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Health Care Current: July 29, 2014
Weekly insights to keep you informed and ahead

#CHSCurrent

This weekly series explores breaking news and developments in the U.S. health care industry, examines key issues facing life sciences and health care companies and provides updates and insights on policy, regulatory and legislative changes.

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My Take: Remember those New Year’s resolutions? It’s time for a checkup

Implementation & Adoption

On the Hill & In the Courts

Around the Country

Breaking Boundaries

My Take: Remember those New Year’s resolutions? It’s time for a checkup 

By Bill Copeland, Vice Chairman, U.S. Life Sciences & Health Care Leader, Deloitte LLP

Earlier this year, we discussed New Year’s resolutions for each of the health care industry sectors—health plans, health care providers and life sciences. During that same month I set my own, and they were generally similar to the resolutions I set every year—eat better, drive slower and read at least two books my 13-year-old likes so that we can talk about them together.

But, just as many of us do around this time of the year, I’ve been reflecting on which of my resolutions I have been able to keep versus those that might need some additional focus. How did I do? As of my mid-year checkup, I’ve eaten a lot of broccoli and squash, but I’m still speeding and I’ve yet to read The Fault in Our Stars or The Giver in their entirety.

New Year’s resolutions are hard to keep. Especially when you consider that only about 8 percent of people ever fully stick to them.1 As we look across the health care system, it’s apparent that each of the sectors has made some progress on their respective resolutions for the year—but there is still work to be done:

Have health plans made new connections?

2014 was a pivotal year for health plans, as the health insurance marketplaces ramped up and plans worked with the U.S. Department of Health and Human Services (HHS) to enroll millions of Americans. As a result, we could have lower uninsured rates in the country. However, health plans know little more than they did in January—though the numbers from open enrollment are largely final, and they know the younger, healthier enrollees waited until the last month, the risk profiles of the enrollees are still somewhat unclear, and premium rates for 2015 have yet to be settled in many states. Health plans are still trying to recover from the higher call volumes to customer service, billing and collection issues and knowledge gaps in their new subscribers’ understanding of what they purchased.

New arrangements and collaborations abound between health plans and providers – for example one health plan’s patient-centered medical home initiative was able to lower costs to $130 million less than projected while increasing quality of care. Joint effort has been key: health plans have relied on the collaborative spirit of health care providers to produce the positive results from these programs. Since January 70 accountable care organizations (ACO) have been announced.2 While the first step can be the most important, there is still a need to invest in new capabilities required to make the transition. And of course the need for a financial imperative that rewards the innovators.

Increased out-of-pocket spending is catching up with consumers, and only one in five of the insured population feels well prepared for their future health care costs.3 While our survey of young adults and health insurance revealed that this age group understands that insurance helps them avoid unwanted costs and gives them peace of mind, plans could do a better job of communicating value and helping them navigate the insurance world. This could become even more critical if last week’s court cases head to the U.S. Supreme Court and the argument against the subsidies is upheld (see story below).

Have health care providers tried anything new?

With new patients coming in their doors almost every day, value-based care arrangements have begun to take the center stage. The first national survey of private and public ACOs found that more than 50 percent of the ACO respondents identified themselves as physician-led organizations. These ACOs were found to be more capable of managing care in the outpatient setting.4 Furthermore, while adoption has been somewhat slow, the number of providers and hospitals that have attested to Stage 2 of Meaningful Use continues to grow.

However, some providers still have work to do in the area of quality: This fall the Centers for Medicare and Medicaid Services (CMS) will finalize the list of hospitals that will receive payment reductions due to their poor performance. As of April 760 hospitals were on the list, and the hospitals in the lowest 25 percentiles could see a 1 percent reduction in their Medicare payments next year. Also, providers have faced increased scrutiny around cost after the release of several datasets over the last six months. These datasets have shed new light on spending patterns. The second half of 2014 will likely see continued pressure for trying out new business models that allow provider groups to take on more risk while managing costs.

Have life sciences companies learned any new languages?

