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States will have more flexibility under the recent changes to Medicaid managed care. But states will need money, manpower and detailed direction, Modern Healthcare reports. Some states are more prepared than others; that could lead to disparities in the improvements to health care quality and access. "The minute the regulation becomes final, a lot of people's work is done, but our work is just beginning. There's a lot of things in here, and they can't all be priorities," says Matt Salo, executive director of the National Association of Medicaid Directors. (Modern Healthcare)
Nine insurers returning to the HealthCare.gov HIX are requesting average premium increases from 9.4 to 37.1 percent. Lower-than-hoped-for enrollment and sicker-than-expected customers are contributing to market instability. "It is a sustainable market for the long term, but right now it is not stable," said Marilyn Tavenner of America's Health Insurance Plans. "Folks will try to price this year to get to stability." (Associated Press)  

Analysis from the HealthCare Cost Institute finds prices for identical procedures vary greatly even within the same state. "Prices for medical services varied more than threefold in certain instances," the team wrote in the report. Differences in places where there is a shortage and high specialist demand make sense. What doesn't is paying twice as much for the same treatment in Miami as in San Francisco. Or even in the same area: "The average price [for pregnancy ultrasound] in Cleveland ($522) was almost three times that in Canton ($183), even though these two Ohio MSAs are only 60 miles apart." (NBC News

Last week, CMS issued a proposed rule for the Medicare Access and CHIP Reauthorization Act to reform physician Medicare payments now that the sustainable growth rate formula is history. It moves toward value-based payments, rewarding or penalizing physicians based on how healthy they keep their patients. "It is hard to overstate the significance of these proposed regulations for patients and physicians," AMA President Steven Stack, MD, said in a statement. "Our initial review suggests that CMS has been listening to physicians' concerns... recasting the EHR Meaningful Use program and by reducing quality reporting burdens." (USA Today; Becker's Hospital Review; rule)
Innovation & Transformation  
A primary care initiative that leverages the expertise of clinical pharmacists--developed at the William S. Middleton Memorial Veterans Hospital in Wisconsin--could change how the VA delivers care across the country. It has added clinical pharmacists--with prescribing privileges--to the patient primary care team. Ellina Seckel, PharmD, program manager at the facility, worked with others to find ways pharmacists could support primary care providers. "We've been able to shift the chronic disease workload off the primary care providers and have the pharmacists be the providers." Pharmacists were able to offset the PCPs' workload by 27 percent. (Wisconsin Health News)
A paper from The Eugene S. Farley, Jr. Health Policy Center offers policy recommendations that would improve the quality of behavioral health care patients receive in clinical settings. "Creating a Culture of Whole Health" offers practical improvements that would eliminate the artificial separation of mental and physical health. "The health care system differentiates physical and behavioral health care. Patients don't," says Benjamin Miller, PsyD, director of the Center. Among the recommendations for payers and policymakers: Establish payment methodologies that support team, not individual, providers. For providers: Engage communities in service to advance needs for behavioral health and assure consistency across care delivery. (the report; announcement; Health Affairs Blog post)
Motivational interviewing reduces the risk of drug overdoses, according to research published in Drug and Alcohol Dependence. Just a single half-hour session with a trained therapist during an ER visit was enough to motivate people who misused prescription opioid painkillers to reduce their use as well as their riskiest behaviors. Patients who had a motivational interview reported a 40.5 percent reduction in risky behavior and about a 50 percent decrease in non-medical use of opioids, vs. 14.7 percent and 39.5 percent respectively when using standard educational care. (United Press International; Drug and Alcohol Dependence)
Consumers & Providers
Veterans newly enrolling for health care from the Department of Veterans Affairs often wait for months before they see a medical provider, according to a new GAO report. The average waiting time at the six medical centers the GAO studied ranged from 22 to 71 days. Of the 180 new enrollees the GAO tracked, 60 still had not been seen by the time the auditors ended their review. VA data indicates that, as of April, the average waiting times for appointments were seven days for primary care, 10 days for specialty care and four days for mental health care. (The Washington Post; GAO report)
Requirements that nurses be licensed in every state they want to work in could create barriers to telemedicine. Six states currently have legislation to adopt a licensure compact allowing nurses to practice telemedicine across state lines, but some--including nursing unions--object. Maureen Swick, senior vice president and chief nurse executive for Inova Health System in Virginia disagrees, calling separate licensing "absolutely crazy" because "we all take the same test. The curriculum from nursing school is all the same." (Fierce Health IT; Wall Street Journal)
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New & Noted   
Anthem bucks HIX trend: Anthem expects to make a profit from the HIX this year, CBS reports. Anthem leaders told analysts they were focused on cutting expenses and improving the profitability of the business they have. They will, however, increase their HIX presence once they acquire Cigna. (CBS News)

Limited English may mean return ED visits: Patients in the emergency department who don't speak English well were 24 percent more likely have an unplanned return visit within 72 hours, compared to English speakers. This suggests "challenges" in ED quality of care, researchers conclude. (Annals of Emergency Medicine)

Ryan and high-risk pools: House Speaker Paul Ryan recently said he wants to eliminate the ban on health insurers denying coverage or charging far higher premiums to those with pre-existing conditions. His proposal: Replace it with high-risk pools. Modern Healthcare's Vital Signs blog explores the issue. (Modern Healthcare)

The Department of Health and Human Services has created a video explaining the Medicare Access and Chip Reauthorization Act to the average consumer. (video)
MarketVoices...quotes worth reading
"Now that we've implemented this across all of our primary care clinics, we actually have same-day access available. So if patients come in and need to be seen by a primary care doctor on the same day, there's someone available."--Ellina Seckel, PharmD, clinical pharmacy specialist at the  William S. Middleton Memorial Veterans Hospital in Madison, Wis., on the benefits of integrating clinical pharmacists on the primary care team, quoted in  Wisconsin Health News 
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Roxanna Guilford-Blake
Sandy Mau




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Wednesday, May 4, 2016