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Industry News
The phrase "opioid epidemic" masks the fact that there are two separate epidemics: heroin, and prescription medications (e.g., OxyContin), according to the Boston Globe. Heroin deaths are largely concentrated across New England and the Midwest, and heroin victims tend to be young men in their 20s and early 30s. Heroin, which once contributed to less than 15 percent of opioid overdose deaths, now accounts for nearly 40 percent. Prescription opioids are killing people all across the country, especially those ages 45-54, including a substantial number of women. (Boston Globe)
A proposal published Thursday in the American Journal of Public Health--endorsed by more than 2,200 physicians and medical students--calls for a move to a single-payer insurance system. Doctors and hospitals would remain privately owned and operated, and physicians could practice on a fee-for-service basis or receive salaries from group practices, hospitals or clinics. "Despite the ACA...uninsurance and underinsurance endure, bureaucracy is growing, costs are likely to rise, and caring relationships take second place to the financial prerogatives of health insurers and providers," say the authors, adding that a single-payer national health program "offers a salutary alternative." (US News; AJPH; AJPH editorial)

Innovation & Transformation  
Group appointments are providing a way for some providers to cut health care costs and improve efficiency. Especially in low-income communities, the approach can ease the shortage of providers. Kaiser Health News profiled a group of expectant mothers at Eisner Pediatric and Family Medical Center in Los Angeles. As a group, they see a nurse midwife for 10 two-hour visits throughout their pregnancies. They take turns being examined and then together, learn more about childbirth and parenting--and even celebrate with a joint baby shower. The approach has its critics, but the women seem to appreciate the care and the camaraderie. (Kaiser Health News)
What competencies do behavioral health clinicians need as part of the primary care team? Competencies for Behavioral Health Providers Working in Primary Care, from the Eugene S. Farley, Jr., Health Policy Center at the University of Colorado, offers a consensus statement on this. Among the competencies: Identify and assess behavioral health needs as part of a primary care team; engage and activate patients; work as a team member to create and implement care plans that address behavioral health; communicate effectively with other providers, staff and patients; and provide culturally responsive, whole-person and family-oriented care. (consensus statement)
Could it be students at the Johns Hopkins Carey Business School are solving problems associated with social determinants of health by studying the HBO series The Wire? Prof. Toby Gordon uses the show as a case study of social determinants--including environmental hazards, stressful living conditions, unemployment, addiction and poor schooling. Students craft solutions including developing new ways to deliver fresh produce, expanding distribution of naloxone for opioid overdoses, designing safe injection sites for addicts to prevent infection and overdosing, and offering job training programs and after-school initiatives for students, including sports and college-prep activities. (The Baltimore Sun

In a Health Affairs Blog post, Dr. Kavita Patel and Caitlin Brandt, both of Brookings, discuss a proposed payment model to combat the high rate of Medicare Part B spending for physician-administered drugs. It would offer a few different reimbursement methods for Part B drugs and include geographically stratified design methodology to test and evaluate the different approaches. They acknowledge the proposal is controversial, but offer provisional support: "[W]e believe the goals of the program and its potential to reduce costs represent an important step in the right direction. We hope the details can be further shaped by ... providers and patients..." (Health Affairs Blog; demonstration program description)
Consumers & Providers
The CDC reported that three out of four young kids diagnosed with attention deficit hyperactivity disorder are put on medication despite research showing behavior therapy is as effective and without stomach aches, sleep problems and other drug side effects. The reason for the choice could boil down to insurance coverage for behavior therapy varying state to state and company to company, as well as a shortage of therapists. (US News
CMS unveiled an interim final rule on Friday that addresses insurers' complaints that people are abusing special enrollments. CMS tightened use of special enrollments to avoid any gaming of the system. The rule could also help the struggling co-op plans. Co-ops can now seek outside funding from investors to build up their capital, something previously banned, Kaiser Health News reports. In addition, CMS has postponed plans to roll out a star-rating system to help consumers shop for coverage on HealthCare.gov. It will now be available for the enrollment period beginning Nov. 1, 2017, Modern Healthcare reports. (KHN; Modern Healthcare)
More people may be unnecessarily taking heart disease medications, due in part to a 2013 update of the formula for calculating risk factors for heart disease. In a new report published in the Journal of the American College of Cardiology, researchers found the new recommendations, created by the American Heart Association and the American College of Cardiology, overestimates the risk of heart trouble up to five to six times. That means that five to six times as many people may be prescribed drugs, like cholesterol-lowering statins, but won't necessarily benefit from them. (Time
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New & Noted   
Alabama adjourns without solving Medicaid crisis: Legislation that could have provided funding to the state's Medicaid program died amid a fight over road funding Tuesday. As it stands now, Medicaid funding of programs covering over 1 million Alabamians, most of whom are children, is in jeopardy. Medicaid officials warn this could drive providers out of the state, ultimately hurting all patients. (Montgomery Advertiser

Smoking or non-smoking? That question isn't often asked at restaurants these days, but it is on health insurance forms. But many smokers aren't telling the truth. "It's bothersome and a concern," said Josh Jordan, a spokesman for Blue Cross of Idaho. "It means nonsmokers will pay more because smokers generally have higher health care costs that were supposed to be partly offset through the surcharge." (Kaiser Health News)

Medical home better for behavioral health: For U.S. adults with mental health issues, a medical home appears to be associated with better care experiences, according to a Commonwealth Fund issue brief. "Medical homes may be one model that can improve care coordination and outcomes for people experiencing mental health issues," the authors conclude. (Commonwealth Fund) 

For many Americans, health care remains unaffordable--and that could have implications for the 2016 elections. Although the Affordable Care Act brought basic health insurance to about 90 percent of Americans, rising deductibles and copayments means those Americans may never see the benefits of their insurance. (NPR; pollrecent study)
MarketVoices...quotes worth reading
"Caring relationships are increasingly taking a back seat to the financial prerogatives of insurance firms, corporate providers, and Big Pharma. Our patients are suffering and our profession is being degraded and disfigured by these mercenary interests."--Dr. Adam Gaffney, co-chair of the working group that produced a proposal calling for a move to a single payer, quoted in US News 
"I don't think it's a very meaningful contribution. It conjures up five-year planning by Stalinists."--Dr. Jeffrey Flier, the dean of Harvard Medical School, on the call discussing the 2000+ physicians endorsing a move to a single payer, quoted in the Washington Post 
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Roxanna Guilford-Blake
Sandy Mau




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Wednesday, May 11, 2016