In May the Chairman of the House Energy and Commerce Committee Fred Upton and Representative Diana DeGette announced their campaign, A Path to 21st Century Cures.”5 Since then, stakeholders from across the life sciences community have stepped in to offer insights around clinical trials, incorporating the patient perspective, and digital health care. In a response letter to the committee, the Pharmaceutical Research and Manufacturers of America (PhRMA) echoed the sector’s focus on enhancing clinical outcomes and patient-reported outcomes for new models based on value.6 In addition, recent action in mergers and acquisitions in the pharmaceutical sector could allow companies to refine the focus of their business as they scale up within particular areas of specialization and exit others. Through such deals, companies could have the opportunity to be more involved in population health and disease management initiatives. As providers begin to be held to stricter quality measures (especially as a condition of payment), these capabilities could become critical areas of collaboration for life sciences companies.

Generally, the rate of health care spending growth has been decreasing—Medicare spending alone is expected to be $1,000 lower per person than was projected in 2010.7 But, efforts can’t stop there. As with all health care, patient care should be at the center of business strategies. Patients are ready to partner: seven in 10 consumers express willingness to take a health status test, and six in 10 would take a test to determine best personalized treatment.8 As the industry strengthens its emphasis on value, the clinical, safety and economic impact of products will likely continue to be in focus.

Winston Churchill once reportedly said, “To improve is to change; to be perfect is to change often.” I’m sure few of us believe that absolute perfection is possible. But, improving starts with setting realistic goals (i.e., resolutions) and revisiting them early and often. Now, please excuse me while I read the last few chapters about Hazel and Augustus in the sad story about two teenagers who are all too familiar with our health care system.

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Sources:
1Auld Lang Syne: Success predictors, change processes and self-reported outcomes of New Year's resolvers and nonresolvers, by John C. Norcross, Marci S. Mrykalo, Matthew D. Blagys , University of Scranton. Journal of Clinical Psychology, Volume 58, Issue 4 (2002).
2Becker’s Hospital Review, “70 Accountable Care Agreements Announced So Far This Year,” July 9, 2014
3Deloitte Center for Health Solutions, “The quest for value in health care: A place for consumers,” 2014
4Colla, Carrie H., Lewis, Valerie A., Shortell, Stephen M., and Fisher, Elliott S. Health Affairs, “First National Survey of ACOs Finds that Physicians are Playing Strong Leadership and Ownership Roles,” June, 2014
5House Energy & Commerce Committee, A path to 21st Century Cures   
6PhRMA, “Enhancing the Ability of Biopharmaceutical Companies to Discover, Develop, and Deliver 21st Century Cures,” June 1, 2014 Letter to the House Energy and Commerce Committee
7Kaiser Family Foundation, “The Mystery of the Missing $1,000 Per Person: Can Medicare’s Spending Slowdown Continue?” July 8, 2014
8Deloitte Center for Health Solutions, “Survey of U.S. Health Care Consumers,” 2014

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Poll results from the July 22, 2014 Health Care Current:


Note: answers have been rounded to the nearest whole number

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Implementation & Adoption 

10.3 million gain health coverage through ACA 

A recent report published in the New England Journal of Medicine analyzed changes in health insurance coverage due to the Affordable Care Act (ACA) and found an overall decline in the uninsured population. The analysis found that the individual mandate and streamlined application process caused even the 24 states that did not expand Medicaid to experience increases in Medicaid enrollees among those eligible under earlier Medicaid rules. The tax subsidies also have helped to increase insured rates among individuals who are not eligible for Medicaid. Other major findings include:

  • The uninsured rate among adults (age 18-64) fell from 21 percent to 16.3 percent from September 2013 through April 2014.
  • The 5.2 percent decrease in the uninsured rate corresponds to 10.3 million newly insured adults (based on 2014 Census estimates).
  • Taking into account that the analysis is based on a sample, the researchers indicate that the estimates could range from 7.3 million to 17.2 million newly insured adults.

The analysis used data from Gallup’s Well-Being Index, which included statistics from January 1, 2012, to June 30, 2014. Coverage gains were higher among individuals eligible for Medicaid under the expansion and among low-income adults due to the availability of tax subsidies for coverage through marketplaces for qualifying individuals. Young adults and Hispanics had the largest gains in insurance. And newly insured adults reported that finding care and paying for it was easier within the first six months of being insured. The Well-Being Index data do not include information on children’s insurance coverage.

(Source: Sommer, Benjamin D, et al. “Health Reform and Changes in Health Insurance Coverage in 2014,” New England Journal of Medicine, July 23, 2014.)

