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Last week, UnitedHealthGroup significantly lowered its profit estimates, blaming it on the Obamacare exchanges. In fact, it indicated it may stop selling individual health insurance through federal and state markets in 2017. Some say this is a gambit to compel the Obama administration to ease regulations. Kaiser Health News offers a roundup of the coverage. In light of that announcement, Aetna and Anthem assured investors that their HIX businesses had performed in line with projections through October. (Kaiser Health News; Reuters)
 

CMS proposed mandating minimum network standards for HIX. It's part of an effort to address the growing issue of narrow provider networks. The Affordable Care Act already requires HIX plans to have enough in-network hospitals and doctors for members so "all services will be accessible without unreasonable delay." The proposed rule--which would take effect in 2017--asks states to establish a quantitative measure to ensure HIX enrollees have sufficient access, Modern Healthcare reports. For states that don't, CMS has proposed a default setting based on travel times or distances to providers. (Modern Healthcare; rule summary)
 

U.S. public health funding has been falling steadily and is expected to keep dropping, according to analysis in the American Journal of Public Health. Real, inflation-adjusted public health expenditures dropped from $281 per capita in 2008 to $255 per capita in 2014. By 2023, public health's share of total health expenditures is projected to fall to 2.40 percent (compared to 3.18 percent in 2002), the researchers estimate. "Obamacare was supposed to add $15 billion to public health funding," says co-author Dr. David Himmelstein, of City University of New York. But Congress cut that. "This year, public health will get less than half" of ACA's promised $2 billion. (Reuters; AJHP; Medical News Today)
Innovation & Transformation 
UnitedHealth Group's new Harken Health subsidiary is trying a modified clinic-based plan that offers unlimited primary care and behavioral visits at no coinsurance charge. Test sites include Chicago and Atlanta. One question is how Harken, with its competitive premiums and lack of coinsurance, will make money. "It's reasonably proven that if you overinvest in primary care, you have lower downstream cost in the system," says Harken's co-founder and CEO, Thomas Vanderheyden. Other insurers, including the parent company, "undoubtedly" will be watching, according to Modern Healthcare. (Modern Healthcare)
 
Technology is changing the location of the clinician/patient encounter. Heal and Pager are smartphone apps similar to Uber; they allow a patient to summon a doctor for a house call. Go2Nurse brings a nurse to homes in Chicago and Milwaukee. Curbside Care offers house calls in the Philadelphia area from nurse practitioners and physicians. "We're bringing back old-school techniques with new-school technology," Dr. Renee Dua, a founder and the chief medical officer of Heal, tells The New York Times. For those who don't want a traditional house call, other telemedicine apps create a virtual house call. (The New York Times Well Blog)
 
Consumers & Providers
Geisinger Health System's new smartphone app--Geisinger ProvenExperience, launched last week--allows patients to report their experience and then ask for money back if they're not happy. "We're going to do everything right," says President and CEO Dr. David Feinberg. "And you're the judge. If you don't think so, we're going to apologize, we're going to try to fix it for the next guy, and as a small token of appreciation we're going to give you some money back." (Wilkes Barre Times-Leader)
 
D.C. hospitals are spending millions every year on abandoned-patient care, the Washington Business Journal reports. "The community somehow feels you can just drop the patient here and the hospitals will be responsible for them," says Patricia Dillard, head of the Care Management Department at George Washington. In such cases, hospitals follow the protocol by searching for the next of kin; if the search is unsuccessful, the care management team notifies the court to assign an advocate. The entire process can take several weeks. To address this, DC-area hospitals formed the "Guardianship Task Force," which is exploring ways to address some of these issues. (Washington Business Journal)
 
 
Adult patients with mental illnesses often don't receive adequate diabetes screening despite  higher rates of chronic conditions. Research published in JAMA Internal Medicine finds only 30 percent of patients taking anti-psychotics have received specific screening. (JAMA Internal Medicine; Modern Healthcare) 
   
 
HealthLeaders Media explores the controversy over dress codes and the distinction between taste and patient safety. It describes the situation at Summa Health, an Ohio-based hospital system that implemented a code banning visible tattoos and body piercings, restricting hair colors and men's beards' length, and requiring female employees to wear hosiery. With younger nursing and physician staff, "body art, and untraditional fashion are just so commonplace. If there's a [clinician] shortage, there's a need to attract people. I'd say it's a good time to reconsider being choosy," says Scott DeBoer, RN, of Chicago. (HealthLeaders Media)
    
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New & Noted   
There's an app for that: CVS Health has five new digital offerings to help customers refill prescriptions and manage medications: an Apple Watch app, a prescription scanning feature, an insurance card scanning feature, a medication reminder called MedRemind and in-store messages. (MobiHealthNews)
 
   
AHA to ONC: How do you measure best? The American Hospital Association is asking the Office of the National Coordinator for Health IT to provide greater detail about the characteristics and metrics used to determine the "best available" interoperability standards. (Beckers Hospital Review)
 
 
Doc shopping: Eight-hospital St. Joseph Hoag Health has partnered with Orange County, Calif., grocery  chains in its "Shop With Your Doc" campaign. St. Joseph held six events this fall; physicians were on-site in the stores to educate shoppers and help them select nutritious foods. (HealthLeaders Media)
Multi-media 
The way health care is financed has changed over the last 50+ years, and the California HealthCare Foundation has developed an interactive graphic illustrating this. It shows who paid for the nation's health care and how much it cost from 1960-2013. (CHCF)
 
MarketVoices...quotes worth reading
     
"We became like a hotel, a boarding house. "-- GW Hospital CEO Barry Wolfman on patient abandonment, quoted in the Washington Business Journal 
     
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Wednesday, November 25, 2015