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:

House May Need to Vote Again on GOP Obamacare Repeal Bill

House Speaker Paul Ryan hasn’t yet sent the bill to the Senate because there’s a chance that parts of it may need to be redone, depending on how the Congressional Budget Office estimates its effects. House leaders want to make sure the bill conforms with Senate rules for reconciliation, a mechanism that allows Senate Republicans to pass the bill with a simple majority. Bloomberg News Friday, May 19, 2017

Price pushes Congress to follow Trump plan for more FDA user fees

HHS Secretary Tom Price pressed Congress to heed President Donald Trump's call to make the FDA rely more on industry fees — and less on taxpayer dollars — for product evaluations, as lawmakers continue work on extending the agency's user fee programs.

Politico. Wednesday, May 17, 2017

Hatch Says He’s Open to Keeping Obamacare’s Individual Mandate

Sen. Orrin Hatch (R-Utah) on Wednesday said he wouldn’t be opposed to delaying the repeal of the individual mandate in the Affordable Care Act, making him one of the most senior Republicans to float the idea. Morning Consult. Wednesday, May 17, 2017

UnitedHealth Doctored Medicare Records, Overbilled U.S. By $1 Billion, Feds Claim

The Justice Department on Tuesday accused giant insurer UnitedHealth Group of overcharging the federal government by more than $1 billion through its Medicare Advantage plans. Kaiser Health News. Wednesday, May 17, 2017

Bipartisan bill will be reintroduced to force pharma to justify price hikes

A bipartisan group of lawmakers will re-introduce a bill on Tuesday that would require drug makers to justify their pricing and provide a breakdown of their expenses before raising prices on some medicines. StatNews. Monday, May 15, 2017

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: Industry Hopeful Senate Health Care Debate Focuses on Policy, Not Politics The health care industry is hopeful senators will be more receptive to outside groups than their House colleagues were, as the Senate takes the reins on overhauling the Affordable Care Act. Morning Consult. May 11, 2017 Senate GOP making tax credits look more like … Obamacare There’s growing support for making the tax credits more generous for poorer people. Senate Republicans are working on a potential breakthrough that could help push through an Obamacare repeal bill – by making insurance subsidies look a lot like Obamacare. Politico May 11, 2017 CMS Gives States Until 2022 To Meet Medicaid Standards Of Care The Trump administration has given states three extra years to carry out plans for helping elderly and disabled people receive Medicaid services without being forced to go into nursing homes. Kaiser Health News. May 11, 2017 Wednesday, May 10, 2017 Aetna Fully Exits Obamacare Exchanges With Pull-Out in Two States The New York Times reports: Health insurer Aetna Inc said on Wednesday it will exit the 2018 Obamacare individual insurance market in Delaware and Nebraska - the two remaining states where it offered the plans. NYTimes. May 10, 2017 Who will decide what the Senate’s health bill looks like? Follow the Medicaid-state senators. The Senate has broken into a series of “working groups” to begin writing its own version of legislation to replace the Affordable Care Act. There’s the leadership-driven group, a group of moderates and there was talk about a more conservative group before it was mostly absorbed into the leadership group. The Washington Post. May 9, 2017 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: Winners And Losers Under The House GOP Health Bill House Republicans have passed a bill to replace the Affordable Care Act. If it is signed into law, the American Health Care Act will affect access to health care for millions of people in the U.S. NPR. May 4, 2017 GOP Senators to Draft Their Own Obamacare Replacement Bill A top Senate Republican said Thursday that even though the House spent months on a health care bill that would repeal and replace the Affordable Care Act, the Senate will use that legislation as a starting point to draft a separate measure. Morning Consult. May 4, 2017. What’s in the AHCA: The Major Provisions of the Republican Health Bill The House health care bill up for a vote on Thursday would roll back the Affordable Care Act’s expansion of Medicaid, eliminate tax penalties for people who do not have health insurance and end taxes on certain high-income people, insurers, drug companies and manufacturers of medical devices to finance the current health law. NYTimes. May 4, 2017 Blue Shield CEO Says GOP’s ‘Flawed’ Health Bill Would Harm Sicker Consumers The chief executive of Blue Shield of California, the largest insurer on the state’s insurance marketplace, issued a blunt critique of the Republican health care bill, saying it would once more lock Americans with preexisting conditions out of affordable coverage. Kaiser Health News. May 3, 2017 NIH to get a $2 billion funding boost as Congress rebuffs Trump’s call for cuts The National Institutes of Health will get a $2 billion funding boost over the next five months, under a bipartisan spending deal reached late Sunday night in Congress. The agreement marks a sharp rejection of President Trump’s proposal to cut $1.2 billion from the medical research agency in the current fiscal year. Stat News May 1, 2017 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: U.S. appeals court blocks Anthem bid to merge with rival Cigna A U.S. appeals court blocked health insurer Anthem Inc's (ANTM.N) bid to merge with Cigna (CI.N) on Friday, upholding a lower court's decision that the $54 billion deal should not be allowed because it would lead to higher prices for healthcare. Reuters April 28, 2017 4 key questions surrounding Obamacare repeal House Republicans are mounting yet another effort to tear down Obamacare and remake the health care system — but the path to delivering on one of the GOP's longest-standing priorities remains complicated and fraught with uncertainty. Politico April 27, 2017 Amid budget talks, White House says it will continue ACA subsidies The White House on Wednesday pledged to continue payments critical to the success of Affordable Care Act exchanges, Politico reports. The pledge will come as a relief to insurers and providers after the administration’s earlier indication that it might withhold payments as a bargaining chip in this week’s budget negotiations. Stat News April 26, 2017 PBM Express Scripts loses biggest client Anthem Express Scripts said Monday that its biggest client, Anthem, will not renew its contract with the pharmacy benefit manager after the current agreement expires at the end of 2019. Modern Healthcare April 24, 2017 Health Care In America: An Employment Bonanza And A Runaway-Cost Crisis In many ways, the health care industry has been a great friend to the U.S. economy. Its plentiful jobs helped lift the country out of the Great Recession and, partly due to the Affordable Care Act, it now employs 1 in 9 Americans — up from 1 in 12 in 2000. Kaiser Health News April 24, 2017 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.

