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In a Republican's perfect world, the Affordable Care Act would be repealed; however, Sen. Bill Cassidy (R-La.) recently said, "...we can't kind of not do anything waiting for those stars to align." He and Rep. Pete Sessions (R-Texas) are breaking from their party's position and suggesting a health care plan that leaves parts of the current system in place, adds a tax credit that is not dependent on income and repeals the individual and employer mandates. It would also repeal the requirements for what the plan must cover. (The Hill) 
Sixty-one percent of those covered through exchanges are getting health care they would have been unable to get otherwise. Three of five ACA enrollees who tried to find a new primary care doctor found it easy to do, and three of five who needed to see a specialist waited two weeks or less. These are some of the Commonwealth Fund Affordable Care Act Tracking Survey's findings. "Providing timely access to care is the fundamental purpose of insurance and in this regard the law is working well for most people," says The Commonwealth Fund's Sara Collins, the report's lead author. (The Commonwealth Fund)
Innovation & Transformation  
A new report from Leavitt Partners offers insights into the CMS Medicare Shared Savings Program. For example, the more contracts an ACO had correlated with higher quality but not greater savings. Twenty-six percent of ACOs earned shared savings, but these savings were highly concentrated among a handful of ACOs. In general, ACOs in high-cost markets were more likely to earn shared savings. Managed Healthcare Executive spoke to Leavitt's David Muhlestein and Douglas Hervey to learn more. (Managed Health Executivereport)
After decades of mistrust, health care providers and payers are working together and building trust by using benchmarking, bundling and aligning interests. "We see relationships with providers now that are nothing like anything we have seen in managed care before," says Lili Brillstein, of Horizon Healthcare Innovations, a division of Horizon Blue Cross Blue Shield of New Jersey. HealthLeaders Magazine reports Horizon is "drawing predictably befuddled inquiries" about how it achieved amicable relations with physicians. "There is no stick. The goal is not to smack them but to work collaboratively to achieve success in the value-based model," says Brillstein. (HealthLeaders Magazine)
Consumers & Providers
Earlier this year, the Department of Health and Human Services' Office of Civil Rights stipulated that organizations covered by HIPAA can charge patients for copies of electronic records only within certain parameters, such as covering the cost of printing and mailing copies. The OCR recommended $6.50. But last week, the ONC said that was just a suggestion. They are permitted to calculate the actual cost of electronic copies of records and charge more than the suggested rate. (Healthcare Finance News)
According to a new study in JAMA Oncology, maintaining a healthy lifestyle--defined as not smoking, not drinking too much, maintaining a body mass index between 18.5 and 27.5 and exercising 75 to 150 minutes weekly--could decrease cancer deaths by 67 percent for men and 59 percent for women. "A substantial cancer burden may be prevented through lifestyle modification. Primary prevention should remain a priority for cancer control," researchers report. The American Cancer Society estimates 595,690 Americans will die of cancer this year. (USA Today; JAMA Oncology)
A recent survey by the Physicians Foundation of more than 1,500 adult patients found that over 90 percent were "highly satisfied" with their primary care physician. However, 62 percent of the participants said they were worried about their ability to pay for medical care if they became ill or injured. These concerns over cost could then lead to patient adherence issues; in fact, 28 percent reported skipping a medical test, missing a follow-up appointment or not seeking treatment for a medical problem in the last year due to cost concerns. (Becker's Hospital Review) 
The Health Insurance Portability and Accountability Act supposedly gives patients legal access to and control over their medical records. In reality, though, this may not always be the case; an essay in the Annals of Internal Medicine explains why. Doctors have concerns about disputes with patients about the records' content, malpractice litigation and how much to share with and about minors and people with mental illness. While control over one's records could prevent errors and lead to patient engagement, it could also be detrimental to, say, a suicidal psychotherapy patient. (Reuters; Annals of Internal Medicine)
"Early hospital participation in the Medicare Shared Savings Program ACO program was not associated with greater reductions in adverse perioperative outcomes for patients undergoing major cancer surgery in comparison with control hospitals," a recent study in Cancer concludes. Researchers evaluated early hospital ACO participation and the outcomes it had in major surgical oncology procedures. Participating practices did not produce greater reductions in adverse outcomes for patients than non-participants. (Cancer)
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New & Noted   
No waiting period: Insurers selling plans with mandated benefits under the Affordable Care Act cannot require people to wait a certain amount of time before they can use those benefits, according to the Centers for Medicare & Medicaid Services. (Modern Healthcare)

Physician as artisan: Psychiatrist Abraham Nussbaum, MD, of Denver Health Medical Center, argues that doctors and patients are being shortchanged by the emphasis on population-based standards of care over individual patient needs and experience. He makes the case for physicians as artisans in his new book, The Finest Traditions of My Calling, which he discusses with Kaiser Health News. (Kaiser Health News)

Those who live in Texas and Florida--the two largest states that haven't expanded Medicaid--have more complaints about health care costs and quality than those in three other large states that did expand it, according to a new survey released by the Texas Medical Center Health Policy Institute. The survey assessed attitudes about the health care system in all five states. (Houston Public Mediasurvey)
MarketVoices...quotes worth reading
"In my own specialty [psychiatry], the current quality metrics all encourage me to perform standardized screens on patients or to document carefully. None of them require me to develop a relationship with a patient so that I can, say, foster hope after a suicide attempt, or knit a psychotic person back into the life of their family. Yet that it was [what] my patients want, those human relationships." -- Psychiatrist Abraham Nussbaum, MD, in an interview with Kaiser Health News.
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Roxanna Guilford-Blake
Sandy Mau




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Wednesday, June 1, 2016


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