AMA Says New Health Policy Must Maintain Coverage for All Currently Covered

https://morningconsult.com/2016/11/15/ama-says-new-health-policy-must-maintain-coverage-for-all-currently-covered/?utm_source=RealClearHealth+Morning+Scan&utm_campaign=5952aea6b6-EMAIL_CAMPAIGN_2016_11_16&utm_medium=email&utm_term=0_b4baf6b587-5952aea6b6-84752421

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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.”

 

 

 

The 1 thing about healthcare that needs to change: 4 executives weigh in

http://www.beckershospitalreview.com/hospital-management-administration/the-1-thing-about-healthcare-that-needs-to-change-4-executives-weigh-in.html

Self-Discovery

From the shift to value-based care to increased price transparency, the healthcare industry is in the midst of significant changes that are aimed at efficiently improving care. However, for that goal to be achieved, problems in the industry such as disparity in access to care and confusing billing systems still need to be addressed, according to healthcare executives.

In a panel discussion on Nov. 9 at the Becker’s 5th Annual CEO + CFO Roundtable in Chicago moderated by Rhoda Weiss, PhD, nationally recognized consultant, speaker, and author, four great minds in healthcare discussed the changes they would like to see in the industry, what gives them pride in their organizations and the issues that keep them awake at night.

7 quotes from Geisinger’s Greg Burke on engaging patients and improving clinical hospitality

http://www.beckershospitalreview.com/patient-engagement/7-quotes-from-geisinger-s-greg-burke-on-engaging-patients-and-improving-clinical-hospitality.html

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At Danville, Pa.-based Geisinger Health System, Greg Burke, MD, an internal medicine physician and chief patient experience officer, aims to ensure the system’s patients are treated with the same type of respect and attention comparable to that delivered to guests at upscale hotels.

In November 2015, Geisenger made national headlines when the system’s CEO David Feinberg, MD, announced patients dissatisfied with their care experience could request refunds for out-of-pocket costs. To date, the system has issued $400,000 in refunds to patients.

Recently, Dr. Burke spoke with U.S. News & World Report on issues surrounding the patient experience, as well as Geisenger’s patient refund program.

Here are seven quotes from Dr. Burke’s interview in U.S. News & World Report.

An ACA primer: Much more than insurance

http://www.healthcaredive.com/news/an-aca-primer-much-more-than-insurance/429497/

Remember the Affordable Care Act? Enacted in 2010, it expanded healthcare insurance to millions of uninsured Americans and increased access to care. But the ACA is much more than expanded coverage; it set in motion a variety of reforms in the healthcare delivery systems aimed at lowering costs and improving quality of care.

That fact was lost on presidential candidate Donald Trump, who told Fox News recently, “I don’t use much Obamacare, I must be honest with you, because it is so bad for the people and they can’t afford it.” Trump’s comments imply Obamacare is an insurance plan people can buy, which is not the case. As we wrap up year six since the ACA was enacted, here‘s what the law is really about and how it impacts providers.

Expanding role of hospitalist PAs achieves similar outcomes at lower cost, study finds

http://www.healthcarefinancenews.com/news/expanding-role-hospitalist-pas-achieves-similar-outcomes-lower-cost-study-finds?mkt_tok=eyJpIjoiWlRkaE16VTBPRGhrTmpWbSIsInQiOiIxRk44S3JKdEd3Mzl5czNscEJZNjI1N210RWE0b0RxNWd3RHhoZUg2TXJCM3U2QnZJWm1VcFhMS2daQ1pmRzEyTG5DU2E0cWFCdGtWQlJKS0N0NE51Y2FubWdZbWptcTRhVHRZaTZJNDM1VT0ifQ%3D%3D

Though more medical centers are relying on hospitalists — hospital-based internal medicine specialists who coordinate the complex care of inpatients — a new study suggests that hospitals can safely lower the cost of hospitalist programs without sacrificing quality of care

The 18-month study published in the Journal of Clinical Outcomes Management compared two hospitalist groups — one with a high physician assistant-to-physician ratio (“expanded PA”) and one with a low PA-to-physician ratio (“conventional”) — and found no significant differences in the important clinical outcomes achieved by both groups.

The study saw little difference in patient mortality, hospital readmissions within 30 days, lengths of stay or specialty consultant use among patients treated by the expanded PA group and those treated by the conventional group.

From January 2012 to June 2013, the researchers implemented an expanded PA staffing model to see larger numbers of adult patients alongside physicians. The expanded PA group consisted of three physicians and three PAs, with PAs caring for 14 patients each day. At the same time, a conventional hospitalist group composed of nine physicians and two PAs had PAs caring for nine patients each day. Physicians in both groups cared for approximately 13 patients a day.

