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Industry News

Three states get conditional approval to start their own exchanges

The Obama administration has given conditional approval to Arkansas, Delaware and Pennsylvania to run state-based insurance exchanges. Meanwhile, the Illinois Hospital Association says the state might be able to establish an exchange at a lower cost by leasing the federal government's technology. Both moves are in anticipation of the potential impact of a U.S. Supreme Court ruling against the administration in King v Burwell. (AP; AP-Illinois)



Medicare beneficiaries living longer, getting sicker

Two-thirds of traditional Medicare beneficiaries over 65 have multiple chronic conditions; roughly 15 percent have at least six, according to a USA Today analysis. Those sickest seniors account for more than 41 percent of the $324 billion spent on traditional Medicare. Boomers moving into the Medicare years are sicker than their predecessors, researchers say--and in many areas of the country, it's getting worse. Since 2008, the number of counties where three-quarters of senior Medicare beneficiaries have multiple chronic conditions has gone up 20 percent. The average elderly patient with five or more chronic conditions sees 13 doctors and fills 50 prescriptions yearly. (USA Today)

Health plans share insights on data warehousing, analytics
At last week's AHIP Institute, UCare and Independence Blue Cross shared insights about data warehouses. Payers that want members with chronic conditions to receive the best care while still controlling costs can't rely on historical data, says Somesh Nigam, chief informatics officer with Independence Blue Cross. "We are quickly realizing that significant decisions require predictive analytics." (FierceHealthPayer)


Innovation & Transformation 

Focus on prevention saves payer almost $8M in one year

Anthem Blue Cross of California saved almost $8 million in just one year by emphasizing preventive care and paying its doctors additional money to give enhanced attention to patients with chronic conditions, including diabetes, asthma and congestive heart failure, the
San Diego Union-Tribune reports. Anthem did not provide the total amount spent on the patients, making it impossible to determine just how much savings the $8 million drop represents. The company did say the program resulted in a 7.3 percent drop in hospital admissions per 1,000 patients from the six large medical groups that were involved. (San Diego Union-Tribune)



Cleveland clinic offers telemedicine option 

Cleveland Clinic, through a collaboration with American Well, is offering 24/7  telemedicine services. Patients can have virtual consultations with contracted professionals using smartphones or computers. Cleveland Clinic is in the process of training its own medical professionals to use the technology and expects them to be online within the next month or so. (Becker's Health IT & CEO Review)
Doctors are increasingly making their records available to patients. Five years ago researchers from Harvard Medical School joined forces with the Geisinger Health System and Seattle's Harborview Medical Center to launch Open Notes. The initiative focused on encouraging health care providers to give patients access to doctors' office notes, then tracked what happened when patients read them. Now, Open Notes estimates about 5 million people see those physicians. Advocates say Open Notes could fundamentally shift the doctor-patient relationship by making it less paternalistic, putting patients in a position to catch mistakes and have more informed conversations with their physicians. (Kaiser Health News)
Consumers & Providers

HIX consumers satisfied with coverage, survey finds 

Eighty-six percent of Americans receiving coverage under the Affordable Care Act from either government-run exchanges or expanded Medicaid coverage are "very" or "somewhat" satisfied with their health insurance, according to a Commonwealth Fund tracking survey released Friday. The survey indicates the law is filling a medical care void with nearly 70 percent using it to get care, while 62 percent said they wouldn't have been able to either "obtain" or "afford" that care if it weren't for the law. (Forbes; survey findings)


Most Michigan counties face primary care physician shortage 

Three-quarters of Michigan counties have a shortage of physicians in at least one primary care field, according to a recent report by Citizens Research Council. Data showed rural areas reported more shortages of primary care physicians than urban areas. The U.S. Department of Health and Human Services' Health Resources and Services Administration has calculated Michigan's supply of primary care physicians meets 63.3 percent of the population need. CRC took that a step further and compared the actual ratio of primary care physicians in each county to the ideal range. (MLive)


A recent Health Affairs Blog provides an update on the pipeline of nurse practitioners, physician assistants and pharmacists. "If these practitioners are fully integrated into the delivery system and allowed to practice consistent with their education and training, this growth can help assure access to cost-effective care across the nation," writes health workforce expert Edward Salsberg. Data suggest the numbers of NPs, PAs and pharmacists have been steadily growing since 2003, with growth rates of 180, 74.7 and 84.8 percent respectively. The number of new NPs and PAs in 2014 was 26,000, compared to an estimated 30,500 new physicians. (Health Affairs Blog)
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New & Noted   

Acquisitions update: Anthem has reportedly offered to buy competitor Cigna. Late last month, Humana began exploring the possibility of a sale, and both Aetna and Cigna were cited as potential buyers. Meanwhile,The Wall Street Journal reports that UnitedHealth Group has approached Aetna about a $40 billion takeover. (Modern Healthcare; WSJ)


Oregon saga continues: Multnomah Circuit Court Judge Henry Kantor has dismissed Oracle's suit against five advisers to former Gov. John Kitzhaber as "frivolous." Oracle contended the Kitzhaber campaign played a major role in the state's decision to shelve the $300 million Cover Oregon HIX project and use HealthCare.gov instead. (The Oregonian)


Massachusetts HIX: The cost of re-configuring the Massachusetts health insurance website to comply with the Affordable Act has grown by $47.2 million. Additional fixes bring the total price tag for the Connector site that failed two years ago and the new, flawed, replacement to $281 million. And more costs are expected. (WBUR)


Deborah Estrin, a professor of computer science at Cornell Tech; Evan Muse, a cardiologist and fellow at Scripps Translational Science Institute; Deborah Peel, a psychiatrist and founder of Patient Privacy Rights; and Whitney Zatzkin, a user of mobile health applications, spoke with
iHealthBeat about the growing use of mobile health apps. "One of the things these mobile apps are doing is empowering our patients. Making them more of the decision-making process, the data-gathering process, the disease management process. Much more than 'Oh yeah my doctor told me to take this pill,'" says Muse. (iHealthBeat)

MarketVoices...quotes worth reading


"In terms of the Baby Boomers, it's going to be a shock. The health care system is not oriented toward their needs." -- Dr. Gerard Anderson, a professor at Johns Hopkins University's Bloomberg School of Public Health, quoted in USA Today
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Wednesday, June 17, 2015































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