Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, August 3, 2018

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:

Express Scripts hits back at criticisms of PBMs, says it 'would do just fine' without drug price rebates

Express Scripts, the country's largest pharmacy benefits manager, is challenging the rhetoric that paints PBMs as the villain behind the rising cost of drugs.

FierceHealthcare

Friday, August 3, 2018

Hospitals see $4.8B lift in final CMS payment rule that focuses on price transparency, interoperability

The Centers for Medicare & Medicaid Services (CMS) has finalized a hospital payment rule that includes an additional $4.8 billion for inpatient services as well as several new requirements around price transparency and data sharing.

FierceHealthcare

Thursday, August 2, 2018

How Rival Opioid Makers Sought To Cash In On Alarm Over OxyContin’s Dangers

As Purdue Pharma faced mounting criticism over deaths linked to OxyContin, rival drugmakers saw a chance to boost sales by stepping up marketing of similarly dangerous painkillers, such as fentanyl, morphine and methadone, Purdue internal documents reveal.

Kaiser Health News

Thursday, August 2, 2018

‘Short Term’ Health Insurance? Up to 3 Years Under New Trump Policy

The Trump administration issued a final rule on Wednesday that clears the way for the sale of many more health insurance policies that do not comply with the Affordable Care Act and do not have to cover prescription drugs, maternity care or people with pre-existing medical conditions.

NY Times

Thursday, August 2, 2018

Individual market enrollment dropping amid premium increases

Enrollment in the individual health insurance market — the market for people who don't get coverage through work — has declined 12 percent in the first quarter of 2018, compared to the same period last year, according to a new analysis released Tuesday.

The Hill

Wednesday, August 1, 2018

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.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer

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 administration to push forward on Medicaid work requirements after court loss

The Trump administration on Thursday said it would continue approving Medicaid work requirement requests from states, despite a district court ruling last month that blocked such requirements in Kentucky.

The Hill

Thursday, July 26, 2018

House delays Obamacare health insurance tax, expands Health Savings Accounts

The House has passed healthcare bills to delay the health insurance tax in Obamacare and to expand the use of Health Savings Accounts ahead of its summer recess.

Washington Examiner

Thursday, July 26, 2018

House votes to repeal ObamaCare medical device tax

The House on Tuesday voted to repeal ObamaCare’s medical device tax, a provision that members of both parties have criticized as harming innovation.

The Hill

Wednesday, July 25, 2018

As Health-Care IPO Boom Continues, Wall Street Tells Investors to Buy

Health-care companies are going public at a startling rate and analysts are as bullish as ever as they kick off initiations of five companies today. The companies range from one developing so-called “off the shelf” immunotherapies to a commercial-stage medical device maker with a non-invasive treatment for depression.

Bloomberg

Tuesday, July 24, 2018

Health care industry branches into fresh meals, rides to gym

That hot lunch delivered to your door? Your health insurer might pick up the tab. The cleaning crew that fixed up your apartment while you recovered from a stroke? The hospital staff helped set that up.

AP News

Tuesday, July 24, 2018

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.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, July 20, 2018

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:

Top News From the Past Week as reported from key news services, and compiled by MCOL

Doctors Raise Alarm About Shortages Of Pain Medications

In hospitals across the country, anesthesiologists and other doctors are facing significant shortages of injectable opioids.

NPR

Friday, July 20, 2018

Merck joins the list of drug makers agreeing to freeze or lower some prices

As political pressure on the pharmaceutical industry builds, Merck has become the latest big drug maker to commit to halting price hikes.

Stat News

Thursday, July 19, 2018

CMS plots path forward for Kentucky work requirements after court setback

The Trump administration is redoubling efforts to allow Kentucky to impose controversial Medicaid work requirements after a federal court halted its attempt to overhaul the safety-net program three weeks ago.

Politico

Wednesday, July 18, 2018

Walmart Names Humana Veteran to Run Its Health and Wellness Unit

Walmart Inc. has hired a former senior executive at insurer Humana Inc. to run its health-care business, a move that could reignite speculation that the two companies will forge a closer partnership.

