Healthcare Triage News: Why Do Insulin Prices Keep Rising?

Healthcare Triage News: Why Do Insulin Prices Keep Rising?

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Frederick Banting discovered insulin in 1921 and didn’t want to profit off of such a life-saving drug. Fast forward to 2019, and the price of insulin continues to increase year over year. Why is that?

 

 

 

 

WHY HEALTH SYSTEMS SHOULD WORRY ABOUT WALGREENS AND CVS

https://www.healthleadersmedia.com/strategy/why-health-systems-should-worry-about-walgreens-and-cvs

 

There’s a building threat from the nation’s two retail drugstore giants to hospitals and health systems as providers move toward value-based care and lower-cost outpatient services.

Even with Amazon threatening to compete with retail drugstore chains CVS Health and Walgreens with its own online pharmacy, these retailers aren’t giving up on brick-and-mortar as a way to attract more patients into their stores.

And that’s bad news for the nation’s hospitals and health systems.

There’s a building threat from the nation’s two retail drugstore giants to hospitals and health systems as medical care providers move away from fee-for-service medicine to value-based care and lower-cost outpatient services.

Walgreens and CVS are looking to healthcare as a way to keep customers coming into their stores, particularly in an era where consumers are fleeing brick-and-mortar to shop online via Amazon.

As front-end retail sales have fallen in recent years, CVS and Walgreens are moving more rapidly into healthcare from simply their historic role of filling prescriptions beyond the pharmacy counter and treating routine maladies with nurse practitioners in their retail centers to more services.

They are partnering more closely with health insurance companies that will work harder to funnel more patients to outpatient healthcare services inside the stores that will make them direct competitors of U.S. hospitals and health systems.

CVS has more than 1,100 retail MinuteClinics compared to 800 five years ago and 400 a decade ago.

CVS was opening 100 clinics per year 10 years ago, and that has slowed because they are now focusing on expanding healthcare services in the clinics as well as their stores generally. The same goes for Walgreens.

Walgreens has increased the services in its retail clinics, advertising the ability of nurse practitioners to conduct routine exams and student physicals and has been aggressively lobbying states across the country to change scope-of-practice laws to allow pharmacists to administer an array of vaccines.

“Why not use those locations as a strategy for healthcare?” Walgreens Chief Medical Officer Dr. Patrick Carroll says of the drugstore chain’s nearly 10,000 locations across the country. “We have the space. We should use it.”

To be sure, Walgreens is looking to provide more physician services like x-rays and procedures by partnering with UnitedHealth Group’s Optum to connect its MedExpress brand urgent care centers to an adjacent Walgreens. Like most retailers, Walgreens’ sales of general merchandise in the front end of the store is falling just as pharmacy sales, personal healthcare, and wellness revenues rise.

In the first such ventures, the Walgreens store and the MedExpress center each have their own entrance with a door inside connecting the urgent care center with the drugstore. It’s designed for a medical provider to guide a patient to either facility depending on their prescription or other needs.

For now, there are 15 locations in six states that have MedExpress urgent care centers connected to Walgreens stores as part of the pilot. The markets include Las Vegas; Dallas; Minneapolis; Omaha, Nebraska; two cities in West Virginia; and Martinsville, Virginia.

“We’re working closely with a number of partners in the healthcare community to bring services closer to our customers,” Carroll said. “With our stores serving as more of a neighborhood health destination, we can best meet the changing needs of our customers, while also complementing our expanded pharmacy services.”

Meanwhile, CVS plans to offer more healthcare services inside its stores after its merger with Aetna closes. CVS executives say they aren’t ruling out developing urgent care centers as well.

CVS’ network of nearly 10,000 pharmacies and over 1,000 retail clinics, and Optum’s growing network of ambulatory facilities like the MedExpress urgent care centers are emerging as a model health insurers want to do business with as fee-for-service medicine gives way to value-based care that keeps patients out of the hospital.

And in CVS’ case, the pharmacy will soon own Aetna, a health plan with more than 20 million members. That combination, which is currently wending its way through the regulatory process, is expected to lead to more narrow network health plans that encourage patients to use providers in the Aetna-CVS network over other health systems’ facilities.

Health systems should be concerned, healthcare analysts say.

“CVS and Aetna, in their own words, are promising to reinvent the front door of American healthcare,” says Kenneth Kaufman, managing director and chair of the consulting firm Kaufman Hall. “That promise should be of serious concern for legacy hospital providers since those providers have occupied that front door for the past 75 years.”

CVS Health President and CEO Larry Merlo is beginning to offer some details to their strategies.