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Poll: Americans choose doctors based on the doctor-patient relationship 

Last week the Associated Press-NORC Center for Public Affairs Research released an analysis from poll data that indicates that Americans say they do not have information readily available on the quality of health care providers. The survey also found that Americans do not trust the information available about quality of care, possibly related to another finding that the definition of quality care varies between the consumer and the health care provider. Specifically, the respondents believe:

  • Good doctors can be chosen using metrics that characterize the doctor-patient relationship (59 percent) over the effectiveness of care received by the patient (29 percent) or their own health outcomes.
  • Poor doctors, conversely, can be identified by their lack of attentiveness, time spent with patients and accessibility.

In choosing a doctor, only 9 percent use a measure related to health outcomes—those who fail to diagnose problems correctly. Doctor-patient relationships – including first impressions – play a major role, with 81 percent of people believing that their first meeting with a doctor plays a very important part in their decision of which doctor to go to. Less than half of the respondents (46 percent) say that cost is factored into their choice of a doctor. About half of the respondents believe that better care comes at a higher cost, and only 37 percent believe there is no relationship between cost and quality. Many health care experts advocate that more education around quality health care would help the public understand that higher cost of care does not necessarily mean higher quality. More findings include:

Opinions on whether specific public reporting requirements would improve quality of care
  Yes, a lot
Yes, a little
No
Don't know/refused
How much they charge for services 31 percent 27 percent 38 percent 4 percent
The effectiveness of the treatments or procedures they provide 47 percent 30 percent 20 percent 2 percent
The health outcomes of patients 41 percent 30 percent 25 percent 4 percent
How satisfied their patients are with the care they receive 45 percent 32 percent 21 percent 2 percent

(Source: “Finding Quality Doctors: How Americans Evaluate Provider Quality in the United States,” The Associated Press-NORC Center for Public Affairs, July 2014.)

Related: Deloitte Center for Health Solutions consumer research has found that as consumers increasingly bear more costs and face more opportunities to choose their health care coverage and care, they could increasingly seek to evaluate options and consider value trade-offs. The health care industry will need to respond to increasing demands for consumer choice. One of the biggest challenges may be educating consumers to move beyond the prevailing viewpoint that “higher prices … [are] a proxy for quality” and to think about shopping for care that is both lower cost and higher quality. Younger people (Millennials born 1982-1995) and Gen X (born 1965-1981) are more likely than older generations to ask about pricing before agreeing to receive treatment, view quality scorecards, and look online for price information.

Looking for value: asking about pricing, searching for quality

Which of the following, if any, have you done in the last 12 months?

Source: Deloitte Center for Health Solutions, “Quest for value in health care: A place for consumers,” 2014

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Medtech expected to be cost effective in care of four health conditions 

Last week Milken Institute released an estimate on the potential economic benefits of medical technology in four diseases: diabetes, heart disease, musculoskeletal disease and colorectal cancer. The study looked at how medical technology impacted health costs, prevented premature death and helped patients to be a more productive part of the workforce. The net overall gain from the use of these technologies was $23.6 billion, despite costs of $51.6 billion for treatment and $31 billion to screen individuals who were found to be free of the screened disease. The report also projected the net savings from medical technology for these diseases in 2035 to be $1.36 trillion. Specifically, the analysis estimates:

  • Insulin pump: The net benefit per user was estimated to be $5,886. While the technology has greater up-front costs, pump users do not visit the emergency department as frequently and tend to have fewer complications than individuals who use self-injection methods.
  • Heart disease diagnostics and surgery: Treatment costs were much higher ($4,534) for those who use technology over non-users. However, higher survival rates (with associated productivity gains) result in a net benefit of $1,930 per person.
  • MRI and joint replacement surgery: Like heart disease, the technologically intense treatment was more expensive for users than non-users, but the net benefit of this therapy was $24,518 in economic impact.
  • Colonoscopy/sigmoidoscopy: Treatment of colorectal cancer using technology was cheaper ($8,841) due to early detection and prevention, resulting in a net benefit of $150,365 per person. Individuals who received this treatment are more often able to have their polyps removed before they develop into colorectal cancer.

(Source: Chatterjee, A., King, J., Sindhu, K., and DeVol, R. “Healthy Savings: Medical Technology and the Economic Burden of Disease,” Milken Institute, July 2014.)