Bloomberg

Tuesday, July 17, 2018

Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates

To an outsider, the fancy booths at a June health insurance industry gathering in San Diego, Calif., aren't very compelling: a handful of companies pitching "lifestyle" data and salespeople touting jargony phrases like "social determinants of health."

NPR

Tuesday, July 17, 2018

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.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, July 13, 2018

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:

CMS promises to ‘restore the doctor-patient relationship’ with 2019 proposed rule

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on Thursday making what officials called “historic changes” to the Medicare program aimed at restoring the doctor-patient relationship.

FierceHealthcare

Friday, July 13, 2018

A Simple Emergency Room Intervention Can Help Cut Suicide Risk

Many people who attempt suicide end up in an emergency room for immediate treatment. But few of those suicide survivors get the follow-up care they need at a time when they are especially likely to attempt suicide again.

NPR

Thursday, July 12, 2018

Amazon Has Global Aspirations for Medical-Supplies Marketplace

Amazon.com Inc. has global aspirations for its medical-supplies marketplace, according to a job listing posted on its website, highlighting the e-commerce giant’s sweeping ambitions to disrupt health care by selling products to hospitals, doctors and dentists and offering prescription drugs.

Bloomberg

Thursday, July 12, 2018

Insurers Urge a Quick Fix After Obamacare Payment Suspension

Insurance-industry groups are pushing the Trump administration to resolve a legal dispute that led to the suspension of billions of dollars of payments that help stabilize Obamacare’s markets.

Bloomberg

Wednesday, July 11, 2018

Judge blocks Kentucky’s Medicaid work requirement

A federal judge has blocked Kentucky from instituting the first-ever Medicaid work requirements, potentially dealing a major blow to the Trump administration's efforts to scale back the health care program for the poor.

Politico

Monday, July 9, 2018

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.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, July 6, 2018

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:

CMS Postpones Deadlines for New Bundled Payments Model

Bundled Payments for Care Improvement (BPCI) Advanced applicants now have until Aug. 8 to submit signed participation agreements and select care episodes.

RevCycleIntelligence

Friday, July 6, 2018

Dems Want to Focus High Court Fight on Abortion, Health Care

In the budding battle royale over the Supreme Court vacancy, what's the Democratic sweet spot between satisfying liberal activists' demands for an all-out fight against President Donald Trump's pick and protecting senators facing tight re-election races in deeply red states?

The Associated Press

Friday, July 6, 2018

Drugmakers try evasion, tougher negotiations to fight new U.S. insurer tactic

In the escalating battle over U.S. prescription drug prices, major pharmaceutical companies are scrambling to limit the economic damage from a new U.S. insurer tactic that coaxes patients away from expensive drugs.

Reuters

Thursday, July 5, 2018

Despite U.S. Court’s Ruling, Medicaid Work Requirements Advance In Other States

The fallout from Friday’s federal court ruling that struck down the Medicaid work requirement in Kentucky was swift.

Kaiser Health News

Monday, July 2, 2018

More Americans pay for ACA health plans, despite Trump administration moves to undercut law

The number of Americans who bought and began to pay for Affordable Care Act health plans grew slightly this year, despite repeated efforts by the Trump administration to undermine the insurance marketplaces created under the law, new federal figures show.

NY Times

Monday, July 2, 2018

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.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, June 29, 2018

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:

Amazon Makes $1 Billion Splash in Health Care, Buying PillPack

Amazon.com Inc. is buying its way into the heart of the U.S. health-care system, instantly shaking up a prescription-drug industry already in the midst of a broader transformation.

Bloomberg

Thursday, June 28, 2018

The High Toll of High-Deductible Health Care Plans

Bloomberg looks at an important trend in health care coverage: the rise of employer-based high-deductible plans that mean many patients and families simply can’t afford to get sick.

Fiscal Times

Wednesday, June 27, 2018

Gawande’s Goal Is Providing The ‘Right’ Health Care In New Venture By 3 Firms

Dr. Atul Gawande, the famed surgeon-writer-researcher chosen to lead a joint health venture by three prominent employers to bring down health costs, said his biggest goal is to help professionals “make it simpler to do the right thing” in delivering care to patients.

