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Industry News

Blue Shield of California protests revocation of tax-exempt status  

Last year, California tax officials quietly revoked the tax-exempt status of Blue Shield of California and ordered it to file tax returns back to 2013. Blue Shield said last week it's protesting the decision. "It's important to have this debate over Blue Shield's public-service mission and how they are fulfilling it," Anthony Wright, executive director of Health Access tells the Los Angeles Times. "What would a white-hat insurer look like?" (Los Angeles Times)


Enrollment in private exchanges isn't living up to predictions. Last June, Accenture predicted 9 million people would be enrolled by 2015, rising to 40 million by 2018. Participation will continue to increase, Inside Health Insurance Exchanges reports, but the Employee Benefit Research Institute estimates just under 3 million active employees participate in exchanges offered by Mercer, Towers Watson, Aon Hewitt and Buck Consultants. Another 3 million are enrolled through other private exchanges. One possible explanation for the slow take-up rate: the improving job market. And generally, employers are slow to embrace new trends in employee benefits. (Inside Health Insurance Exchanges)



Pennsylvania Gov. Tom Wolf has set in motion a switch to traditional Medicaid expansion from former Governor Tom Corbett's alternative "Healthy Pennsylvania" program. The expansion, to be implemented in phases, is set to be in place by the end of September, says Ted Dallas, acting secretary of the Pennsylvania Department of Human Services, who says no coverage will be interrupted in the process. (The Philadelphia Inquirer; Kaiser Health News)


Innovation & Transformation

Study: Patients in PCMHs less likely to visit ED 

Medicare patients being treated in patient-centered medical homes had fewer emergency department visits than those not cared for in a PCMH, according to research published in the Annals of Emergency Medicine. The findings suggest "steps taken by practices to attain patient-centered medical home recognition such as improving care access may decrease some of the demand for outpatient ED care," the researchers conclude. However, although PCMH patients were associated with fewer ED visits and lower costs than their counterparts, there was no effect on whether the patient was actually hospitalized, MedPage Today reports. (MedPage Today; Annals of Emergency Medicine)



Beyond exchanges: ACA fosters innovation, PwC report says 

The Affordable Care Act has helped usher in an entire new health economy, leading to the creation of at least 90 new companies since 2010, according to a new PwC report. The report identifies five ways the ACA has "starkly altered" the industry landscape: a shift in risk; emphasis on primary care; new entrants; a rapid change in insurance from wholesale to retail; and the role of states that have or have not embraced the law. The law's emphasis on prevention and reduced hospital admissions has spurred the industry to spread and shift risk, according to the report. (Medcity NewsPwC report)



Study: Viewing records during hospital stay may minimize patient anxiety 

Access to electronic records during a hospital stay may ease patient anxiety and confusion, according to a small study published in JAMA. Patients frequently have access to electronic medical records after care is completed, not during. The study sampled individuals from different socioeconomic backgrounds, and while viewing their records did not help them better understand their condition or catch medical errors as researchers had hoped, it did decrease worry and confusion without a significant increase in the effort required of the doctors and nurses involved. (Reuters; JAMA)
Consumers & Providers

Don't get your hopes up: Permanent SGR fix faces hurdles and a deadline

Modern Healthcare recently offered a good news/bad news take on SGR. The good news: Congress is closer than ever to repealing and replacing the Medicare physician-payment system. The bad news: It must act by March 31, and "there are at least six potential landmines" that could blow up the deal. They include the Congressional Budget Office, higher beneficiary cost-sharing and, of course, any "poison pill" amendments. (Modern Healthcare)



Penalties loom; CMS requires up-to-date physician directories 

New CMS rules require Medicare Advantage plans and those offered through HealthCare.gov to update doctor directories with "real time" details about which doctors are included in the plans and accepting new patients. Inaccuracies may trigger penalties up to $25,000 a day per beneficiary or bans on new enrollment. (Kaiser Health News) 

Survey: About 9 percent of docs still don't use--or plan to use--EHRs

Of 3,437 physicians polled--most in primary care--about 9 percent said they had no plans to begin using EHRs, according to a survey published in the Annals of Internal Medicine. Those who don't use EHRs tend to be older and work in solo or two-physician independent practices. Most non-adopters also used fee-for-service as their primary compensation and were less likely to participate in incentives focused on continuity and quality of care, or chronic and complex patient management. (Medical Economics) 


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New & Noted   

Mission-driven: In a new interview with Health2 Resources, Paul Grundy, MD, MPH, founding president of the Patient-Centered Primary Care Collaborative and IBM's director of Global Healthcare Transformation, discusses his work in the early days of the medical home and the barriers to real transformation. (H2R)



MU3: CMS has issued its proposed rule for EHR Meaningful Use Stage 3; the 301-page proposed rule includes requirements for hospitals and providers. It also issues a 431-page proposed rule on new 2015 Edition EHR certification requirements. Public comment is due by May 29. (HealthLeaders Media)


Waiting for SCOTUS: In a Health Affairs blog post, three experts look at King v. Burwell and its the potential impact of its outcome on children. They discuss two reports--one on Medicaid eligibility, the other on the future of the Children's Health Insurance Program. (Health Affairs Blog)



Health Leads, which trains doctors to ask patients about their social needs and then connects patients with organizations that can meet those needs, operates in seven cities. Founder Rebecca Onie came up with the idea while volunteering at a hospital. She often asked doctors, "If you had unlimited resources, what's the one thing you would give your patients?" The most frequent answers: food, transportation, or a better place to live, because those were the real problems--and the underlying cause of many patients' health problems. (NPR)

MarketVoices...quotes worth reading


"It goes back to my fundamental core beliefs. I abhor violence, and the health care delivery system is a form of violence. We witness needless suffering and death due to a lack of access to appropriate, coordinated care. I have no choice: When you have this voice inside of you telling you to act, you act." -- Paul Grundy, MD, MPH, founding president of the Patient-Centered Primary Care Collaborative and IBM's director of Global Healthcare Transformation, on what drives his work on behalf of the medical home, in an interview with Health2 Resources.      


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Wednesday, March 25, 2015































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