http://www.commonwealthfund.org/publications/blog/2016/dec/2016-health-care-year-in-review
This was a tumultuous year in health care and elsewhere. Wherever we looked, the improbable and unbelievable became true and believable: from Brexit to a President-elect Trump to alleged foreign sabotage of our political institutions. Historians will dissect the remnants of these events for decades. For us, for now, let’s focus on health care, which is plenty.
Drug industry unveils massive new campaign to counter criticism
Under withering public criticism, the drug industry is doubling down on its arguments that the debate over drug prices is distorted, rolling out a multimillion-dollar ad campaign to repair its reputation and defend the value its medications provide.
The industry’s major lobbying group here, the Pharmaceutical Research and Manufacturers of America, unveiled the campaign on Monday. Officials said they would spend in the “high” tens of millions of dollars every year for the next four to five years, rehabilitating their image in the wake of former industry executive Martin Shkreli and the political backlash to rising prices.
“Less hoodie, more lab coats” is how PhRMA President and CEO Stephen Ubl described the advertising campaign in a briefing with reporters. (Shkreli, not missing an opportunity for publicity, responded with a hastily produced website detailing how double-digit price increases are hardly unique to companies outside PhRMA’s membership.)
The campaign, branded “GoBoldly,” sounds like a more aggressive version of the industry’s previous image-making campaign, “From Hopes to Cures.” It will emphasize that biopharmaceutical companies develop breakthrough medications that save lives and that they can be the answer to the problem of health care costs, rather than the cause.
The first television ad being released as part of the new campaign is being called “Do Not Go Gentle.” It blends Dylan Thomas’s famous poem with images of goggled scientists peering through microscopes and patients heading into treatment.
The PR campaign will be paired with a series of events intended to remake the public debate, from one about drug prices to one about medical breakthroughs and the value that novel medications provide by saving costs in the long run. The industry believes its preferred policies — value-based contracts and a modernized Food and Drug Administration — can fix the cost problem better than more direct price controls that drug makers view as their greatest threat.
“We have a great story to tell and we’re going to do a better job telling it,” Ubl said.
That is a promise, though, that industry officials have been making for more than a year. What Monday’s announcement made clear is that they are prepared to spend huge sums of money to fulfill it.
http://fortune.com/2016/12/19/healthcare-drug-costs-2017-predictions/
At the start of 2016, we made 10 healthcare predictions for the year ahead. Overall, we were 50% right, which is either a failing grade in high school or a great average in baseball.
In the win column, we predicted that the Federal Trade Commission (FTC) would block a major hospital merger, and they did just that with Advocate and NorthShore health systems in Chicago. We predicted that the technology-enabled insurance startup craze would be a bust, and Oscar promptly lost a ton of money. Finally, we were correct that employers would become more engaged in healthcare cost management with many adding “frozen carrots,” or financial incentives to drive usage of services that lower healthcare costs.
Our biggest bust was on the PCSK9’s—we predicted these new cholesterol drugs would be blockbusters. Thus far, they have been a total flop. We were also wrong when we predicted wearables would become medically useful treatments. And, to our surprise, there were more setbacks than breakthroughs in continuous biosensors, devices such as glucose monitors for diabetics.
We’re hoping to bat above .500 this coming year. Here are our 10 healthcare industry predictions for 2017:
http://www.healthcaredive.com/news/21st-century-cures-act-explained/431491/
On Wednesday, the Senate voted 94-5 to pass the long-awaited 21st Century Cures Bill. As it has backing from the current White House administration, President Barack Obama is expected to sign the legislation into law.
The law has been called the “most important bill of the year” by Senator Lamar Alexander (R-TN), as Politico Pulse reported Tuesday. The bill, while bipartisan, is not without controversy. While the House version of the legislation passed swimmingly with a vote of 392-26, the bill did have its share of opponents in the Senate– including Sen. Elizabeth Warren (D-MA) and Sen. Bernie Sanders (I-VT) – who think the bill is too favorable to pharmaceutical companies. Both Sanders and Warren were among the five Senators to vote against the measure.
And as Modern Healthcare’s Merrill Goozner notes in an editorial, it’s likely the true impact of the bill won’t be known right away but will be realized as the years pass. “The final details of the 996-page legislation…weren’t known until five days before it passed,” Goozner wrote.
About three years of work and efforts from 1,400 lobbyists for 400 companies went into the making of this $6.3 billion package. It seeks to deliberately speed medical research and treatments. Because seemingly no healthcare legislation can be a reasonable length (it’s about 90 pages longer than the ACA) and because nothing in healthcare is simple, we’ve summarized some of the notable implications of the bill in four buckets: Health IT, mental health, FDA reform and research and care funding.
http://www.vox.com/science-and-health/2016/11/30/12945756/prescription-drug-prices-explained
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There isn’t much evidence that Americans use an inordinately high amount of prescription drugs. It’s just that when we buy prescription medications, we pay more for the exact same product.
The American Medical Association’s House of Delegates vowed Tuesday to work with the incoming Trump administration and Congress on health care reform, but said any new reforms shouldn’t result in people losing coverage.
“A core principle is that any new reform proposal should not cause individuals currently covered to become uninsured,” the group said in a statement. “We will also advance recommendations to support the delivery of high quality patient care. Policymakers have a notable opportunity to also reduce excessive regulatory burdens that diminish physicians’ time devoted to patient care and increase costs.”
The group added that it was committed to improving health insurance so patients can access high quality and affordable care. The group released a policy framework, noting they would advocate for expanding insurance coverage and choice.
Additionally, the group says it will also advocate to make sure policies offered through insurance exchanges, Medicare Advantage and Medicaid managed care offer wide provider networks. They’re also focused on encouraging prescription drug price and cost transparency.