Kaiser Health News

Tuesday, June 26, 2018

House overwhelmingly passes final opioid package

The House on Friday overwhelmingly passed sweeping bipartisan opioid legislation, concluding the chamber’s two-week voteathon on dozens of bills to address the drug abuse epidemic.

Politico

Monday, June 25, 2018

Reversal of Fortune: Obamacare Rate Hikes Pose Headache for Republicans

Obamacare premiums are once again poised to spike by double digits in 2019, causing heartburn for politicians as voters will head to the polls within days of learning about the looming hit to their pocketbooks.

Politico

Sunday, June 24, 2018

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.

Five Questions for Kelly Proctor, Physical Environment Sector Lead, DNV GL Healthcare: Post-Webinar Interview

By Claire Thayer, June 28, 2018

Recently, Kelly Proctor, Physical Environment Sector Lead, DNV GL Healthcare, participated in a Healthcare Web Summit webinar discussion on Workplace Violence, Security Vulnerability Analysis, and Ensuring Sound Security Management. If you missed this informative webinar presentation, watch the On-Demand version here. After the webinar, we interviewed Patrick on five key takeaways from the webinar:

 1. What is ISO 9001?

Kelly Proctor: ISO 9001 is a Quality Management System that ensures risk based thinking and continual improvement.

2. Why introduce ISO 9001 to hospitals and tie this to the accreditation process?

Kelly Proctor: ISO 9001 when implemented properly will ensure that the hospital considers all risks both internally and externally while building an effective Quality Management System. The Quality management system will be the infrastructure for all the other standards and requirements for the organization as well as serve as the quality improvement program forcing the hospital to consider risks, both internally and externally. A strong ISO 9001 program will improve processes and sustainability.

3. Your webinar focused on Security Management and specifically NFPA 99 2012 Chapter 13.  Can you define this for our audience?

Kelly Proctor: All CMS reimbursed hospitals are required to follow the National Fire Protection Agency (NFPA) 99 2012 Edition and NFPA 101 2012 Edition standards. CMS allows hospitals to exclude Chapters 7, 8, 12 and 13 of the NFPA 99 2012 standards however DNV-GL does not allow its client hospitals to exclude chapters 12 (Emergency Management) and Chapter 13 (Security Management). Chapter 13, has a focus on the security of the hospital and requires the hospital to identify its security risks, areas to be secured, abduction risks and security measures, Work Place Violence and more.

4. In your discussion on the value of conducting a thorough Security Vulnerability Analysis (SVA), you've indicated that this should be considered as living document.  Can you tell us more?

Kelly Proctor: The SVA should be considered a living document because as your security risks change so should your SAV. NFPA 99 requires an annual review of the SVA however if there are changes in the hospital risks the SVA should be adjusted to reflect these changes.

5. What are the 7 building blocks for developing an effective workplace violence prevention program?

Kelly Proctor: These 7 building blocks can be found in the NIAHO standards Revision 18 under the interpretive guidelines. They are as follows:

• Establishment of a Threat Assessment Team

• Hazard Assessments

• Workplace Hazard Control and Prevention

• Training and Education

• Incident Reporting, Investigation, Follow-up and Evaluation

• Recordkeeping

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:

Court rules insurers not entitled to ObamaCare payments

A federal appeals court on Thursday ruled that insurers are not entitled to collect billions of dollars they claim the federal government owes as part of an ObamaCare program.
The Hill
Thursday, June 14, 2018

How America Got Hooked On A Deadly Drug

An inside look at how Purdue Pharma pushed OxyContin despite risks of addiction and fatalities. Purdue Pharma left almost nothing to chance in its whirlwind marketing of its new painkiller OxyContin.
Kaiser Health News
Wednesday, June 13, 2018

An unlikely winner from the AT&T-Time Warner decision — CVS Health

Shares of drugstore CVS Health jumped Wednesday, a day after a federal judge decided to permit AT&T's bid for Time Warner in what many on Wall Street are considering a tacit go-ahead for other so-called vertical mergers.
CNBC
Wednesday, June 13, 2018