What Goes into Combating Healthcare Fraud

By Claire Thayer, April 27, 2017 According to the National Health Care Anti-Fraud Association, most health care fraud is committed by organized crime groups and a very small minority of dishonest health care provider. The NHCAA tells us that the most common types of fraud include: ·         Billing for services that were never rendered-either by using genuine patient information, sometimes obtained through identity theft, to fabricate entire claims or by padding claims with charges for procedures or services that did not take place. ·         Billing for more expensive services or procedures than were actually provided or performed, commonly known as "upcoding"-i.e., falsely billing for a higher-priced treatment than was actually provided (which often requires the accompanying "inflation" of the patient's diagnosis code to a more serious condition consistent with the false procedure code). ·         Performing medically unnecessary services solely for the purpose of generating insurance payments. ·         Misrepresenting non-covered treatments as medically necessary covered treatments for purposes of obtaining insurance payments-widely seen in cosmetic-surgery schemes, in which non-covered cosmetic procedures such as "nose jobs" are billed to patients' insurers as deviated-septum repairs. ·         Falsifying a patient's diagnosis to justify tests, surgeries or other procedures that aren't medically necessary. ·         Unbundling - billing each step of a procedure as if it were a separate procedure. ·         Billing a patient more than the co-pay amount for services that were prepaid or paid in full by the benefit plan under the terms of a managed care contract. ·         Accepting kickbacks for patient referrals. ·         Waiving patient co-pays or deductibles for medical or dental care and over-billing the insurance carrier or benefit plan (insurers often set the policy with regard to the waiver of co-pays through its provider contracting process; while, under Medicare, routinely waiving co-pays is prohibited and may only be waived due to "financial hardship"). While the U.S. Department of Justice, FBI, CMS and other government entities are busy identifying and tracking down fraud schemes, Deloitte research points out that an emerging area of interest in health care fraud and abuse enforcement is that of relationship scrutiny. This weeks’ edition of the MCOL Infographic, co-sponsored by LexisNexis, highlights some of the costs associated with fighting healthcare fraud: (Click to View Full Size Image) (Click to View Full Size Image) 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.