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Survey: some physician specialty compensations rose while others dropped 

Results from Modern Healthcare’s annual physician survey found that compensation rose for 12 physician specialties, while it declined for 11 other specialties in 2013. Results for specific specialties include:

  • Of the 12 specialties with increases in compensation, only five had an increase greater than the consumer price index (CPI) for 2013: oncologists, neonatologists, intensivists, plastic surgeons, and OB/GYNs. In 2012 compensation growth exceeded CPI (1.7 percent) in 15 specialties.
  • On average, oncologists saw the highest increase in compensation, a 5.6 percent increase.
  • Of the 11 specialties with a decline in pay, six saw compensation drop by 1.5 percent or less.
  • Radiation oncologists saw the largest drop, a decrease from $479,917 to $441,602 (8 percent), but they were still the fourth highest paid specialty.
  • Family physicians and pediatricians had the lowest compensation rate for the sixth consecutive year. Family doctors were the only primary care specialty that saw a slight increase—less than 0.4 percent—while pediatricians had an average decline of approximately 1 percent.

The reasons for compensation trends for physician pay vary. For example, radiation oncology saw new treatment technology called stereotactic body radiation therapy emerge—this type of therapy only requires five sessions, versus the previous treatment that required a more intensive treatment cycle of around 40 sessions. One expert attributed the lack of change in the compensation for orthopedic surgeons’ to Medicare’s reduction of 5 percent and 12 percent for total hip replacements and total knee replacements, respectively.

(Source: Andis Robeznieks, Modern Healthcare, “Specialists see little change in compensation, survey finds,” July 19, 2014)

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Report reviews state laws used to enhance market competition in health care 

This month the National Academy of Social Insurance and Catalyst for Payment Reform released an analysis of policies related to market competition among providers in the states. The report grouped the policies into several categories:

Law Approach States that have such a law
Antitrust-related laws and certificates of public advantage (CPA)
These laws deal with anticompetitive provider consolidation and federal and state remedies. Some states (five) carve out exemptions (CPAs) for providers that merge or consolidate to improve health care delivery.
All states
Transparency around quality and price
States release data on hospital prices or charges and sometimes on quality. 42 states
Laws encouraging competitive behavior in health plan contracting
“Most favored nation” clauses: These laws limit provider influence on charge rates, banning providers from charging an insurer more than the lowest rate that they have agreed to pay another insurer.

18 states

 


“Any willing provider” clauses: These regulations require health plans to accept any qualified provider who is willing to agree to a plan’s terms and conditions. 9 states
Regulating prices
Many states are forming commissions and/or state regulatory bodies that monitor and review health care prices.
6 states
Development of ACOs
Legislation that allows for reviews of changes in market competition from the formation of ACOs. Only one state has enacted this type of legislation. Texas
Departments of Insurance Most states have a formal rate review program, but only one state has expanded the authority of its insurance department to annually limit price increases for inpatient and outpatient services.
Rhode Island
Certificate of need
Laws that limit lower cost providers from entering the market. 31 states

The report identified six states (California, Massachusetts, New Hampshire, New York, Pennsylvania, and Rhode Island) as active in trying to increase competition among providers. These states are using four approaches to do this: challenging potential mergers under antitrust laws, creating resources to maintain a competitive health care market (e.g., antitrust bureau in the state attorney’s office), allowing conditional settlements for mergers and bringing greater transparency to provider prices.

(Source: Delbanco, Suzanne and Bazzaz, Shaudi. “State Policies on Provider Market Power,” National Academy of Social Insurance, July 2014.)

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On the Hill & In the Courts 

Courts split on ACA federal tax subsidies under HIX 

Last Tuesday the Court of Appeals for the D.C. Circuit issued a 2-1 opinion on Halbig v. Burwell, ruling that federal subsidies issued through the federally-facilitated health (FFM) insurance marketplace are unlawful. However, a few hours after the ruling, the Court of Appeals for the Fourth Circuit in Richmond rejected similar claims made in King v. Burwell. Both cases center on individuals who live in states that did not establish a state-based marketplace (SBM). The plaintiffs in both cases do not wish to purchase insurance, but due to the availability of subsidies for their insurance, they do not qualify for exemptions from the insurance mandate. The opinions for each of the rulings were as follows:

