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Those newly insured though the Affordable Care Act were sicker, used more medical care and had higher medical costs than those who already had coverage, according to a Blue Cross and Blue Shield Association study of its policyholders. Of note: New policyholders had nearly twice the rate of diabetes, more than twice the rate of hepatitis C infection and three times the rate of HIV. The findings, The New York Times explains, are noteworthy because BCBS plans operate nationally and have the largest share of the individual market in many states, giving them an unrivaled source of claims data. (The New York Times; BCBS study)
In a House Energy and Commerce Subcommittee on Health hearing, CMS Chief Medical Officer Patrick Conway testified that many current alternative payment models (APMs)--including some under the CMS Innovation Center--won't meet the "high bar" created by The Medicare Access and CHIP Reauthorization Act of 2015. However, CMS expects to have a "reasonable set" of APMs that will grow over time. He didn't go into detail about eligibility criteria but said he's asking specialty societies to suggest models appropriate to their area of expertise. (Bloomberg BNA)

If the remaining states expand Medicaid, it could greatly expand access to behavioral health care, according to a new report from the Department of Health and Human Services. HHS estimates 1.9 million uninsured people have substance abuse or mental illness conditions that require treatment and would qualify for Medicaid under the Affordable Care Act, but live in states that have not expanded the program. (announcement; FierceHealthPayer; report)
Innovation & Transformation 
Last week, President Obama announced a new task force on mental health parity. A 2008 law intended to create parity hasn't succeeded: Enforcement has been weak, and advocates say discrimination has continued, Kaiser Health News reports. "It's better late than never, and you can't not be grateful for the fact that we're finally implementing a law that was passed nearly a decade ago," says Patrick Kennedy, former congressman and one of the parity law's authors. "But it's troubling ... that it took the administration this long to address a problem that's been with us for many years." (Kaiser Health News; White House memo)
The New York law requiring prescriptions be filed electronically took effect last week and includes exemptions for a dozen special circumstances, but Joseph Maldonado, MD, the medical society's president, wants more. Many physicians write very few prescriptions, he says. "Mandating these physicians to adopt costly and cumbersome technologies that, so far, have proven to be extremely challenging may cause many long time physicians to give up patient care altogether," he said in a statement. (Healthcare IT News)

The University of Pennsylvania's community health worker model, shown to reduce admissions and improve health outcomes for hospitalized patients, can also be used in outpatient settings, according to a study in Population Health Management. This allows for rapid scale-up of evidence-based CHW interventions in new settings, according to researchers. In the Individualized Management for Patient-Centered Targets, or IMPaCT™ model, CHWs visit patients facing multiple chronic conditions and help them navigate the health care system and carry out daily activities. CHWs are peers; they come from low-income communities and provide social support to address real-life health issues. (FierceHealthcare; announcement)
Consumers & Providers
Data threats are increasing, and health care organizations need to take a proactive, not reactive, approach, Mac McMillan, security expert and CEO of CynergisTek, tells Healthcare Informatics. "The research we've seen indicates that if you're doing the right things, the majority of ransomware attacks can be avoided." One "right thing" is a 24/7 security operations center. Meanwhile, threats will grow, because "the one thing that healthcare fears more than anything else is not having their data. And ransomware attacks that very vulnerability, fear. So from an extortion perspective, it is the perfect vehicle for attacking vulnerability." (Healthcare Informatics)
According to a study of gastrointestinal patients, black people were about 19 percent more likely to die or experience serious complications than white patients. But when they received treatment at hospitals with more diverse patient populations, they were 20 percent less likely to die or experience major complications, and their charges were 51 percent lower than if they were seen at hospitals with less diversity. The findings suggest doctors may do a better job of caring for minorities when they routinely see patients from a broad variety of racial and ethnic backgrounds, says lead author Dr. Philip Okafor of the Mayo Clinic. (Reuters; American Journal of Gastroenterology)
Consumers are willing to use personal health records but barriers imposed by others and the low bar set by the Meaningful Use program are impeding such adoption, according to a study published in the Journal of Medical Internet Research. Researchers noted PHRs are a "tremendous opportunity" to increase patient engagement adoption rates, but suggested Meaningful Use may actually be slowing innovation in PHRs because vendors may be striving to provide only minimum PHR functionalities. In addition, providers may be creating administrative burdens on patients' online access to their records, they said. (FierceEMR; Journal of Medical Internet Research)
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New & Noted   
Employees want a raise: The number of workers who say they would give up some health benefits to get a pay raise has grown from 10 to 20 percent since 2012, according to a survey by the Employee Benefit Research Institute. (Kaiser Health News)

Medicaid MU trails Medicare MU: Physicians participating in the Medicaid Meaningful Use program are progressing more slowly than those participating in the Medicare side of the program, creating disparities. (Health Services Research)
Jost on first MLR audits: In his ongoing series, "Implementing Health Reform," Timothy Jost discusses the results of the first audits conducted under the  Affordable Care Act's medical loss ratio program. The audits, he says, indicate a need for clearer standards. (Health Affairs)

AMA President Steve Stack, MD, recently talked about physician burnout tied to providers having to balance the day-to-day realities of patient care with federal and state mandates regulating aspects of that care, such as physician EHR use and clinical quality reporting. According to Stack, demonstrating meaningful EHR use as part of the EHR Incentive Programs serves as a perfect example of how regulation can contribute to physician burnout. (video interview; EHR Intelligence)
MarketVoices...quotes worth reading
"Doctors will get behind things that support better quality of care and support them in their clinical practice. It's the nonsensical stuff that makes it infuriating and challenging." -- AMA President Steve Stack, MD, in EHR Intelligence
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Editorial Team
Roxanna Guilford-Blake
Sandy Mau




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Wednesday, April 6, 2016