6 Ways to Improve Your Member Communications

By Claire Thayer, April 24, 2017 Change Healthcare doubled member engagement for a regional health plan after introducing engagement best practices with a marketing mix that included email, blog posts, social media, a direct mail campaign, presentations to key group leaders and on-site workshops. This special edition of the MCOL Infographic, co-sponsored by Change Healthcare, identifies 6 effective ways for health plans to improve communications with members:  (Click to Enlarge Image) (Click to Enlarge Image) 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: Lawmakers revisiting requiring those on Medicaid to work A simple question — should adults who are able to work be required to do so to get taxpayer-provided health insurance? — could lead to major changes in the social safety net. AP News. Friday, April 21, 2017 How G.O.P. in 2 States Coaxed the Health Law to Success or Crisis In Oklahoma, which has raged against the Affordable Care Act, insurance premiums are among the nation’s highest. New Mexico, which oversees its marketplace, has one of the lowest average premium costs. The New York Times. Friday, April 21, 2017 White House pressures GOP leaders on Obamacare showdown next week A frantic and impatient White House is pressuring House GOP leaders for another showdown vote on repealing Obamacare next week so it can notch a legislative win before President Donald Trump’s first 100 days in office. Politico. Thursday, April 20, 2017 Sen. Grassley Demands Scrutiny Of Medicare Advantage Plans Sen. Chuck Grassley (R-Iowa) wants federal health officials to tighten scrutiny of private Medicare Advantage health plans amid ongoing concern that insurers overbill the government by billions of dollars every year. Kaiser Health News. Tuesday, April 18, 2017 G.O.P. Bill Would Make Medical Malpractice Suits Harder to Win Low-income people and older Americans would find it more difficult to win lawsuits for injuries caused by medical malpractice or defective drugs or medical devices under a bill drafted by House Republicans as part of their plan to replace the Affordable Care Act. The New York Times. Saturday, April 15, 2017 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: Bipartisan Senate Bill Takes Step Against Opioid Epidemic Morning Consult reports: A bipartisan Senate bill unveiled Thursday would impose strict limits on some opioid prescriptions, a small tweak to federal law that is part of an ongoing effort in Congress to curb overuse of the drugs. Morning Consult. Thursday, April 13, 2017 States Moving More Medicaid Patients To Managed Care Private health insurance companies stand to reap a bigger share of the Medicaid business as states deal with budget shortfalls and increased spending on medical care. Forbes. Thursday, April 13, 2017 Trump Signs Law Giving States Option To Deny Funding For Planned Parenthood President Trump quietly signed legislation Thursday that rolls back an Obama-era rule protecting certain federal funds for Planned Parenthood and other organizations that provide legal abortions. NPR. Thursday, April 13, 2017 Trump administration issues final rule on stricter Obamacare enrollment The Trump administration on Thursday issued a final rule that will shorten the Obamacare enrollment period and give insurers more of what they say they need in the individual insurance market, likely making it harder for some consumers to purchase insurance, healthcare experts said. Reuters. Thursday, April 13, 2017 Repeal, Replace … Revise: Your Guide To How A Trump Proposal Might Change ACA Insurance Repeal and replace is on-again, off-again, but that doesn’t mean the rules affecting your insurance will remain unchanged. The Trump administration’s proposed rule aimed at stabilizing the health law’s insurance marketplace could have rapid, dramatic effects on people who do not get insurance through work and buy it on the Affordable Care Act’s exchanges. Kaiser Health News. Thursday, April 13, 2017 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: No Obamacare cease-fire in red states The epic collapse of the Obamacare repeal bill created an odd opportunity for 19 states that have long shunned Medicaid expansion. Politico, Friday, March 31, 2017 Pence breaks tie, allowing Senate to revoke Obama order on abortion provider funding Vice President Mike Pence returned to the Senate Thursday afternoon -- the second time in one day -- to cast a tie-breaking vote on legislation to undo an Obama-era regulation on funding for abortion providers. The Hill, Thursday, March 30, 2017 House GOP Weighing Another Try on Obamacare Vote Next Week House Republicans are considering making another run next week at passing the health-care bill they abruptly pulled from the floor in an embarrassing setback to their efforts to repeal Obamacare. Bloomberg, Wednesday, March 29, 2017 Senators Demand Answers About Possible Probe Of HHS Secretary Price Nine senators are pushing U.S. Attorney General Jeff Sessions to reveal what he knows about a reported investigation into Health and Human Services Secretary Tom Price’s stock trades that a top federal prosecutor might have begun before being fired by the Trump administration this month. Kaiser Health News, Wednesday, March 29, 2017 Justice Department Joins Lawsuit Alleging Massive Medicare Fraud By UnitedHealth The Justice Department has joined a California whistleblower’s lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans. Kaiser Health News Tuesday, March 28, 2017 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.

