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Industry News
There's more money to be made investing in drugs to extend cancer patients' lives by a few months than in drugs that would prevent cancer, according to research published in The American Economic Review. The research suggests two factors--"corporate short-termism and the structure of the patent system"--create incentives that distort private research investments. "R & D on cancer prevention and treatment of early-stage cancer is very socially valuable, yet our work shows that society provides private firms--perhaps inadvertently--with surprisingly few incentives to conduct this kind of research," the authors tell The New York Times. (The New York Times; The American Economic Review) 
 

A federal experiment to control spending and improve care for "dual-eligibles"--those who qualify for Medicaid and Medicare--has had a "rocky start," according to The Wall Street Journal. Enrollment in the pilot programs is lower than anticipated, likely due to patient reluctance to switch to the new programs. Thirteen states have agreed to try the streamlining of services, but "dual-eligible" patients have shown reluctance. States and the federal government currently spend about $300 billion a year on dual-eligibles. (Kaiser Health News; The Wall Street Journal) 


A health plan law that requires at least two multi-state plans be available in all states by 2017 appears to be impotent. It doesn't require insurers to offer the plans, and most so far have opted not to, Kaiser Health News reports. Linda Blumberg of the Urban Institute says "Conceptually, the idea just didn't have legs. It's too hard to find an insurer who could suddenly compete across the breadth of states and do better on rates than existing insurers." (Kaiser Health News)
Innovation & Transformation 
States have played a dominant role in multipayer patient-centered medical home initiatives. Although Medicaid agencies have generally provided the infrastructure and support, other state departments and agencies can play roles, according to a recent Health Affairs Blog post. It discusses how state insurance departments, employee benefits and public health departments and agencies in collaboration with Medicaid, private payers and others have undertaken significant roles to strengthen multipayer PCMH efforts. (Health Affairs Blog)
 
Correctly structured accountable care can benefit patients with diabetes, according to a new Brookings Institution brief. Specifically, better alignment of reimbursement with prevention and chronic disease management can support the workforce structures, care management systems and care coordination tools needed to help diabetes patients and their clinicians manage the condition. The researchers looked at five successful accountable care examples from India, Mexico, Spain and the U.S. All use the Accountable Care Framework, which includes population, performance measures, continuous improvement, payments and incentives, and care coordination and transformation--a framework that may apply to other chronic conditions. (Brookings Institution) 
 

People participating in a Medicare home visit program had lower hospitals admission rates, lower risk of nursing home admission and increased numbers of office visits. Researchers evaluated UnitedHealth Group's HouseCalls program, which has been offered to Medicare Advantage plan members in Arkansas, Georgia, Missouri, South Carolina and Texas since January 2008. "Assuming that this effect is sustainable, this particular combination of an in-home assessment and follow-up on the care plan recommendations has the potential to help elderly patients safely age in place, access office-based care, and avoid costly institutional care," the researchers conclude. (Health Affairs) 
 
Consumers & Providers
2015 was a banner year, and not in a good way. According to the Department of Health and Human Services, there were 253 health care breaches that each affected at least 500 individuals. Overall, 112 million records were involved. The top 10 data breaches alone accounted for just over 111 million records that were lost, stolen or inappropriately disclosed, Forbes reports. The top six affected at least 1 million individuals--and four of those were Blue Cross Blue Shield organizations. Overall, "Hacking/IT Incident" represented 21 percent of all breaches. "Theft" represented 29 percent. (Forbes)
 
As of December 2015, roughly 23.3 million lives were covered by ACOs, according to Leavitt Partners. In a new report, it predicts federal and state incentives and penalties, together with the success of some ACOs, will drive ACO growth in the immediate future. The report looks at four potential scenarios; under the most likely one, the population covered by ACOs is expected to reach 105 million in 2020. This assumes the federal government will continue to demonstrate strong support of the model. (Becker's Hospital Review; Leavitt Partners)
 
 
A California state law that took effect January 1 requires hospitals to identify a caregiver during a patient's hospitalization and inform that caregiver of the individual's discharge date and instructions, including proper medication schedules. The goal is to improve the transition home by engaging informed family members and friends. Some warn, however, that laws like it add a layer of bureaucracy, and even supporters acknowledge it's possible an identified family member may not be interested in helping. (Modern Healthcare) 
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New & Noted   
Pregnant in NY? Don't sweat open enrollment:  New York recently became the first state to allow pregnant women to sign up for health care via the state exchange at any time. Under legislation passed last month, pregnancy acts as a "qualifying event" for health care on the state health exchange. (PBS NewsHour)

CMS seeks input on quality reporting programs: The Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT have issued a request for information: "Certification Frequency and Requirements for the Reporting of Quality Measures under CMS Programs." Deadline for comments: Feb. 1. (Healthcare Informatics; RFI)

Bevin to overhaul Medicaid: Kentucky Gov. Matt Bevin, a staunch opponent of the Affordable Care Act, plans to overhaul the state's expanded Medicaid program with an ACA-based waiver. He didn't offer many details, according to Modern Healthcare, but he did cite Indiana's cost-sharing model as possible approach. (Modern Healthcare)


Multi-media 
House-call paramedics work to cut hospital readmissions in a Glendale, Calif. pilot. Southern California Public Radio reports on the year-long experiment designed to keep congestive heart failure patients from being readmitted to the hospital within 30 days of discharge. (audio and slideshow) 
 
MarketVoices...quotes worth reading
     
"You can never have enough follow up with a patient--it's multiple layers of protection." --Dr. Harry Balian, chairman of Glendale Adventist's cardiology department, discussing a program that uses paramedics to make house calls and how it relates to the role of home health nurses, quoted by Southern California Public Radio 
 
 
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Wednesday, January 6, 2016