  • Court of Appeals for the D.C. Circuit: The majority opinion in this case ruled that the U.S. Internal Revenue Service (IRS) cannot provide tax subsidies to individuals who purchase qualified health plans through the FFM. The case centered on Congress’s intent for subsidies to be offered through the FFM. The Court found that the section of the ACA in question “plainly distinguishes exchanges established by states from those established by the federal government.” Circuit Judge Griffith opined that “by making tax credits available in the 36 states with the federal marketplace, the IRS Rule significantly increases the number of people who must purchase health insurance or face a penalty.” He went on to say that the IRS rule also requires large employers to provide their employees with health insurance coverage.
  • Court of Appeals for the Fourth Circuit: Circuit Judge Gregory wrote the majority opinion, ruling that the text is “ambiguous and subject to multiple interpretations.” The Court deferred to the IRS’s determination and upheld the rule, stating that, “confronted with the Act’s ambiguity, the IRS crafted a rule ensuring the credits’ broad availability and furthering the goals of the law.”

While the courts’ rulings could be significant in the future, for now, the law remains the same and subsidies are still available to individuals who have been receiving them. Two additional, similar cases are pending review. The Supreme Court could decide to take up the case. During the first open enrollment season, 85 percent of the 8 million marketplace enrollees qualified for federal subsidies, which reduced the amount those enrollees need to pay for coverage. A recent analysis from the Robert Wood Johnson Foundation found that a ruling in favor of the challenge against subsidies could result in $36.1 billion loss in tax subsidies in 2016. Shortly after the first ruling was announced, a Department of Justice spokesperson announced that the Administration will seek review from the full Court of Appeals for the D.C. Circuit.

Analysis: Unlike the 2012 U.S. Supreme Court decision on the ACA, the legal issue of these cases does not center on whether the law is constitutional. Instead, the issue is whether the law was implemented correctly through regulation. It is a question of Congressional intent and reading of the statutory language for meaning. If subsidies were not available through the FFM, the implementation of the ACA could be seriously damaged. Affordability of coverage could be significantly reduced for many individuals in the 36 states covered by the FFM. In addition, a ruling against the availability of subsidies for the FFM could mean that a far greater number of individuals would likely be exempt from the individual mandate, possibly leading to much lower participation and a destabilized risk pool. For more analysis, view the blog post, Understanding the court action around the ACA.

Related: On Thursday the IRS released drafts of the form that employers will have to use to comply with the employer mandate. Many health care experts view this as a sign that the Administration will not delay the employer mandate again, even though some lawmakers and opponents of the mandate have been asking for a delay. The employer mandate for groups with more than 50 employees was delayed last July until January 1, 2015 (see the July 3, 2013 Health Care Reform Memo). In February of this year, the IRS gave mid-size employers (50-99 employees) an additional year to comply (see the February 18, 2014 Health Care Current).

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ONC issues response to Congress regarding its role in health IT 

In a response letter to a June 3, 2014, request from the House Energy and Commerce (E&C) Committee, the Office of the National Coordinator for Health Information Technology (ONC) recently provided clarification on the agency’s statutory authority to create a Health IT Safety Center to regulate software and other health IT projects and to issue a new user fee to vendors and developers (see the June 10, 2014 Health Care Current). ONC’s answers to specific questions in the letter include:

E&C question, June 3, 2014 ONC response, July 8, 2014
Under what statutory authority does ONC believe it can regulate health IT and electronic health records (EHR) meaningful use after authorization for the Medicare and Medicaid incentive programs expire?

The authority for Medicare and Medicaid EHR Incentives Program are separate from the role of the ONC.

  • CMS is in charge of administering the programs and will offer incentives for Medicare through 2016 and for Medicaid through 2021.
  • ONC was created by the HITECH Act “to perform a broad range of duties ‘in a manner consistent with the development of a nationwide health information technology infrastructure.’” The Public Health Service Act (PHSA) gives ONC further authorization in this area.
What authority does the ONC have moving forward to participate in regulatory activities with the Federal Communications Commission (FCC) and the U.S. Food and Drug Administration (FDA)?
A joint report by the ONC, FDA, and FCC did not propose that the Health IT Safety Center would have the authority to regulate health IT, and it said that the FDA did not need to issue new areas of oversight. Instead, it recommended the center to serve as a collaborative workgroup where private and public stakeholders would be represented and help “establish a governance structure for the creation of a sustainable, integrated health IT learning system.” These efforts would rely on ONC-coordinated activities and would help foster transparency and health IT innovation.
What scope does the ONC plan to play in future health IT and safety EHR certification strategies moving forward? A PHSA statute calls for the National Coordinator to perform duties consistent with the ongoing development of health IT infrastructure to protect and promote patient safety. The statute gives the National Coordinator the authority “to establish programs for the voluntary certification of health IT.” Moving forward, the ONC said it plans to continue coordinating and promoting health IT certification criteria as it relates to interoperability, privacy, security, and quality reporting with key governmental agency partners (FDA, FCC, and AHRQ) and private stakeholders. More specifically, the ONC plans to focus on creating and implementing a roadmap for interoperability, supporting care innovation and establishing frameworks for the appropriate use of health data.