Fed Up With Rising Costs, Big U.S. Firms Dig Into Healthcare

At its Silicon Valley headquarters, network gear maker Cisco Systems Inc is going to unusual lengths to take control of the relentless increase in its U.S. healthcare costs.
Reuters
Monday, June 11, 2018

How early retail health clinics set the stage for today’s mega-mergers

Fifteen years ago, we launched Take Care Health Systems, a pioneering company in retail health clinics. Little did we know that our clinics, and similar ones that followed, would become an important component of the current merger and acquisition and partnership activity currently reshaping health care.
Stat News
Monday, June 11, 2018

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.

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: Justice Department takes aim at heart of health law The Trump administration said in a court filing late Thursday that it will no longer defend key parts of the Affordable Care Act, including the requirement that people have health insurance and provisions that guarantee access to health insurance regardless of any medical conditions. The Associated Press Friday, June 8, 2018 CDC: Suicide rates on the rise in almost every state Suicide rates are on the rise in almost every state, according to a new analysis released Thursday by the Centers for Disease Control and Prevention (CDC). The Hill Thursday, June 7, 2018 Medicare Financial Outlook Worsens Medicare’s financial condition has taken a turn for the worse because of predicted higher hospital spending and lower tax revenues that fund the program, the federal government reported Tuesday. Kaiser Health News Tuesday, June 5, 2018 Judge orders Maine to implement voter-approved Medicaid expansion A Maine court has ordered the state to move ahead with Medicaid expansion, which was approved by voters last year but blocked by Republican Gov. Paul LePage. The Hill Monday, June 4, 2018 Medicare drug prices up 77% despite decrease in prescriptions, OIG finds Despite an overall decrease in prescriptions, prices for Medicare Part D brand-name drugs are rising — and so are beneficiaries' out-of-pocket expenses, according to a report from the Office of the Inspector General. Becker's Hospital Review Monday, June 4, 2018 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.

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: Why the Trump administration made it easier for Virginia Republicans to expand Medicaid In becoming the first state in nearly two years to open Medicaid to more of its poor residents, Virginia lawmakers found political buffering and momentum in a recent conservative health policy shift in Washington. The Washington Post, Thursday, May 31, 2018 Number of opioid prescriptions falls for fifth year in a row The number of opioid prescriptions issued nationwide has dropped by 22 percent between 2013 and 2017, which a doctors group touted as progress in fighting the epidemic of opioid addiction. The Hill, Thursday, May 31, 2018 When Scientists Develop Products From Personal Medical Data, Who Gets To Profit? If you go to the hospital for medical treatment and scientists there decide to use your medical information to create a commercial product, are you owed anything as part of the bargain? NPR, Thursday, May 31, 2018 How drugmakers are facing the entrance of consumer giants into healthcare The wave of consumer companies deepening their forays into healthcare, coupled with broader health system change and questions about advertising effectiveness, has spawned a bracing set of conditions for drugmakers. On one hand, they're expanding beyond a traditional reliance on pharmaceuticals as a sole value proposition. MM&M, Tuesday, May 29, 2018 What hospitals, payers, and pharma think about buying generic drugs from Intermountain's startup The overwhelming majority of providers said they'd buy medications from a health-system-led pharma company, and both providers and payers believe other hospitals will follow the lead of Intermountain, SSM Health and Trinity Health in forming their own generic drug companies. Healthcare Finance News, Tuesday, May 29, 2018 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.

