Research Roundup - January 2017


Lawmakers Defang Plan for Lower-Cost Dental Therapists

By Ken Alltucker | AZCentral | Jan. 23, 2017

A push to license a new type of dental provider has stalled at the Arizona legislature, according to AZCentral. Dental therapists would operate under the supervision of licensed dentists and perform minor dental procedures. Proponents say dental therapists could provide basic dental services at lower cost and help ease the state’s dentist shortage, especially in rural and tribal communities. These “midlevel providers” are already allowed in Minnesota, Maine and Vermont and practice in tribal areas in Alaska, Oregon and Washington.


State to Stop Coordinating Care for Medicare and Medicaid Beneficiaries

By Virgil Dickson | Modern Healthcare | Jan. 18, 2017

California Gov. Jerry Brown’s latest fiscal budget proposes ending a program that coordinates care for people dually eligible for both Medicaid and Medicare. The proposed budget did not include funding for its Coordinated Care Initiative (CCI) after the program failed to show evidence of saving money, according to Modern Healthcare. However, Brown said he’d like to preserve elements of the effort, including asking payers to continue to oversee benefits for dual-eligibles. Brown also hopes to continue the MLTSS program because it kept people in their homes instead of hospitals or nursing homes. In order to continue those services, new legislation would have to be drafted.

CU Petitions California to Protect Patients From Hospital Infections

By Consumers Union | Jan. 23, 2017

A new analysis by Consumers Union found that California is failing to hold hospitals accountable for improving care when they report high patient infection rates. Consumers Union noted that inspectors are unable to take timely action to protect patients because the California Department of Public Health fails to share the infection data it collects from hospitals with inspectors until long after it is reported.


Health Price Cap Plan May be Seen as a Hybrid Between Free and Regulated Market

By Martha Bebinger | WBUR | Jan. 26, 2017

Wary that existing and future federal regulations won’t do enough to make healthcare affordable,  a proposal by the Massachusetts governor would cap the prices many hospitals, doctors and labs are paid for the next three years, according to WBUR. Providers would be divided into three categories based on price, with lower-priced hospitals eligible for rate increases and highest-price providers ineligible for increases.


State Gets Final Approval to Begin Next Phase of Healthcare Transformation

The Seattle Medium | Jan. 11, 2017

Gov. Jay Inslee and the Washington State Health Care Authority announced an agreement that ensures the state can continue transforming the Medicaid program to achieve better health, reward high-quality care and curb healthcare costs, according to the Seattle Medium. Officials said the five-year Washington State Medicaid Transformation Project provides up to $1.1 billion of incentives to reward high-quality care. It takes a patient-centered, holistic approach to care and creates partnerships with communities to address social determinants of health. The project also provides $375 million to support critical services for Medicaid clients.


Two Major Players Break From Statewide Alliance

By Mike Tighe | La Crosse Tribune | Jan. 5, 2017

UW Health and the Marshfield Clinic Health System withdrew their membership in AboutHealth on Dec. 31, 2016, according to the La Crosse Tribune. AboutHealth was founded two-and-a-half years ago in a quest to improve healthcare and rein in costs. The alliance of Wisconsin provider groups will continue to exist with six members - Gundersen, Aspirus, Aurora Health Care, Bellin Health, ThedaCare and ProHealth Care.

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Recent Reports

Engaging Consumers in the Quality Measurement Enterprise

By Thomas Concannon, et al. | RAND | January 2017

Quality measurement has several barriers to effectively engaging consumers, according this RAND study funded by Community Catalyst. These barriers include the lack of consumer engagement in early stages of the quality measurement process, the diversity of consumers that can be hard to represent with a small number of consumer advocates, and the lack of resources and time for consumers to adequately respond to requests for involvement. To address these concerns, consumer advocates should: focus national attention on consumer-centered quality measurement; assess the extent to which quality measurement processes are open or closed to consumers nationally; convene independent and public reviews of quality measurement development; and build and share knowledge and technical expertise about the process.

ACO-Affiliated Hospitals Reduced Hospitalizations from Skilled Nursing Facilities Faster Than Other Hospitals

By Ulrika Winblad | The Commonwealth Fund | Jan. 10, 2017

A study of hospitals in U.S. metropolitan areas found that although all hospitals reduced 30-day readmissions among those patients discharged to skilled nursing facilities, hospitals affiliated with accountable care organizations (ACOs) reduced readmissions more quickly, according to The Commonwealth Fund. Although more information is needed about the specific mechanisms that are most effective in reducing readmissions, careful attention should be paid to the discharge planning methods and information exchange practices used by ACO-affiliated hospitals, which could contribute to the difference in reduced readmission rates.

