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Industry News
Provider-sponsored health plans may succeed this time around, according to a piece in National Law Review. Hospitals and health systems often couldn't make a success of the plans because they didn't fully understand the business of insurance, lacked experience and were unable to maintain the significant cash reserves necessary under risk-based capital requirements. But now, changes in the health care landscape make it possible. (FierceHealthcareNational Law Review)

Blue Shield of California, citing Covered California exchange losses, is taking action--but unlike its competitors, it's not leaving the exchange. Rather, it's closing down for the four days after Labor Day. It will require most staff to use paid time-off during that time, and expects to save $4 million dollars. It also proposes raising individual premium rates on the ACA marketplace on average by 39 percent. (Healthcare Dive)
People who gained coverage through the Affordable Care Act are filling significantly more prescriptions than before and paying less for their drugs. These newly insured filled, on average, 28 percent more prescriptions and had 29 percent less out-of-pocket spending per prescription in 2014 compared to 2013. Those gaining Medicaid coverage had larger increases in prescription fill rates (79 percent) and reductions in out-of-pocket spending per prescription (58 percent) than those who gained private insurance. "These results demonstrate that by reducing financial barriers to care, the ACA has increased treatment rates while reducing out-of-pocket spending, particularly for people with chronic conditions." (Health AffairsKaiser Health News)
Hundreds of drugs administered through Medicare Part D increased their cost per prescription by 10 percent or more in 2014, with more than 20 drugs jumping by 100 percent or more, according to a Politico analysis of CMS data. Newer drugs weren't the only ones that increased dramatically. For example, the generic steroid fluorometholone had the second-highest spike, rising by nearly 341 percent per claim. (Kaiser Health News; Politico Pro - subscription only)
Innovation & Transformation  
A recent article in HealthLeaders Magazine asks the question: "How Real is Healthcare Consumerism?" Health care consumerism has driven changes in how the industry talks about cost and quality, and evolved considerably in recent years, but it's "still a long way from true consumer shopping." What's becoming clear: "Consumers and healthcare leaders are both realizing that making healthcare choices is not the same as finding the best deal on a television set--and it never will be." (HealthLeaders Media)

Two population health programs yield big results in Louisiana
Louisiana launched a statewide direct-to-consumer patient engagement campaign and an emergency department data-registry pilot. A year later, health IT use among at-risk patients increased 23 percent, and non-emergent emergency department use dropped 10.2 percent in the Medicaid managed care organization pilot site. Louisiana is now expanding this model to all five Medicaid MCO plans and is offering it to commercial  plans and self-funded employers, Healthcare IT News reports. (Healthcare IT News)
Consumers & Providers
"Before a drug can be marketed, it has to go through rigorous testing to show it is safe and effective. Surgery, though, is different," explains science writer Gina Kolata in The New York Times. So even when randomized clinical trials show a particular operation to be useless, it continues to be performed. Among the examples she offers are vertebroplasty and surgery for a torn meniscus. As a result, she says, it falls to the patient to ask for the evidence on any particular surgery. It also raises questions about how--or even whether--certain procedures should be presented as options. (The New York Times)
It's probably no surprise that IT company Oracle uses technology to support employee wellbeing and engagement. Andy Campbell, human capital management strategy director, discusses Oracle's approach, giving special attention to Millennials. "Investing in employee wellbeing does not have to involve spending millions on a new campus full of juice bars and gyms. In fact, engagement often occurs at a much more personal level," he points out. (Personnel Today)
Focused leadership and a strong IT plan can help providers achieve clinical integration. A recent column in Becker's Hospital Review offers five health IT "must dos" to make it happen. "Keep your IT plan singularly focused on driving high-quality outcomes. The culture of your IT organization will need to become more patient- and consumer-centered, so every investment in systems to improve workflow and care processes is money well spent." (Becker's Hospital Review)
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New & Noted   
Buying into primary care: Banner Heath, which operates hospitals in several states, recently acquired 32 urgent-care centers in Arizona from Urgent Care Extra. The centers will be rebranded as Banner Urgent Care starting Oct. 1. (Modern Healthcare)

WSJ: One big problem with ACA: The Wall Street Journal identifies one primary reason the Affordable Care Act is struggling: "Selling mispriced insurance is a precarious business model. By disrupting the link between premiums and risk, the law weakens insurers' business models." (WSJ)

Arizona, Southeast hit hardest by withdrawals: With the failure of several co-ops and the withdrawals of Aetna, UnitedHealthcare, Humana and other insurers, consumers will have fewer choices. The impact varies by location, and is likely to hit Arizona, the Carolinas, Georgia and parts of Florida hardest. (Kaiser Health News)
The Veteran's Administration recently held its first-ever VA Innovation Demo Day, an opportunity for VA employees to show off ideas for improving health care for veterans. The ideas ranged from installing red parking brakes on wheelchairs to changing the primary care team. Dr. Ellina Seckel shared her innovation: incorporating pharmacists on the primary care team. "When you use each team member to the top of their ability and their expertise, the result is increased access, enhanced clinical outcomes, and happy patients," she says. (Gray DC Video)

Editor's note: Seckel's comprehensive medication management program is featured in a report from Health2 Resources and Blue Thorn Inc.,
MarketVoices...quotes worth reading
"I think there is a placebo effect not only on patients but on doctors. The successful patient is burned into their memories and the not-so-successful patient is not. Doctors can have a selective memory that leads them to conclude that, 'Darn it, it works pretty well.'"--Dr. David Kallmes of the Mayo Clinic, on why surgeons continue to perform surgeries that the evidence demonstrates are ineffective, quoted in The New York Times.

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Roxanna Guilford-Blake
Sandy Mau




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Wednesday, August 24, 2016

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