Clinton vs. Trump: 5 critical election issues

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/hillary-vs-trump-5-critical-election-issues?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=25102016

While Hillary Clinton vows to forge ahead with Obamacare if she is elected president, Donald Trump would scrap it altogether. The end results would be two very different forms of healthcare, and industry leaders have much to consider.

Brill“Many different factors are weighing on managed care executives such as the costs of pharmaceuticals, diagnostics and devices; the impact of consolidation amongst hospitals, physicians, health plans; and the losses in the exchange marketplace,” says Managed Healthcare Executive editorial advisor Joel V. Brill, MD, chief medical officer, Predictive Health, LLC, which partners with stakeholders to improve coverage of value-driven care. “With each of these factors, plans can, at least at a high level, make some educated guesses about the relative risk of each factor and impact to the bottom line.”

The election results, however, are much less certain, which from a risk perspective, weighs heavily on the minds of healthcare executives, Brill says. “How can you plan for business knowing that whatever you are doing currently could be upended in the beginning of November?”

To help provide some clarity, Managed Healthcare Executive identified five of the top industry issues, reviewed the candidates’ platforms for each, and asked industry experts to weigh in.

Narrow networks: savings at what cost?

Narrow networks: savings at what cost?

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You probably chafe a bit every time you learn that a certain doctor or hospital isn’t part of your insurance network. Narrowing the scope of your network helps insurers save money. They can drive hard bargains with doctors and hospitals to get lower prices and walk away from higher-priced ones.

Increasingly, insurers are offering narrow network plans. Would you enroll in one? So long as quality doesn’t suffer, consumers should welcome the lower premiums they may offer.

Researchers at the Leonard Davis Institute at Penn analyzed the relationship between network size and premiums for plans offered in the Affordable Care Act marketplaces. Plans with very narrow networks (covering care by less than 10 percent of physicians) charged 6.7 percent lower premiums than plans with much broader networks (covering care by up to 60 percent of physicians). This translates into an annual savings for an individual of between $212 and $339, depending on age and family size. For a young family of four, the savings could reach nearly $700 per year.

“Marketplace consumers are looking for value,” said Daniel Polsky, the University of Pennsylvania health economist who led the study. “That level of savings could be a very good deal for consumers, but whether these plans provide value depends on how they are achieving those savings.”

One way plans might save money could make it harder for patients to get care — so that they get less of it. Narrow network plans may do this if they don’t cover enough nearby providers, with the ones they do cover too busy to take new patients in a timely fashion. Clearly this would be especially problematic if appointments with one’s preferred primary care doctor are hard to obtain.

Are today’s narrow network plans actually doing this? Until recently, we had no data to answer this question. But two studies published earlier this year — one focused onMassachusetts, the other on California — provide some insight.

10 things to know about CMS’ new mandatory cardiac bundle

http://www.beckershospitalreview.com/finance/10-things-to-know-about-cms-new-mandatory-cardiac-bundle.html

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CMS proposed Monday a new mandatory bundled payment program for heart attacks and bypass surgeries that includes changes to the existing Comprehensive Care for Joint Replacement Model as part of its larger goal to shift Medicare from quantity to quality incentives.

Here are 10 things to know about the proposed rule.

Measuring What Really Matters

http://altarum.org/health-policy-blog/measuring-what-really-matters

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Not everything that is important for a person’s health can be measured and not everything that can be measured in health care is important to the average person.

For too long, value has been defined only for the benefit of regulators and purchasers. Our health care system is purpose-built to cater to their performance needs, oversight, and expectations, and as such has fostered the proliferation of all sorts of clinical quality measures by multiple organizations. The current state of quality measurement serves these audiences reasonably well.

However, the problem with evaluating quality using these tools is twofold. First as a physician, I still see too much variation in the technical quality of American health care. Second, clinical measures alone ignore how value is perceived through the eyes of those who actually use the delivery system. When we look at the highest users of health care – those with serious medical problems and functional limitations – we now have an abundance of technical measures for each condition on their problem list, and yet really no understanding of whether we are contributing to a person’s quality of life. Frankly, I care little about the fact that my 100-year-old grandmother has never had a screening colonoscopy, but I care mightily that no one seems responsible for her successful discharge and transition home after a bout of urosepsis.

We cannot improve what we do not measure…and it is time to start measuring health care from the vantage point of those needing care, not just for those who provide and pay for it. And if we are to achieve the dramatic improvements anticipated through new payment and service delivery models, the mushrooming of purely clinical measures must be thinned out to make room for a new generation of metrics that consider outcomes from the person’s perspective.

 

Hennepin Health: A Care Delivery Paradigm for New Medicaid Beneficiaries

http://www.commonwealthfund.org/publications/case-studies/2016/oct/hennepin-health

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This case study is one in an ongoing series examining programs that aim to improve outcomes and reduce costs of care for patients with complex needs, who account for a large share of U.S. health care spending.