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Industry News
A growing number of provider-led plans are available on the health insurance exchanges,
Kaiser Health News reports, citing data from McKinsey. When the marketplaces opened in 2014, there were 64 provider-led plans; next year there will be 72. Still, such plans are rare. In 2014, 13 percent of U.S. health care systems offered plans that covered 18 million members--about 8 percent of all people. Most are in Medicaid managed care or Medicare Advantage plans. Provider-led plans are competitively priced, but analysts say it remains to be seen how many will succeed long term. (Kaiser Health News; McKinsey)

The U.S. Supreme Court is hearing oral arguments today, Dec. 2, in a case that could determine whether Vermont can require a health insurance company to provide data about its customers' claims. The case could undermine state efforts to collect health insurance claims in a database. As SCOTUSblog notes,Gobeille v. Liberty Mutual Insurance Company 
will never get the coverage King v. Burwell did, "but at heart it considers much the same policy question: to what extent does federal law facilitate the centralized management of health care?" (SCOTUSblog; Rutland Herald)

A Forrester Research report predicts that cases of ransomware involving lifesaving medical devices such as connected pacemakers and infusion pumps could occur in 2016. Medical device makers have been on the lookout for potential vulnerabilities, and the FDA warned earlier this year that certain infusion pumps should not be connected to hospital networks.
MassDevice reports that, unlike holding data and devices held hostage, holding medical devices could lead to serious injury or death. (MassDevice)
Innovation & Transformation 
Providers are "cautiously optimistic" about Medicare's mandatory hip and knee replacement bundled-payment program. The final rule, released last month, includes several concessions to hospitals and surgeons. Perhaps most significant is that it delays implementation of the mandatory program from Jan. 1 until April 1. Other changes include reducing downside risk and providing protections from Anti-Kickback Statute and the Stark Law. (HealthLeaders Media; final rule)
The Community Pharmacy Foundation recent awarded Health2 Resources and Blue Thorn Consulting a research grant to explore community pharmacy and patient-centered comprehensive medication management. "Our goal is to highlight community pharmacist practices that have successfully integrated comprehensive medication management services into team-based collaborative care among ambulatory patients," explains Terry McInnis, MD, MPH, CPE, FACOEM, president of Blue Thorn Consulting, senior advisor to Health2 Resources and principal investigator. (Hawaii News Now)
The University of North Carolina Eshelman School of Pharmacy will use a $2.4 million American College of Clinical Pharmacy grant  to study the implementation of comprehensive medication management  in primary-care medical practices. The award will help fund a multi-state practice and research laboratory to study best practices. Among the questions it will seek to answer: Which patients and populations benefit the most? What is the effect on quality of care and the patient experience? (announcement)

The American College of Physicians has published a position paper in the Annals of Internal Medicine exploring the factors driving the growth of direct patient-contracting practices and the limited evidence on the impact on patient care. A review of the literature reveals potential benefits such as better access for some patients and fewer administrative hassles for providers, but it also raises concerns about access for the most vulnerable patients. Among the recommendations: Consider the patient-centered medical home as a practice model, and conduct additional research. (Annals of Internal Medicine; ACP announcement)
Consumers & Providers
Open enrollment is when most Americans can change their health insurance. But few do; health plans are complicated, price comparisons are difficult and it's hard to determine whether one's doctors are in a plan's network. But, according to Washington Post columnist Catherine Rampell, it behooves consumers to compare. "Multiple economic studies have found that insurers jack up rates on those too lazy or inattentive to investigate other options. Insurers take advantage of consumers' vague recollection that they did their homework last year... But the plan that was the best deal a year ago could well be the worst one now." (Washington Post)
Many of those signing up for HIX plans face higher premiums, fewer doctors and skimpier coverage; this could keep healthy customers from signing up, the Wall Street Journal warns. That threatens the program's appeal to the healthy customers it needs. Insurers attribute their moves in part to the high cost of some customers they are gaining under the law, which doesn't allow them to bar clients with existing health conditions. Insurers have raised premiums steeply for the most popular plans at the same time they have boosted out-of-pocket costs such as deductibles, copays and coinsurance. (Wall Street Journal--subscription required)
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New & Noted   
Stuck in the 20th century: Most people can't use email, texting and other tools to share medical information with their doctors, despite the fact that many would like to do so, according to Nielsen research. (Washington Post)
Violence against clinicians: Patient-on-clinician violence is on the rise. Among the 26,000 significant injuries due to workplace assault in 2013, nearly 75 percent were reported in the health care and social services sectors, according to the Bureau of Labor Statistics. (STAT)

Shopping made hard: Patients want to comparison shop for health care, but inaccurate prices on online calculators make it difficult. And it's not just the prices: Some estimators reflect an aggregate range of possible costs; others are based on historic pricing, or claims data from varying sources. And often, some procedures aren't even included. (NPR)
Based on a survey of primary care clinicians in early 2015, JAMA's Visualizing Health Policy infographic examines the experiences and attitudes of primary care practitioners since January 2014, when most of the ACA's provisions went into effect. Generally, they have a more negative view of the impact on cost of patient care, but a more positive view of the law's impact on patient access to health care and insurance. (JAMA)
MarketVoices...quotes worth reading
"All the functionality that we live our lives on isn't available in health care. You use your phone every day to send a text message or email; you can't do that to over 90 percent of physicians. You take a picture, and you want to send it someone; you can't do that [with doctors' offices] today. This is not cutting-edge technology we're talking about." -- Dr. Robert Pearl, chairman of the Council of Accountable Physician Practices, quoted in the Washington Post

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Sandy Mau




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Wednesday, December 2, 2015