At Drug Hearing, Senators Discuss Meanings Of Price And Value — And Debate Health Reform
On Tuesday, June 13, the Senate Health, Education, Labor, & Pensions (HELP) Committee held the first of three planned hearings on high drug prices. This hearing, titled “How the Drug Delivery System Affects What Patients Pay,” was designed to elicit basic information about how drug prices, overall spending, and patient costs have changed over time, and about the drivers of these metrics. The hearing featured four non-industry witnesses, with the plan that industry representatives will be included in future hearings.
One of the most important points to come out of the hearing was that there is bipartisan concern abo...
Source: Health Affairs Blog - June 20, 2017 Category: Health Management Authors: Rachel Sachs Tags: Costs and Spending Drugs and Medical Innovation Medicaid and CHIP Payment Policy Medicaid best-price rule outcomes-based contracts prescription drug prices value-based pricing Source Type: blogs
Making Practice Guidelines And ‘Choosing Wisely’ More Effective
I always thought I was an informed patient, favoring conservative treatment and helping to save Medicare and the health system money; but when push came to shove, I was a coward that did not speak up when unnecessary tests were ordered.
I think my reaction says something about the limits that even informed patients have in their ability to save the system money and ultimately raises questions about the usefulness of practice guidelines, “choosing wisely,” and evidence-based medicine to do the same. This isn’t an attack on these crucial efforts to bring more science to the practice of medicine. It is a plea for them t...
Source: Health Affairs Blog - June 20, 2017 Category: Health Management Authors: William Vaughan Tags: Costs and Spending Featured Medicare Quality Choosing Wisely practice guidelines Source Type: blogs
Sandoz v. Amgen: What The Court Settled, What It Didn ’t, And What Might Come Next
On June 12, the United States Supreme Court released a heavily anticipated decision relating to patent disputes between the developers of new biological medicines and the manufacturers of “biosimilar” copies of those medicines. This was the Court’s first ruling on the patent provisions of the Biologics Price Competition and Innovation Act (BPCIA), enacted in 2010 as part of the Affordable Care Act.
Biologics are typically complex, larger molecules that are derived from animals and microorganisms, in contrast to traditional, smaller-molecule drugs that are usually synthesized from chemicals. Biosimilars are akin to ...
Source: Health Affairs Blog - June 19, 2017 Category: Health Management Authors: Erika Lietzan Tags: Costs and Spending Drugs and Medical Innovation biologics Biologics Price Competition and Innovation Act biosimilars Food and Drug Administration Hatch Waxman Source Type: blogs
Savings Reported By CMS Do Not Measure True ACO Savings
While participation in Medicare accountable care organizations (ACOs) continues to grow—9 million Medicare beneficiaries are currently attributed to Medicare Shared Savings Program (MSSP) ACOs alone, up 1.3 million since 2016—controversy swirls around their impact as analysts disagree about the success of the model. Some argue that ACOs have saved money (albeit a small amount) and that they could realize greater savings as the years go on. Others believe that there have been no savings at all from ACOs and that reform requires a new approach.
Some of this disagreement arises from the commentators’ differing c...
Source: Health Affairs Blog - June 19, 2017 Category: Health Management Authors: Michael Chernew, Christopher Barbey and J. Michael McWilliams Tags: Costs and Spending Medicare Payment Policy ACOs Source Type: blogs
New Leader, New Era: Five Building Blocks For A Reinvigorated World Health Organization
The World Health Assembly’s election of Tedros Adhanom Ghebreyesus to serve as its 9th Director-General may be the most momentous in the Organization’s 70 years for reasons far beyond electing the first African. The World Health Organization (WHO) faces a crisis in confidence following its anemic response to Ebola. It remains caught in an unvirtuous cycle: Member State loss of trust results in a paucity of funding and the continual inability to perform. This is a moment to take stock of the new Director-General’s record and vision, as well as the reforms needed to transform WHO into the 21st century institution the ...
