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Industry News
Nearly a quarter of those insured through a health insurance exchange dropped or lost their coverage, according to federal data released last week. It shows 9.9 million people were paying, as of June 30, for plans purchased through a state or federal HIX. Contrast that with the roughly 12.7 million consumers who signed up for a 2015 health plan. Possible reasons, according to the Washington Post: Some simply failed to pay. Others obtained coverage through an employer or qualified for Medicare or Medicaid. And 423,000 were removed because they failed to provide proof of citizenship or immigration status. (Washington Post)
The House GOP lawsuit charging that the administration illegally spent money on the Affordable Care Act is moving forward, Modern Healthcare reports. District Court Judge Rosemary Collyer found the House had made a compelling case that suing the White House was the only way to preserve its constitutional power to control federal spending and stop the administration from distributing $136 billion in insurance company subsidies Republicans say Congress never approved. She also ruled, however, that the House lacks standing to sue over an allegation that the administration had no right to delay the law's employer mandate. (The New York Times; Modern Healthcare)

The Obama administration says it needs more time than expected to evaluate a large-scale test that aims to better manage benefits for individuals dually eligible for Medicare and Medicaid. The 12 participating states appear willing to stay in the program despite the challenges, Modern Healthcare reports. All report high beneficiary opt-out rates. Most rely on private health plans to manage care, and those plans have dropped out in some states. In addition, some providers have reportedly told patients they won't continue seeing them if they enroll in a managed-care plan under a dual-eligible demo. (Modern Healthcare)

Innovation & Transformation 
An Ohio hospital is turning liberal arts college students into health workers. Wooster Community Hospital's Community Care Network trains and uses college students as community health workers. After the first year, patients enrolled in the program had a 26 percent reduction in ED use and 51 percent reduction in hospital readmissions. Each student is assigned two patients whom they visit once a week. Students review disease-specific discharge booklets with patients, help them set goals and ensure they have the proper resources to maintain or improve their health. The students also report any issues to the patients' primary care providers. (HealthLeaders Media)
The Medicare Advantage Value-Based Insurance Design Model will be tested in seven states starting in 2017. It gives health plans the flexibility to provide new supplemental benefits tailored to the enrollees' clinical needs, such as the elimination of copays for eye exams for beneficiaries with diabetes or extra tobacco cessation assistance for enrollees with COPD. The model starts Jan. 1, 2017 and will run for five years in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee. (Healthcare Finance News)
Negotiators for the United Automobile Workers are proposing an independently governed health care co-op that would cover union and salaried employees, and retirees at Ford, General Motors and Fiat Chrysler, according to Crain's Detroit Business. Many experts think it's a terrific idea: Such a health care cooperative could help the bottom line for both sides and help employers more fluidly manage the health care benefit package in anticipation of the Cadillac tax. Among the options on the table: UAW directly contracting with physicians, hospitals and other providers. (Crain's Detroit Business)
Consumers & Providers
ACOs cite difficulty accessing data outside the organization and data integration as their top two challenges, according to an eHealth Initiative survey. Behavioral health, long-term care and home health agencies were among the least likely to be integrated with an ACO. The difficulty bringing together independent physicians and other diverse provider organizations is "the dirty secret with ACOs," Premier's Bryan Bowles said during an eHI webinar. He also pointed to a lack of backing for ACOs, and a shortage of experienced professionals in data modeling and other disciplines to put trustworthy data together. (FierceHealthIT; webinar slides)

Personalized medicine vs. population health: Cross purposes?
Precision medicine (aka "personalized medicine") runs counter to population health, suggests a New England Journal of Medicine essay. Precision medicine has been long on potential but short on delivery; it could undercut more "mundane" population health efforts. "In public health it is called the 'paradox of prevention.' Very small reductions in risk at the individual level can produce huge consequences at a population level. The problem with precision medicine is that some very significant achievements at the individual level can be achieved without having much of an impact at a population level," co-author Ronald Bayer, PhD, tells HealthLeaders Media. (HealthLeaders Media; New England Journal of Medicine)

The percentage of eligible professionals and hospitals that completely changed EHR vendors quadrupled between Meaningful Use program years 2013 and 2014, according to the Office of the National Coordinator for Health IT. Michelle Holmes of ECG Management Consultants says she expects the rate to continue to rise, citing three reason providers might change vendors: dissatisfaction with current systems; implementation of an integrated/single database strategy; and situational changes, including mergers and acquisitions. (Health Data Management; iHealthBeat; ONC data)
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New & Noted   
Leaky records:A new study from Microsoft researchers warns many types of databases used for electronic medical records are vulnerable to leaking information despite the use of encryption. (Network World; study)
ONC names chief nursing officer: Rebecca Freeman, RN, is joining the Office of the National Coordinator for Health IT as chief nursing officer. She will spearhead the agency's nursing outreach and help shape its clinical informatics activities. (Government Health IT)
Recent breach could affect 10 million: Excellus BlueCross BlueShield in New York is the latest health insurer to suffer a major cyberattack, this one affecting up to 10 million individuals. The company learned of the attack in August 2015, but intruders had first accessed the network in December 2013. (Health Data Management)
Sixty-seven percent of health care professionals use some form of telemedicine or plan to in the next few years, according to a new infographic by Vidyo that looks at current telehealth trends, future projections and regulatory advances. (HIN)
MarketVoices...quotes worth reading
"There is much we might learn delving deeper into the biological and genetic foundations of disease. At the same time we must recognize that major achievements in our lifetime will not come from those investments, but will come from changing the conditions under which people live and the conditions under which they receive care. There we will see returns on investment within our lifetime. The investments we are making in precision medicine and genomics are for the future." -- Ronald Bayer, PhD, explaining why population health needs to take priority over personalized/precision medicine, in a HealthLeaders Media interview 

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Wednesday, September 16, 2015



Colorado RCCO video: Making a Medical Neighborhood Happen