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Industry News
The Justice Department last week filed lawsuits to block the Aetna/Humana and Anthem/Cigna mergers. Now things will get interesting. Aetna promised to "vigorously" preserve the merger and outlined its defense against claims the acquisition would significantly reduce competition, Benefits Pro reports. Both Aetna and Anthem contend the mergers will lead to greater choice and affordability. Meanwhile, Reuters reports that if the mergers are ultimately blocked, the four companies could go on a "buying spree," leading to even more consolidation. (Benefits ProReuters)

UnitedHealthcare has acquired Rocky Mountain Health Plans, an independent nonprofit health insurer in Colorado. The move combines "United's state-of-the-art technology and the extraordinary community relationships of Rocky," says Steve ErkenBrack, RMHP president and CEO. RMHP will convert to a for-profit and then sell the stock it issues to UnitedHealthcare, the Denver Post explains. Those proceeds will fund the Rocky Mountain Health Plans Foundation to improve health care access in the region. The deal is expected to close by the end of 2016. (Denver Post) 
Too few medications, like too many, can be dangerous. Research published in the British Journal of Clinical Pharmacology found patients aged 80 and older were at 39 percent increased mortality risk and 26 percent higher risk of hospitalization for each appropriate prescription they did not receive. More than half the participants were taking five or more medications. Two-thirds were not receiving medications they should have, and 56 percent were misusing medications. Forty percent were both underusing and misusing medications. Only 9 percent had no polypharmacy, underuse or observed misuse. (ReutersBritish Journal of Clinical Pharmacology)
Two-thirds of the federally funded co-ops created by the ACA to sell health insurance to individuals and small employers have folded; those that remain are diversifying to stay alive. New failures are piling up among the member-run health insurance co-ops carrying out one of the Affordable Care Act's most idealistic goals, leaving just seven remaining when the law's fourth enrollment season starts in the fall. There were 23 in 2014. (Kaiser Health News)
Innovation & Transformation  
Relatient, a health care communications company, and Uber are teaming up to get patients to the doctor on time. Because the two companies' IT systems are integrated, appointment details will be pre-populated, reminders can be sent and Uber drivers reserved. During the ride, the patient will receive a message to check in with the provider so the necessary paperwork is completed. Missed appointments can cost doctors as much as $150,000 a year and can also lead to higher medical risks for the patient. (Health Data Management)
Pharmacy Practice News recently profiled William S. Middleton Memorial Veterans Hospital's innovative use of clinical pharmacists. The Madison, Wisc., clinic has improved employee satisfaction and opened up same-day access for new and existing patients--and it was a finalist in the VA's Shark Tank-style competition. Clinical pharmacists with prescribing privileges are part of the Patient Aligned Care Team (PACT). They've been able to take over more than a quarter of primary care appointments. Ellina Seckel, PharmD, Middleton's PACT program manager, is now helping other VA sites launch similar programs. (Pharmacy Practice News)
Consumers & Providers
A study in JAMA Internal Medicine found 14.9 percent of Medicaid recipients discharged from hospitals in 2011 filled a prescription for opioid painkillers within a week; 42.5 percent of those filled another within at least 90 days. The random sample of 623,957 Medicare beneficiaries included only those who did not fill a prescription for opioids for at least 60 days before being hospitalized. Hospitals that had higher opioid use rates tended to have higher patient satisfaction for inpatient pain control--a metric CMS has proposed removing from payment calculations. (Kaiser Health NewsJAMA Internal Medicine)
Access to insurance doesn't mean access to services. Provider directories for some health plans in California are so inaccurate they create an "awful" situation for consumers trying to find doctors, according to research published in Health Affairs. Secret shoppers posing as patients could schedule an appointment with a primary care physician less than 30 percent of the time. "Network accuracy is an important [...] component of access for patients. [...] The more frustrated people become as they are trying to access care, the more likely they are to defer or forgo care, or to choose more expensive options such as emergency departments."
An unencrypted cellphone with no password protection cost Catholic Health Care Services of the Archdiocese of Philadelphia $650,000. An employee lost the phone, which contained patient data. The Office of Civil Rights (OCR) determined this was a HIPAA breach because there was no password or encryption on the device. The OCR and FTC, jointly, as well as the National Institute of Standards and Technology, have released guides to help address these issues. (MedPage Today)
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New & Noted   
Data diving for dementia risk factors: A five-year, $13 million Kaiser Permanente study will revisit patient physicals from the 1960s through the 1980s to evaluate how risk factors in early and mid-life affect brain health and dementia risk among a large, ethnically diverse cohort. (Kaiser Permanente announcement)

Low HIX enrollments help deficit: Projections for the 2016 federal deficit have dropped by about $16 billion less than what was predicted this past February, according to the White House. Lower-than-expected enrollment in the Affordable Care Act insurance exchanges accounts for about $6 billion of that. (Modern HealthcareWhite House analysis) 

Starbucks to launch private exchange: Starbucks has announced plans to expand health coverage for employees--including part-timers--through a private exchange designed and managed by AON. (Forbes)

Health In The American Workplace: Are We Doing Enough?, an hour-long forum sponsored by the Robert Wood Johnson Foundation, Harvard T.H. Chan School of Public Health and National Public Radio, features a panel of experts in workplace culture and public opinion. They explore lessons learned from employers that cultivate healthy environments to see if there are feasible measures to produce a more accessible, supportive, healthier workplace. (forum video)
MarketVoices...quotes worth reading
"It's really a transformative way to deliver care. Patients know they're supported by a whole team of providers, so they really enjoy it and love the relationships they can create."--Ellina Seckel, PharmD, of William S. Middleton Memorial Veterans Hospital, on the innovative use of clinical pharmacists on the primary care team, quoted in Pharmacy Practice News

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Editorial Team
Roxanna Guilford-Blake
Sandy Mau




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Wednesday, July 27, 2016