Cartoon – Those in favor say ‘aye’ and those opposed say ‘bye’
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Caring for High-Need, High-Cost Patients — An Urgent Priority
Improving the performance of America’s health system will require improving care for the patients who use it most: people with multiple chronic conditions that are often complicated by patients’ limited ability to care for themselves independently and by their complex social needs. Focusing on this population makes sense for humanitarian, demographic, and financial reasons.
From a humanitarian standpoint, high-need, high-cost (HNHC) patients deserve heightened attention both because they have major health care problems and because they are more likely than other patients to be affected by preventable health care quality and safety problems, given their frequent contact with the system. Demographically, the aging of our population ensures that HNHC patients, many of whom are older adults, will account for an increasing proportion of users of our health care system. And financially, the care of HNHC patients is costly. One frequently cited statistic is that they compose the 5% of our population that accounts for 50% of the country’s annual health care spending.
At least three steps are essential to meeting the needs of these patients: developing a deep understanding of this diverse population; identifying evidence-based programs that offer them higher-quality, integrated care at lower cost; and accelerating the adoption of these programs on a national level. Although we are making progress in each of these areas, much work remains.
Four ways demand for healthcare data will grow in 2017
The New Year presents challenges on many fronts, including questions surrounding how President-elect Donald Trump will change healthcare policy. Yet, “repeal and replace” or “replace and improve” activities on The Hill, though not “business as usual,” won’t necessarily slow down data-driven focus areas in healthcare that will continue in 2017.
Here are four key ways demand for data will grow in the year ahead:
1. Increased demand for insight into discharge gaps, risks and exposures.
As delivery and payment models continue placing risk within the care setting, increased insight into the member’s (the patient’s) likelihood of adherence or compliance is critical in evaluating expected outcomes and coordination of care post-discharge. Socioeconomic data surrounding the patient and their caregiver can complete the picture of their expected behavior.
2. Maximizing identity management capabilities.
Identity insight and management solutions will be critical to ensure the right approach for the right member but, more importantly, to securely house and validate identity data. While a national patient identifier may become closer to reality at some point, for now, identity management techniques can be critical to ensuring all operational processes and players within the care payment and delivery setting can link the right information for each individual.
3. Integration of health-tracking wearables into care analytics.
The market for wearable fitness and health devices has grown exponentially. Integration of health tracking wearables into the care analytic systems creates opportunities for using wearable metrics as a basis for member rewards but also in risk scoring for compliance augmentation for new targets, for member engagement, and for prediction of medical complications or improvement.
4. Evaluation of provider performance.
While the release of MACRA benchmarks has gotten considerable attention the past month, it is really only a beginning. Commercial plans have attempted various P4P approaches over the years with one missing ingredient, now shared with MACRA: Insight into patient profiles and behaviors and their influence and impact on ultimate outcomes. Socioeconomic data augmenting existing measurement sources can serve a critical role in tiering performance measures with patient make-up to arrive at a more mutually accepted performance structure.
Healthcare organizations and payers should reach out to new data sources, augment their thinking with them, and redefine how their day is focused on insights into their most valuable player: the customer, the member and the patient.
Top 2017 challenges healthcare executives face
Working as a managed care executive in today’s healthcare environment is a demanding role. According to Managed Healthcare Executive’s 2016 State of the Industry Survey, challenges abound. Government requirements and mandates, such as implementing value-based reimbursement, are difficult to meet. Meanwhile, employing new technologies, such as electronic health records and data analytics, is no easy task. Pharmaceutical costs continue to rise dramatically, burdening the entire system.
The survey findings, based on 160 responses, show the biggest challenges that executives at health systems, health plans, pharmacy benefit organizations, and more anticipate next year. Here’s a closer look at the survey results, and what industry experts say organizations can do to overcome them.
Top 10 states most affected by ACA repeal
Making good on one of his campaign promises in his first executive order, President Trump directed his administration to take steps that will facilitate the repeal and replacement of the Affordable Care Act (ACA).
Although the future of the ACA and what comes next is murky, what is clear is that certain states would suffer more than others from a repeal. In order to assess repeal’s impact on Americans based on where they live, personal-finance website WalletHub analyzed states across seven key metrics that range from “growth of uninsured rate by 2019 post-ACA repeal” to “potential economic impact due to repeal of premium tax credits and Medicaid expansion (2019 to 2023).”
“The most affected states by the ACA repeal have some of the highest insured rates in the country and have expanded Medicaid,” says WalletHub analyst Jill Gonzalez.
Here are the top 10 states that are most affected by repeal of the ACA, according to the report.
Federalism and the End of Obamacare
http://www.yalelawjournal.org/forum/federalism-and-the-end-of-obamacare
Federalism has become a watchword in the acrimonious debate over a possible replacement for the Affordable Care Act (ACA). Missing from that debate, however, is a theoretically grounded and empirically informed understanding of how best to allocate power between the federal government and the states. For health reform, the conventional arguments in favor of a national solution have little resonance: federal intervention will not avoid a race to the bottom, prevent externalities, or protect minority groups from state discrimination. Instead, federal action is necessary to overcome the states’ fiscal limitations: their inability to deficit-spend and the constraints that federal law places on their taxing authority. A more refined understanding of the functional justifications for federal action enables a crisp evaluation of the ACA—and of replacements that claim to return authority to the states.
