare and Medicaid Innovation could mandate more participation in its models, Director Liz Fowler told attendees at a Health Affairs event last week. She wants to recapture the health care industry's lost momentum on the transition from volume- to value-based care, which stalled in recent years because it's relatively easy for most providers to continue practicing fee-for-service medicine, Modern Healthcare reports. "The penalties for doing so are really not that great," Fowler said. (Modern Healthcare*)

CONSUMERS & PROVIDERS

No, patients don’t want low-value care

There is no direct link between receiving low-value care and favorable patient ratings, according to research published in JAMA Internal Medicine. This suggests worries that reductions in low-value care lead to lower patient experience ratings are "overblown," says study co-author Dr. Michael McWilliams. “Whether it’s because less wasteful physicians are adept at informing patients why a requested test or procedure is unnecessary, or because most low-value care is due to provider practice patterns and not patient demand, we should be reassured that we can tackle waste in the system without great patient backlash or flunking providers on their ‘scorecards.’” (Healthcare Finance News; JAMA Internal Medicine; announcement)

Medicaid expansion associated with better cancer survival

More lower-income Americans are surviving cancer due to expanded Medicaid health care coverage, according to research presented at the American Society of Clinical Oncology annual meeting. "People who are uninsured are very likely to forego screening, so they miss detection of early lesions where a cure would be far more likely," says Lori J. Pierce, MD, a radiation oncologist at the University of Michigan. "Those who are uninsured are unlikely to receive cancer care, and for those who are able to start cancer treatment they're unlikely to complete their cancer care." (Consumer Health Day)

NEW & NOTED

Blood donations are safe: COVID-19 is not a threat to the U.S. blood supply, according to analysis by the National Institutes of Health published in Transfusion. (NIH; Transfusion)

Pediatric sepsis increased: Children who received surgery during the first part of the COVID-19 pandemic in 2020 developed sepsis at higher rates than pre-pandemic, according to new research published in Hospital Pediatrics. Researchers could speculate on the reasons; they could include delays in diagnosis or workflow and PPE issues. (Modern Healthcare*; Hospital Pediatrics)

CBO on HHS negotiations: Allowing the HHS secretary to negotiate drug prices could save businesses $195 billion and another $98 billion for workers by 2030, according to analysis conducted for West Health by Milliman. Analysts specifically looked at HR3; CBO analysis from 2019 estimated that the bill would save Medicare $456 billion over the course of a decade. (Becker’s Hospital Review; West Health announcement)

MULTI-MEDIA

AAFP hosts webinar on resilience and suicide prevention

As part of the AAFP’s Leading Physician Wellbeing certificate program, the American Foundation for Suicide Prevention (AFSP) is presenting a 75-minute webinar, “Physician Mental Health: Preventing Suicide and Building Resilience.” It’s available to AAFP members and nonmembers alike. (webinar)

MARKETVOICES...QUOTES WORTH READING

"No other payer comes close to matching the influence wielded by our agency, and many payers follow our lead. And that means that we are in a unique position to be a healthcare disruptor and a driver for change," Fowler said. "We take that responsibility very seriously."—CMMI Director Liz Fowler said during a Health Affairs event last week, quoted in Modern Healthcare*