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HRSA clarifies treatment of orphan drugs under the 340B program 

Last week the Health Resources and Services Administration (HRSA) issued notice of a new rule, “Implementation of the Exclusion of Orphan Drugs for Certain Covered Entities under the 340B Program.” The rule clarifies that orphan drugs used for treatments other than their originally designated purpose must offer discounts under the 340B program. This rule follows a U.S. District Court judge ruling that rural and cancer hospitals could no longer receive discounted prices for orphan drugs when using them for purposes other than those for which they were approved (see the June 3, 2014 Health Care Current). The 340B program requires drug manufacturers to provide discounted prices for outpatient drugs to eligible health care covered entities, including critical access hospitals, free-standing cancer hospitals, sole community hospitals and rural referral centers. The rule, which was effective as of yesterday, Monday, July 28, is interpretive, so it does not have a comment period.

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HHS Office of Inspector General to review ACA subsidy payment accuracy 

Earlier this month the HHS Office of the Inspector General (OIG) released a report that examined states’ abilities to verify the accuracy of information from applicants to the SBM and FFM. OIG reviewed IRS data on tax subsidies following recent inquiries on the accuracy of information submitted by applicants. The OIG report found that the FFM was unable to resolve 2.6 million of the 2.9 million inconsistencies from October through December because the eligibility system from CMS was not fully operational. OIG noted that inconsistencies do not always mean an applicant has provided inaccurate information, enrolled in a plan or inappropriately received financial assistance through federal subsidies. Ultimately, the review concluded that data on inconsistencies were limited (e.g., FFM could not establish how many applicants had at least one inconsistency) and most of the marketplaces face challenges in resolving the issue. The SBMs varied in their capacity to solve the inconsistencies, with four reporting they were unable to resolve any, and seven reporting they had no delay in solving their issues. The OIG will be further reviewing application information inconsistencies and the accuracy of subsidy payments and will report the results in spring 2015. The OIG recommended that CMS develop and make public a plan to both resolve inconsistencies in the FFM and oversee SBMs efforts in this area.

(Source: Department of Health and Human Services, Office of Inspector General, “Marketplaces faced early challenges resolving inconsistencies with applicant data,” July 2, 2014; Department of Health and Human Services, Office of Inspector General, “Not all internal controls implemented by the federal, California, and Connecticut Marketplaces were effective in ensuring that individuals were in qualified health plans according to federal requirements,” June, 2014)

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Around the Country 

Louisiana’s Medicaid prepaid plan model reduces cost; plans to consolidate delivery models 

A Louisiana Department of Health and Hospitals (DHH) analysis found that over the first three years of Bayou Health, the state’s Medicaid managed care program, the prepaid (capitation) plan model was more successful than the shared savings model and saved the state $13 per beneficiary per month. The shared savings program, which paid providers a management fee together with traditional fee-for-service (FFS) arrangements, was both more costly and less predictable. The state also announced its plans to move to a prepaid, premium-based plan model for 900,000 of the 1.4 million Medicaid enrollees in the state. Additional changes the state anticipates to make to the program include:

  • Enhance plan selection: Enrollees will have the option to choose a health plan or be auto-assigned at the time of their application. Historically, beneficiaries enrolled in FFS and then chose their health plan afterward.
  • Make pharmacy benefits consistent: Managed care organizations (MCOs) will develop a common pharmaceutical formulary within six months of their contract so that there is continuity statewide.
  • Expand enrollees: Bayou Health will allow populations previously excluded from managed care coverage (e.g., home/community based waiver population) to enroll on a voluntary basis.
  • Improve mental health care coordination: DHH plans to better coordinate between health plans and the Behavioral Health Partnership to simplify billing and payment for services and prescriptions.
  • Add new quality performance measures: MCOs will report on 20 new performance measures in addition to the 25 performance measures and 10 administrative measures they are currently measured against.  