While cautioning that it’s “very early” in the development of new programs the combined company will develop, Merlo has said the larger company plans to first focus on three primary patient populations: those patients with any of five chronic diseases: diabetes, hypertension, hyperlipidemia, asthma, and depression.

CVS and Aetna will also focus on “patients undergoing transitions in care,” and a third “broader focus on managing high-risk patients,” Merlo told analysts on the company’s second quarter earnings call in May.

“By extending our new health care model more broadly in the marketplace, patients will benefit from earlier interventions and better connected care leading to improved health outcomes,” Merlo said on September 20 at a CVS Health town hall meeting in Los Angeles.

“Think again about that senior leaving the hospital, knowing that the care plan prescribed by her doctor is being seamlessly coordinated by CVS and her caregiver. By fully integrating Aetna’s medical information and analytics with CVS Health’s pharmacy data and our 10,000 community locations, we can enable more effective treatment of the whole patient,” he says.

 

Efforts to Undo Pre-Existing Condition Protections Put Millions of Women and Girls at Risk

https://www.americanprogress.org/issues/women/news/2018/06/21/452643/moving-backward/

A mother and her child visit the doctor, October 2013.

The Affordable Care Act (ACA) prohibits discriminatory insurance practices in pricing and coverage in the individual market. Before the law was enacted, women routinely were denied coverage or charged more for insurance based on so-called pre-existing conditions. For example, in the individual insurance market, a woman could be denied coverage or charged a higher premium if she had been diagnosed with or experienced HIV or AIDS; diabetes; lupus; an eating disorder; or pregnancy or a previous cesarean birth, just to name a few. The ACA provided women with protections for pre-existing conditions and access to comprehensive, affordable, and fair health services.

But recent efforts to eliminate key ACA protections, discussed below, would put millions of women and girls once again at risk of being charged more or denied coverage for individual insurance.

Efforts to eliminate ACA protections threaten the security of women with pre-existing conditions

Recently, the U.S. Department of Justice refused to uphold the law in Texas v. United States, when it argued that the community rating and guaranteed issue provisions of the ACA are unconstitutional. Without guaranteed issue, women could be denied coverage based on their medical history, their age, and their occupation, among other factors. Without community rating, women could be charged more, or priced out of the insurance market altogether, based on their health status or other factors. Insurance companies could also try to reinstate gender rating, a common pre-ACA practice in which insurance companies charged women higher premiums than they did men, even though other parts of the ACA protect women from discrimination in the health care system.

Now, think tanks and conservative opponents of the ACA are introducing proposals to repeal the ACA yet again. If implemented, these proposals would similarly put women at risk of being denied coverage or charged more because of their health status.

More than half of all women and girls have pre-existing conditions

The authors estimate that more than half of women and girls nationwide—more than 67 million—have pre-existing conditions. There are also nearly 6 million pregnancies each year, a commonly cited reason for denying women coverage on the individual market before the ACA. The two tables available for download below provide state-level detail for the number of women and girls with pre-existing conditions and the number of pregnancies.

A large share of women have coverage through an employer or Medicaid and would, therefore, not face discriminatory practices such as medical underwriting or denials based on health conditions. But the data make clear that allowing insurers to return to pre-ACA practices could lead to millions of women and girls being denied coverage or charged more based on their health status if they ever sought coverage in the individual market.

 

 

Where Are All the New Diabetes Drugs?

http://www.realclearhealth.com/2017/02/20/where_are_all_the_new_diabetes_drugs_275278.html?utm_source=RealClearHealth+Morning+Scan&utm_campaign=43886a5bc1-EMAIL_CAMPAIGN_2017_02_20&utm_medium=email&utm_term=0_b4baf6b587-43886a5bc1-84752421

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As oncologists race forward with new treatments verging on science fiction and biotech companies press on with drugs for once-hopeless rare disorders, one of the world’s most pervasive diseases looks like it’s been left behind.

There are few new drugs on the horizon for diabetes, which affects about 29 million Americans. Most of the treatments in late-stage development are simply improved versions of what’s out there — taken weekly versus daily, or orally instead of by injection.

So has pharma run out of ideas in diabetes?

The top 5 conditions affecting communities, according to new BCBSA tool

http://www.healthcaredive.com/news/blue-cross-blue-shield-health-index/431194/

Mapping technologies and population health make a beautiful pairing. Using geographical data can assist care delivery strategies as tech tools such as GIS can track and trend health data for a community overtime.

“As the move to accountable care and value-based payments takes hold, providers and health plans are increasingly interested in applying GIS to assess risk based on geography and the populations that live there, reveal where the greatest need is, and prioritize areas for interventions,” Danny Patel, account executive for health and human services at GIS software maker Esri, told Healthcare Dive in May.