Driving Consumer Engagement with Powerful Provider Directories

By Claire Thayer, March 30, 2017 First impressions really do matter, especially with the millennial generation. A recent article published by Modern Healthcare tells is that “millennials are more than twice as likely as older patients to research providers on websites such as Yelp, Consumer Reports and Angie's List. A third of millennials said they have switched providers when dissatisfied, 12 percentage points higher than that of other generations.” The provider directory is often the vehicle for the patients’ first impressions on the scope of the provider health care network and related facilities.  Additionally, Medicare providers are putting revenue at risk when not getting first impressions right, with quality scoring now being tied to overall patient satisfaction. This week, a special edition of the MCOL Infographic, co-sponsored by LexisNexis Health Care, highlights the role of the provider directory and its importance in overall consumer engagement:

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:

GOP’s 3-Bucket Strategy To Repeal And Replace Health Law Is Springing Leaks

Kaiser Health News reports: Republicans in Washington working to overhaul the Affordable Care Act say their strategy consists of “three buckets.” But it appears that all three may be leaking.

Price dodges on Medicaid rollback, immunization

Politico reports: Confronted by Medicaid recipients during a televised town hall event on CNN, Health and Human Services Secretary Tom Price offered few details Wednesday when asked to explain the reasoning behind the GOP's plan to roll back the health care program.

GOP Health Bill Narrowly Clears House Budget Committee

Morning Consult reports: The House Budget Committee on Thursday narrowly advanced the Republican health care bill to repeal and replace significant parts of the Affordable Care Act, with three Republicans voting against the measure.

By The Numbers: Trump’s Choice For FDA Chief Is Versatile, Entrenched In Pharma

Kaiser Health News reports: President Donald Trump’s pick to lead the Food and Drug Administration has deep ties to the pharmaceutical industry as a consultant, investor and board member. Scott Gottlieb, 44, also has worn many hats in a career that included two previous stints at the FDA, practicing as a physician, and writer/editor roles at prestigious medical journals.

Deciphering CBO’s Estimates On The GOP Health Bill

Kaiser Health News reports: The Congressional Budget Office is out with its estimate of what effects the Republican health bill, “The American Health Care Act,” would have on the nation’s health care system and how much it would cost the federal government. The GOP plan is designed to partially repeal and replace the Affordable Care Act passed during the Obama administration.

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:

To Save On Drug Costs, Insurer Wants To Steer You To ‘Preferred’ Pharmacies

Kaiser Health News reports: One of California’s largest insurers has proposed a change in the benefits of commercial plans next year that would require consumers to pay more for drugs at pharmacies outside an established network.

Kaiser Health News

Friday, March 10, 2017

What Hospitals Waste

ProPublica reports: Just outside Portland, Maine, there’s a 15,000-square-foot warehouse that’s packed with reasons the U.S. health care system costs so much: Shelves climb floor to ceiling, stacked with tubs overflowing with unopened packages of syringes, diabetes supplies and shiny surgical instruments that run hundreds of dollars apiece.

ProPublica

Thursday, March 9, 2017

Ryan brings out slideshow to sell GOP healthcare bill

The Hill reports: Jacket off and sleeves rolled up, Speaker Paul Ryan (R-Wis.) on Thursday ditched the podium and delivered a 25-minute TED Talk-like presentation on why the new GOP health bill represents the best, and perhaps only, chance to repeal ObamaCare.

The Hill

Thursday, March 9, 2017

Lawmakers take up Obamacare revision without an independent scorekeeper

The Washington Post reports: Two committees in the Republican-led House have begun drafting sweeping health legislation without the benefit of an objective estimate of its impact from the Congressional Budget Office (CBO) — a reckless move, critics say, considering that they are dealing with the well-being of tens of millions of Americans and an industry that accounts for close to one-fifth of the economy.