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: Insurers, small businesses praise move to delay Obamacare health insurance tax After logging a victory in Congress to suspend a controversial Obamacare tax beginning in 2019, health insurers and small businesses are now setting their sights on 2020. Washington Examiner Thursday, May 24, 2018 Pfizer Settles Kickback Case Related To Copay Assistance For $24M Pfizer will pay the government nearly $24 million as part of a settlement to resolve allegations that it funneled money through a foundation resulting in illegal kickbacks. Kaiser Health News Thursday, May 24, 2018 Drugmakers Blamed For Blocking Generics Have Jacked Up Prices And Cost U.S. Billions Makers of brand-name drugs called out by the Trump administration for potentially stalling generic competition have hiked their prices by double-digit percentages since 2012 and cost Medicare and Medicaid nearly $12 billion in 2016, a Kaiser Health News analysis has found. Kaiser Health News Wednesday, May 23, 2018 Insurance Consolidation May Soon Include Hospitals, Create Powerhouses The continued market consolidation and efforts to create an “all-in-one” approach to healthcare insurance customers may lead to carriers acquiring large hospital networks, particularly if the CVS-Aetna transaction proves to be successful and profitable, one analyst says. HealthLeaders Media Wednesday, May 23, 2018 Kaiser Permanente commits $200M to reduce homelessness Kaiser Permanente is teaming up with mayors of a number of American cities to fight housing insecurity and homelessness. The Oakland, California-based integrated health system said late last week it will invest up to $200 million. Healthcare Dive Tuesday, May 22, 2018 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.

Medication Nonadherence: Data and Analytics Can Make an Impact

By Claire Thayer, May 16, 2018

Over two-thirds of hospital readmissions are directly due to medication nonadherence.  Many factors contribute to patients not taking their medications, including fear of side effects, out-of-pocket costs, and misunderstanding intended use.  Interventions targeted at understanding the underlying causes on nonadherence are critical to improving chronic disease outcomes.  Successful interventions include: educating patients on purpose and benefits of treatment regimen, reducing barriers to obtain medication, as well as use of health IT tools to improve decision making and communication during and after office visits. 

This weeks’ edition of the MCOL infoGraphoid, co-sponsored by DST Health, explores how data and analytics can provide insight to drive behavior change to improve adherence.

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.

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 touts plan to lower drug costs but rejects Medicare negotiations President Donald Trump on Friday will unveil a sweeping strategy for lowering drug prices that aims to reshape Medicare, boost competition and pressure foreign governments that the White House believes are “freeloading” off of the U.S. pharmaceutical industry, two senior administration officials said Thursday night. Politico Thursday, May 10, 2018 Medical device recalls reach historic levels in 2018 with software as leading cause Medical device recalls reached record highs in the first three months of 2018 thanks to software complications that are likely to continue with the proliferation of high-tech devices. Fierce Healthcare Wednesday, May 9, 2018 How Mayo Clinic's prescribing guidelines are cutting opioid prescriptions by half After analyzing opioid prescribing practices following surgery and improving prescribing guidelines, researchers at the Mayo Clinic Department of Orthopedic Surgery in Rochester, Minn., saw a 48 percent decrease in opioids prescribed for hip and knee replacement surgery, according to a study published in Clinical Orthopaedics and Related Research. Becker's Hospital Review Tuesday, May 8, 2018 Trump proposes $15 billion spending cuts, targets children's health program U.S. President Donald Trump will request a package of $15 billion in spending cuts from Congress on Tuesday, including some $7 billion from the Children’s Health Insurance Program championed by Democrats, senior administration officials said on Monday. Reuters Tuesday, May 8, 2018 Health insurance CEOs earned $342.6M in 2017 Nearly every health insurance CEO got a pay raise in 2017—in most cases, bringing home more than 300 times the amount their average employee earned. Fierce Healthcare Monday, May 7, 2018 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.

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:

‘Pharma Bro’ Shkreli Is In Prison, But Daraprim’s Price Is Still High 

It was 2015 when Martin Shkreli, then CEO of Turing Pharmaceuticals and the notorious “pharma bro,” jacked up the cost of the lifesaving drug Daraprim by 5,000 percent. Overnight, its price tag skyrocketed from $13.50 a pill to $750.

Kaiser Health News

Friday, May 4, 2018

Health Insurers Had Their Best Quarter in Years, Despite the Flu

U.S. health insurers just posted their best financial results in years, shrugging off worries that the worst flu season in recent history would hurt profits.

