Research Roundup - July 2016


Alaska Enacts New Telemedicine Law: What Providers Should Know

By Nathaniel Lacktman and Thomas Ferrante | The National Law Review | July 13, 2016

Alaska’s use of telemedicine is set to expand thanks to a law passed on June 21,2016, according to The National Law Review. Out-of-state providers will now be able to prescribe--a practice previously limited to in-state physicians--and expands authorization to use in various clinical practices. This follows a related law passed June 14, 2016, that required parity coverage of telemental health services.

State to Consider Unified Health Care Authority

Juneau Empire | July 7, 2016

The Alaska Department of Administration will conduct a feasibility study on the creation of a “health care authority” with the power to buy insurance in bulk, according to Juneau Empire. Buying in bulk may help the current insurance market, which at the moment is limited to one participating company due to high costs associated with too many high-risk residents and too few healthy residents to offset the cost. The completed report is expected June 30, 2017.


Covered California Health Plan Rates To Jump 13.2 Percent in 2017

By Chad Terhune and Pauline Bartolone | Kaiser Health News | July 19, 2016

On the heels of two years of average rate increases at 4 percent, consumers in California and likely several other states, will be hit with a double digit increase in premiums in 2017, according to Kaiser Health News. According to Peter Lee, executive director of Covered California, prices for 2017 reflect the rising cost of care, not efforts by insurers to increase their profits.

Boeing Takes Direct-to-Employee ACO Model to SoCal, Will Offer to 15,000 Staff

By Patrick Connole | AIS Health | July 13, 2016

AIS Health reports that Boeing will offer direct contract accountable care plans to its workers in Southern California. This is the first time the state has seen this health benefit model presented to group health members.  Boeing’s director of health care strategy looked at a variety of factors, including quality scores, network overlap with employee geography, and history of innovation and leadership when choosing the health system it would use. Boeing’s move may be part of a more general movement in the healthcare space where accountable care is growing as providers align with employers and consumers.


HealthCT Crumbles Under ACA Risk-Adjustment Charge

By Erica Teichert | Modern Healthcare | July 9, 2016

One week after CMS announced it is owed a $13.4 million in risk-adjustment obligations from HealthyCT, the states co-op insurer, the Connecticut Insurance Department issued an order of supervisions, according to Modern Healthcare. This prevents the insurer from writing new business or renewing policies.

Sweeping Plan Put Forward to Control Rising Healthcare Costs

By Kyle Constable | The CT Mirror | July 13, 2016

The CT Mirror reports that a state-hired consulting firm presented a plan to Connecticut’s Health Care Cabinet that calls for the largest reorganization and consolidation of health-related state agencies in more than 20 years. The plan further calls for increased networking between healthcare providers so the state can implement value-based payments in the Medicaid program and state employee benefits program.


Illinois Insurance Regulators Try to Save Co-op Plan

By Carla K Johnson | Chicago Sun Times | July 12, 2016

After CMS’ announcement that it is owed $31.8 million in risk-adjustment obligations, the Illinois Department of Insurance is shutting down the state co-op, Land of Lincoln Health, according to the Chicago Sun Times. Twenty-three co-ops were established under the Affordable Care Act, many of which have already closed.


Maryland Hospitals Launch Effort to Inform Consumers on Changing Landscape

By Meredith Cohn | The Baltimore Sun | July 28, 2016

The Maryland Hospital Association has created a campaign, A Breath of Fresh Care, to engage and direct patients to hospital wellness and chronic disease management initiatives, according to the Baltimore Sun. The effort stems from an experiment with federal legislators to align hospital payments with incentives to provide more efficient and better coordinated care.


Oregon Hospital Payment Report, 2014

By Office of Health Analytics | Oregon Health Authority | July 1, 2016

The first annual report from the Oregon Health Authority using Oregon’s all-payer claims database data found significant variation in payments among hospitals in the state. The report provides hospital-specific information on five categories of procedures: diagnostic imaging, diagnostic procedures, surgical procedures, medical treatments and pregnancy.

State: Pay-For-Performance Program has Improved Oregon’s Health

By Dennis Thompson | Portland Business Journal | June 23, 2016

An Oregon Health Authority report found the Oregon Health Plan’s pay-for-performance program has resulted in three years of continued health care improvement for nearly all the state’s Coordinated Care Organizations (CCOs), according to Portland Business Journal. The CCOs were particularly successful with achieving their quality metrics, with 15 out of 16 earning 100 percent of the associated incentive funds.


Virginia Republicans Launch New Panel on Healthcare Reform

By Associated Press | Modern Healthcare | July 15, 2016

A new workgroup is being created with the intent to change the state’s certificate of need law, according to Modern Healthcare. Lawmakers and the state hospital association have been working to loosen the oversight of the State Board of Health on approving new or expanded health facilities or major equipment purchases.

Recent Reports

CMS Offers Guidance to States on Value Based Drug Purchasing

By Adam Rubenfire | Modern Healthcare | July 14, 2016

On July 14, CMS released a guidance document encouraging state Medicaid agencies to adopt payment based on outcomes to offset high drug costs, according to Modern Healthcare. Value-based contracts require doctors, insurers, pharmacy benefit managers and drug companies to cooperate and share data. [link]

New Health System Scorecard Finds Improvement in Most U.S. Communities Since ACA Took Effect

By David C. Radley, et al. | The Commonwealth Fund | July 14, 2016

A comprehensive report from the Commonwealth Fund on regional health performance found general improvements in access, prevention and treatment, avoidable hospital use and cost, and health outcomes since the passage of the Affordable Care Act. However, the report found disparities still persist. Areas with a disproportionate share of low-income residents fared worse, particularly in the measures of access to care, quality of care and health outcomes.