The Washington Post

Wednesday, March 8, 2017

Three Key Senators Ask GAO to Investigate Possible Abuses Of The Orphan Drug Act

Kaiser Health News reports: Building on weeks of mounting pressure to address high prescription drug prices, three influential U.S. senators have asked the government’s accountability arm to investigate potential abuses of the Orphan Drug Act.

Kaiser Health News

Tuesday, March 7, 2017

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.

Inaccurate Provider Directories Have a Direct Impact on Patients

By Claire Thayer, March 8, 2017

Provider directories are important tool for consumer engagement with health plans and provider networks. And in many instances, the provider directory is the vehicle for the patients’ first impressions of providers and the network they represent.  The consequences of directory inaccuracies create barriers to care as well as impact patient satisfaction. And while state and regulatory agencies are imposing stiff fines for non-compliance, a new report from the California Department of Managed Care finds that most insurers still have a ways to go in this regard as many have directories that contained “data inaccuracies significant enough to render them unusable.”

A recent special edition of the MCOL Infographic, co-sponsored by LexisNexis Risk Solutions, highlights the impact of directory inaccuracies on patients:

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’s nominee to run Medicare and Medicaid advances

The Associated Press reports: President Donald Trump’s nominee to run Medicare and Medicaid won committee approval Thursday, clearing her for a final floor vote in the Senate.

AP via The Washington Post, March 2, 2017

Faring Better Than Many ACA Insurers, Molina Backs Health Law ‘Tuneup’

Kaiser Health News reports: Some large health insurance companies have suffered losses under the Affordable Care Act, leading to a few high-profile exits from the online marketplaces. Humana is just the latest, announcing in January that it will stop offering health insurance on the ACA health exchanges at year’s end.

Kaiser Health News,  March 2, 2017

High-Risk Pools Another Sticking Point Among Republicans

Morning Consult reports: Sen. Rand Paul on Wednesday expressed opposition to House GOP leaders’ plan to cover people with pre-existing conditions, highlighting another division that Republicans must overcome to repeal the Affordable Care Act.

Morning Consult, March 1, 2017

Insurers pay twice as much as hospitals for hip and knee implants

Stat News reports: Imagine this: You go to buy a car, but you don’t know who makes it, how other customers feel it’s performing, or how its price compares to other cars in its class.

Stat New, February 28, 2017

Hospitals, Both Rural And Urban, Dread Losing Ground With Health Law Repeal

Kaiser Health News reports: More than a year ago, she lost her job at a nearby rural hospital after it closed and, as Republicans work to dismantle the Affordable Care Act, wonders whether she’ll soon be out of work again.

Kaiser Health News, February 28, 2017

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. 

How Health Plans Impact Revenue Performance and Improve Quality Outcomes

By Claire Thayer, March 2, 2017

The Healthcare Effectiveness Data and Information Set (HEDIS) measures developed by the National Committee for Quality Assurance (NCQA) are now used by over 90% of health plans to measure quality performance.  HEDIS consists of 81 measures across 5 domains of care and address a broad range of important health issues, including:     

• Asthma Medication Use
• Persistence of Beta-Blocker Treatment after a Heart Attack
• Controlling High Blood Pressure
• Comprehensive Diabetes Care
• Breast Cancer Screening
• Antidepressant Medication Management
• Childhood and Adolescent Immunization Status
• Childhood and Adult Weight/BMI Assessment

Many health plans report HEDIS data to employers or use their results to make improvements in their quality of care and service.  Each year, NCQA publishes The State of Health Care Quality Report to raise awareness on key quality issues and drive improvement in the delivery of evidence-based medicine. This report documents performance trends over time, tracks variation in care and recommends quality improvements.  Additionally, HEDIS data is also incorporated into many health plan ‘report cards’ and increasingly used by consumers and purchasers to track and compare health plan performance.

This week, a special edition of the MCOL Infographic, co-sponsored by DST Health Solutions, focused on strategic trends and key elements of performance improvement for health plans: 

 

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:

CMS nominee breezes through confirmation hearing

The Hill reports: President Trump's pick to lead the Center for Medicaid and Medicare Services (CMS) cruised through her confirmation hearing Thursday, though Democrats showed frustration at her refusal to offer specifics.