Bloomberg

Thursday, May 3, 2018

CVS ‘Moving Forward’ With Aetna Deal, Profit Tops Estimates

CVS ‘Moving Forward’ With Aetna Deal, Profit Tops Estimates CVS Health Corp. said it’s making “good progress” on getting regulatory approval for its $68 billion deal to buy health insurer Aetna Inc. -- one of two megamergers in the health-care industry that are under antitrust scrutiny.

Bloomberg

Wednesday, May 2, 2018

HHS Secretary Alex Azar to Supreme Court: Time to rule on Medicare case that affects $4 billion

Health and Human Services Secretary Alex Azar asked the U.S. Supreme Court to review an appeals court case won by numerous hospitals over disproportionate share hospital payments.

Healthcare Finance News

Wednesday, May 2, 2018

Bill Gates got President Trump fired up about a universal flu vaccine

Bill Gates was talking to President Trump in the Oval Office last month when the conversation turned to the notion of a universal flu vaccine — probably, as Gates recalled in an interview, “the longest conversation about universal flu vaccine that the president’s ever had.”

Stat News

Monday, April 30, 2018

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.

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: CMS extension of transitional health plans could ding ACA market The CMS has once again allowed insurers and states to renew so-called transitional health plans that pre-dated Affordable Care Act coverage requirements and that don't have to comply with those rules. Modern Healthcare Thursday, April 26, 2018 Anthem sees profits rise after scaling back participation in ObamaCare Anthem experienced a profit boost in the first quarter of 2018 after scaling back its participation in the ObamaCare markets, the health insurer announced Wednesday. The Hill Wednesday, April 25, 2018 HHS proposes Medicare payment rules to encourage hospitals to be clearer about prices The Trump administration is proposing to rewrite rules on federal payments to hospitals treating older Americans on Medicare, making it easier for patients to see the prices of procedures and care. The Washington Post Tuesday, April 24, 2018 Senate Health panel approves opioid bill The Senate Health Committee unanimously voted Tuesday to send the panel’s bipartisan opioid bill to the chamber’s floor. The Hill Tuesday, April 24, 2018 Insurer group issues warning on Trump administration's short-term health plan proposal The nation's largest trade group for health insurance companies is sounding the alarm on a proposal from the Trump administration that would expand the sale of plans that cover fewer services. The Hill Monday, April 23, 2018 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.

Five Questions for Erin Benson and Rich Morino with LexisNexis Health Care: Post-Webinar Interview