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Survey: Massachusetts boasts high usage of EHR systems 

Last week the Massachusetts eHealth Institute (MeHI) released a study on provider health IT adoption and consumer use of health IT. Primary care physicians have the highest adoption rate at 96 percent, closely followed by 86 percent of specialists. Other sectors, such as behavioral health and long-term and post-acute care organizations have a lower adoption rate of 55 percent. Among Massachusetts consumers, approximately half have used health IT to communicate directly with their provider. Additional findings include:

  • Health information exchange (HIE): 26 percent of providers are participating in a health information exchange, and 68 percent say they plan on connecting if they are given more clarity and support.
  • Consumers: Consumers have generally positive attitudes toward health IT: Seventy-eight percent believe that using EHR improves care, and 85 percent feel secure with their health care information being stored electronically.
  • Physician-consumer relationships: The study found a disconnect between providers and consumers, as 24 percent of consumers report that their providers discussed health IT with them. Meanwhile, 61 percent of providers state that they discussed health IT with their patients.
  • Use of EHR technologies: The study found that EHR technology is used most commonly for medication reconciliation (81 percent), quality reporting (81 percent) or prescribing electronically (76 percent), with a smaller number of practices using EHRs to support clinical decisions (64 percent) or for public health reporting (55 percent).

Starting January 1, 2015, Chapter 224 of the Acts of 2012 in Massachusetts requires provider to show “demonstrated proficiency in health IT” as a condition of their license renewal. By January 1, 2017, all providers must implement interoperable systems that connect to Mass HIway, the statewide HIE. Three different populations were surveyed to determine their attitudes toward health IT: 507 practice managers, 308 health care providers and 807 individual adult consumers.   

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Breaking Boundaries 

Researchers a step closer to 3D-printing of tissues and organs for transplantations 

Researchers from the Universities of Sydney, Harvard, Stanford, and MIT are closer to being able to print full organs and tissues that may be used for transplants. This process, known as bio-printing, allows researchers to print “prototypes” of organs and tissues. Researchers used a high-tech bio-printer to create a multitude of tiny fibers that are interconnected and follow the structure of artificial blood vessels. The printed 3-D structure was then covered in protein-based material to solidify the organ/tissue. Once solidified, the bio-printed fibers were removed, leaving behind a network of tiny channels coated with endothelial cells to form stable blood capillaries within a week. If the researchers succeed in using bio-printing techniques to fabricate organs and tissues with enough precision, the new technology could join a growing 3D-printing market in the medical technology industry. A recent Deloitte report, 3D opportunity in medical technology, found that in 2012, 16.4 percent of the total 3D-printing market was accounted for by medical applications. This is partly due to its strong alignment to medical device needs and major industry investments. This new technology has major implications for the future of health care; 3D-printed artificial organs and tissue systems may be life saving for patients in need of fast transplants.

(Source: University of Sydney, “A step closer to bio-printing transplantable tissues and organs,” July 2, 2014; Snyder, Glenn H., Cotteleer, Mark J, and Kotek, Ben, Deloitte University Press “3D opportunity in medical technology,” April 28, 2014)

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Report: 3D market to reach $8.6 billion by 2020 

Allied Market Research predicts that the 3D printing market will reach $8.6 billion by 2020 due to an increased demand for a wider variety of complex objects made from different materials manufactured in a faster, more efficient way. To date, according to the report, the market for 3D printed objects has been constrained by the cost of personal printing and software and lack of partner assistance, but improving both the technology and manufacturing will help the market grow. There are many methods to creating 3D objects. In 2013, stereolithography generated the largest revenue, holding 33 percent of the market share. Some of the key materials used in 3D printing are polymers, metals and ceramics. 3D printing technology adoption is growing in many markets, but the two lead industries for adoption are aerospace and health care. With 44 percent of market revenue in 3D printing, North America leads the market largely due to its health care, consumer, aerospace and automobile industry, followed by Europe. 

(Source: Allied Market Research, “3D Printing Market (Technologies, Materials, Applications and Geography) - Global Opportunity Analysis and Forecast-2013-2020,” July 2014)

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