“The new AMA policy acknowledges the carte blanche approach to drug pricing needs to change to align with the health system’s drive for high-quality care based on value,” AMA President Andrew Gurman said in a separate statement. “This transformation should support drug prices based on overall benefit to patients compared to alternatives for treating the same condition. We need to have the full picture to assess a drug’s true value to patients and the health care system.”
Drug prices continue to bedevil the economics of the U.S. healthcare system in a variety of ways.
Prescription drug prices rose 7 percent between September 2015 and September of this year, according to a new report (.pdf) from the Altarum Institute’s Center for Sustainable Healthcare Spending. No other category rose more than 2.9 percent. Hospital prices rose just 1.2 percent, although that’s up significantly from the 0.7 percent annual increase between September 2014 and September of last year.
Meanwhile, Altarum’s healthcare spending report (PDF) tells a slightly different story. Prescription drug spending rose only at a 4.5 percent annual rate between September 2015 and August of this year. That’s down from the 7.2 percent growth rate from September 2014 to 2015, and the 12.4 percent rate between August 2013 and 2014.
However, hospital spending grew at a 6.6 percent annual rate in September, up from 3.4 percent between September 2014 and 2015. That’s higher than the overall 5.5 percent growth rate.
That dovetails with forecasts that U.S. healthcare spending will reach 20 percent of the gross domestic product (GDP) by the middle of next decade. According to Altarum, it currently amounts to 18.2 percent of GDP. But another report suggested that the Affordable Care Act will actually cut healthcare spending over the long term by $2.6 trillion.
The report, which is closely read by many healthcare policy experts but gains little attention in most media circles, raised some concerns from advocacy groups.
The election outcome itself could create more problems for the ACA. The insurance plans sold on the law’s exchanges have already experienced substantial losses due to adverse selection, leading many insurance companies to pull back on their participation. The prospect of a Trump administration steering ACA implementation may be enough to convince some of the insurers still offering products on the exchanges in 2017 to rethink their plans. If more insurance companies head for the exits, the exchanges could become even less stable than they already are.
The “replace” part of “repeal and replace” has always been the tricky part for ACA opponents, and that will also be true for the incoming Trump administration. During the campaign, Trump offered only the vaguest outline of a plan that wouldn’t come close to serving as a starting point for a workable proposal. The ACA, for all of its problems, brought many low-income households into insurance coverage, through an expansion of the Medicaid program and through heavy subsidization of the insurance plans offered on the exchanges. Unless Trump wants to preside over a massive increase in the number of Americans without health insurance during his presidency, he will have to offer a plan that ensures households with low incomes can secure health insurance in some new way.
With Donald Trump headed to the White House and his party firmly in control of Congress, Republicans will finally have a chance to prove what they’ve been saying all along: that they can produce a better version of healthcare reform than the Affordable Care Act.
It’s clear that the ACA is as imperiled as it has ever been. Trump has fervently vowed to repeal it–and with Republican control of both chambers of Congress, he may well get his wish. After all, the law’s most visible component, the exchanges, are on shaky ground as it is, with premiums rising and some health insurers retreating from the marketplaces.
Plus, President Barack Obama’s last attempt at convincing Republicans to work on fixing the ACA–not repealing it–fell on deaf ears even before the party’s resounding victory Tuesday.
What gets lost in all the talk about the ACA’s uncertain future, though, is the fact that while some insurers have struggled to make a profit in the individual marketplaces, there are other aspects of the law to which they have become quite attached.
Take Medicaid expansion, an idea championed by Democrats (and even once embraced by Vice President-Elect Mike Pence) that has been a boon to insurance companies in the form of lucrative managed care contracts. Some companies that specialize in slimmed-down Medicaid plans have also thrived on the exchanges where others have floundered.
Then there’s the ACA’s provisions that encourage the transition to value-based payments, which insurers have embraced and largely retooled their business models to reflect. Accountable care organizations, for example, have sprung up like wildfire, producing promising results for some companies.
A wholesale repeal of the ACA would also erase the law’s historic gains in reducing the uninsured rate. Though many of the newly insured have turned out to be costlier to cover than expected, such a move would still rob insurers of millions of new customers.
The question, then, becomes what will replace the law–and that’s where it gets interesting.
Trump has a plan, but it is short on details. Perhaps most visibly, he has advocated for selling insurance across state lines–a timeworn GOP talking point that many experts agree is not feasible. He would also repeal Medicaid expansion and convert Medicaid federal matching funds into a block grant, the latter of which would drastically cut Medicaid funding and coverage.
One analysis from The Commonwealth Fund says that his plan could add nearly 20 million peopleto the ranks of the uninsured, and even more if his Medicaid proposals come to fruition.
With much about President-elect Donald Trump’s health-care agenda still unclear, the health-care industry’s initial response to his election has been scattered. Hospital stocks were down. Health insurers’ stock prices were mixed. Pharmaceutical and biotech stocks, on the other hand, got a big bump.
Trump’s clearest policy position in health care has been his commitment to repealing the Affordable Care Act and replacing it with another policy. But the responses to his election varied in large part because the details of exactly what would replace the Affordable Care Act and how that transition would occur have been vague. Without knowing those details, it’s hard for investors to have a clear response, said Benjamin Isgur, a leader in the PwC Health Research Institute.
“These health organizations are like large ships, and you can’t turn them on a dime,” Isgur said. “When you think back to what it took to get ready for the ACA, for many health-care companies, it was two to three years of developing plans and provider networks and marketing plans. . . . There’s a lot of work that is required to implement any new program.”
HENRY KOTULA 