Last week, Erin Benson, Director Marketing Planning and Rich Morino, Director, Strategic Solutions, LexisNexis Health Care, participated in a Healthcare Web Summit webinar discussion on opportunities for health plans to leverage social determinants of health data to attain quality goals while managing cost and enhancing member experience.  If you missed this engaging webinar presentation, watch the On-Demand version here. After the webinar, we interviewed Erin and Rich on five key takeaways from the webinar: 1. What are some of the ways that member health is impacted on a daily basis by social, economic and environmental factors? Erin Benson and Rich Morino: The environment in which a person lives impacts their likelihood to develop health conditions as well as their likelihood to effectively manage those conditions. Care recommendations need to be a good fit for a member’s environment, not just their medical condition. If recommendations won’t work within the person’s physical environment, aren’t affordable or conveniently located, and are provided in a way that is hard for the member to understand, they won’t be effective at improving health. Studies support this fact. For example, 75-90% of primary care visits are the result of stress-related factors (JAOA Evaluating the Impact of Stress on Systemic Disease: The MOST Protocol in Primary Care). Money, work and family responsibilities – all reflective of social determinants of health -- are cited as the top three causes of stress (APA 2015). 2. We've heard reference to aggregating data at the zip code level for use in personalizing care for members. However, this is one of your top five myths about socio determinants of health. Can you tell us more? Erin Benson and Rich Morino: While aggregate data can be useful in certain capacities, it isn’t recommended as a best practice for personalizing care. Within a single zip code, it is not unusual to see variance in income levels, crime rates and other factors impacting an individual’s neighborhood and built environment, so we recommend looking at an individual’s neighborhood from the perspective of their specific address. Focusing on zip code alone also ignores the influences of education, economic stability and social and community context so we recommend incorporating these other social determinants of health into decision-making in order to view the member holistically and create a more comprehensive plan of care outreach.   3. Can you briefly explain why previous generations of SDOH have failed to improve health outcomes? Erin Benson and Rich Morino: There are two primary reasons why previous generations of SDOH have failed to improve health outcomes, data and workflow.   In order to get sufficient value, the data needs to address all 5 categories of SDOH to properly draw useful insights.  The data should also be at the member level, and address who the member’s family and close associations.  Without that information, we cannot tell if someone is socially isolated or living with caregivers, for instance. The second reason why previous generations of SDOH have failed is how they are deployed in the workflow.  An example would be a plan simply adding them to an existing claims-based model to achieve an increase in lift.  The lift is nice, but no changes in process are filtering down to the Care Management team interacting with the members.   In this scenario, a lot of value was ignored. A better method would be if the plan also built models identifying members with barriers to improved health outcomes.  If you now apply this to your chronic or at-risk population you can determine not just who is sick and in need of help, but how to most likely achieve success in an intervention program.  Care Managers would immediately know the challenges to success, and what type of intervention program the member should be in enrolled in from the start. 4. One of the SDOH models to uncover health barriers referenced during your webinar was social isolation. Can you provide more context for us here? Erin Benson and Rich Morino: Studies have shown that social isolation can increase risk of heart disease by 29% and stroke by 32% (New York Times How Social Isolation Is Killing Us). By understanding factors about an individual such as who else is living in the household with them, their predicted marital status, and how close their nearest relatives and associates live to them, healthcare organizations can identify who may be socially isolated. This allows care providers to ask the right questions to determine if that person needs access to social support systems such as support groups or community resources to improve their health outcomes. 5. What are some ways social determinants can help health plans enhance predictions and improve care management? Erin Benson and Rich Morino: The most common way of utilizing SDOH data so far has been to incorporate it into existing claims-based predictive models to improve predictive accuracy or to use it to create new predictive models. The second use is for care management purposes and this is where social determinants of health can be truly transformational. We recommend as a best practice to use social determinants of health insights to also build models that identify health barriers. The combination of models allows healthcare organizations to better stratify the risk of their members and then better tailor care to their medical and social needs.

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: Top News From the Past Week as reported from key news services, and compiled by MCOL Opioid prescriptions fell 10 percent last year, study says Prescriptions for opioids fell sharply last year, the steepest drop in the amount of painkillers dispensed to patients in 25 years, according to a report from IQVIA Institute for Human Data Science, the research arm of a health-care data firm. The Washington Post Thursday, April 19, 2018 Congress Urged To Cut Medicare Payments To Many Stand-Alone ERs The woman arrived at the emergency department gasping for air, her severe emphysema causing such shortness of breath that the physician who examined her put her on a ventilator immediately to help her breathe. Kaiser Health News Tuesday, April 17, 2018 1.7 million people could be impacted by Medicaid work requirements in 10 states About 1.7 million Medicaid beneficiaries could be impacted by work requirement proposals in 10 states, according to new report released Monday from the PwC Health Research Institute. The Hill Monday, April 16, 2018 CVS Rallies After Amazon Report CVS Health Corp., along with rival drugstores and drug distributors, rallied after a report that Amazon.com Inc. had shelved plans to sell drugs to hospitals and other businesses. Bloomberg Monday, April 16, 2018 New Medicaid Requirements Signals Trump Crackdown On Public Assistance Programs Michel Martin speaks to Diane Rowland from The Kaiser Family Foundation about a new order from President Trump to establish work requirements for recipients of Medicaid and other federal benefits. NPR Sunday, April 15, 2018 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.