The upshot of the piece is that there’s much to be said—more than the ACA’s supporters generally acknowledge—for returning power to the states. That’s so even with respect to some of the ACA’s most sacrosanct provisions:
[C]onsider the ban on medical underwriting. The ACA reflects the judgment that it is unfair to deny coverage to the sick or to ask them to pay more for their coverage. The ACA thus embraces policies—in particular, the much-maligned individual mandate—that its drafters thought necessary to cope with the risk that people will wait until they got sick to purchase coverage. For the ACA’s supporters, the individual mandate is a reasonable price to pay to prevent discrimination against the sick. But many people don’t see it the same way. Some reject the claim that the government should be in the business of guaranteeing coverage for everyone. Others don’t think that medical underwriting, however distasteful, warrants a heavy-handed purchase obligation. Still others doubt that the individual mandate is strictly necessary to prevent adverse selection, and would prefer less-intrusive alternatives. If those who disagree with the ACA’s approach command the levers of political power within a state, why shouldn’t those states be allowed to try something different?
The argument can be generalized to most of the ACA’s insurance reforms. And I can already hear the response: Because this “something different” will not work. The ACA’s opponents are completely unrealistic about the tough tradeoffs that health-care policymaking entails. They will take federal money and squander it, leaving millions of people without coverage.
That might be right; indeed, I suspect it is right. But that’s my judgment. Lots of smart people do not share that judgment. And if federalism means anything, it is that national judgment should not supersede state judgment, absent a good reason for federal intervention. Yes, federal money might be squandered in a state that adopts stupid insurance rules. People could go bankrupt and even die as a result of the lack of coverage. But that’s an issue between the state and its voters. If other states use the money more effectively, the state with the stupid rules will come under pressure to improve them. And what if it turns out that what seemed stupid is not so stupid after all?
Democracy rests on the conceit that we all have an equal voice in determining what the good is, which is why Michigan voters don’t get to tell Ohioans how to spend their tax dollars, even if Wolverines know in their hearts that they make better decisions than Buckeyes. And while the federal government can make decisions for Ohio, it should not do so just because it doubts the wisdom, intelligence, or values of Ohio residents. “The states have bad ideas” is a poor justification for federal law (unless, again, those bad ideas turn on views about the inferiority of minority groups). Federalism thrives when we recognize the limits of what we know, appreciate that good people can hold views that many others find repugnant, and acknowledge that our own misconceptions and prejudices can blind us. Sometimes federalism means letting the states wave their crazy flags.
I’d welcome any suggestions and criticisms. And a big thank you to the Yale Law Journal, which has moved with stunning speed to get the piece up.
GOP Considers Medicaid Reforms for Reconciliation Bill
https://morningconsult.com/2017/02/14/gop-considers-medicaid-reforms-reconciliation-bill/
House Republicans are weighing specific reforms to Medicaid that could be included in a reconciliation measure to overhaul the Affordable Care Act.
How to deal with the federal expansion of Medicaid under the ACA is one of the main unanswered questions as Congress works to overhaul Obamacare — one that has exposed divisions between the House’s most conservative members and GOP lawmakers from states that chose to expand the federal program for low-income Americans.
Rep. Brett Guthrie (R-Ky.), the vice chairman of the Energy and Commerce Health Subcommittee, said Tuesday that lawmakers are considering what types of reforms — specifically shifting to per capita allotments or allowing states to choose block grants — could be included in a House reconciliation bill to repeal the ACA.
“We’re going to deal with Medicaid reform in reconciliation, is kind of what was discussed. There’s no details yet,” Guthrie told reporters Tuesday after a House GOP conference meeting. Guthrie led a working group focused on Medicaid reforms in the last Congress.
Rep. Michael Burgess (R-Texas), who chairs the health subcommittee, told reporters Medicaid reform would be a discussion all week. House Majority Whip Steve Scalise’s office held a listening session Tuesday afternoon with members on Medicaid, and other committees are also gathering feedback. House Republicans are expecting to learn more information about health reform in a Thursday conference meeting focused on Obamacare.
House Speaker Paul Ryan attended the GOP senators’ policy lunch on Tuesday, and told attendees that appropriators and the authorizing committees are working out Medicaid reforms, Sen. Marco Rubio (R-Fla.) said.
In the House, proposals to transition to per capita allotment or block grants were included in the House GOP’s “Better Way” agenda, rolled out last year.
Cigna ends merger with Anthem, sues for more than $14B
In a move that defies Anthem’s push to fight for their deal, Cigna has terminated its merger agreement with Anthem and filed suit against the larger insurer.
Earlier this month, a federal judge ruled against the two insurers’ planned merger, saying it would violate antitrust law by lessening competition in the national accounts market. Anthem responded by saying it intends to appeal the ruling.
But in a statement issued Tuesday, Cigna said that given the court’s decision, it “believes that the transaction cannot and will not achieve regulatory approval and that terminating the agreement is in the best interest of Cigna’s shareholders.”
Thus, Cigna filed a suit against Anthem in the Delaware Court of Chancery, seeking a declaratory judgment that Cigna has lawfully terminated the merger agreement and that Anthem is not permitted to extend the termination date.
The suit also asked the court to compel Anthem to pay Cigna the $1.85 billion termination fee outlined in the merger agreement, plus additional damages of more than $13 billion. Those damages “include the lost premium value to Cigna’s stockholders caused by Anthem’s willful breaches of the merger agreement,” according to a question-and-answer document filed with the Securities and Exchange Commission.
For its part, Anthem maintains that “under the terms of the merger agreement, Cigna does not have a right to terminate the agreement. Therefore, Cigna’s purported termination of the merger agreement is invalid,” a company spokesperson said in an emailed statement. “Anthem will continue to enforce its rights under the merger agreement and remains committed to closing the transaction.”
Cartoon – How are you doing on your Unspoken Objectives?
Cartoon – Accomplishing Stuff Feels Good
