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Industry News
Federal officials still don't know how much they will recoup of the $1.2 billion spent on loans and startup costs for health care cooperatives that eventually failed, Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid Services, told the Senate Finance Committee last week. Republicans grilled him, arguing that officials should have seen the warning signs. Kaiser Health News has a roundup of the coverage. (Kaiser Health News)
Health care merger and acquisition activity is likely to remain strong in 2016, driven by the growth of value-based payment models, Modern Healthcare reports. Private equity players will continue to seek out primary care practices that have expertise in the managed care environment. Post-acute care providers have been in a fragmented market, but that could change as hospital systems take on more responsibility for outcomes. And the walls between health systems and insurers may continue to break down. (Modern Healthcare)
Is capital drying up for digital health startups? Experts say "yes"
Digital health startups have benefited from easy access to capital, but that may be changing. According to Modern Healthcare, many health systems and their venture capital arms believe tech entrepreneurs don't really understand their business. Many of the new tools try to solve a patient problem but create more work for providers and don't necessarily fit workflow. In addition, health care is just different: It will always be a brick and mortar business with a digital business layered on top of it, explains Ambar Bhattacharyya, managing director at Maverick Capital. ( Modern Healthcare)
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Innovation & Transformation
A third of patients with chronic conditions who exchanged secure emails with their doctors said these communications improved th eir overall health, according to a Kaiser Permanente study published in The American Journal of Managed Care. Fewer than 1 percent said emailing made their health worse. "As more patients gain access to online portal tools associated with electronic health records, emails between patients and providers may shift the way that health care is delivered and also impact efficiency, quality and health outcomes," observes Mary E. Reed, DrPH, of Kaiser Permanente, the study's lead author. (Kaiser Permanente announcement; The American Journal of Managed Care)
In Medicare plans, telemedicine isn't catching on as fast as some would hope. After being introduced nearly 20 years ago, it's currently available only with Anthem and a University of Pittsburgh Medical Center health plan, Kaiser Health News reports. One reason for the reluctance: Concern that such service might increase Medicare expenses due to its convenience. "The very advantage of telehealth, its ability to make care convenient, is also potentially its Achilles' heel," says Ateev Mehrotra of Rand Corporation. (KHN)
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Even with subsidies to make coverage more affordable, many people who buy health insurance on the marketplaces spend more than 10 percent of their income on premiums, deductibles and other out-of-pocket payments, according to analysis from the Urban Institute. Most notable: 10 percent of people with incomes between 200 and 500 percent of poverty ($23,540 to $58,850) will pay at least 21 percent of their income toward premiums and out-of-pocket costs, the study found. ( Kaiser Health News; Urban Institute paper)
Large independent, physician-owned primary care groups offer a promising alternative to hospital or multispecialty practice employment, according to findings published in the Annals of Family Medicine. The report, which analyzed five practices, found these groups "have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting." (Medscape Medical News; Annals of Family Medicine)
ProPublica recently released a piece on the insecurity of medical records. Charles Ornstein, a senior reporter at ProPublica, spent the past year reporting on loopholes and lax enforcement of HIPAA. He noted that he was often reminded of his interview years ago with the late Farrah Fawcett after her privacy was breached. "It seems that there are areas that should be off-limits," she once told him. The investigation unveils the current state of data security and how little is done to protect private records. (The Washington Post)
Cost-sharing for plans on state and federal exchanges remained essentially unchanged from 2014 to 2015, according to research from the Commonwealth Fund. In fact, 56 percent of enrollees in HIX plans saw cost-sharing reductions in 2015. However, for those without cost-sharing reductions, average copayments, deductibles and out-of-pocket limits under catastrophic, bronze and silver plans are considerably higher than under employer-based plans. For prescription drugs, HIX plans lack the financial protection provided by employer-based plans. (Commonwealth Fund)
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New & Noted
Faith-based cost sharing: More people are turning to health-care ministries to cover their medical expenses instead of buying traditional insurance. The ministries, unregulated by states, provide a health care cost-sharing arrangement among people with similar beliefs. (The Wall Street Journal--subscription required)
Bearish on provider-led networks: Provider-led health care networks aren't equipped to function like insurance companies, warns Joel Zinberg, MD, JD, FACS, of American Enterprise Institute. In a Health Affairs Blog post, he says the "current effort to consolidate providers and make them into ersatz insurers is a prescription for disaster." (Health Affairs Blog)
Cigna suspension: CMS has suspended new enrollment in Cigna's Medicare Advantage health insurance and prescription drug plans, citing "widespread and systemic failures" that prevented patients from accessing services. Specifically, CMS says Cigna did not handle patient complaints and grievances properly. (Kaiser Health News)
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Multi-media
In this 40-minute video, Matthew Rae of the Kaiser Family Foundation shares findings from the 2015 Kaiser Employer Health Benefits Survey. He spoke to self-funded employers at an Alliance Learning Circle last month. (HealthShareTV)
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MarketVoices...quotes worth reading
"After spending the past year reporting on loopholes and lax enforcement of the Health Insurance Portability and Accountability Act, the federal patient-privacy law known as HIPAA, I've come to realize that it's not just celebrity patients who are at risk. We all are."
-- Charles Ornstein, a senior reporter for ProPublica covering health care and the pharmaceutical industry, writing in The Washington Post.
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Copyright 2009-2016, H2RMinutes
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Wednesday, January 27, 2016
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