The Hill

Thursday, February 16, 2017

The IRS Has Just Made Obamacare’s Individual Mandate Optional

The Fiscal Times reports: When President Trump signed an executive order shortly after taking office designed to weaken the Affordable Care Act, some questioned whether the instructions to federal agencies to look for ways to ease the law’s burden on businesses and individuals would have any real bite.

The Fiscal Times

Wednesday, February 15, 2017

Amid Obamacare uncertainty, insurance giant Humana plans to leave marketplaces in 2018

Los Angeles Times reports: Humana Inc., one of the nation’s largest health insurers, will stop selling Obamacare health plans next year, the company announced Tuesday. The move threatens to rattle jittery insurance markets and further complicate Republicans’ push to repeal and replace the Affordable Care Act.

LA Times

Tuesday, February 14, 2017

Aetna, Humana end $34 billion merger agreement

CNBC reports: Aetna and rival Humana are terminating their merger, after their $34 billion deal was blocked by a federal court on antitrust grounds. Aetna will pay Humana a $1 billion break-up fee, in accordance with the agreement.

CNBC

Tuesday, February 14, 2017

Drugmaker Marathon ‘Pausing’ Delivery Of $89,000-A-Year Muscular Dystrophy Drug

Kaiser Health News reports: In a surprise move Monday, Marathon Pharmaceuticals told patient advocates that it would “pause” the launch of its drug Emflaza because of pricing concerns expressed by patients and advocacy groups.

Kaiser Health News

Monday, February 13, 2017

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:

Tom Price Is Confirmed as Health Secretary

The New York Times reports: The Senate early Friday approved the nomination of Representative Tom Price to be secretary of health and human services, putting him in charge of President Trump’s efforts to dismantle the Affordable Care Act.

The New York Times

Friday, February 10, 2017

Obama’s Drug Czar: The Opioid Crisis Must Continue To Be A Federal Priority

Kaiser Health News reports: The GOP is working to repeal and replace the 2010 health law, known for insuring more than 20 million people. And the change could affect another health concern: the nation’s opioid abuse problem.

Kaiser Health News

Thursday, February 9, 2017

Judge, Citing Harm To Customers, Blocks $48 Billion Anthem-Cigna Merger

The New York Times reports: The ruling, by Judge Amy Berman Jackson of the Federal District Court for the District of Columbia, came two weeks after another federal judge blocked a proposed $37 billion merger between Aetna and Humana on antitrust grounds. Judge Jackson wrote in her order that she found the Justice Department’s arguments against the deal persuasive, and that putting Anthem and Cigna together would harm customers.

NY Times

Thursday, February 9, 2017

How Would Republican Plans for Medicaid Block Grants Actually Work?

The New York Times reports: There are only so many ways to cut Medicaid spending. You can reduce the number of people covered. You can reduce the benefit coverage. You can also pay less for those benefits and get doctors and hospitals to accept less in reimbursement. Or you can ask beneficiaries to pay more.

NY Times

Monday, February 6, 2017

Trump Says Health Law Replacement May Not Be Ready Until Next Year

The New York Times reports: President Trump said in an interview that aired on Sunday that a replacement health care law was not likely to be ready until either the end of this year or in 2018, a major shift from promises by both him and Republican leaders to repeal and replace the law as soon as possible.

NY Times

Sunday, February 5, 2017

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:

Repeal Ripples: Five Obamacare Exchange Chiefs Contemplate An Uncertain Future

Kaiser Health News reports: The health insurance marketplaces created by the Affordable Care Act are in their third year of selling health insurance plans to people who don’t get insurance through work.

Kaiser Health News, January 27, 2017

Senators' ObamaCare replacement bills highlight GOP divide

The Hill reports: As House and Senate Republicans unveiled an aggressive plan to repeal and replace the Affordable Care Act within the next three months, disagreement over two Senate bills introduced this week shows the stark divide within the party over a way forward.

The Hill, January 26, 2017

What President Trump's executive order means for hospitals & physicians: 14 key thoughts

Becker's Hospital Review reports: President Donald Trump signed an executive order on Jan. 20 to reduce the economic burden of the ACA. Fourteen academics and leaders of healthcare companies and hospitals discuss the executive order's implications on hospitals and physicians.

