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Industry News

States must pick 2017 benchmark plans by June 1

States need to select their Essential Health Benefits benchmark plan for 2017 by June 1, 2015, so advocates have a small window now to offer input. Once state selections are made--or default plans identified for states that don't choose a plan--the Center for Consumer Information and Insurance Oversight will publish state selections for public comment. But advocates shouldn't wait for that public comment period, according to a blog post from Georgetown University's Center on Health Insurance Reforms, which discusses options for those who want to be heard now. (CHIRblog)


Cyberattacks on the rise, costing billions...

A rise in cyberattacks against doctors and hospitals is costing the U.S. health care system $6 billion a year, according to a report released this month by the Ponemon Institute. Criminal attacks against health care providers have more than doubled in the past five years, with the average data breach costing a hospital $2.1 million. One reason: Organized criminals who once targeted retailers and financial firms increasingly go after medical records. Nearly 90 percent of health care providers were hit by breaches in the past two years, half of them criminal in nature, the report found. (Bloomberg Business) 

...In light of cyberattacks, health care security must adapt or die
Increasing frequency of cyberattacks and the high prices fetched by medical records on the black market means the health IT industry must adapt or be overtaken, warns Intermountain Healthcare's Chief Information Security Officer Karl West. The security priorities of the recent past are no longer sufficient for safeguarding sensitive data. (Healthcare IT News)


Innovation & Transformation

BCBS to launch private retiree HIX this summer

Blue Cross Blue Shield Association plans to launch its retiree private HIX this summer. BCBSA's Maureen Sullivan cites pent-up demand for such a solution from the 8 to 9 million US retirees. The Blues HIX is aimed at retirees familiar with BCBS who wanted to "stay Blue." It's part of a continued upswing in the retiree HIX market, explains Cary Grace, CEO of Aon Exchange Solutions. "We have seen more energy around and questions [about] offering those types of solutions," Grace says. "Yet, the focus so far has been on how do you make the transition from a medical standpoint." ( Employee Benefit News)



A recent Government Accountability Office (GAO) report recommends replacing paper Medicare cards with electronically readable "smart cards" which could reduce Medicare fraud. Electronic cards could convey beneficiaries' identities electronically while also sharing insurance information with providers and facilitating the electronic exchange of medical information. The report identified several challenges to the adoption of an electronic card system, notably that CMS would have to update its card management process and claims processing system. (iHealthBeat; report)



Beyond medicine: Alternative models find ways to support patients

The Boston Globe looks at how new models of care delivery are unfolding with the story of nurse practitioner Gail Metcalf  and her patient, 86-year-old Rose Fiorino, who lives with lung disease and CHF. Metcalf makes house calls as part of a program to control costs by managing many aspects of patient care. Metcalf's employer is Pioneer ACO Beth Israel Deaconess Care Organization. Insurers, doctors and hospitals are increasingly ditching the fee-for-service system for alternative contracts focusing on prevention. Sometimes preventive care involves steps that seem to have little to do with medicine, such as finding discounts for food or heating. (Boston Globe)


Consumers & Providers

HIX efforts: CMS to focus on physician outreach and engagement 

This summer, CMS plans to address one of the failings of the HIX program: physician engagement. "We haven't done enough to help people understand what the ACA means for them as providers," says Susie Butler, director of partner relations in the CMS communications office. Efforts include establishing more public-private partnerships, training assisters and improving provider awareness through videos or slideshows. (Inside Health Policy--subscription required)


Frakt: Cost sharing not effective for chronically ill patients  

The practice of cost sharing may be contributing to the overall slowing of health care spending; however, it may backfire for patients with chronic illnesses, according to health economist Austin Frakt. When applied indiscriminately, cost sharing may cause sicker patients to delay or avoid preventive care, as well as cut back on prescription drug spending. One possible fix would be specifically targeted cost-sharing reductions, also known as value-based insurance design. (The NY Times Upshot Blog)
Health plans offered through Covered California have narrower hospital networks than commercial insurance plans but they don't appear to have lower-quality providers or differences in geographic access, according to a study published in Health Affairs. "Although the hospital networks for Marketplace plans do appear to be, on average, narrower than those for the commercial plans, the Marketplace networks have comparable quality for two of the quality measures and actually have higher average quality for the third." (Health Affairs)
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New & Noted   

Insurers covering retail clinic visits:  Insurance covers more than four in five visits at clinics run by CVS Health and Walgreens. More than 80 percent of Walgreens clinic visits are covered by insurance; at CVS MinuteClinics, that number is 84 percent. (Forbes)



DeSalvo poised to leave ONC:  The White House has nominated Dr. Karen DeSalvo to be assistant secretary for health at HHS. If confirmed, she would leave her post as head of Office of the National Coordinator for Health Information Technology. DeSalvo was hired to lead the ONC in 2013. (Modern Healthcare)



A national nurse? Bipartisan legislation introduced last week would create a new "national nurse" position. The position would be charged with public education campaigns aimed at reducing obesity and heart disease, among other diseases. ( Kaiser Health News)



Going old school: How to deal with EHR downtime

In a slide show on dealing with unexpected EHR downtime, Health Data Management addresses the question, "What happens to those tech savvy fishes when they're tossed out of their electronic water and onto the stationery ground?" (Health Data Management)

MarketVoices...quotes worth reading


"The health-care industry is being hunted and hacked by the elite financial criminal syndicates that had been targeting large financial institutions until they realized health-care databases are more valuable." -- Tom Kellermann, chief cybersecurity officer at Trend Micro Inc. (Bloomberg Business)


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Roxanna Guilford-Blake
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Wednesday, May 13, 2015































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