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Industry News
Expect a new round of HIPAA audits from the Office for Civil Rights. These audits will target the business associates of health care providers, insurers and other HIPAA-covered entities in addition to the entities themselves, Modern Healthcare reported. "Business associates" generally got a bye in the first round of audits completed in December 2012. But now, they are in the game. And according to a 2013 report by the OCR, two-thirds of the entities audited--including 47 of 59 health care providers and 20 of 35 health plans--lacked complete and accurate risk assessments. (Modern Healthcare)
The Centers for Medicare & Medicaid Services announced last week it reached its goal of tying 30 percent of Medicare payments to value. It accomplished this ahead of schedule--the deadline was the end of this year. "There were many who doubted whether we could reach the goal and certainly the exact timeline," said Dr. Patrick Conway, chief medical officer for CMS. "We even, internally, questioned whether we could reach the goal or not." The next goal: 50 percent by 2018. Within Medicare, $117 billion is now spent on value-based care, The Hill reports (The Hill)
OptumRx, the pharmacy benefit manager of UnitedHealth Group Inc., has signed an agreement with Walgreens Boots Alliance--the first step in a strategic relationship with the pharmacy chain. Walgreens will fill 90-day prescriptions for OptumRx customers at its mail delivery prices, starting Jan. 1, 2017. The model puts OptumRx on more equal footing with its two largest competitors, CVS Health--which is made up of pharmacies and a pharmacy benefit manager--and Express Scripts Holding Corp., Reuters reports. (Reuters)
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Innovation & Transformation
New health care market entrants threaten clinic- and hospital-based doctors' dominance. That may be a good thing, says Dr. Ravi Parikh, a resident at Brigham and Women's Hospital in Boston. "As a future primary care provider, I hope that our system can bridge the divide between our traditional medical behemoths and these innovative organizations... I've learned [to practice medicine] in the safe confines of the hospital and primary care clinic. But I also hope to practice in a novel delivery system that cares for patients where they are." (STAT)
Humana's move to tie executive compensation to health outcomes may be more self-serving than it looks, according to the International Business Times. Humana tested that model for 2015, tying 80 percent of an executive's cash incentive to the company's earnings and 20 percent to consumer health metrics, according to a recent filing with the Securities and Exchange Commission. The idea is viewed as innovative among health insurers, but some experts suggest the new model is in fact a subtle way of protecting executive pay. (IBT)
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A study published in the Annals of Family Medicine finds patient expectations, physician behaviors within the consultation, and health outcomes differ substantially between high- and low-deprivation areas. In each setting, patient perceptions of the physicians' empathy predict health outcomes. "This new paper adds to evidence already shown that the outcomes of the consultations are worse in such patients in deprived areas," and that an empathetic patient-centered approach leads to better outcomes, says lead author Dr. Stewart Mercerhe. The paper also demonstrates the "inverse care law": the availability of good medical care tends to vary inversely with a population's need for it. (Annals of Family Medicine; Medical Xpress)
Medicare beneficiaries may face higher prescription drug bills this year because more than half of covered drugs in standalone plans require them to pay a percentage of the cost rather than a flat fee, Kaiser Health News reports. Fifty-eight percent of covered drugs in Part D drug plans are subject to "coinsurance" in 2016 rather than flat copayments, the Avalere Health analysis found. The percentage of drugs requiring coinsurance has climbed steadily, increasing from 35 percent in 2014 to 45 percent last year. (Kaiser Health News)
The number of 2016 exchange enrollees is up only slightly from last year and, just as last year, enrollees are older and poorer than expected, Brian Blase of the Mercatus Center at George Mason University writes in Forbes. "This is generally very bad news for insurers ... It also shows that the conventional wisdom about how the large increase in the individual mandate tax penalty would induce additional younger and healthier people to enroll seems wrong." (Forbes)
More Americans are turning to urgent care clinics, and patients are finding the dual benefit of the ones that are attached to a hospital: convenience but with a safety net if their problem proves more serious than they thought. Over the past two years, hospital chains, health systems and insurance companies have snapped up--or developed strategic relationships with--urgent care centers, according to The Wall Street Journal. One driver: active patients over 50 who want convenient care but also want to be connected to a system where such visits can become part of their medical record. (The Wall Street Journal)
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New & Noted
NP, PA popular career options: Nurse practitioner and physician assistant are on the Bureau of Labor Statistics' list of fastest growing jobs. Job growth of 35 percent is expected for NPs and 30 percent for PAs from 2014 to 2024. (BLS)
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Multi-media
"Innovation all around, but it ain't in healthcare; Internet and apps for you, but we get ancient software." In case you missed it, last year's video from doctor/rapper ZDoggMD gives voice to the frustrations physicians feel about EHRs. And for those who aren't quite hip enough to get it: "EHR State of Mind" parodies the Jay-Z/Alicia Keys duet, "Empire State of Mind." (YouTube)
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MarketVoices...quotes worth reading
"Instead of 'firing' customers who are no longer stepping through its Supercenter doors, Walmart is working to find ways to serve them. Hospitals and medical clinics should make a similarly large investment to bring health care to our patients--or risk losing them to the Amazons of our own field."-- Dr. Ravi Parikh, a resident at Brigham and Women's Hospital in Boston, in a STAT column
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