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: More Americans Choose a Health Savings Account with a High Deductible Plan for Their Financial Security Approximately 22 million Americans have chosen a health savings account (HSA) coupled with a high deductible health plan (HDHP), according to a new survey from America’s Health Insurance Plans (AHIP). AHIP Thursday, April 12, 2018 Drug executives to testify before Congress about their role in U.S. opioid crisis Current and former executives with the pharmaceutical distributors that are accused of flooding communities with powerful prescription painkillers have been summoned to testify before Congress about their role in the U.S. opioid epidemic. The Washington Post Thursday, April 12, 2018 Why America's physician shortage could top 120k by 2030 The U.S. could face a shortage of more than 121,000 physicians by 2030, according to updated data from the Association of American Medical Colleges. The estimate is higher than AAMC's 2030 projections published last year. Becker's Hospital Review Wednesday, April 11, 2018 JP Morgan: Value-Based Care Will Guide Amazon, Berkshire Work Amazon, JP Morgan, and Berkshire Hathaway will build their new company upon best practices in value-based care, including improving preventive care and managing member costs through data sharing, said JP Morgan Chase & Co. CEO Jamie Dimon in an investor letter. HealthPayer Intelligence Monday, April 9, 2018 Medicaid patients have better access to care than uninsured Medicaid enrollees have better access to medical care than people who are uninsured, according to a new insurance industry study that refutes critics who say patients are better off without the government program for the poor. Washington Examiner Monday, April 9, 2018 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.

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: CDC director pledges to bring opioid epidemic 'to its knees' The new director of the top U.S. public health agency on Thursday pledged to work to bring the nation's opioid epidemic "to its knees" and said he believes the AIDS epidemic could be ended in three to seven years. ABC News Thursday, March 29, 2018 Walmart talking with Humana on closer ties; acquisition possible: sources U.S. retailer Walmart Inc (WMT.N) is in early-stage talks with health insurer Humana Inc (HUM.N) about developing closer ties, with the acquisition of Humana being discussed as one possibility, people familiar with the matter said on Thursday. Reuters Thursday, March 29, 2018 White House: 'No one is talking about privatizing the VA' President Donald Trump said Thursday he fired Veterans Affairs Secretary David Shulkin because he wanted to give veterans more choices, but a spokesperson said his actions did not signal a desire to privatize veterans' health services. Politico Thursday, March 29, 2018 Thousands Mistakenly Enrolled During California’s Medicaid Expansion, Feds Find California signed up an estimated 450,000 people under Medicaid expansion who may not have been eligible for coverage, according to a report by the U.S. Health and Human Services’ chief watchdog. Kaiser Health News Wednesday, March 28, 2018 Urgent Care Center Utilization Skyrocketed by 1725% in Last Decade Healthcare payers saw urgent care center utilization grow by 1725 percent from 2007 to 2016, indicating that urgent care may the one of the fastest-growing choices for receiving healthcare. HealthPayer Intelligence Monday, March 26, 2018 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.

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: CMS plans Medicaid 'red-tape' rollback for states States could see less administrative burdens in the near future thanks to a proposed regulatory rollback by the Medicaid agency. Fierce Healthcare Friday, March 23, 2018 Graphic: Opioid Painkiller Is Top Prescription In 11 States Americans fill about 4.5 billion prescriptions each year, at a cost of more than $323 billion. But what are we actually buying? Kaiser Health News Thursday, March 22, 2018 Medical Research, Drug Treatment And Mental Health Are Winners In New Budget Bill The big budget deal reached this week in the House doesn't include a long-sought-after provision to stabilize the Affordable Care Act marketplaces. But the $1.3 billion plan, set to fund the government through September, has lots of new money for medical research, addiction treatment and mental health care. NPR Thursday, March 22, 2018 States Extend Medicaid For Birth Control, Cutting Costs — And Future Enrollment The Trump administration is weighing whether to allow Texas to receive millions of federal Medicaid dollars for its family planning program, which bars abortion providers. Kaiser Health News Thursday, March 22, 2018 Highmark Health added $1B in net income in 2017 with a ‘substantial turnaround’ in ACA plans Highmark Health’s Affordable Care Act exchange plans were profitable for the first time in 2017 as the insurer added $1 billion in net income compared to 2016. The Pittsburgh-based Blues plan that covers nearly 5 million members in Pennsylvania, West Virginia and Delaware saw significant growth in commercial and government plans, including its Medicare Advantage segment. Fierce Healthcare Tuesday, March 20, 2018 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.