Health Spending for Low-, Middle-, and High-Income Americans

By Samuel L. Dickman, et al. | Health Affairs | July 2016

Wealthier Americans are spending the most on healthcare services, according to Health Affairs. Since 2004, health expenditures have fallen for Americans with the lowest income, risen 10 percent for middle-income Americans and almost 20 percent for Americans with the highest income.

National Health Expenditure Projections, 2015-25: Economy, Prices and Aging Expected to Shape Spending and Enrollment

By Sean P. Keehan, et al. | Health Affairs | July 2016

Health spending growth is projected to grow an average 5.8 percent for the period of  2015-25, according to this Health Affairs article. This spending growth is associated with changes in economic growth, faster growth in medical prices, and population aging. The share of total health expenditures paid for by federal, state and local governments is projected to increase to 47 percent by 2025.

Value-Based Insurance Design: Potential Strategy for Lower Costs, Increased Quality

By Todd Shimp | Health Care Value Hub | July 2016

Value-based insurance design aims to incentivize healthy behavior by reducing cost-sharing requirements for high-value care, such as diabetes medication.  The Hub’s new Easy Explainer examines the increasingly popular strategy and what the evidence says about its impact on consumers.

Patients Pay a Higher Share of Hospital Bills, Study Finds

By Robert Channick | Los Angeles Times | June 27, 2016

A study by the University of Michigan found out-of-pocket hospitalization costs rose 37 percent from 2009-2013, with the average patient spending more than $1,000 per hospital visit, according to the Los Angeles Times. This is due, in part, to increases in consumer cost sharing, including a 86 percent rise in deductibles and a 33 percent rise in coinsurance.

Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries

By Carrie H. Colla, et al. | The Commonwealth Fund | June 24, 2016

Enrollment in Medicare accountable care organizations is associated with reductions in health spending as well as fewer emergency department visits and hospitalizations, according to a study by the Commonwealth Fund. Annual spending for Medicare beneficiaries with at least three chronic conditions dropped by 2 percent, acute-care spending by 2.3 percent, and skilled nursing facility spending by 5 percent.

Decoding Big Pharma’s Secret Drug Pricing Practices

By Robert Langreth, et al. | Health Affairs Blog | June 23, 2016

This study found that 30 of 39 drugs studied had price increases of more than double the rate of inflation from 2009 to 2015, even after estimated discounts were factored in, according to Bloomberg. Although several pharmaceutical manufacturers discredited the report suggesting rebates and discount levels were underestimated, no manufacturers were willing to share data proving otherwise.

‘Secret Shopper’ Study Finds Marketplace and Commercial Plans Generally Lacking in Provider Lists and Network Accuracy

By Simon Haeder, et. al. | Health Affairs | July 2016

According to this Health Affairs study, consumers were able to schedule an appointment with selected physician less than 30 percent of the time due to inaccurate provider lists available from their plan.  This study is similar to one conducted by Consumers Union in 2014, which garnered similar results.  These studies show that having access to healthcare insurance doesn’t necessarily mean ease of access to healthcare services.

Commentary/ News

DOJ Announces Lawsuit Against Anthem, Aetna Insurer Deals

By Bob Herman | Modern Healthcare | July 21, 2016

The Justice Department went to court to officially seek to block two mergers involving four of the nation's five healthinsurers, according to this Modern Healthcare article.  Consumer advocates have been adamantly against the mergers citing decreased competition would mean increased health insurance premiums for the consumer, among other things.   

New Directions for Medicare Physician Payment

By Jordan Kiszla and Rachel Nuzum | The Commonwealth Fund | June 21, 2016

In April,  the U.S. Department of Health and Human Services issued a proposed rule to implement the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. The legislation ties Medicare physician payments to the quality of care, according to the Commonwealth Fund. This may be a significant step for aligning provider payment with value rather than volume.

Finding the Hidden ROI in EHR Implementation

By Jeff Goldsmith and Erick McKesson | Modern Healthcare | July 15, 2016

Rushed implementation of electronic health records (EHRs) may have led to reductions in productivity for providers due to management’s failure to bridge the gap between the new technology, financial managers and the front line clinicians, according to Modern Healthcare. If implemented correctly, EHR should produce efficiencies in the form of reduced clerical overburden and reduced rework due to inadequate or inaccurate documentation.

Physicians Seek Employed Status to Weather Payment Risks

By Dave Barkholz | Modern Healthcare | July 9, 2016

Mounting regulatory challenges for providers, such as payment reforms striving to replace the fee-for-service with value-based payments, has led physician groups to seek mergers with larger systems better equipped to withstand the changing healthcare environment, according to Modern Healthcare. Such high levels of consolidation have not taken place since the 1990s.

Health Costs are Going Down! So Why are They Not Actually Going Down?

By Kyle Bradford Jones | The Huffington Post | June 30, 2016

Despite a slower growth in healthcare than originally predicted, consumers will likely not notice significant savings, according to the Huffington Post.This is likely the result of a variety of factors, including increased cost-shifting to consumers through high deductibles, co-payments and coinsurance.

Health Spending Growth: Still Facing a Triangle of Painful Choices

By Charles Roehrig | Health Affairs Blog | June 23, 2016

Although we’ve seen a decrease in the rate of growth in healthcare spending, it is likely not sustainable in the long run without painful sacrifices, according to this Health Affairs Blogpost. The triangle of painful choices depicts the tradeoff between the level of healthcare spending, tax revenues and defense and other non-health spending.