Source: Health Affairs Blog - June 19, 2017 Category: Health Management Authors: Lawrence O. Gostin Tags: Featured Global Health Policy Millennium Development Goals UNAIDS World Health Organization Source Type: blogs
ACA Round-Up: Mental Health And Substance Use Parity, Premium Tax Credits, And A New Marketplace Reinsurance Proposal
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that the financial requirements and treatment limitations imposed on mental health and substance use disorder (MH/SUD) benefits must not be more restrictive than the predominant financial requirements and treatment limitations imposed on substantially all medical and surgical benefits. The MHPAEA requires plans and insurers to disclose their criteria for making medical necessity determinations with respect to MH/SUD to any current or potential participant, beneficiary, or contracting provider, and to make available the reasons for denial of payment...
Source: Health Affairs Blog - June 16, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Mental Health Parity and Addiction Equity Act reinsurance Source Type: blogs
‘Will It Work Here?’: Health Systems Need Contextual Evidence Before Adopting Innovations
Health systems are eager to learn about better ways to deliver care. This requires innovation—doing something differently from how it is currently done. In a recent Health Affairs article, Elizabeth McGlynn and Mark McClellan noted that innovations often fail to meet expectations, particularly when they are spread from the initial site that piloted the innovation. McGlynn and McClellan pointed to the absence of evidence as to what makes these innovations work as a source of these failures and encouraged health systems to evaluate innovations. In addition to the critical role evidence plays in making decisions of whet...
Source: Health Affairs Blog - June 16, 2017 Category: Health Management Authors: Cindy Brach Tags: Diffusion of Innovation Health Professionals Hospitals Quality care delivery innovation evidence-based decisions innovation adoption Source Type: blogs
Medicare ’s Programs Should Compete
Over the past two decades, Medicare has evolved into three separate programs or payment systems: fee-for-service (FFS), sometimes termed traditional Medicare; Medicare Advantage (MA); and the Medicare Shared Savings Program (MSSP), or accountable care organizations (ACOs). Regulations governing these three programs differ substantially. For example, participating plans, physicians, and other eligible clinicians are reimbursed and financially incented in different ways. Under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, FFS providers and some ACOs can earn an annual bonus that would increase their reimb...
Source: Health Affairs Blog - June 15, 2017 Category: Health Management Authors: David Introcaso Tags: Costs and Spending Featured Insurance and Coverage Medicare Payment Policy Accountable Care Organizations AHCA MACRA Medicare Advantage Medicare Shared Savings Program MedPAC Source Type: blogs
The Basis For Compromise On Medicaid Reform And Expansion
The House-passed health care bill—known as the American Health Care Act (AHCA)— includes the most far-reaching changes in Medicaid financing since the program was enacted in 1965. The legislation would roll back the Affordable Care Act’s (ACA) substantial federal support for expanding program eligibility, and it would impose an upper limit on per-enrollee federal Medicaid spending in future years.
The Congressional Budget Office (CBO) estimates that the AHCA would reduce federal expenditures on Medicaid by $834 billion over the next decade. Medicaid enrollment would fall by 14 million people in 2026. CBO pred...
Source: Health Affairs Blog - June 15, 2017 Category: Health Management Authors: Joseph Antos, James Capretta and Benedic Ippolito Tags: Following the ACA Insurance and Coverage Medicaid and CHIP ACA repeal and replace AHCA Medicaid expansion Source Type: blogs
Finding Common Ground On Medicaid Reform For Dual Eligibles
Editor’s Note: This is the final post in a five-part Health Affairs Blog series, produced in conjunction with the Bipartisan Policy Center, examining current issues and care models in the delivery system reform effort. Each post is jointly authored by Democratic and Republican leaders in health policy. Read all of the posts here.
Medicaid is the primary source of health insurance for families and children that meet the income and program eligibility requirements. It is also the largest single source of financing for long-term services and supports (LTSS), which help individuals who need it engage in the activities of dai...
Source: Health Affairs Blog - June 15, 2017 Category: Health Management Authors: Cindy Mann and Avik Roy Tags: Featured Medicaid and CHIP Medicare Payment Policy Quality bipartisan delivery system reform dual eligibles Source Type: blogs
The American Health Care Act Could Chip Away At The Medicare Savings Programs
The American Health Care Act (AHCA) is not just an alarming, slapdash effort to repeal the Affordable Care Act—it’s also a plan to radically weaken Medicaid, our nation’s health care safety net. Indeed, the US House-passed bill’s most dramatic savings—$834 billion according to Congressional Budget Office estimates—are achieved by slashing federal funding to Medicaid, which provides health coverage to nearly 75 million low-income Americans, and undoing the program’s basic guarantee.