ACOs Serving High Proportions of Racial and Ethnic Minorities Lag in Quality Performance

By Valerie Lewis, et al. | The Commonwealth Foundation | Jan 10, 2017

ACOs that serve a high number of minority patients performed worse on most quality-of-care measures than those serving a comparatively small number of minority patients, according to an analysis of Medicare ACOs by The Commonwealth Fund. Compared with patients in other ACOs, those in ACOs serving a high proportion of minority patients tended to be sicker and poorer. New policies may be needed to support these ACOs in their efforts to improve patient care.

U.S. Healthcare Administrative Costs are Double the Global Average

By Alanna Petroff | CNN Money | Jan. 11, 2017

Administrative costs in the U.S. healthcare system are the highest in the developed world, accounting for 8 percent of spending, compared to about 3 percent globally, according to CNN Money. The Organization for Economic Co-operation (OECD) report suggests that poor coordination between healthcare providers, duplication of tasks and doctors spending too much time on paperwork all contributed to inflated administrative costs. They cautioned, however, that spending cuts should be carefully managed to avoid damaging beneficial activities, such as data analysis.

The Case for Capitation

By Brent C. James and Gregory P. Poulsen | Harvard Business Review | July-August 2016

To rein in healthcare costs, we should cut waste from work processes and lower operating costs by improving quality, according to the Harvard Business Review. Ongoing reform efforts by the federal government and private insurers won’t be enough to improve quality and reduce waste. The solution is to change the way businesses, government, and other purchasers pay for healthcare to population-based payment. An optimal payment method must address inadequate, unnecessary, uncoordinated, and inefficient care and suboptimal business processes that eat up between 35 and 50 percent of the more than $3 trillion spent annually on health care. That suggests more than $1 trillion is being squandered.

Payer Mergers Could Help Lower Prices Paid to Providers

By Eric Roberts, et al. | Healthcare Finance News | Jan. 7, 2017

A new study published in Health Affairs suggests that health insurer mergers could lower the prices paid to providers, according to Heathcare Finance News. Insurers with market shares of 15 percent or more negotiated prices for office visits that were 21 percent lower than prices negotiated by insurers with shares of less than 5 percent.


U.S. Healthcare Needs a Wakeup Call from India

By Robert Pearl | USA Today | Jan. 29, 2017

In Bangalore, India, heart surgeons perform daily state-of-the-art heart surgery on adults and children at an average cost of $1,800--about 2 percent of the $90,000 that the average heart surgery costs in the U.S., according to this column by the CEO of Permanente Medical Group in USA Today.The high quality and low cost represent the type of disruptive innovation that has impacted nearly all industries in the United States and should serve as a wake-up call for American doctors and hospitals.

Paying Doctors Bonuses for Better Health Outcomes Doesn’t Work

By Stephen Soumerai and Ross Koppel | Vox | Jan. 25, 2017

While financially incentivizing physicians to improve performance makes sense in theory, in practice pay-for-performance doesn’t work, according to this op-ed in Vox. While evidence is mixed on the impact of pay-for-performance initiatives, the evidence supporting its’ adoption often have fatal flaws, including a “history bias.” Among the reasons that pay for performance doesn’t work is that programs are using unreliable quality measures and encouraging patient cherry-picking.

The $4,500 Injection to Stop Heroin Overdoses

By Shefali Luthra | Washington Post | Jan. 27, 2017

Kaleo Pharma has raised the price of a life-saving drug from $690 in 2014 to $4,500, joining high-profile price hikes by other companies (e.g., EpiPen), according to an article in the Washington Post. Called Evzio, it is used to deliver naloxone, a life-saving antidote to overdoses of opioids. More than 33,000 people are said to have died from such overdoses in 2015.

State Insurance Commissioners Oppose Selling Insurance Across State Lines

By Emily Rappleye | Beckers Hospital Review | Jan. 27, 2017

The National Association of Insurance Commissioners (NAIC) wrote to House leadership calling for more flexibility for states when considering an ACA replacement but denounced proposals that would allow the sale of insurance across state lines, according to Beckers Hospital Review. The NAIC’s fears that the interstate sale of insurance because it would jeopardize consumer protections and strip states of the option to form agreements amongst themselves.

Aetna-Humana Merger Blocked by U.S. Federal Judge

By Berkeley Lovelace Jr. | CNBC | Jan 23, 2016

The proposed merger was blocked due to anti-trust concerns, according to CNBC. "The government identified 364 counties across 21 states where it argues that concentration in the Medicare Advantage market would rise above the presumptively unlawful level if the merger proceeds, and 17 counties across 3 states where that would be true in the public exchange markets," according to Judge John Bates. The Anthem-Cigna merger decision has yet to be made.

Merger Activity Among Physician Medical Groups Strong for the Year

By Jeff Lagasse | Healthcare Finance News | Jan. 18, 2016

Mergers and acquisitions in the fourth quarter of 2016 were 17 percent higher compared to the same time period in 2015, according to Healthcare Finance News. In general, 2016 was a strong year for mergers and acquisitions.