While providers can look to reduce unnecessary readmissions using such efforts, plans like Blue Cross Blue Shield Association – which recently released its new BCBS Health Index – can use local health data to understand the health of a county/population. The tool, using blinded claims data from more than 40 million commercially-insured BCBS members, identifies the health conditions with the greatest impact on the commercially insured. The tool includes information on over 200 conditions.

“What the health index gives us is the ability to work with local stakeholders…to talk about where we need to focus broader health resources,” Maureen Sullivan, chief strategy and innovation officer at Blue Cross Blue Shield Association, told Healthcare Dive. She said the tool isn’t a “healthiest place to live” navigator but rather a starting point to understand conditions affecting communities and develop peer networks.

Life expectancy in the US has decreased. That’s troubling

http://www.healthcaredive.com/news/life-expectancy-in-the-us-has-decreased-thats-troubling/431984/

Dive Insight:

Recent data show that a human’s lifespan is “fixed and subject to natural constraints” and that the limit of the “world’s oldest person” has not increased since the 1990s, when French woman Jeanne Calment died at age 122.

Still, the CDC’s findings paint a poor picture of the health of the U.S. population, as it shows an increase in “virtually every cause of death,” David Weir from the Institute for Social Research at the University of Michigan was quoted in The Washington Post. In fact, the rate of deaths related to eight of the 10 leading causes of death increased from 2014 to 2015. Only one decreased. The rate for heart disease increased 0.9% while the rate for cancer decreased by 1.7% from 2014 to 2015.

For American males, life expectancy changed from 76.5 years in 2014 to 76.3 years in 2015 and American females saw a decrease from 81.3 years in 2014 to 81.2 years in 2015. Earlier this year, CDC released data that showed more Americans died in 2014 from heart disease than any other cause with 74% of American deaths attributed to the same 10 common causes of death.

Worldwide, a recent study found in 2010, nearly a third of adults had hypertension.

“We’re seeing the ramifications of the increase in obesity,” said Tom Frieden, director of the Centers for Disease Control and Prevention, was quoted in The Washington Post.

Four areas of unnecessary senior healthcare

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/four-areas-unnecessary-senior-healthcare?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=19102016

The number of seniors in the United States is projected to nearly double over the next 34 years—from 43 million in 2012 to nearly 84 million by 2050. During that time period, the number of seniors 85 and older is expected to jump from nearly 6 million to 19 million.

“Our Parents, Ourselves: Health Care for an Aging Population,” a report issued by the Dartmouth Atlas Project, a program of The Dartmouth Institute for Health Policy and Clinical Practice, also reveals that the number of seniors in Medicare private health plans such as Medicare Advantage increased from 6.4 million beneficiaries in 1999 to nearly 12 million in 2011—and that number continues to rise.

Because seniors are likely to experience frequent, complex interactions across many providers in the healthcare system, often there’s no single healthcare provider coordinating all of their care, according to the report, which was released in early 2016.

In addition, the American Geriatrics Society’s Choosing Wisely guidelines, which were released in 2013 and updated in 2015, provide geriatrics-specific recommendations to the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. The campaign advances a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures.

Here are four areas of elderly care—highlighted in the report and guidelines—that healthcare systems and health plans should be aware of to ensure that elderly patients aren’t receiving unnecessary care.

Big Soda sponsored 96 health groups — a big conflict of interest, study says

https://www.washingtonpost.com/news/to-your-health/wp/2016/10/10/big-soda-sponsored-96-health-groups-a-big-conflict-of-interest-study-says/

Nearly 100 national health and medical groups — including the American Heart Association, the American Diabetes Association and the Centers for Disease Control and Prevention — enjoy sponsorships by Coca-Cola Co. or PepsiCo, according to a new study by two Boston University researchers.

The report lands as the sugar industry’s supersized role in shaping — and spinning — health policy has come under increasing scrutiny. It also comes as the negative health effects of sugar and sugary drinks, including a link to rising obesity rates, are better understood.

“Now, most organizations refuse tobacco money,” write the study authors, Daniel Aaron and Michael Siegel. “Perhaps soda companies should be treated similarly.”

The American Beverage Association, which represents both Coca-Cola and PepsiCo, responded to the study with a statement saying: “America’s beverage companies are engaged in public health issues because we, too, want a strong, healthy America. We have a long tradition of supporting community organizations across the country. As this report points out, some of these organizations focus on strengthening public health, which we are proud to support.”

Coca-Cola and PepsiCo did not respond to a request for comment about the study.