Healthcare insurance companies are actively fighting to keep drug costs low for their members and for their own bottom lines. Now a new policy brief offers state policymakers tips on how to shift more of the costs to payers in an effort to protect consumers.
The brief (.pdf) from the National Association of Insurance Commissioners outlines several regulations policymakers can adopt to ease consumers’ cost burdens, including:
In a church basement in a poor East Baltimore neighborhood, a Johns Hopkins doctor enlisted residents to help answer one of the most fraught questions in public health: When a surge of patients — from a disaster, disease outbreak or terrorist attack — overwhelms hospitals, how should you ration care? Whose lives should be saved first?
For the past several years, Dr. Lee Daugherty Biddison, a critical care physician at Johns Hopkins, and colleagues have led an unusual public debate around Maryland, from Zion Baptist Church in East Baltimore to a wellness center in wealthy Howard County to a hospital on the rural Eastern Shore. Preparing to make recommendations for state officials that could serve as a national model, the researchers heard hundreds of citizens discuss whether a doctor could remove one patient from lifesaving equipment, like a ventilator, to make way for another who might have a better chance of recovering, or take age into consideration in setting priorities.
At that first public forum in 2012 in East Baltimore, Cierra Brown, a former Johns Hopkins Hospital custodian, said she favored a random approach like a lottery. “I don’t think any of us should choose whether a person should live or die,” she said.
Alex Brecht, a youth program developer sitting across from her, said he thought children should be favored over adults. “Just looking at them, seeing their smiles, they have so much potential,” he said.
“Who’s going to raise them?” asked Tiffany Jackson, another participant.
The effort is among the first times, Dr. Daugherty Biddison said, that a state has gathered informed public opinion on these questions before devising policy on them. “I don’t want to be in a position of making these decisions without knowing what you think,” she told the residents. “We as providers,” she said, “don’t want to make those decisions in isolation.”
Rationing already occurs in delivering medical care in the United States, though some practices are little acknowledged. Committees struggle regularly over policies for allocating scarce organs for transplant.
During widespread drug shortages in recent years, doctors have sometimes chosen among cancer patients for proven chemotherapy regimens and among surgical patients for the most effective anesthetics. And doctors sometimes have to choose among patients who need treatment in intensive care units, which are often filled to capacity.
The wholesale price of a single pen was about $47 in 2007, and it rose to $284 this summer, according to Richard Evans, a health care analyst at SSR. But consumers can no longer buy a single pen, so the retail price to fill a prescription today at Walgreens is about $633, according to GoodRX.
It’s the latest in a string of controversies over rising drug prices that have caught the attention of lawmakers on Capitol Hill.
The drug’s manufacturer, Mylan NV, responded to the criticism Thursday, announcing it will offer customers whose insurance doesn’t pay the full cost coupons for up to $300 off the injectors. But it’s unclear if that will be enough to tamp down the anger.
At least three senators have called for investigations into the price of the EpiPen, and Sens. Charles Grassley, R-Iowa, and Richard Blumenthal, D-Conn., have sent letters to Mylan demanding an explanation for the increase.
http://altarum.org/health-policy-blog/to-improve-medicaid-measure-everywhere
“In God we trust. All others must bring data.”
So said W. Edwards Deming, a management consultant widely regarded as one of the most influential figures in quality management of the 20th century.
One would think that in the data-driven 21stcentury, we’d have come a long way in applying that dictum to health care. To some degree, we have—Medicaid and CHIP programs that contract with managed care entities include provisions around quality measurement and reporting in state contracts and make use of the Healthcare Effectiveness Data and Information Set. This reporting serves as the foundation of targeted quality improvement projects in states and helps inform consumer choice through products such as the state-published report cards and annual rankings of health insurance plans set out by the National Committee for Quality Assurance.
But this kind of systematic, comprehensive reporting is largely and notably absent from fee-for-service Medicaid and CHIP. We can’t afford to go without it. It’s imperative that we know what works well in Medicaid and CHIP and what areas of the program need attention or improvement. These programs combine to cover more than one in four Americans and command more than half a trillion dollars in federal and state spending per year.
With this in mind, Safety Net Health Plan members of the Association for Community Affiliated Plans (ACAP) have come together to support a suite of legislation on Capitol Hill. This legislation would extend the benefits of quality measurement and reporting to all Medicaid and CHIP delivery systems—including areas such as fee-for-service that have typically not provided regular, systematic quality data.
The good news is that lawmakers in Washington have taken the first steps toward bringing quality measurement forward into the 21st century by introducing two bills.
Restricting kids to a vegan diet could be considered child abuse punishable by jail time in Italy if a new proposal by a lawmaker in that country passes.
A Pasadena doctor convicted of falsely certifying that more than 79 patients were terminally ill as part of a scheme to bilk Medicare and Medi-Cal was sentenced by a federal judge to four years in prison.
U.S. District Judge S. James Otero also ordered Boyao Huang, 43, to pay $1,344,204 in restitution last week. In May, Huang was found guilty of four counts of healthcare fraud at the conclusion of a two-week trial that centered on a ploy to defraud the government of $8.8 million by making it pay for hospice-related services. Huang could have received up to 10 years in prison for each of the counts.