Nevertheless, these draconian reforms have been among the lesser told stories of the AHCA’s anticipated impact. The...
Source: Health Affairs Blog - June 15, 2017 Category: Health Management Authors: Maura Calsyn and Stacy Sanders Tags: Costs and Spending Following the ACA Insurance and Coverage Medicaid and CHIP Medicare Payment Policy ACA repeal and replace American Health Care Act dual eligibles Source Type: blogs
Health Affairs Web First: State Health Spending, 1991-2014
The Centers for Medicare and Medicaid Services (CMS) Office of the Actuary has studied patterns of health spending in the states, producing data known as the State Health Expenditure Accounts. A new study, released by Health Affairs as a Web First, presents highlights from the latest data set, which covers 1991 to 2014, a period that included the initial implementation of the Affordable Care Act (ACA) as well as an economic recession and subsequent recovery.
According to the study, which examines health spending by state and enrollee, as well as spending for the three largest payers (Medicare, Medicaid, and private health ...
Source: Health Affairs Blog - June 14, 2017 Category: Health Management Authors: Lucy Larner Tags: Elsewhere@ Health Affairs Featured Web First Source Type: blogs
On AHCA, CMS Actuary Finds Smaller Coverage Losses, Smaller Spending Reductions Than CBO
On June 13, 2017, the Office of the Chief Actuary of the Centers for Medicare and Medicaid Services released its report on the Estimated Financial Effect of the “American Health Care Act of 2017.” The CMS Office of the Actuary is responsible for evaluating the financial condition of the Medicare program, projecting Medicare and Medicaid expenditures, and predicting the financial effects of proposed health care legislation. Even though the office is located within the Department of Health and Human Services (HHS), it is generally regarded as independent and CMS actuaries have provided unwelcome information to administra...
Source: Health Affairs Blog - June 14, 2017 Category: Health Management Authors: Timothy Jost Tags: Costs and Spending Following the ACA Insurance and Coverage bare counties ACA Marketplaces health care networks Medicaid expansion risk corridors Star ratings Source Type: blogs
Moving The Needle On Primary Care: Covered California ’s Strategy To Lower Costs And Improve Quality
Many of the national policy discussions today are focused on who will be covered and the scope of benefits consumers will receive. Unfortunately, as important as these issues are, neither of them in any way addresses the underlying issues of high health care costs and the highly variable quality of care in the United States. To foster sustainable reform, we need to focus on promoting high-value care, which means we need to address not only insurance coverage but also reform of the delivery system. Covered California, a state health insurance exchange, has taken advantage of its role as a purchaser to work with health plans...
Source: Health Affairs Blog - June 14, 2017 Category: Health Management Authors: Lance Lang, Peter V. Lee and Kevin Grumbach Tags: Costs and Spending Featured Insurance and Coverage Organization and Delivery Quality CalPERS Covered California Health Benefit Exchange Contracting patient-centered medical homes Payment Reform Primary Care Source Type: blogs
What To Expect When You Are Managing A Population Health Coalition
Collaboration among a litany of health care and community-based organizations (CBOs) has become a popular approach to pursuing health improvements in cities and towns across the United States. Examples of cross-sector coalitions can be found in the work of Way to Wellville, the Institute for Healthcare Improvement’s 100 Million Healthier Lives initiative, and, in many cases, the winners of the Robert Wood Johnson Foundation’s (RWJF’s) Culture of Health Prize.
Over the past few years, health care and community-based providers have expressed to me a combination of excitement and fear about integrating their work with t...
Source: Health Affairs Blog - June 13, 2017 Category: Health Management Authors: Lauren Taylor Tags: GrantWatch Hospitals Population Health Public Health community-based organizations Health Philanthropy Health Promotion and Disease PreventionGW Health Research & Educational Trust Politics Robert Wood Johnson Foundation Source Type: blogs