Becker's Hospital Review, January 24, 2017

Judge blocks major health insurance merger

Politico reports: A federal judge has blocked Aetna’s merger with Humana after finding that the health insurers’ $37 billion deal would leave seniors with fewer and costlier options for private Medicare coverage.

Politico, January 23, 2017

Lingering FTC concerns could stall $9.4B Walgreens-Rite Aid merger

Becker's Hospital Review reports: With the deadline fast approaching to close the merger between Deerfield, Ill.-based Walgreens Boots Alliance and Camp Hill, Pa.-based Rite Aid, Federal Trade Commission lawyers still have concerns about the transaction, people familiar with the matter told Bloomberg.

Becker's Hospital Review, January 23, 2017

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. 

Understanding Impact of Socioeconomic Data on Health Outcomes

By Claire Thayer, January 26, 2017

While advancements in medical technologies have contributed to improved health outcomes, health care systems are increasingly retooling their focus to understanding the basic socio determinants of health, the underlying factors of how socio and economic conditions are correlated to health outcomes of patient populations along with the role of local communities in addressing these issues.  As health care providers undertake more risk with population health management and value-based payment arrangements, health care providers are being held accountable not only health care costs, but also the health of their patient populations.

The CDC outlines some of the factors related to health outcomes as:

• ·         How a person develops during the first few years of life (early childhood development)
• ·         How much education a person obtains
• ·         Being able to get and keep a job
• ·         What kind of work a person does
• ·         Having food or being able to get food (food security)
• ·         Having access to health services and the quality of those services
• ·         Housing status
• ·         How much money a person earns
• ·         Discrimination and social support

This week, a special edition of the MCOL Infographic, co-sponsored by LexisNexis Health Care, highlights many of the key socioeconomic factors impacting health outcomes for patient populations:

 

Additional reading:

Tackling Patients’ Social Problems Can Cut Health Costs, Kaiser Health News, January 23, 2017

Socio Determinants of Health: Know What Affects Health, CDC

Healthy People 2020 – Socio Determinants of Health, Health People.gov

Using Social Determinants of Health Data to Improve Health Care and Health: A Learning Report, Robert Wood Johnson Foundation, May 2016

Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Kaiser Family Foundation, November 4, 2015.

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’s Nominee For Agriculture Has Key Health Role

Kaiser Health News reports: Amid the cacophony of confirmation hearings for Cabinet nominees, President-elect Donald Trump reportedly has settled on former Georgia Gov. Sonny Perdue to fill the final Cabinet-department vacancy: Secretary of Agriculture. Although consumers may simply think of the Department of Agriculture (USDA) as responsible for overseeing the farming industry, it also plays a key role in promoting health.

Kaiser Health News

Friday, January 20, 2017

How Large Employer Health Plans Could Be Affected By Obamacare Overhaul

NPR reports: If you think that you wouldn't be touched by a Republican overhaul of Obamacare because you get health insurance through your job at a big company, think again.

NPR

Thursday, January 19, 2017

Anthem aims for 30% reduction in number of opioid prescriptions by 2019

Becker's Hospital Review reports: Indianapolis-based Anthem said it wants to reduce the amount of opioids prescribed to policyholders by 30 percent by the end of 2019. The insurer said in a Wednesday news release it is also committed to helping its affiliated health plans double the number of consumers who receive counseling as part of medication-assisted therapy for opioid addiction.

Becker's Hospital Review

Thursday, January 19, 2017

Health Law Repeal Could Cost 18 Million Their Insurance, Study Finds

The New York Times reports: Eighteen million people could lose their insurance within a year and individual insurance premiums would shoot upward if Congress repealed major provisions of the Affordable Care Act while leaving other parts in place, the nonpartisan Congressional Budget Office said on Tuesday.

NY Times

Wednesday, January 18, 2017

Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies

Kaiser Health News reports: More than 30 years ago, Congress overwhelmingly passed a landmark health bill aimed at motivating pharmaceutical companies to develop new drugs for people whose rare diseases had been ignored. By the drugmakers’ calculations, the markets for such diseases weren’t big enough to bother with.

Kaiser Health News

Tuesday, January 17, 2017

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.